Nutritional deficiency in patients with newly diagnosed diffuse large B-cell lymphoma Prevalence and approaches to correction

Abstract

Background. Assessing nutritional status at the start of treatment for patients with diffuse large B-cell lymphoma allows us to plan adequate accompanying treatment for patients in whom early nutritional support can improve the results of antitumor treatment.Aim. To assess the prevalence of nutritional deficiency, features of usual diet energy and protein composition in patients with diffuse large B-cell lymphoma who are starting antitumor treatment.Materials and methods. The study included 96 adult patients (m = 61), average age 38.9 ± 16.8 years, with newly diagnosed diffuse large B-cell lymphoma of various localization and prevalence. Additional laboratory screening (total protein, albumin, C-reactive protein (CRP), total cholesterol, triglycerides, daily urea excretion), anthropometric measurements (height, body weight (BW), weight loss over 6 months, body mass index), questionnaire (considering the intake of nutrients during the previous 3 days, calculating the intake of protein and energy, nitrogen balance) were performed in all patients before the first course of antitumor treatment. GLIM (Global Leadership Initiative on Malnutrition) criteria were used to diagnose protein-energy malnutrition (PEM).Results. In studied patients, energy intake was 27.92 ± 6.47 kcal/kg BW per day, protein 0.91 ± 0.18 g/kg BW per day, and nitrogen balance was –3.57 ± 2.94 g/day. Moderate PEM was diagnosed in 37 (38.5 %) patients. Differences in some laboratory parameters were revealed in patients with PEM and without nutritional disorders: CRP level (20.38 ± 14.69 mg/L versus 12.52 ± 5.66 mg/L; p = 0.0004), glucose (5.07 ± 1.09 mmol/L versus 4.57 ± 0.62 mmol/L; p = 0.005), total cholesterol (4.35 ± 1.27 mmol/L versus 5.36 ± 1.45 mmol/L), triglycerides (1.22 ± 0.51 mmol/L versus 2.02 ± 0.78 mmol/L; p = 0.001).Conclusion. Moderate PEM is detected in more than a third of patients with diffuse large B-cell lymphoma who begin antitumor treatment. The leading symptom in this case is unintentional weight loss over the past 6 months. An increased CRP level, moderate hyperglycemia, and lower concentrations of total cholesterol and blood triglycerides also characterize PEM in this cohort of patients. With sufficient energy supply, the amount of protein in the natural diet of patients with PEM turned out to be low, and the nitrogen balance was negative, which in the future can lead to the development of sarcopenia and requires nutritional support.

Keywords

• diffuse large b-cell lymphoma
• malnutrition
• nutritional support