背景:营养状态受损会危及急性淋巴细胞白血病(ALL)患者的积极预后。在低收入和中等收入国家,约50%的ALL患儿在诊断时营养不良,接受抗肿瘤治疗会增加耗尽其营养储备的风险。对癌症相关营养不良患者实施营养干预。我们旨在评估营养干预对诊断为接受治疗的ALL儿童的影响。
方法:使用预定义的协议,我们搜索了已发表或未发表的随机对照试验:CochraneCENTRAL,MEDLINE,EMBASE,LILACS,还有SciELO,并进行了补充搜索。研究表明,至少有50%的参与者在≤18岁的儿童中诊断为ALL。积极的抗肿瘤治疗,并纳入营养干预措施.研究选择和数据提取由三名评审员独立进行,以及两名审稿人对偏见风险的评估。结果以表格形式和叙述方式合成。
结果:25项研究(在4097项记录中)满足纳入要求。在18项研究中存在较高的偏倚风险。分析的干预措施按化合物/食物分类(n=14),微量营养素(n=8),营养支持(n=3)。在每组中,测试的干预措施和成分(剂量和时间)是异质的。关于我们的主要结果,没有一项研究报告无脂肪质量作为结果.在许多研究中报道了与营养状况和人体测量相关的炎症和代谢标志物,但在整个研究中差异很大。对于我们的次要结果,在任何一项研究中,均未将脂肪量或体内水分作为结局报告.然而,一些研究报告了一些不同的不良事件.
结论:这篇综述强调了对ALL患儿进行营养干预的高质量随机对照试验的必要性。基于他们有限的数量和异质性的结果。
■Guzmán-LeónAE,洛佩兹-特罗斯五世,阿维拉-普拉多J,Bracamontes-PicosL,HabyMM,SteinK.系统评价方案:接受肿瘤治疗的急性淋巴细胞白血病儿童的营养干预。系统评价的国际前瞻性登记册。2021年;PROSPEROCRD:42,021,266,761(https://www。crd.约克。AC.uk/prospro/display_record.php?RecordID=266761)。
BACKGROUND: A compromised nutritional status jeopardizes a positive prognosis in acute lymphoblastic leukemia (ALL) patients. In low- and middle-income countries, ~ 50% of children with ALL are malnourished at diagnosis time, and undergoing antineoplastic treatment increases the risk of depleting their nutrient stores. Nutrition interventions are implemented in patients with cancer related malnutrition. We aimed to evaluate the effect of nutrition interventions in children diagnosed with ALL under treatment.
METHODS: Using a predefined protocol, we searched for published or unpublished randomized controlled trials in: Cochrane CENTRAL, MEDLINE, EMBASE, LILACS, and SciELO, and conducted complementary searches. Studies where at least 50% of participants had an ALL diagnosis in children ≤ 18 years, active antineoplastic treatment, and a nutrition intervention were included. Study selection and data extraction were conducted independently by three reviewers, and assessment of the risk of bias by two reviewers. Results were synthesized in both tabular format and narratively.
RESULTS: Twenty-five studies (out of 4097 records) satisfied the inclusion requirements. There was a high risk of bias in eighteen studies. Interventions analyzed were classified by compound/food (n = 14), micronutrient (n = 8), and nutritional support (n = 3). Within each group the interventions and components (dose and time) tested were heterogeneous. In relation to our primary outcomes, none of the studies reported fat-free mass as an outcome. Inflammatory and metabolic markers related to nutritional status and anthropometric measurements were reported in many studies but varied greatly across the studies. For our secondary outcomes, fat mass or total body water were not reported as an outcome in any of the studies. However, some different adverse events were reported in some studies.
CONCLUSIONS: This review highlights the need to conduct high-quality randomized controlled trials for nutrition interventions in children with ALL, based on their limited number and heterogeneous outcomes.
UNASSIGNED: Guzmán-León AE, Lopez-Teros V, Avila-Prado J, Bracamontes-Picos L, Haby MM, Stein K. Protocol for a Systematic Review: Nutritional interventions in children with acute lymphoblastic leukemia undergoing an tineoplastic treatment. International prospective register of systematic reviews. 2021; PROSPERO CRD:42,021,266,761 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=266761 ).