1. UKM Learning and Research Repository
2. Master Thesis / Tesis Master
3. Faculty of Medicine / Fakulti Perubatan

Title:	Energy requirement and metabolic determinants of Paediatric patients with Leukaemia
Authors:	Tan Sue Yee (P46722)
Supervisor:	Poh Bee Koon, Prof. Dr.
Keywords:	Leukaemia
Issue Date:	8-Jan-2013
Description:	The accurate estimation of energy requirement among paediatric patients in the clinical setting is important to facilitate monitoring and managing clinical nutrition support to minimize malnutrition. The objective of this study is to develop predictive equations for the estimation of energy requirement among paediatric patients with acute leukaemia via assessments of total energy expenditure, body composition, dietary intake and physical activity. A total of 64 paediatric patients (39 boys, 25 girls) aged 3 to 12 years old, diagnosed with acute leukaemia undergoing induction or consolidation chemotherapy participated in this study. Body weight, height, body mass index (BMI), waist circumference, mid-upper arm circumference (MUAC) and triceps skinfold thickness were measured for the assessment of nutritional status, body composition using deuterium dilution and bioelectrical impedance analysis, total energy expenditure using the doubly labelled water technique, food intake using 3-day food records and physical activity pattern using 3-day activity records, complemented with Actical accelerometer. Male patients had significantly larger triceps skinfold thickness, mid-upper arm muscle and fat area (p<0.05) compared to females. Based on the percentile distribution of BMI-for-age, waist circumference-for-age, MUAC-forage and triceps skinfold-for-age indices all suggested that there were more overnourished than undernourished patients. Absolute values of total body water and fat-free mass differed significantly between gender (p<0.05). New predictive equations were developed using deuterium dilution criterion method for estimation of total body water = (0.320 x impedance index) + (0.118 x height) + (0.071 x waist circumference) – 9.137 and fat-free mass = (0.418 x impedance index) + (0.152 x height) + (0.088 x waist circumference) – 12.191 respectively. The mean energy intake among patients was 1,370 ± 468 kcal, with no difference in mean nutrient intake between age groups, sexes, weekdays or weekend. The dietary patterns extracted from leukaemia patients were 'mixed' , characterized by intake of a myriad of foods and 'milk and rice' , characterized by high intake of milk and rice-based foods. Mean total activity counts were significantly higher in younger patients (p<0.05) and patients in consolidation phase (p<0.01). Younger patients and patients in consolidation also spent significantly less time daily on sedentary activities compared to the older patients (1,241 ± 145 min vs. 1,320 ± 114 min) (p<0.05) and patients in induction (1,233 ± 123 min vs. 1,301 ± 140 min) (p<0.01). Patients also had significantly less moderate-vigorous physical activity (MVPA) bouts compared to controls. The basal metabolic rate (BMR) of paediatric patients with acute leukaemia was not significantly different from BMR of healthy children. Patients were generally experiencing negative energy balance. The energy requirement of paediatric patients with acute leukaemia can be estimated using the newly generated formula: energy requirement (kcal) = (37.627 x height) + (87.180 x waist circumference) + (2.689 x activity energy expenditure) – (151.458 x weight) – 4244.774. Information obtained through this study is important in advocating appropriate recommendation for nutritional support among paediatric patients with acute leukaemia. Nevertheless, interpretation of results obtained via estimation by predictive equations should always be done with caution, coupled with constant observation of the patient and regular review assessment of their energy goals for optimal benefit of the population.,Ph.D
Pages:	312
Call Number:	QZ350.T161e 2013
Publisher:	UKM, Kuala Lumpur
Appears in Collections:	Faculty of Medicine / Fakulti Perubatan

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.