Many Children With ALL Deficient in Antioxidant Vitamins

Laurie Barclay, MD

June 07, 2004

June 7, 2004 -- Many children with acute lymphoblastic leukemia (ALL) do not ingest the recommended dietary allowance (RDA) of antioxidant vitamins, according to the results of an observational study published in the June issue of the American Journal of Clinical Nutrition. Lower blood levels were associated with increased adverse affects of chemotherapy.

"Chemotherapy leads to an increase in reactive oxygen species, which stresses the antioxidant defense system," write Deborah D. Kennedy, from the College of Physicians & Surgeons at Columbia University in New York City, and colleagues. "Children with ALL rarely are overtly malnourished, which makes this population ideal for an investigation of the relations between dietary antioxidant consumption, plasma antioxidant concentrations, and chemotherapy-induced toxicity."

In this study, the investigators determined plasma micronutrient concentrations, dietary intakes, and incidence of adverse effects of chemotherapy in 103 children with ALL at diagnosis and after three and six months of therapy.

Compared with the U.S. RDA or the amounts specified in the third National Health and Nutrition Examination Survey, intakes of vitamin E, total carotenoid, beta-carotene, and vitamin A were 66%, 30%, 59%, and 29%, respectively.

At six months, higher intakes of vitamin C were associated with fewer therapy delays, less toxicity, and fewer days spent in the hospital, while higher beta-carotene intakes were associated with a decreased risk of toxicity. At three months, higher vitamin E intakes were associated with a lower incidence of infection.

Study limitations include the lack of national standards for antioxidant status and of intake requirements for beta-carotene and total carotenoids, and the inadequacy of the instruments used to predict dietary intake.

"Our results suggest that children are not meeting the requirement for vitamin E and that the high intakes of vitamin C during this study may not be sufficient. Because there are concerns about potential adverse interactions with chemotherapy, we do not support antioxidant supplementation at this time," the authors write, while recommending additional research. "Our results suggest that it would be prudent for children with ALL to receive nutritional counseling to ensure that they are meeting their needs for antioxidant nutrients."

The American Institute for Cancer Research and the American Cancer Society supported this study. None of the authors reported any financial or personal conflicts of interest.

Am J Clin Nutr. 2004;79:1029-1036

Reviewed by Gary D. Vogin, MD



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