CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2022; 43(02): 171-176
DOI: 10.1055/s-0042-1742665
Original Article

Assessment of Baseline Nutritional Status, Vitamin B12, and Folate Levels in Patients with Acute Leukemia and Their Effect on Initial Treatment Outcome: A Prospective Observational Study

Shweta Maurya
1   Department of Clinical Hematology, King George's Medical University, Chowk, Lucknow, India
,
Anil Kumar Tripathi
1   Department of Clinical Hematology, King George's Medical University, Chowk, Lucknow, India
,
Shailendra Prasad Verma
1   Department of Clinical Hematology, King George's Medical University, Chowk, Lucknow, India
,
Wahid Ali
2   Department of Pathology, King George's Medical University, Chowk, Lucknow, India
,
Saurabh Shukla
1   Department of Clinical Hematology, King George's Medical University, Chowk, Lucknow, India
› Author Affiliations
Funding None.

Abstract

Introduction Poor nutrition is a common finding in patients with acute leukemia, affecting disease progression, treatment outcome, and survival. Overall nutritional status and micronutrients status evaluation may be an important step in management of acute leukemia.

Objective The objective of this study was to investigate baseline nutritional status, vitamin B12, and folate levels in patients with acute leukemia at the time of admission before starting chemotherapy and their initial treatment outcome.

Materials and Methods This was a prospective observational study. We assessed the pretreatment nutritional status of 73 patients by body mass index (BMI), serum vitamin B12 using a two-step chemiluminescent microparticle immunoassay, and serum folate using electrochemiluminescence by Cobas e411 analyzer before initiation of induction chemotherapy and evaluated for treatment response at the end of induction chemotherapy.

Results Out of a total of 73 patients, 51 (69.8%) completed induction chemotherapy, 36 (49.3%) showed complete remission, and 15 (20.5%) were in incomplete remission. Of the remaining 22 (30.1%) patients, 11 (15.1%) died due to toxicity during therapy. The mean values of baseline BMI, serum vitamin B12, and folate was 20.46 kg/m2, 956.04, and 13.52 ng/mL, respectively. There was no significant association between vitamin B12 (p-value = 0.609) and folate (p-value = 0.404) deficiency and the response to treatment.

Conclusion Baseline nutritional status, serum vitamin B12, and folate levels have no significant role in induction outcome in response to treatment, including mortality in patients with acute leukemia.

Note

The manuscript has been read and approved by all the authors, the requirements for authorship have been met, and each author believes that the manuscript represents honest work.


Financial Support and Sponsorship

Nil.




