Objective To investigate the changes of nutritional status in pediatric acute lymphoblastic leukemia(ALL) patients during therapies for remission induction with L-asparaginase(L-asp),and to compare the different nutritional status in ALL pediatric patients during therapies for remission induction with L-asp between the regular diet intervention group and the collaborative care model (CCM) diet intervention group. Methods Totally 121 pediatric ALL patients undergoing therapies for remission induction with L-asp in a children's hospital in Shanghai from March 2015 to February 2016 were enrolled in this study and were divided into two groups,with control group from March 2015 to August 2015 and intervention group from September 2015 to February 2016.Patients in control group received the regular diet intervention by nurses.while patients in intervention group received the CCM diet intervention.The nutritional status of the patients was recorded and compared between the two groups. Results During the remission induction with L-asp in pediatric ALL patients,the mid-upper arm circumference,the muscle mass and the serum albumin decreased significantly(P<0.05).The muscle mass of the patients in control group were significantly higher than those in the intervention group(P<0.05) on the first day of L-asp,but there was no significant difference between the two groups on the last day of using L-asp(P>0.05).The change of decrease in mid-upper arm circumferences of the patients in the control group was significantly faster and wider than those in the intervention group(P<0.05). Conclusions The pediatric ALL patients have insufficient energy intake,the loss of fat-free mass and the different levels of hypoproteinemia during the remission induction with L-asp.Nutrition support is suggested to be delivered at the beginning of the therapy.The mid-upper arm circumferences of the patients receiving CCM diet intervention decreased slower than those receiving regular diet intervention.The fat-free mass of the patients receiving the CCM diet intervention lost less than those receiving the regular diet intervention.Therefore,collaborative care model can provide better nutrition support for ALL pediatric patients.
Key words
acute lymphoblastic leukemia /
L-asparaginase /
collaborative care model /
diet intervention /
nutritional status
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References
[1] 崔炎.儿科护理学[M].北京:人民卫生出版社,2015:498.
[2] Hijiya N,van der Sluis IM.Asparaginase-associated toxicity in children with acute lymphoblastic leukemia[J].Leuk Lymphoma,2016,57(4):748-757.
[3] Yazbeck N,Samia L,Saab R,et al.Effect of malnutrition at diagnosis on clinical outcomes of children with acute lymphoblastic leukemia[J].J Pediatr Hematol Oncol,2016,38(2):107-110.
[4] Esfahani A,Ghoreishi Z,Abedi Miran M,et al.Nutritional assessment of patients with acute leukemia during induction chemotherapy:association with hospital outcomes[J].Leuk Lymphoma,2014,55(8):1743-1750.
[5] Lott TF,Blazey ME,West MG.Patient participation in health care:an underused resource[J].Nurs Clin North Am,1992,27(1):61-76.
[6] Unutzer J.The Collaborative Care Model:An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes [EB/OL].http://www.medicaid.gov.2013-5.
[7] Briend A,Maire B,Fontaine O,et al.Mid-upper arm circumference and weight-for-height to identify high-risk malnourished under-five children[J].Matern Child Nutr,2012,8(1):130-133.
[8] 陈碧兰.儿童急性白血病患者营养状况调查[J].福建医药杂志,2009,31(5):125-126.
[9] Halpern-Silveira D,Susin LR,Borges LR,et a1.Body weight and fat-free mass changes in a cohort of patients receiving chemotherapy[J].Support Care Cancer,2010,18(5):617-625.
[10] 赵卓琦,费俊,洪莉,等.临床营养师在营养支持小组中的作用及临床实践[J].中国食物与营养,2014,20(9):83-86.
[11] 江秀丽,孙爱莲,王蕾.营养干预对急性淋巴细胞白血病病儿化疗效果影响[J].青岛大学医学院学报,2013,49(5):448-450.
[12] World Health Organization Collaborating Centre on Health Workforce Planning and Research.Model of Care Initiative in Nova Scotia(MOCINS):Final Evaluation Report[R].Canda:Dalhousie University,2010:1-90.
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