Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease.

Andréa Z Pereira,Morgani Rodrigues,Bianca Laselva De Sá,Catarina Lôbo Santos De Souza,Afonso Celso Vigorito,Elaine Maria Borges Mancilha,George Maurício Navarro Barros,Eduardo José De Alencar Paton,Alexandre De Almeida Candolo,Juliana Todaro,Juliana Bernardo Barban,Ana Elisa De Paula Brandão-Anjos,Telma Sigolo Roberto,Lilian Pinheiro Lopes,Roberto Luiz Da Silva,Ana Carolina Leão Silva,Rosana Ducatti Souza Almeida,Alessandro De Moura Almeida,Cláudio Galvão De Castro,Maria Cristina Martins De Almeida Macedo,José Salvador Rodrigues De Oliveira,Thays De Cássia Ruiz Rodrigues,Vergílio Antônio Rensi Colturato ,Maria Cláudia Rodrigues Moreira ,Paulo César Ribeiro ,Mary E.d Flowers

doi:10.31744/einstein_journal/2020ae4799

Abstract

ABSTRACTThe Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease was approved by Sociedade Brasileira de Transplante de Medula Óssea , with the participation of 26 Brazilian hematopoietic stem cell transplantation centers. It describes the main nutritional protocols in cases of Graft- versus -host disease, the main complication of hematopoietic stem cell transplantation.

Highlights

There are no clear literature data on the impact of the pre-hematopoietic stem cell transplantation (HSCT) nutritional status as a cause of higher or lower incidence of Graft-versus-host disease (GVHD), nor on the best way to perform its assessment.[13,14,15,16] Some studies report that high rates of malnutrition[17] and worsening of nutritional status are associated to more severe GVHD in the gastrointestinal tract (GIT), mouth, and lung.[18]
The nutritional status in acute GVHD (a-GVHD) or Chronic GVHD (c-GVHD) is affected by several symptoms, which are widely discussed later, such as prolonged hospital stay and high doses of corticosteroids, which profoundly affect
Nutrition recommendations: macronutrients Calories Nutritional needs in patients undergoing HSCT increase due to intense catabolism.[27]. It is suggested that energy requirements during the early phase of HSCT and GVHD are up to 130% to 150% of estimated basal energy expenditure, which amounts to 30 to 50kcal/kg body weight per day, and these increased energy requirements contribute to patients’ weight loss.[25,28,29] This chronic hypermetabolic state found in these patients is a response to inflammatory cytokines and changes in norepinephrine and glucagon levels.[25,30,31] Some studies show increased serum glucagon levels leading to up to a 10% increase in basal metabolism, einstein (São Paulo). 2020;18:1-20

Summary

In the lungs

Oral supplements Regardless of the type and severity of GVHD, when the patient has a dietary intake below 70% of the energy requirements in the last 3 days, and symptoms that impair adequate nutrition, it is important to intervene with the use of high-calorie and high-protein nutritional supplements (adapted according to the phase of the restricted diet in the case of intestinal GVHD). The standard treatment of GIT GVHD is corticoid therapy, which has direct effects on body composition, leading to increased body fat, decreased lean mass, water and sodium retention, hypertriglyceridemia, hypercholesterolemia, sarcopenia and bone demineralization, and this may mask the nutritional status of patients.[25]. Parenteral diet Patients with GIT GVHD in the acute and early phase of the disease usually present diarrhea,

Bowel rest

Expansion of diet

Findings

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