Nutritional and Body Composition Changes in Paediatric β-Thalassemia Patients Undergoing Hematopoietic Stem Cell Transplantation: A Retrospective Study Using Bioelectrical Impedance Analysis

Figures & data

Table 1 Demographic and Clinical Characteristics of 40 Pediatric Patients Undergoing Haematopoietic Stem Cell Transplantation (HSCT)

Patients Characteristics	n	Proportion (95% CI)
Median age (range)	8.4 (2 to 15 years)
Gender
Male	22	55.00% (0.40%, 0.70%)
Female	18	45.00% (0.31%, 0.60%)
Type of HSCT
Haploidentical donor	25	62.50% (0.47%, 0.76%)
Matched related donor	7	17.50% (0.09%, 0.32%)
Matched unrelated donor	8	20.00% (0.11%, 0.35%)
Condition regimen
CY + BU + Flu + TT	40	100.00% (0.91%, 1.00%)
GVHD prophylaxis
CsA + MTX+MMF	7	17.50% (0.09%, 0.32%)
Tacrolimus+CY+MMF	33	82.50% (0.68%, 0.91%)
W/H or BMI/A-Z score
Normal	32	80.00% (0.65%, 0.90%)
Moderately wasted	6	15.00% (0.07%, 0.29%)
Severe wasted	1	2.50% (0.01%, 0.13%)
Over weight	1	2.50% (0.01%, 0.13%)
H/A-Z score
Normal	25	62.50% (0.47%, 0.76%)
Moderately stunted	10	25.00% (0.14%, 0.40%)
Severely stunted	5	12.50% (0.05%, 0.26%)

Note: Proportion’s 95% confidence intervals (CI) was estimated using Wilson score method.

Abbreviations: CY, cyclophosphamide; BU, busulfan; Flu, fludarabine; TT, thyroglobulin; CsA, cyclosporin A; MTX, methotrexate; MMF, mycophenolate mofetil.

Table 2 Nutritional Status Changes Pre- and Post-Haematopoietic Stem Cell Transplantation (HSCT)

	W/H or BMI/A-Z Rank Change			P-value***
	Improved/Sustained (%)*	Deteriorated (%)**	Total (%)
Normal	26 (81.25%)	6 (18.75%)	32 (100%)	0.011
Wasting	2 (28.57%)	5 (71.43%)	7 (100%)
Overweight	1 (2.5%)	0 (97.5)	1 (100%)

Notes: *Compare with pre HSCT, W/H or BMI/A-Z rank improved or sustained, including severely wasted to moderately wasted or normal, and moderately wasted to normal. **Compare with pre HSCT, W/H or BMI/A-Z rank deteriorated, including normal to moderately wasted or severely wasted, and moderately wasted to severely wasted. ***Fisher’s exact test was performed.

Table 3 Comparative Analysis of Body Composition Parameters Before and After Haematopoietic Stem Cell Transplantation (HSCT) in Pediatric Patients

	Pre-HSCT ()	Post-HSCT ()	t	P
Weight (kg)	22.152±7.459	20.735±6.569	6.313	<0.001
Height	119.625±16.972	120.382±17.054	−5.066	<0.001
BMI	15.189±1.699	14.05±1.477	8.846	<0.001
FFM (Kg)	18.26±5.712	17.273±5.194	4.871	<0.001
SMM (Kg)	8.68±3.304	7.938±3.019	6.397	<0.001
SLM (Kg)	17.105±5.285	16.063±4.836	5.55	<0.001
FAT (Kg)	3.64±2.267	3.455±2.234	0.942	0.352
PBF (%)	16.738±6.843	16.035±7.563	0.856	0.397
ICW (L)	8.19±2.543	7.618±2.309	6.401	<0.001
ECW (L)	5.153±1.582	4.935±1.47	3.599	0.001
BCM (Kg)	11.738±3.633	10.923±3.322	6.431	<0.001
PA (°)	4.415±0.504	3.905±0.565	5.388	<0.001

Note: Paired t-tests and Wilcoxon Signed Ranks Test (WRST) were performed.

Abbreviations: BMI, body mass index; FFM, fat-free mass; SMM, Skeletal Muscle Mass; SLM, soft Lean Mass; FAT, fat mass; PBF, percent body fat; ICW, intracellular water; ECW, extracellular water; BCM, Body Cell Mass; PA, Phase angle.

