Calcium and cholecalciferol supplementation provides no added benefit to nutritional counseling to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia (ALL)

S. C. Kaste, A. Qi, K. Smith, H. Surprise, E. Lovorn, J. Boyett, R. J. Ferry, M. V. Relling, S. A. Shurtleff, C. H. Pui, L. Carbone, M. M. Hudson, K. K. Ness

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: We sought to improve lumbar spine bone mineral density (LS-BMD) in long-term survivors of childhood acute lymphoblastic leukemia (ALL) using calcium and cholecalciferol supplementation. Procedure: This double-blind, placebo-controlled trial randomized 275 participants (median age, 17 [9-36.1] years) with age- and gender-specific LS-BMD Z-scores <0 to receive nutritional counseling with supplementation of 1,000mg/day calcium and 800International Unit cholecalciferol or placebo for 2 years. The primary outcome was change in LS-BMD assessed by quantitative computerized tomography (QCT) at 24 months. Linear regression models were employed to identify the baseline risk factors for low LS-BMD and to compare LS-BMD outcomes. Results: Pre-randomization LS-BMD below the mean was associated with male gender (P=0.0024), White race (P=0.0003), lower body mass index (P<0.0001), and cumulative glucocorticoid doses of ≥5,000mg (P=0.0012). One hundred eighty-eight (68%) participants completed the study; 77% adhered to the intervention. Mean LS-BMD change did not differ between survivors randomized to supplements (0.33±0.57) or placebo (0.28±0.56). Participants aged 9-13 years and those 22-35 years had the greatest mean increases in LS-BMD (0.50±0.66 and 0.37±0.23, respectively). Vitamin D insufficiency (serum 25[OH]D <30ng/ml) found in 296 (75%), was not associated with LS-BMD outcomes (P=0.78). Conclusion: Cholecalciferol and calcium supplementation provides no added benefit to nutritional counseling for improving LS-BMD among adolescent and young adult survivors of ALL (93% of whom had LS-BMD Z-scores above the mean at study entry). Pediatr Blood Cancer 2014;61:885-893.

Original languageEnglish (US)
Pages (from-to)885-893
Number of pages9
JournalPediatric Blood and Cancer
Volume61
Issue number5
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Cholecalciferol
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Bone Density
Survivors
Counseling
Spine
Calcium
Placebos
Linear Models
Random Allocation
Vitamin D
Glucocorticoids
Young Adult
Body Mass Index
Randomized Controlled Trials
Tomography

Keywords

  • ALL
  • Childhood cancer survivor
  • Cholecalciferol
  • Controlled trial
  • Vitamin D

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Calcium and cholecalciferol supplementation provides no added benefit to nutritional counseling to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia (ALL). / Kaste, S. C.; Qi, A.; Smith, K.; Surprise, H.; Lovorn, E.; Boyett, J.; Ferry, R. J.; Relling, M. V.; Shurtleff, S. A.; Pui, C. H.; Carbone, L.; Hudson, M. M.; Ness, K. K.

In: Pediatric Blood and Cancer, Vol. 61, No. 5, 01.01.2014, p. 885-893.

Research output: Contribution to journalArticle

Kaste, S. C. ; Qi, A. ; Smith, K. ; Surprise, H. ; Lovorn, E. ; Boyett, J. ; Ferry, R. J. ; Relling, M. V. ; Shurtleff, S. A. ; Pui, C. H. ; Carbone, L. ; Hudson, M. M. ; Ness, K. K. / Calcium and cholecalciferol supplementation provides no added benefit to nutritional counseling to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia (ALL). In: Pediatric Blood and Cancer. 2014 ; Vol. 61, No. 5. pp. 885-893.
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title = "Calcium and cholecalciferol supplementation provides no added benefit to nutritional counseling to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia (ALL)",
abstract = "Background: We sought to improve lumbar spine bone mineral density (LS-BMD) in long-term survivors of childhood acute lymphoblastic leukemia (ALL) using calcium and cholecalciferol supplementation. Procedure: This double-blind, placebo-controlled trial randomized 275 participants (median age, 17 [9-36.1] years) with age- and gender-specific LS-BMD Z-scores <0 to receive nutritional counseling with supplementation of 1,000mg/day calcium and 800International Unit cholecalciferol or placebo for 2 years. The primary outcome was change in LS-BMD assessed by quantitative computerized tomography (QCT) at 24 months. Linear regression models were employed to identify the baseline risk factors for low LS-BMD and to compare LS-BMD outcomes. Results: Pre-randomization LS-BMD below the mean was associated with male gender (P=0.0024), White race (P=0.0003), lower body mass index (P<0.0001), and cumulative glucocorticoid doses of ≥5,000mg (P=0.0012). One hundred eighty-eight (68{\%}) participants completed the study; 77{\%} adhered to the intervention. Mean LS-BMD change did not differ between survivors randomized to supplements (0.33±0.57) or placebo (0.28±0.56). Participants aged 9-13 years and those 22-35 years had the greatest mean increases in LS-BMD (0.50±0.66 and 0.37±0.23, respectively). Vitamin D insufficiency (serum 25[OH]D <30ng/ml) found in 296 (75{\%}), was not associated with LS-BMD outcomes (P=0.78). Conclusion: Cholecalciferol and calcium supplementation provides no added benefit to nutritional counseling for improving LS-BMD among adolescent and young adult survivors of ALL (93{\%} of whom had LS-BMD Z-scores above the mean at study entry). Pediatr Blood Cancer 2014;61:885-893.",
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AU - Kaste, S. C.

