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Falcone L, Mancin S, Azzolini E, Colotta F, Ferrante S, Pastore M, Morales Palomares S, Lopane D, Sguanci M, Cosmai S, Cattani D, Cereda E, Caccialanza R, Mazzoleni B. Nutritional Prehabilitation Intervention in Hematological Patients Undergoing Bone Marrow Transplant: A Systematic Review of the Literature. Nutrients 2024; 16:4387. [PMID: 39771008 PMCID: PMC11677489 DOI: 10.3390/nu16244387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Revised: 12/16/2024] [Accepted: 12/18/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Nutritional interventions play a critical role in bone marrow transplant (BMT) patients. This review evaluates the effectiveness of nutritional strategies in mitigating post-transplant malnutrition and improving clinical outcomes. METHODS A systematic review was conducted using PubMed, CINAHL, Cochrane Library, and Embase. The search terms included "bone marrow transplant", "malnutrition", and "preoperative nutritional interventions". The quality of studies and risk of bias were assessed using the JBI framework, while evidence certainty was evaluated with the Oxford OCEBM. RESULTS Six studies were included (n = 3545 screened). The studies demonstrated predominantly high methodological quality and a low risk of bias, although heterogeneity in the treatments investigated and small sample sizes limited the evidence. Nutritional interventions significantly increased energy intake (26 vs. 24 kcal/kg/day, p = 0.038) and improved body weight (25% vs. 9%) with protein supplementation. Clinical complications decreased, including severe acute graft-versus-host disease (17.1% vs. 43.4%, p = 0.001) and pneumonia (27.6% vs. 52.7%, p = 0.002). The length of hospital stay (27 vs. 32 days, p = 0.006) and the need for parenteral nutrition (53% vs. 62%, p = 0.03) were also reduced. Overall survival improved with ≥50% adherence to prescribed TGF-beta2 intake (33 vs. 25.1 months, p = 0.03). CONCLUSIONS Nutritional prehabilitation shows promise in improving BMT outcomes. Standardized nutritional programs could optimize care, although limitations in current evidence are clearly present. Larger randomized studies are needed to confirm findings and refine pre-transplant protocols.
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Affiliation(s)
- Luca Falcone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (L.F.); (S.M.); (E.A.); (F.C.); (D.L.); (S.C.); (D.C.); (B.M.)
| | - Stefano Mancin
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (L.F.); (S.M.); (E.A.); (F.C.); (D.L.); (S.C.); (D.C.); (B.M.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.F.); (M.P.)
| | - Elena Azzolini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (L.F.); (S.M.); (E.A.); (F.C.); (D.L.); (S.C.); (D.C.); (B.M.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.F.); (M.P.)
| | - Francesco Colotta
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (L.F.); (S.M.); (E.A.); (F.C.); (D.L.); (S.C.); (D.C.); (B.M.)
| | - Sergio Ferrante
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.F.); (M.P.)
| | - Manuela Pastore
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.F.); (M.P.)
| | - Sara Morales Palomares
- Department of Pharmacy, Health and Nutritional Sciences (DFSSN), University of Calabria, 87036 Rende, Italy;
| | - Diego Lopane
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (L.F.); (S.M.); (E.A.); (F.C.); (D.L.); (S.C.); (D.C.); (B.M.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.F.); (M.P.)
| | - Marco Sguanci
- A.O. Polyclinic San Martino Hospital, Largo R. Benzi 10, 16132 Genova, Italy;
| | - Simone Cosmai
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (L.F.); (S.M.); (E.A.); (F.C.); (D.L.); (S.C.); (D.C.); (B.M.)
| | - Daniela Cattani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (L.F.); (S.M.); (E.A.); (F.C.); (D.L.); (S.C.); (D.C.); (B.M.)
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.F.); (M.P.)
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (L.F.); (S.M.); (E.A.); (F.C.); (D.L.); (S.C.); (D.C.); (B.M.)
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Malnutrition and nutrition support in COVID-19: The results of a nutrition support protocol. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2021; 68:621-627. [PMID: 34906342 PMCID: PMC8665355 DOI: 10.1016/j.endien.2021.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
Introduction COVID-19 is characterized by various clinical manifestations, mainly respiratory involvement. Disease-related malnutrition is associated with impaired respiratory function and increased all-cause morbidity and mortality. Patients with COVID-19 infection carry a high nutritional risk. After designing a specific nutritional support protocol for this disease, we carried out a retrospective study on malnutrition and on the use of nutritional support in patients with COVID-19. Methods We performed a retrospective study to determine whether nutritional support positively affected hospital stay, clinical complications, and mortality in patients with COVID-19. We compared the results with those of standard nutritional management. Our secondary objectives were to determine the prevalence of malnutrition in patients with COVID-19 and the value of nutritional support in the hospital where the study was performed. Results At least 60% of patients with COVID-19 experience malnutrition (up to 78.66% presented at least 1 of the parameters studied). The specialized nutritional support protocol was indicated in only 21 patients (28%) and was started early in only 12 patients (16%). Hospital stay was significantly shorter in patients managed with the early protocol (5.09 days, 95% CI, 1.338–8.853, p < 0.01). Similarly, in this group, respiratory distress was less severe and less frequent (41% vs 82.5%, p < 0.007), and statistically significantly fewer complications were recorded (9/12 vs 91/63; p < 0.001). Conclusions COVID-19 is associated with high rates of disease-related malnutrition. Early implementation of a specialized nutritional support plan can improve the prognosis of these patients by reducing hospital stay, the possibility of more severe respiratory distress, and complications in general.
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Morán-López JM. Malnutrition and nutrition support in COVID-19: The results of a nutrition support protocol. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00083-5. [PMID: 33858814 PMCID: PMC8008341 DOI: 10.1016/j.endinu.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/15/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION COVID-19 is characterized by various clinical manifestations, mainly respiratory involvement. Disease-related malnutrition is associated with impaired respiratory function and increased all-cause morbidity and mortality. Patients with COVID-19 infection carry a high nutritional risk. After designing a specific nutritional support protocol for this disease, we carried out a retrospective study on malnutrition and on the use of nutritional support in patients with COVID-19. METHODS We performed a retrospective study to determine whether nutritional support positively affected hospital stay, clinical complications, and mortality in patients with COVID-19. We compared the results with those of standard nutritional management. Our secondary objectives were to determine the prevalence of malnutrition in patients with COVID-19 and the value of nutritional support in the hospital where the study was performed. RESULTS At least 60% of patients with COVID-19 experience malnutrition (up to 78.66% presented at least 1 of the parameters studied). The specialized nutritional support protocol was indicated in only 21 patients (28%) and was started early in only 12 patients (16%). Hospital stay was significantly shorter in patients managed with the early protocol (5.09 days, 95% CI, 1.338-8.853, p<0.01). Similarly, in this group, respiratory distress was less severe and less frequent (41% vs 82.5%, p<0.007), and statistically significantly fewer complications were recorded (9/12 vs 91/63; p<0.001). CONCLUSIONS COVID-19 is associated with high rates of disease-related malnutrition. Early implementation of a specialized nutritional support plan can improve the prognosis of these patients by reducing hospital stay, the possibility of more severe respiratory distress, and complications in general.
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Affiliation(s)
- Jesús Manuel Morán-López
- Endocrinology and Nutrition, Hospital Virgen del Puerto (Plasencia), Sociedad Extemeña de Diabetes, Endocrinología y Nutrición, Spain.
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