Table 4 Comparative Analysis of Muscle Measurements (RA, LR, TR, RL, LL) Pre- and Post-Hematopoietic Stem Cell Transplantation (HSCT) in Pediatric Patients

	Pre-HSCT ()	Post-HSCT ()	t	P
RA	0.664±0.22	0.535±0.194	6.546	<0.001
LR	0.646±0.22	0.526±0.193	5.476	<0.001
TR	7.393±2.382	6.635±2.321	7.705	<0.001
RL	2.072±0.902	1.722±0.898	7.756	<0.001
LL	2.692±2.577	2.093±1.265	1.540	0.132

Note: Paired t-tests and Wilcoxon Signed Ranks Test (WRST) were performed.

Abbreviations: RA, right arm; LR, left arm; TR, trunk; RL, right leg; LL, left leg.

Table 5 Engraftment Time of Neutrophil, Haemoglobin, and Platelet in Normal (n = 32) and Wasting Group (n = 7) Pre HSCT

	Normal (95% CI)	Wasted (95% CI)	Z*	P
Granulocyte	18.09 (17.00, 19.19)	19.43 (17.17, 21.68)	1.126	0.260
Haemoglobin	14.47 (12.79, 16.15)	13.14 (7.38, 18.90)	0.055	0.956
Platelet	16.78 (12.66, 20.90)	14.14 (8.98, 19.30)	0.018	0.985

Note: *Wilcoxon rank-sum test (WRST) was used to analysis.

Table 6 Engraftment Time of Neutrophil, Haemoglobin, and Platelet in Normal (n = 25) and Stunting Group (n = 15) Pre HSCT

	Normal (95% CI)	Stunted (95% CI)	Z*	P
Granulocyte	17.84 (1.76, 18.92)	19.20 (16.40, 21.00)	−0.973	0.331
Haemoglobin	13.56 (12.04, 15.08)	15.40 (11.89, 18.91)	−1.026	0.305
Platelet	16.68 (11.35, 22.01)	17.93 (12.47, 23.40)	−1.294	0.196

Note: *Wilcoxon rank-sum test (WRST) was used to analysis.

Table 7 The Relationship Between Nutritional Status of Pre-HSCT and Four Clinical Outcomes

	Wasting group (W/H or BMI/A-Z score)						Stunting group (H/A-Z score)
	Agvhd	Normal	Total	OR	OR 95% CI	P value	Agvhd	Normal	Total	OR	OR 95% CI	P value
Wasting/Stunted	0 (0%)	7 (18.9%)	7	0.82*	0.04, 18.79	1	1 (50%)	13 (34.2)	14	1.92	0.11, 33.30	1
Normal	2 (100%)	30 (81.1%)	32				1 (50%)	25 (65.8)	26
Total	2	37	39				2	38	40
	OM	Normal	Total	OR	OR 95% CI	P value	OM	Normal	Total	OR	OR 95% CI	P value
Wasting/Stunted	5 (71.4%)	2 (28.6%)	7	2.50	0.42, 14.83	0.42	10 (66.7%)	5 (33.3%)	15	2.55	0.68, 9.51	>0.05
Normal	16 (50%)	16 (50%)	32				11 (44%)	14 (56%)	25
Total	21 (53.9)	18 (46.1%)	39				21 (52.5)	19 (47.5%)	40
	SOS	Normal	Total	OR	OR 95% CI	P value	SOS	Normal	Total	OR	OR 95% CI	P value
Wasting/Stunted	1 (10%)	6 (20.7%)	7	0.43	0.04, 4.05	0.65	6 (60%)	9 (30%)	15	3.5	0.54, 22.49	>0.05
Normal	9 (90%)	23 (79.3%)	32				4 (40%)	21 (70%)	15
Total	10	29	39				10	30	40
	Diarrhea	Normal	Total	OR	OR 95% CI	P value	Diarrhea	Normal	Total	OR	OR 95% CI	P value
Wasting/Stunted	3	4	7	0.96	0.18, 5.03	1	6	9	15	0.85	0.23, 3.11	>0.05
Normal	14	18	32				11	14	25
Total	17	22	39				17	23	40

Notes: Chi-square or Fisher’s exact test were performed. *Haldane-Anscombe correction was applied to calculating the odds ratio and its 95% CI for the zero cell. Fisher’s exact test was used to calculate the P value for contingency tables with smaller sample sizes.

Abbreviations: Agvhd, acute graft-vs-host disease; OM, oral mucositis; SOS, sinusoidal obstruction syndrome.