Estado nutricional e hormônios relacionados com o apetite em crianças e adolescentes com leucemia durante a fase de indução da quimioterapia

Abstract

Cancer is a group of several diseases that have in common an uncontrolled proliferation of abnormal cells, and it can occur at anywhere in the body. The most frequent tumors in childhood and adolescence are the leukemias, and the Acute Lymphoblastic Leukemia (ALL) is the most prevalent. The evidenced malnutrition in these patients is related to anorexia-cachexia syndrome triggered by the disease, but also on changes in appetite, which occur during chemotherapy and interfere in the nutritional status as well as in response to antineoplasic therapy. Although it recognized a possible influence of hormones related to appetite on the changes in food consumption of ALL patients during chemotherapy, few studies have investigated the hormonal changes in patients with childhood cancers. Thus, the aim of this study was to evaluate the nutritional status and levels of key hormones related to appetite in children and adolescents with Acute Lymphoblastic Leukemia (ALL) in the induction phase of chemotherapy. For this purpose, it was assessed 14 children/adolescents diagnosed with ALL during the 28 days of induction chemotherapy cycle. At baseline (prior to initiation of chemotherapy), in the middle and at the end of this cycle were performed anthropometric measurement, weighted food record 24 hours and biochemical and hormone levels were obtained. It were evaluated the following hormones related to appetite: leptin, ghrelin, insulin and cortisol. Most patients had normal weight at the beginning of treatment which did not change significantly during the induction cycle. The dietary intake increased over the cycle, particularly in relation to proteins and lipids intake from the beginning to the end of treatment. Platelet levels and transaminase glutamic pyruvic significantly increased, and a significant reduction in blood glucose, creatinine and sodium levels were observed. Regarding appetite hormones, ghrelin significantly increased between the baseline and the half of the cycle (p = 0.027), but not through the end. In conclusion, the ALL treatment induction period caused an increase in energy and nutrients intake, as well as an increase in the concentration of ghrelin, but no impact on the anthropometric status of patients or in other hormones related to appetite.