Unlike adults with cancer, children diagnosed with cancer rarely have overt malnutrition, especially if the diagnosis was made in a timely fashion. Nutritional deficiencies can develop as a result of the treatment itself or of complications that arise from the chemotherapy or radiation. Antioxidant use is not part of the conventional treatment of children with cancer and therefore it is considered complementary or alternative medicine. However, more studies show that children with cancer were using some form of complementary medicine and almost half of those children were taking vitamin supplements.
Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer, and therefore patients with ALL represent a large homogenous population of children for study. Most children with ALL do not have overt malnutrition, which makes them a reasonable population in which to investigate the effect of antioxidant status. Therefore, some researchers from Columbia University investigated the effect of therapy on antioxidant intakes in children with ALL, the relationship between dietary antioxidant intakes and plasma antioxidant concentration and the relationship between the incidence of side effects due to treatment and antioxidant intake.
A six-month observation study was conducted on 103 children with ALL. Blood was collected at three regularly scheduled visits (before chemotherapy was given, three months after diagnosis and six months after diagnosis) to test for antioxidant status (total ascorbate, vitamins A and E and total carotenoids). A 24-hour food recall and FFQ were administered on the same days as the blood collection. Data on adverse side effects of chemotherapy was also collected at these three time points.
The children ingested vitamin E, total carotenoid, beta-carotene and vitamin A in amounts that were 66%, 30%, 59% and 29%, respectively, of the US recommended dietary allowance or of the amounts specified in the third National Health and Nutrition Examination Survey. Greater vitamin C intakes at six months were associated with fewer therapy delays, less toxicity and fewer days spent in the hospital. Greater vitamin E intakes at three months were associated with a lower incidence of infection, while greater beta-carotene intakes at six months were associated with a decreased risk of toxicity. Antioxidant supplementation was rare, with 4%, 3% and 1% of patients using supplements at time points 1, 2 and 3.
The findings of this study definitely show that antioxidant intakes, except for vitamin C, are inadequate in children and adolescents with ALL. However, despite adequate intakes of vitamin C, almost half of the patients had inadequate plasma concentrations. There have been concerns about potential adverse interactions between antioxidant supplement and chemotherapy, so Kennedy et al. do not support supplementation at this time. The results do suggest that it would be wise for children with ALL to receive nutritional counseling to ensure that they are meeting their needs for antioxidant nutrients.
Deborah D. Kennedy, Katherine L. Tucker, Elena D. Ladas et al., Low antioxidant vitamin intakes are associated with increases in adverse effects of chemotherapy in children with acute lymphoblastic leukemia, Am J Clin Nutr 79:1029-1036 (June 2004) [Address reprint requests to K. M. Kelly, Division of Pediatric Oncology, Columbia University, 161 Fort Washington Avenue, Irving Pavillion 7, New York, NY 10032. E-mail: kk291@columbia.edu]
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