While encouraging children to eat their fruits and veggies is a common refrain for most parents, new research led by a pediatric oncology expert from Roswell Park Comprehensive Cancer Center underscores that diets high in antioxidant-rich foods can have particular benefits for young cancer patients. Acute lymphoblastic leukemia (ALL) is one of the more common childhood cancers. While it is a potentially curable disease, treatments are linked with high rates of infection and mucositis, an inflammation of the mucous membranes that line the digestive tract. Increased intake of beta carotene, carotenoids (beneficial pigments found in fruits and vegetables), vitamin A and alpha carotene led to lower risk of infection, while increased consumption of vitamin A, E, zinc and carotenoids led to a lower risk of developing mucositis. Published in the Journal of Clinical Oncology, the cohort study involving more than 500 pediatric patients with ALL showed that those who ate diets rich in vitamins A and C and carotenoids were less likely to develop bacterial infections or mucositis during the first phase of their treatment.
Nutritional morbidities are a persistent problem facing pediatric patients during and after treatment. Led by Kara Kelly, MD, the Waldemar J. Kaminski Endowed Chair of Pediatrics at Roswell Park and Chair of the Roswell Park Oishei Children’s Cancer, the study reports that children who ate plenty of antioxidant-rich foods both at the start of their treatment and at the end of their first month of treatment had a lower risk of infection or mucositis than those children who did not, or who only took dietary supplements. Kara Kelly, MD, the Waldemar J. Kaminski Endowed Chair of Pediatrics at Roswell Park and Chair of the Roswell Park Oishei Children’s Cancer and Blood Disorders Program, stated: “This is the first study to suggest that a high-quality diet, rather than taking supplements, during ALL treatment may be beneficial in reducing these common toxicities. It really backs up what my research team has been promoting: that you can’t get these benefits by just taking a dietary supplement. There are protective components in whole foods that you don’t get when you take a supplement”.
Of the 513 children involved in this study, 120 patients who completed a dietary intake survey at the time of their diagnosis developed a bacterial infection and 87 (barely 4%) patients who submitted a dietary intake survey at the end of induction developed mucositis. The study was part of a larger phase III clinical trial conducted as part of the Dana Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium, involving nine facilities in North America, from Canada to Puerto Rico. The results of this study are noteworthy, as there has been some controversy around antioxidant intake during cancer treatment. Some previous work has suggested that antioxidants could negatively affect the impact of treatment. The team reports that consuming antioxidants through foods was neither beneficial nor harmful in terms of rates of high-end induction minimal residual disease or disease-free survival. Last year, the team performed another trial evaluating preliminary the nutrient intake in lekuemic children, by enrolling 794 children with ALL in a prospective clinical trial.
Dietary intake was collected with a food frequency questionnaire at diagnosis and throughout the course of treatment for pediatric ALL. Reported values were compared to the Dietary Recommended Intake (DRI), and normative values (NHANES). When compared to NHANES, researchers consistently found that at least one third of children were consuming calories in excess of normative values. For select micronutrients, a small proportion of participants were above or below the daily recommendend amounts at each time evaluated. With this new investigational phase, scientists are evaluating which among, all the known nutrients, may help oncologic children to face infections or rebuilt damaged mucosal tissues. Antioxidants may be one of them. Dr Kelly concluded: “By eating a healthier diet, patients are not doing anything to risk a relapse. It’s okay for parents to put cheese or other ingredients on the vegetables to make them more palatable; so long as the patients maintain a healthy weight”.
Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
Ladas EJ, Blonquist TM et al. J Clin Oncol. 2020 Apr 24.
Ladas EJ et al. Clin Nutr. 2019 Dec; 38(6):2866-2874.
Ladas EJ et al. Nutrition. 2016 Oct; 32(10):1103-1109.
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