Following Transplant, Patients Need Assistance With Nutrition

A study presented at the 2019 ASH Annual Meeting found that following hematopoietic cell transplantation (HCT), patients report poor adherence to the 2015 Dietary Guidelines for Americans (DGA) and are not receiving the necessary daily nutrients. “These findings reinforce the need to incorporate nutrition into HCT survivor care,” the researchers noted.

The study included adults who underwent autologous or allogeneic HCT for a hematologic disease and were at least one-year post-transplantation. Researchers assessed dietary intake via the Block 2014 food frequency questionnaire, and estimated diet quality (defined as adherence to the DGA) via the Healthy Eating Index-2015 (HEI-2015; a score of ≤50 indicates “poor diet quality,” 51-80 suggests a “diet that needs improvement,” and >81 indicates “good diet quality”).

Between December 2017 and September 2018, 124 survivors were invited to participate, of whom 90 completed the dietary intake assessment: 51 received autologous HCT and 39 received allogeneic HCT. Most patients were male (56%), white (72%), married (81%), and completed some college education (57%). In addition, many participants were overweight (34%) or obese (37%), and median time from HCT was 5.2 years.

Mean HEI-2015 scores were 61.6 among 18- to 64-year-olds and 60.7 among those ≥65 years, which the authors noted are “slightly higher” than the general U.S. population. Only 10% of participants reported adhering to a good-quality diet. Most (82%) had a diet that was in need of improvement, while 8% reported a poor-quality diet.

More than 50% of participants fell below the estimated average requirement intake for the following: vitamin A (720 mcg/d), vitamin C (82 mg/d), vitamin D (4.4 mcg/d), magnesium (253 mg/d), and calcium (781 mg/d). Fiber intake (8.9 g/1,000 kcal/d) was also significantly below the adequate intake of 14 g/1,000 kcal/d. Meanwhile, sodium intake (2,834 mg/d) exceeded the DGA recommendation of 2,300 mg/d.

Patient-reported “change in taste” was the only factor associated with lower-quality diets (P=0.02), as 29% of HCT survivors reported persistently altered taste sensation.

The researchers noted that the willingness of recent HCT survivors to participate in a dietary intervention was relatively high: More than two-thirds (73%) indicated an interest in participating in a dietary intervention. However, patients who were within two years of HCT were more likely to be receptive to a diet intervention than survivors who were more than two years post-transplant (52% vs. 28%; P=0.0013).

Reference

Farhadfar N, Kelly DL, Mead LE, et al. Diet quality of long-term allogeneic and autologous stem cell transplant (HCT) survivors. Abstract 4565. Presented at the 2019 ASH Annual Meeting, December 9, 2019; Orlando, Florida.