TY - JOUR
T1 - Micronutrient status influences clinical outcomes of paediatric cancer patients during treatment
T2 - a prospective cohort study
AU - Revuelta Iniesta, Raquel
AU - Gerasimidis, Konstantinos
AU - Paciarotti, Ilenia
AU - McKenzie, Jane M.
AU - Brougham, Mark F H
AU - Wilson, David C
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Background: Research reporting plasma micronutrient status and its impact on clinical outcomes in 24 paediatric cancer is scarce. Therefore, we investigated the prevalence of plasma micronutrient 25 abnormalities and their impact on clinical outcomes and treatment complications. 26
Methods: A multicentre prospective-cohort study of children aged <18 years diagnosed with cancer 27 was performed between Aug 2010-Jan 2014. Clinical and nutritional data were collected at diagnosis, 28 3, 6, 9, 12 and 18 months. Micronutrient status was established using in-house laboratory references 29 (vitamin B12, vitamin A and Vitamin E/Ch) and aged adjusted Z-scores (Mg, Se, Zn and Cu) generated 30 from a cohort of healthy Scottish children. Clinical outcomes were classified as “event free survival 31 (EFS)” or “event” (relapse, death, new metastasis or becoming palliative) and treatment complications. 32 Descriptive statistics, logistic regression multilevel analysis were performed. 33
Results: Eighty-two patients [median (IQR) 3.9 (1.9-8.8) years, 56% males] were recruited. Of these, 34 72 (88%) samples were available, 74% (53/72) patients had micronutrient abnormalities at baseline; 35 deficiencies (25%, 18/72), excesses (19%, 14/72) and a combination of both (29%, 21/72), which 36 continued for 18 months. Vitamin A deficiency (15%, 3/20) and excess (50%, 10/20) were most 37 prevalent at 18 months, whilst vitamin E/Cholesterol and vitamin B12 were mostly within the normal 38 range. Prevalence of Zn deficiency at diagnosis was 36% (16/44 adjusted for CRP), which remained at 39 these levels throughout the study. Reduction in each selenium concentration unit increased the odds of 40 an event by 2% (OR 0.02) and lower Se predicted higher complications at diagnosis [β (-1.2); t (-2.1); 41 95% CI (-2.9 – (-0.04)); p = 0.04], 3 months [β (-3.9); t (-4.2); 95% CI (-5.57 – (-2.02)); p < 0.001] and 42 12 months [β (-2.3); t (-2.4); 95% CI (-4.10 – (-0.34)); p = 0.02] 43
Conclusions: Given the prevalence of micronutrient abnormalities and the negative impact of low 44 selenium on clinical outcome, micronutrient status should be assessed and monitored in paediatric 45 cancer patients. Larger multicentre population based studies and clinical trials are now warranted.
AB - Background: Research reporting plasma micronutrient status and its impact on clinical outcomes in 24 paediatric cancer is scarce. Therefore, we investigated the prevalence of plasma micronutrient 25 abnormalities and their impact on clinical outcomes and treatment complications. 26
Methods: A multicentre prospective-cohort study of children aged <18 years diagnosed with cancer 27 was performed between Aug 2010-Jan 2014. Clinical and nutritional data were collected at diagnosis, 28 3, 6, 9, 12 and 18 months. Micronutrient status was established using in-house laboratory references 29 (vitamin B12, vitamin A and Vitamin E/Ch) and aged adjusted Z-scores (Mg, Se, Zn and Cu) generated 30 from a cohort of healthy Scottish children. Clinical outcomes were classified as “event free survival 31 (EFS)” or “event” (relapse, death, new metastasis or becoming palliative) and treatment complications. 32 Descriptive statistics, logistic regression multilevel analysis were performed. 33
Results: Eighty-two patients [median (IQR) 3.9 (1.9-8.8) years, 56% males] were recruited. Of these, 34 72 (88%) samples were available, 74% (53/72) patients had micronutrient abnormalities at baseline; 35 deficiencies (25%, 18/72), excesses (19%, 14/72) and a combination of both (29%, 21/72), which 36 continued for 18 months. Vitamin A deficiency (15%, 3/20) and excess (50%, 10/20) were most 37 prevalent at 18 months, whilst vitamin E/Cholesterol and vitamin B12 were mostly within the normal 38 range. Prevalence of Zn deficiency at diagnosis was 36% (16/44 adjusted for CRP), which remained at 39 these levels throughout the study. Reduction in each selenium concentration unit increased the odds of 40 an event by 2% (OR 0.02) and lower Se predicted higher complications at diagnosis [β (-1.2); t (-2.1); 41 95% CI (-2.9 – (-0.04)); p = 0.04], 3 months [β (-3.9); t (-4.2); 95% CI (-5.57 – (-2.02)); p < 0.001] and 42 12 months [β (-2.3); t (-2.4); 95% CI (-4.10 – (-0.34)); p = 0.02] 43
Conclusions: Given the prevalence of micronutrient abnormalities and the negative impact of low 44 selenium on clinical outcome, micronutrient status should be assessed and monitored in paediatric 45 cancer patients. Larger multicentre population based studies and clinical trials are now warranted.
U2 - 10.1016/j.clnu.2021.03.020
DO - 10.1016/j.clnu.2021.03.020
M3 - Article
SN - 0261-5614
VL - 40
SP - 2923
EP - 2935
JO - Clinical Nutrition
JF - Clinical Nutrition
IS - 5
ER -