ESPEN 2021 Late Breaking Abstracts

Topic: Nutritional epidemiology

Abstract Submission Identifier: ESPEN21-LB-1897

ARE CARDIO-METABOLIC LATE-EFFECTS MODIFIABLE THROUGH A LOW-FAT DIET IN LONG-TERM SURVIVORS OF PEDIATRIC ALLOGENEIC STEM CELL TRANSPLANTATION?

L. L. Pedersen^*, ¹, T. Gerbek ¹, E. Muhic ¹, T. Christiansen ¹, K. Kok ¹, K. Sørensen ¹, C. Mølgaard ^{1, 2}, K. G. Müller ^{1, 3}

¹Dept of Pediatrics & Adolescent Medicine, University Hospital, ²Dept of Nutrition, Exercise & Sports, ³Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark

Rationale: Increasing survival rates in allogeneic hematopoietic stem cell transplantation (HSCT) has led to an increased focus on the late-effects of the treatment, including early onset metabolic syndrome (MetS). While lifestyle factors such as nutrition play a role in the development of MetS in the general population,  total body irradiation (TBI) are a significant risk factor among HSCT-survivors. We have limited insights into the role of dietary factors in this group. The aim of this study was to describe the diet of long term survivors of pediatric HSCT and to explore associations with MetS.

Methods: Patients undergoing HSCT in Denmark before the age of 18 (1980-2018) and were >18 years of age at the inclusion were eligible. 85 patients completed a 3-day dietary record and results were compared with Nutrition Recommendations¹ and with previous reports on diets in the background population. Median age 31 years (19-53) and follow-up time 22 years (7-37). Both malignant and benign diseases. Conditioning were TBI-based (53%), BuCy (28%) or other (19%).

Results: Overall intake of macro- and micronutrients was within the recommendations, except the distribution of fatty acids. A high number of patients had a higher intake of saturated fat (SF), and lower intake of mono and poly unsaturated fat than recommended. Also it showed a low intake of vitamin D and in females also iron. 23 patients (27%) had MetS, corresponding to the prevalence in the background population at 50-80 years. Of those 22 (95%) were treated with TBI, confirming TBI as a dominant risk-factor (p<0.0001). Total fat intake was higher in patients with MetS (85 vs 71g/day (p<0.005) and 37E% vs 34E% (p<0.02)) and these patients had also a higher intake of SF (27 vs 22g/day (p<0.04)). Patients treated with TBI having MetS had a higher intake of fat than TBI-treated patients without MetS (84 vs 66g/day (p<0.002) and 37E% vs 32E%, (p<0.01)) and also SF (27 vs 21g/day (p<0.02)).

Conclusion: This study suggest that HSCT and the use of TBI induces a state of hypersensitivity to the harmful effects of fat in the diet, indicating the importance of an individualized diet to reduce metabolic late effects of HSCT and cardio-metabolic disease later in life.

References: 1. Nordic Council of Ministers (2014) Nordic nutrition recommendations. 5th edn, Cph, DK.

Disclosure of Interest: None Declared

Keywords: Allogeneic HSCT, Late effects, Metabolic syndrome, Nutrition