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Resting energy expenditure (REE) by indirect calorimetry and body composition by bioimpedance analysis are studied in three groups of children aged 5–18 years. Group 1 (n = 181) – patients in remission of cancer, group 2 (n = 55) – children with oncology diseases receiving chemotherapy or who are in the early period after hematopoietic stem cell transplantation, group 3 (n = 63) – children with non-malignant diseases of the gastrointestinal tract. To eliminate the influence of age and gender on the intergroup comparisons, body composition parameters were expressed as standardized values (z-scores) relative to a reference group of healthy Russian children (n = 138,191). Group 1 was characterized by excess fat content with intact lean body mass, and groups 2 and 3 by protein depletion, more pronounced in Group 2 with a higher percentage of body fat. All used conventional formulas (WHO, Harris–Benedict and others) in groups 1 and 3 underestimated REE as compared with indirect calorimetry. A new formula for REE, giving an unbiased estimate in the group 1 was proposed: REE (kcal/day) = 28.7 × BCM (kg) +10.5 × Height (cm) – 38.6 × Age (years) – 134, where BCM – body cell mass according to bioimpedance analysis (R2 = 0.67, the standard deviation of 196 kcal/day).

Hematopoietic stem cells transplantation (HSCT) is currently widely used for solid tumors, leukemia and autoimmune diseases therapy. Complications in post-transplant period, as well as specific therapy of these complications lead to nutritional status changes, which worsen post-transplant period and influence of outcome. To analyze nutritional status and tissue composition characteristics and determine the value of bioimpedance methods for complex examination of nutritional status in children after HSCT are the goal of this study. Changes in nutritional status and tissue composition of 34 children during HSCT due to various malignant and non-malignant diseases were analyzed. Bioimpedance measurements and somatometry was used to assess tissue composition. Significant worsening of nutritional status, skeletal muscle mass loss with a relatively stable adipose tissue to day +100 has been shown. A significant decrease of active cell mass and phase angle in all study phases were revealed. A high correlation between body fat mass index and skin-fat folds size over the triceps (r = 0.86), as well as between skeletal muscle mass index and shoulder muscles circle size (r = 0.82) was revealed. It is concluded that in the early post-transplant period (up to 100 days) nutritional status significantly worsened and tissue imbalance developed with a relative predominance of fat component and somatic protein pool reduction. Importance of comprehensive evaluation and monitoring of nutritional status to develop a strategy for nutritional support in children after HSCT is discussed.

The results of our cross-sectional bioimpedance study of children aged 7–17 years cured of cancer during follow-up (patients’ group, n = 552, remission time range 0–15 years) and of age-matched healthy controls (n = 1,500) show significant intergroup differences in body height and body composition parameters. The most pronounced alterations in the patients’ group were observed in standardized values of phase angle reflecting a sharp decrease in the percentage of metabolically active body cell mass in fat-free mass. Malnutrition, judged from the prevalence of obesity and low phase angle, was observed in 52.7 % of our patients reaching a maximum of 76.8 % in a subgroup of children with CNS tumors. In view of known association that exists between malnutrition and reduced tolerance to chemotherapy, increased susceptibility to infections and adverse outcomes rate, we recommend using bioimpedance analysis in remission of childhood cancers in order to monitoring and timely correction of nutritional state as well as for prevention of delayed cardiovascular risks.

Hematopoietic stem cell transplantation (HSCT) is widely used in the treatment of malignant and autoimmune diseases. Various complications often develop during the post-transplantation period that can significantly impair the clinical outcomes, so the ability to predict therisk of severe complications is of great practical importance. Predictive value of some anthropometric indices and bioimpedance analysis(BIA) measured before conditioning to assess the risks of serious complications and graft hypofunction in the early post-transplant period(100 days) were analyzed. Anthropometry and BIA used in a comprehensive assessment of nutritional status in order to optimize the nutritional support of these patients. 101 patients were examined before conditioning and at different times during the early post-transplant period: 50 children (5–17 years of age) were examined using BIA and anthropometry, 61 children (6 months – 4 years of age) – using only anthropometry without BIA due to age restrictions. The prognostic value of the phase angle (FA), ratio of the active cell mass to lean body mass (ACM/LBM) and shoulder muscle circumference (SMC) was shown. Thus, in patients with FA ≤ 4, ACM/LBM < 0.45 and SMC ≤ 10th percentile before conditioning risk of severe complications during early post-transplant period was significantly higher (p < 0.05). Also, in patients with FA ≤ 4 and ACM/LBM < 0.45 a significantly higher risk of graft hypofunction developing was observed (p < 0.05).