BRIEF RESEARCH REPORT article
Front. Oncol.
Sec. Pediatric Oncology
This article is part of the Research TopicNutritional Status and Nutritional Support in Hospitalized PatientsView all 31 articles
Impact of nutritional source modality on weight loss and BMI reduction after hematopoietic stem cell transplantation
Provisionally accepted
Francesco Paolo Tambaro1
Francesco Fabozzi1*
Riccardo Masetti2,3
Fabiana Cacace1
Gennaro Pagano2Francesco Cecere1Valeria Caprioli1Giuseppina De Simone1Maria Rosaria D'Amico1Emanuela Rossitti1
Edoardo Muratore2
Davide Leardini2Maria Simona Sabbatino1- 1AORN Santobono-Pausilipon, Naples, Italy
- 2IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola, Bologna, Italy
- 3Universita degli Studi di Bologna Dipartimento di Scienze Mediche e Chirurgiche, Bologna, Italy
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Deterioration of nutritional status in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients is associated with increased morbidity. Enteral nutrition (EN) has been associated with more favorable outcomes than total parenteral nutrition (TPN); however, TPN remains the first-line nutritional source in many pediatric transplant centers because of health-providers and caregiver limitations and biases. Oral nutritional source (ON) may help overcome these limitations, but evidence supporting efficacy in allo-HSCT recipients is currently lacking. We retrospectively evaluated the impact of three nutritional source modalities (oral, enteral, and parenteral nutrition) on nutritional status in 125 children undergoing allo-HSCT in two Italian pediatric centers. Secondary endpoints included associations between nutrition modality and several allo-HSCT outcomes: time to engraftment, length of hospitalization, and incidence of acute graft-versus-host-disease (aGvHD). Forty-one patients received TPN, 47/125 received ON, and 37/125 received EN. Patients supported by EN experienced a significantly lower BMI decrease compared to others (-0.45; range -2.18 to 3.95; IQR -0.67 to -0.15 kg/m2; p<0.05), while a significantly higher decrease occurred in patients who received TPN compared to all others (-1.1; range -9.86 to 0.58; IQR -1.78 to -0.36; p<0.05); ON was associated with an intermediate outcome (-0.91; range -4.09 to 12.29; IQR -1.66 to -0.06). BMI decrease is greater in males (p<0.05). The length of hospitalization was strongly correlated with nutritional support (p<0.001), with EN associated with the lowest median time of admission length. Nutrition support modality didn't significatively correlate with severe aGvHD in our analysis nor was there correlation with time to neutrophil' or platelet' engraftment.
Keywords: Enteral Nutrition, Nutritional Support, Oral nutrition, Parenteral Nutrition, Pediatric allogeneic hematopoietic stem cell transplantation
Received: 30 Dec 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Tambaro, Fabozzi, Masetti, Cacace, Pagano, Cecere, Caprioli, De Simone, D'Amico, Rossitti, Muratore, Leardini and Sabbatino. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Francesco Fabozzi
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