الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Leukemia is a type of cancer involving blood and bone marrow, normally bone marrow function is to produce red blood cells, white blood cells and platelets. Genetic abnormalities cause the bone marrow to produce abnormal cells that lack normal differentiation and increased production with decreased apoptosis. This results in the presence of abnormal malfunctioning white blood cells called (blast cells).
Treatment of acute leukemia include multiple cycles of intensive chemotherapy which affects the patient’s status significantly. Treatment usually starts with a cycle named induction remission cycle which is accompanied by massive weight loss on short time and change in body composition.
Malnutrition is defined as imbalance of nutrition, which includes over nutrition and under nutrition, but in cancer research its commonly referring to under nutrition especially as the patients usually lose a lot of weight, it can even present as a more severe form called cachexia which is defined as progressive involuntary weight loss with depletion of host reserves of skeletal muscle and adipose tissue. Malnutrition in cancer patients is attributed to multiple factors such as side effects of chemotherapy including anorexia, loss of appetite, mucositis, nausea, vomiting, diarrhea, the disease inflammatory process and psychological effect of the disease.
Body composition changes take place in acute leukemia cases, Adaptation mechanisms to anorexia differ in cancer patients than starvation cases. In starvation cases, muscle content tends to be conserved at the cost of body fat stores, which are favorably used to fuel the body with needed energy. In contrast, relatively more muscle content is lost in the development of cancer cachexia and these changes in body composition are not reversed if adequate energy and other nutrients are provided, as may occur in starvation states.
Various tools for nutritional assessment are present, but no gold standard is chosen yet for such cases. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends that all patients with cancer to be screened for nutritional risk early in the course of their care, regardless of body mass index and weight history.
The aim of the present study was to assess nutritional status of acute leukemia patients attending Hematology Department at Medical Research Institute by using anthropometric measurements and clinical signs, to determine the adequacy of energy and macronutrients for these patients and to investigate the relationship between patients’ nutritional status, length of hospital stay and length of disease duration.
This study was conducted according to the guidelines of medical research involving human subjects and was approved by ethics committee of High Institute of Public Health, Alexandria University, Egypt. Written consent was taken from everyone after explaining the aim of the study.
A cross-sectional approach was used to conduct this study. Ninety patients who were already diagnosed of having acute leukemia from records were selected for this study.
Data was collected from patients using a pre-designed structured interviewing questionnaire included collection of socio-demographic data, medical history (duration of the disease, number of chemotherapy cycles, hospital stay, use of regular medications and supplements), dietary habits and dietary intake assessment using the 24-hour recall method. Clinical assessment also performed focusing on examination of loss of subcutaneous fat, muscle wasting. Hospital records were reviewed to obtain the diagnosis of patient’s disease and their laboratory tests (complete blood count, serum albumin level, liver function tests and kidney function tests). Anthropometric measurements including weight and height were taken then BMI was calculated for all cases, middle arm circumference, triceps skin fold and body composition measurements was taken by bioelectrical impedance analysis using body fat analyzer for assessment of percent of total body fat, water and muscle.
After completion of data collection, data were revised, coded and the statistical analysis was conducted using IBM SPSS software (Statistical Package for the Social Sciences; SPSS Armonk, NY: IBM Corp) version 20.0. Statistical significance was set at (P) values ≤ 0.05.
Data was analyzed using the following tests:
1. Chi-square test: For categorical variables, to compare between different groups.
2. Fisher’s Exact or Monte Carlo correction: Correction for chi-square when more than 20% of the cells have expected count less than 5.
3. Student t-test: For normally distributed quantitative variables, to compare between two studied groups.
4. Mann Whitney test: For abnormally distributed quantitative variables, to compare between two studied groups.
6.2. Conclusions
from the results of the present study, the following can be concluded:
• The majority of patients didn’t receive any medications of other diseases than leukemia while the highest percent had dietary supplement.
• The most common types of dietary supplement used by acute leukemiapatients were calcium and potassium.
• The majority of leukemia patients had feeding problems represented in loss of appetite, nausea and change of taste.
• The majority of leukemia patients didn’t suffer from muscle loss or subcutaneous fat loss.
• Inadequate intake of energy and protein was reported in the majority of the study patients.
• Malnutrition was reported in 21.1% of patients based on BMI.
• The highest percent of malnourished patients were from rural areas.
• Malnutrition was found to be high among patients who had a higher number of chemotherapy cycles, longer disease duration and hospital stay.
• The use of dietary supplement was lower among malnourished patients than normal weight patients.
• The most common type of dietary supplement used among malnourished patients was calcium followed by magnesium.
• Loss of appetite and change of taste were the most prevalent feeding problem in malnourished patients.
• The percent of patients who suffer from muscle wasting was higher than those who had subcutaneous fat loss.
• Daily energy and macronutrient intake were lower in malnourished patients than in normal weight patients.
• Body fat, muscle and water percent were lower in malnourished patients than other patients.
• Most of the patients had anemia, decreased WBCs count and hypoalbuminemia. A higher percent of malnourished patients had decreased WBCs count than normal weight patients.
6.3. Recommendations
from the results of the present study, the following can be recommended:
• Training programs should be directed to physicians to increase their nutritional knowledge regarding the patient’s needs beside increasing their skill to assess the patient’s nutritional status.
• Screening of all acute leukemia patients for nutritional risk should be done early in the course of their care, regardless of body mass index and weight history.
• Early and systemic screening should be done to prevent nutritional status from deterioration and provide a better disease outcome.
• Expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure.
• Research studies should be conducted for further investigations of the role of regular nutritional assessment and nutrition management in the outcome of acute leukemia patients.
• Use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, decreasing inflammation and hypermetabolic stress, and increasing physical activity.