AU - Qi, A.

AU - Smith, K.

AU - Surprise, H.

AU - Lovorn, E.

AU - Boyett, J.

AU - Ferry, R. J.

AU - Relling, M. V.

AU - Shurtleff, S. A.

AU - Pui, C. H.

AU - Carbone, L.

AU - Hudson, M. M.

AU - Ness, K. K.

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N2 - Background: We sought to improve lumbar spine bone mineral density (LS-BMD) in long-term survivors of childhood acute lymphoblastic leukemia (ALL) using calcium and cholecalciferol supplementation. Procedure: This double-blind, placebo-controlled trial randomized 275 participants (median age, 17 [9-36.1] years) with age- and gender-specific LS-BMD Z-scores <0 to receive nutritional counseling with supplementation of 1,000mg/day calcium and 800International Unit cholecalciferol or placebo for 2 years. The primary outcome was change in LS-BMD assessed by quantitative computerized tomography (QCT) at 24 months. Linear regression models were employed to identify the baseline risk factors for low LS-BMD and to compare LS-BMD outcomes. Results: Pre-randomization LS-BMD below the mean was associated with male gender (P=0.0024), White race (P=0.0003), lower body mass index (P<0.0001), and cumulative glucocorticoid doses of ≥5,000mg (P=0.0012). One hundred eighty-eight (68%) participants completed the study; 77% adhered to the intervention. Mean LS-BMD change did not differ between survivors randomized to supplements (0.33±0.57) or placebo (0.28±0.56). Participants aged 9-13 years and those 22-35 years had the greatest mean increases in LS-BMD (0.50±0.66 and 0.37±0.23, respectively). Vitamin D insufficiency (serum 25[OH]D <30ng/ml) found in 296 (75%), was not associated with LS-BMD outcomes (P=0.78). Conclusion: Cholecalciferol and calcium supplementation provides no added benefit to nutritional counseling for improving LS-BMD among adolescent and young adult survivors of ALL (93% of whom had LS-BMD Z-scores above the mean at study entry). Pediatr Blood Cancer 2014;61:885-893.

AB - Background: We sought to improve lumbar spine bone mineral density (LS-BMD) in long-term survivors of childhood acute lymphoblastic leukemia (ALL) using calcium and cholecalciferol supplementation. Procedure: This double-blind, placebo-controlled trial randomized 275 participants (median age, 17 [9-36.1] years) with age- and gender-specific LS-BMD Z-scores <0 to receive nutritional counseling with supplementation of 1,000mg/day calcium and 800International Unit cholecalciferol or placebo for 2 years. The primary outcome was change in LS-BMD assessed by quantitative computerized tomography (QCT) at 24 months. Linear regression models were employed to identify the baseline risk factors for low LS-BMD and to compare LS-BMD outcomes. Results: Pre-randomization LS-BMD below the mean was associated with male gender (P=0.0024), White race (P=0.0003), lower body mass index (P<0.0001), and cumulative glucocorticoid doses of ≥5,000mg (P=0.0012). One hundred eighty-eight (68%) participants completed the study; 77% adhered to the intervention. Mean LS-BMD change did not differ between survivors randomized to supplements (0.33±0.57) or placebo (0.28±0.56). Participants aged 9-13 years and those 22-35 years had the greatest mean increases in LS-BMD (0.50±0.66 and 0.37±0.23, respectively). Vitamin D insufficiency (serum 25[OH]D <30ng/ml) found in 296 (75%), was not associated with LS-BMD outcomes (P=0.78). Conclusion: Cholecalciferol and calcium supplementation provides no added benefit to nutritional counseling for improving LS-BMD among adolescent and young adult survivors of ALL (93% of whom had LS-BMD Z-scores above the mean at study entry). Pediatr Blood Cancer 2014;61:885-893.

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KW - Cholecalciferol

KW - Controlled trial

KW - Vitamin D

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