Parenteral Nutrition in a Bone Marrow Transplant Patient With Hepatic Complications

Kaproth, Peggy L.; Barber, Jacqueline R.; Moore, R. Foster; Shronts, Eva P.

doi:10.1177/011542659000500118

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…Others report that individuals undergoing HSCT have energy requirements 1.3 to 1.5 times those obtained by using the Harris-Benedict equation. [27][28][29] We were unable to find differences in MEE between the two patient groups, allogeneic and autologous specifically. None of the commonly reported side-effects, fever and acute graft-versus-host disease (GVHD), were associated with an increased MEE.…”

Section: Discussionmentioning

confidence: 99%

Energy expenditure in children undergoing hematopoietic stem cell transplantation

Ringwald-Smith

Heslop

Krance

et al. 2002

Bone Marrow Transplant

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Summary:Prior studies suggest that patients undergoing hematopoietic stem cell transplantation (HSCT) for malignancy have nutritional needs that are greater than their estimated needs. To determine whether energy estimation equations accurately predict energy expenditure of pediatric patients undergoing HSCT, we prospectively compared the estimated energy expenditure (EEE) and measured energy expenditure (MEE) of 40 patients at four time-points. We also investigated whether energy requirements changed during the transplant period. MEE was determined by indirect calorimetry. Data from 34 patients (autologous HSCT = 10, allogeneic HSCT = 24) were sufficient for analysis. The World Health Organization equation adequately approximated MEE only on day 14 after HSCT. At all other timepoints, measured energy expenditure was significantly less than estimated energy expenditure obtained by using the WHO equation (applicable to all patients), the Seashore equation (for patients Ͻ15 years of age; n = 19), or the Harris-Benedict equation (for patients у15 years of age; n = 15). The median measured energy expenditure varied significantly over the study period and was greatest on day 14 after HSCT. Until accurate equations have been identified for estimating these patients' needs, the use of indirect calorimetry may be medically warranted. Medical nutrition therapy is an important part of the management of hematopoietic stem cell transplantation (HSCT) in children. During the transplant period, numerous factors can alter nutritional requirements. First, the intense chemotherapy and, in some cases, radiation given before transplantation may cause tissue damage, mucositis, nausea and vomiting, and diarrhea, any of which may increase caloric requirements or lead to protein catabolism.1-3 Second, graft-versus-host disease (GVHD), which often follows allogeneic HSCT, may increase energy requirements and lead to a negative nitrogen balance. 4 Third, the energy requirements of children are increased by the demands of physical growth. Therefore, the goals of medical nutrition therapy in this patient population are to restore or maintain lean body mass, to provide the nutrients needed for recovery of the hematopoietic and immune systems, and to facilitate normal growth and development. 5Prior studies, most of which were conducted in adults undergoing HSCT, revealed that energy needs change throughout the course of transplantation and that patients appear to expend more energy than is estimated by standard predictive equations. 4,6,7 Energy expenditure may be determined by standard estimation equations and through the use of indirect calorimetry. Indirect calorimetry can be extremely useful in the daily nutritional management of hospitalized patients who are at risk for nutritional depletion and who may be suffering from catabolic stress as a result of infection, trama, or treatment complications. 8To date, the energy requirements of pediatric patients undergoing HSCT have not been systematically studied. We prospectively compared the ...

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Section: Discussionmentioning

confidence: 99%

Energy expenditure in children undergoing hematopoietic stem cell transplantation

Ringwald-Smith

Heslop

Krance

et al. 2002

Bone Marrow Transplant

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“…The parenteral contribution of protein, in standard amino acidic solution form, is stabilised at 1.4-1.5 g/kg/day [82][83][84].…”

Section: Nutritional Indications During Mucositis Associated With Hemmentioning

confidence: 99%

ADI nutritional recommendations for dysphagia

Barbiera

Bosetti

Ceravolo

et al. 2009

Mediterr J Nutr Metab

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“…Others have estimated caloric needs as a percentage of basal energy expenditure by using the Harris-Benedict equation, and most studies estimate that energy requirements in BMT recipients are 1.3 to 1.5 (130% to 150%) times the predicted basal energy expenditure. 74,80,81 Protein requirements can be more accurately assessed by determining nitrogen balance. It is unlikely that providing adequate nitrogenous substrate will overcome the catabolic effect of BMT and allow for a positive nitrogen balance.…”

Section: Metabolic and Nutritional Alterationsmentioning

confidence: 99%

“…Although the range of recommended protein intake for adult BMT recipients is 1.2 to 1.5 g/kg per day, most investigators agree that protein needs will be more accurately met by providing 1.5 g/kg per day, which is nearly double the recommended daily intake for healthy adults. 16,74,80,81 Increased needs may be observed in children and patients with severe stress, GVHD, fever, and intestinal losses.…”

Section: Metabolic and Nutritional Alterationsmentioning

confidence: 99%

Nutrition Support in Bone Marrow Transplant Recipients

Herrmann¹,

Petruska²

1993

Nut in Clin Prac

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Bone marrow transplantation is a complex therapy designed as curative for a variety of malignant and nonmalignant diseases. It is a highly invasive procedure that uses high-dose chemotherapy and may also include radiation treatment. This results in immunosuppression that is often followed by infection, graft-vs-host disease, pulmonary complications, veno-occlusive disease of the liver, and metabolic and nutritional abnormalities. Parenteral nutrition has been the mainstay of nutrition support in patients undergoing bone marrow transplantation. Parenteral nutrition has not been uniformly successful in improving nutritional status or outcome. Enteral nutrition offers many theoretical advantages but is often not well tolerated. Coordinated efforts of the health care team are needed to optimize the nutrition support of these complicated cases.

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Parenteral Nutrition in a Bone Marrow Transplant Patient With Hepatic Complications

Cited by 5 publications

References 19 publications

Energy expenditure in children undergoing hematopoietic stem cell transplantation

Energy expenditure in children undergoing hematopoietic stem cell transplantation

ADI nutritional recommendations for dysphagia

Nutrition Support in Bone Marrow Transplant Recipients

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