RT Dissertation/Thesis
T1 Nutritional status and its impact on outcome in patients undergoing allogeneic haematopoietic cell transplantation and an experimental trial to improve the supply of a specific micronutrient 
A1 Urbain,Paul
WP 2012/05/31
AB The first two studies investigated the course of the nutritional status in patients un-dergoing allogeneic haematopoietic cell transplantation (alloHCT) and the validity of nutritional markers as independent risk factors for outcome. In line with others, we detected an overall good nutritional status before alloHCT by employing quick screening tools such as BMI and the SGA questionnaire for identifying malnutrition. However, upon closer inspection, we observed unintentional weight loss previous to alloHCT to be a frequent condition, detecting many more underweight patients using age- and gender-specific BMI classification and overall low bioelectrical impedance phase angle values at admission. Deterioration in nutritional status during the early post-transplant period was significant in the cohort. Furthermore, we identified ano-rexic patients and those with clinically-relevant aGVHD (≥°II) to have an increased risk for a decline in nutritional status during early rehabilitation. In addition, it could be demonstrated for the first time that the pretransplant phase angle (≤25th percen-tile) used as a standardised value was an independent predictor for 2-year overall survival, non-relapse mortality and progression-free survival. BMI adjusted for age and gender emerged as an independent risk factor for OS and NRM. Both of these nutritional markers performed better than numerous generally-accepted risk factors, and they were the only significant prognostic values for outcome in this cohort be-sides HLA-C compatibility, donor and remission status. In addition, these two nutri-tional markers are theoretically modifiable during the often lengthy treatment period before transplantation. Further investigation is necessary to demonstrate whether or not the phase angle can be increased by strategies that enhance muscle mass via physical training together with nutritional support, and whether it can prevent dete-rioration in nutritional status and lead to beneficial effects on outcome after alloHCT.
The third study investigated the association between AOX status (α-tocopherol, ascorbic acid and ß-carotene) in buccal mucosa cells (BMC) or plasma and the risk of developing oral mucositis (OM) after conditioning chemotherapy. We observed no significant differences in baseline AOX concentrations in plasma or BMC among the different OM groups (no or mild, ulcerative and severe OM), revealing that no single AOX has predictive value for the incidence or severity of OM after conditioning chemotherapy. However, patients with an overall good plasma AOX status tended to require a shorter duration of parenteral nutrition, which is a relevant clinical and economic marker for OM treatment compared to patients with at least one plasma AOX beneath the normal range. These findings may indicate that an intact antioxidative network is more relevant than any one AOX for lowering the OM risk. Future studies should consider both the exogenous- and endogenous AOX systems.
The fourth study revealed a generally low serum 25-hydroxyvitamin D [25(OH)D3] status in these patients at admission. Furthermore, their 25(OH)D3 status remained low during the early post-transplant period, showing a trend towards further deterio-ration, especially in patients with corticosteroid-treated aGVHD. In addition, we con-ducted a detailed investigation of the impact of well-known influencing factors on baseline serum 25(OH)D3 status, revealing only higher body fat mass to be an inde-pendent risk factor for reduced baseline status. In fact the most important influenc-ing factors, namely dietary factors and season, revealed no detectable impact, most probably due to inadequate oral intake, prolonged disease history, and hospitalisa-tion. In conclusion, these results provide a clear rationale for the use at least of vitamin D-containing multivitamin preparations in standard multivitamin prescrip-tions, and for the monitoring of vitamin D status at regular intervals from the date of diagnosis.
The fifth study was a randomised controlled trial revealing for the first time in humans that the bioavailability of vitamin D2 from vitamin D2-enhanced button mushrooms via UV-B irradiation is effective in improving vitamin D status in young, healthy adults and not different than a vitamin D2 supplement. The vitamin D2 enhancement of mushrooms boosts their nutraceutical value by creating both an abundant and excellent source of vitamin D2 that opens up new opportunities in fighting widespread vitamin D deficiency.
K1 Ernährung
K1 Hochdosischemotherapie
K1 Überleben
K1 Risikofaktor
K1 Vitamin-D-Mangel
K1 Mundschleimhaut
K1 Knochenmarktransplantation
K1 Champignon 
PP Hohenheim
PB Kommunikations-, Informations- und Medienzentrum der Universität Hohenheim
UL http://opus.uni-hohenheim.de/volltexte/2012/701