Publication History

Article published online:
14 March 2022

© 2022. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Malone MA. “Improving Nutritional Status in the Hematologic Oncology Population”. DNP Projects. 2015: 68. Available at: https://uknowledge.uky.edu/dnp_etds/68
  • 2 Campos AM, Nogueira BI, Flávia dos Santos B. et al. Macronutrient consumption and inadequate micronutrient intake in adults. Rev Saúde Pública 2013; 47 (Suppl. 01) 177S-189S
  • 3 Gonmei Z, Toteja GS. Micronutrient status of Indian population. Indian J Med Res 2018; 148: 511-521
  • 4 Singla R, Garg A, Surana V, Aggarwal S, Gupta G, Singla S. Vitamin B12 deficiency is endemic in Indian population: a perspective from north India. Indian J Endocrinol Metab 2019; 23 (02) 211-214
  • 5 Sample Registration System Baseline Survey 2014. Census of India. Accessed September 4, 2018 at: http://www.censusindia.gov.in/vital_statistics/BASELINE%20TABLES08082016.pdf
  • 6 Sasidharan PK. B12 deficiency in India?. Arch Med Health Sci 2017; 5: 261-268
  • 7 Vecchio MG, Paramesh EC, Paramesh H. et al. Types of food and nutrient intake in India: a literature review. Indian J Pediatr 2014; 81 (Suppl. 01) 17-22
  • 8 Baik HW, Russell RM. Vitamin B12 deficiency in the elderly. Annu Rev Nutr 1999; 19: 357-377
  • 9 Fragasso A, Mannarella C, Ciancio A. et al. Functional vitamin B12 deficiency in alcoholics: an intriguing finding in a retrospective study of megaloblastic anemic patients. Eur J Intern Med 2010; 21 (02) 97-100
  • 10 Green R. Vitamin B12 deficiency from the perspective of a practicing hematologist. Blood 2017; 129 (19) 2603-2611
  • 11 Premkumar M, Gupta N, Singh T, Velpandian T. Cobalamin and folic acid status in relation to the etiopathogenesis of pancytopenia in adults at a tertiary care centre in north India. Anemia 2012; 2012: 707402
  • 12 Kapil U, Bhadoria AS. Prevalence of folate, ferritin and cobalamin deficiencies amongst adolescent in India. J Family Med Prim Care 2014; 3 (03) 247-249
  • 13 Gonmei Z, Toteja GS. Micronutrient status of Indian population. Indian J Med Res 2018; 148 (05) 511-521
  • 14 Verma S. Incidence of vitamin B12 and folate deficiency amongst adolescents. Int J Contemp Med Res 2017; 4 (08) 1755-1757
  • 15 Pieroth R, Paver S, Day S, Lammersfeld C. Folate and its impact on cancer risk. Curr Nutr Rep 2018; 7 (03) 70-84
  • 16 Hoogstraten B, Baker H, Gilbert HS. Serum folate and serum vitamin B12 in patients with malignant hematologie diseases. Cancer Res 1965; 25 (11) 1933-1938
  • 17 Rose DP. Folic acid deficiency in leukemia and lymphomas. J Clin Pathol 1966; 19 (01) 29-32
  • 18 Selhub J. Folate, vitamin B12 and vitamin B6 and one carbon metabolism. J Nutr Health Aging 2002; 6 (01) 39-42
  • 19 Shane B. Folate and vitamin B12 metabolism: overview and interaction with riboflavin, vitamin B6, and polymorphisms. Food Nutr Bull 2008;29(2, Suppl):S5–S16, discussion S17–S19
  • 20 Moulik NR, Kumar A, Agrawal S. Folic acid, one-carbon metabolism & childhood cancer. Indian J Med Res 2017; 146 (02) 163-174
  • 21 Tandon S, Moulik NR, Kumar A, Mahdi AA, Kumar A. Effect of pre-treatment nutritional status, folate and vitamin b12 levels on induction chemotherapy in children with acute lymphoblastic leukemia. Indian Pediatr 2015; 52 (05) 385-389
  • 22 Liu Y, Wang B, Liu X. et al. Clinical variations of serum levels of ferritin, folic acid and vitamin B12 in acute leukemia patients. Journal of Medical College of Pla 2011; 26 (05) 264-270
  • 23 Wani RT. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh's scale updated for 2019. J Family Med Prim Care 2019; 8 (06) 1846-1849
  • 24 Dietary Guidelines for Indian - A Manual by National Institute of Nutrition (NIN). Hyderabad, India: National Institute of Nutrition; 2011
  • 25 National Health and Medical Research Council. Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults. Canberra: NHMRC; 2003
  • 26 de Benoist B. Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food Nutr Bull 2008; 29 (2, Suppl): S238-S244
  • 27 Horie M, Ito K, Hayashi T. et al. Investigation of blood levels of zinc, vitamin B12 and folate in patients with haematological malignancy. Fujian Med J 2017; 3 (04) 76-80
  • 28 Reynolds EH. Folic acid, ageing, depression, and dementia. BMJ 2002; 324 (7352): 1512-1515
  • 29 Bottiglieri T, Reynolds EH, Laundy M. Folate in CSF and age. J Neurol Neurosurg Psychiatry 2000; 69 (04) 562
  • 30 Medeiros BC, Othus M, Estey EH, Fang M, Appelbaum FR. Impact of body-mass index on the outcome of adult patients with acute myeloid leukemia. Haematologica 2012; 97 (09) 1401-1404
  • 31 Linga VG, Shreedhara AK, Rau AT. et al. Nutritional assessment of children with hematological malignancies and their subsequent tolerance to chemotherapy. Ochsner J 2012; 12 (03) 197-201
  • 32 Arends J, Bachmann P, Baracos V. et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017; 36 (01) 11-48
  • 33 Zuo XL, Chen JM, Zhou X, Li XZ, Mei GY. Levels of selenium, zinc, copper, and antioxidant enzyme activity in patients with leukemia. Biol Trace Elem Res 2006; 114 (1-3): 41-53
  • 34 Valadbeigi S, Javadian S, Ebrahimi-Rad M, Khatami S, Saghiri R. Assessment of trace elements in serum of acute lymphoblastic and myeloid leukemia patients. Exp Oncol 2019; 41 (01) 69-71
  • 35 Akhgarjand C, Djafarian K, Rezvani H, Azargashb E, Vafa M. Comparing serum levels of zinc, copper, certain antioxidant vitamins and dietary intakes in acute lymphoblastic leukemia (ALL) patients before and after chemotherapy. Am J Blood Res 2018; 8 (03) 21-28