American Journal of Clinical Nutrition, Vol. 79, No. 6, 1029-1036, June 2004
© 2004 American Society for Clinical Nutrition
ORIGINAL RESEARCH COMMUNICATION
Low antioxidant vitamin intakes are associated with increases in adverse effects of chemotherapy in children with acute lymphoblastic leukemia1,2,3
Deborah D Kennedy1, Katherine L Tucker1, Elena D Ladas1, Susan R Rheingold1, Jeffrey Blumberg1 and Kara M Kelly1
1 From the Division of Pediatric Oncology, Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York (DDK, EDL, and KMK); the Division of Oncology, The Children’s Hospital of Philadelphia (SRR); and the US Department of Agriculture Jean Mayer Human Nutrition Research Center for Aging ((KLT and JB) and the Friedman School of Nutrition Science and Policy (DDK, KLT, and JB) at Tufts University, Boston
Background: Chemotherapy leads to an increase in reactive oxygen species, which stresses the antioxidant defense system. Children with acute lymphoblastic leukemia rarely are overtly malnourished, which makes this population ideal for an investigation of the relations between dietary antioxidant consumption, plasma antioxidant concentrations, and chemotherapy-induced toxicity.
Objective: This study was conducted to investigate the effect of therapy on antioxidant intakes in children with acute lymphoblastic leukemia, the relation between dietary antioxidant intakes and plasma antioxidant concentrations, and the relation between the incidence of side effects due to treatment and antioxidant intake.
Design: We conducted a 6-mo observational study of 103 children with acute lymphoblastic leukemia. Plasma micronutrient concentrations, dietary intakes, and incidence of side effects of chemotherapy were ascertained at diagnosis and after 3 and 6 mo of therapy.
Results: Throughout the 6-mo study period, subjects ingested vitamin E, total carotenoid, ß-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 6 mo were associated with fewer therapy delays, less toxicity, and fewer days spent in the hospital. Greater vitamin E intakes at 3 mo were associated with a lower incidence of infection. Greater ß-carotene intakes at 6 mo were associated with a decreased risk of toxicity.
Conclusion: A large percentage of children undergoing treatment for acute lymphoblastic leukemia have inadequate intakes of antioxidants and vitamin A. Lower intakes of antioxidants are associated with increases in the adverse side effects of chemotherapy.
Key Words: Acute lymphoblastic leukemia • antioxidants • chemotherapy toxicity • nutrition • diet • children