Clinical Outcomes, Nutritional Status, Exercise and Psychosocial Factors in Pediatric Hematopoietic Cell Transplant

Children who receive hematopoietic cell transplants (HCT) are at high nutritional risk due to
comorbidities and complications that are likely to develop before, during and after
transplant. Prior to transplant, many children undergo multiple rounds of chemotherapy which
affect appetite and cause gastrointestinal toxicities that limit food intake. During
transplant, painful mucositis makes it difficult to consume adequate nutrients and often
children will require nutrition support such as parenteral or enteral nutrition. Energy
imbalance and physical deconditioning following transplant can result in loss of lean body
mass and functional impairment; these nutritional side effects are exacerbated if the child
develops graft-versus-host disease. After transplant, a substantial number of childhood
cancer survivors become overweight and develop metabolic syndrome. However, little is known
about the prevalence and distribution of pediatric malnutrition (under-nutrition as well as
obesity), the psychosocial factors that affect dietary intake and how the quality of the
child's food intake and physical activity level throughout the transplant process might
affect body composition and clinical outcomes. In this exploratory study, we will monitor
nutritional status in pediatric patients undergoing HCT. This study will test the feasibility
of collecting patient-reported dietary intake data along with anthropometric, body
composition, functional status and psychosocial measurements that may influence dietary
intake in pediatric patients undergoing HCT. The data collected in this preliminary analysis
will inform future interventional studies.