Our Integrative Therapy Program was the first to systematically evaluate the dietary intake of antioxidants in children with cancer. In 2004, we discovered that a large percentage of children undergoing treatment for acute lymphoblastic leukemia have inadequate intakes of antioxidants and vitamin A. Lower intakes of antioxidants were also associated with increases in the adverse side effects of chemotherapy. The results of this study were reported in the American Journal of Clinical Nutrition.
In 2005, in Pediatric Blood Cancer , we reported that among children with acute lymphoblastic Leukemia (ALL), antioxidant levels and oxidative stress appear to be associated with duration and complications of treatment.
In 2008, we reported that dietary supplements are a commonly used CAM modality for children with cancer, with the prevalence of supplement use ranging from 35 to 50 percent in the United States. This research led to the first, prospective, cohort study of dietary intake in pediatric cancer patients (see DALLT study below).
Dietary Intake in Children with Cancer
With the Dana-Farber Cancer Institute Consortium, we have launched The Diet and Acute Lymphoblastic Leukemia Treatment (DALLT) Cohort Study, the first to examine dietary intake in a homogenous population of children with cancer. This multicenter study of 794 patients with ALL revealed that twenty-seven percent of the children were overweight/obese and up to 79 percent exceeded daily recommended calorie intake. While the majority of these patients were within recommended values for vitamin C and calcium, we found deficiencies in vitamins E and D.
One surprising discovery was the wide range of dietary intakes for zinc and folate, with significant differences exist between standard-risk and high-risk patients. The importance of folate for the treatment of ALL and the development of therapy-related toxicities in ALL has been well documented. Thus, the finding that most children are either under or exceed the RDA may have clinical applications, relating to the development of infections—a serious complication of treatment.
The findings from DALLT are being explored in a prospective trial supported by the American Cancer Society. Dr. Ladas will be evaluating the feasibility of dietary intervention during timepoints where children are most likely to gain weight.
Brain Tumor Nutrition Study
Dr. Ladas and her colleagues are now undertaking a similar initiative to explore the role of nutrition for children with brain tumors focusing on patients aged 3 to 21 who have been diagnosed with medulloblastoma/PNET, ependymoma and low-grade glioma. This study is a collaboration with Toronto’s Hospital for Sick Children, the Anna and Robert H. Lurie Children’s Hospital of Chicago, Children’s Hospital, Children’s Hospital Los Angeles, the Nemours Children’s Clinic (Jacksonville, Florida) and the Dana Farber Cancer Institute (Boston). The primary purpose of this longitudinal study is to determine the role of B vitamins on the incidence and severity of neuropathy in children receiving treatment for a brain tumor.
Children with brain tumors consistently have difficulty maintaining dietary intake and nutritional status throughout surgery, radiation, and chemotherapy, although the causes, timing, and duration of compromised nutrition status have not been well documented. Weight loss is typically severe (more than 5 to 10 percent of body weight) and may contribute to toxicities yet there are no consistent clinical guidelines for intervention. We hypothesize that poor quality dietary intake and low nutritional status increase the incidence and risk for peripheral neuropathies, compromise energy levels, and reduce quality of life.