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Effects of Lucerne leaf concentrate supplementation on the nutritional status of chronic myeloid leukemia (CML) patients
Aditi Lodha and Kanika Verma
Department of Home Science, University of Rajasthan, Jaipur, India

Hemant Malhotra
Department of Medicine, SMS Medical College, Jaipur, India, and

Beena Mathur and Aachu Agrawal

Department of Home Science, University of Rajasthan, Jaipur, India
Abstract
Purpose This paper aims to assess the effect of Lucerne leaf concentrate supplementation on the nutritional status of chronic myeloid leukaemia (CML) patients. Design/methodology/approach The study was undertaken on 21 patients in the age group of 18-60 years suffering from myeloid leukemia. At the baseline, data on weight, height, haemoglobin, RBC count, WBC, TLC, platelet count and nutrient intake were collected for all patients. Then they were given 10 gm LC (dark green extract from Lucerne) per day for three months and after that all parameters were assessed again. Findings Statistical analysis revealed a signicant increase in Hb ( p , 0.05) in women, while RBC increased signicantly ( p , 0.01) in both males and females. Pre- and post-assessment of diet of the patients revealed that there was a signicant increase in the energy, protein, calcium, iron, riboavin, niacin and vitamin C in female patients, while in male patients the difference was signicant for niacin only. Originality/value Lucerne supplementation helped in maintaining or bringing about an increase in body weight, Hb, by increasing RBC counts. Keywords Patients, Diseases, Nutrition Paper type Research paper

Nutrition & Food Science Vol. 39 No. 1, 2009 pp. 46-49 q Emerald Group Publishing Limited 0034-6659 DOI 10.1108/00346650910930815

Introduction Leukaemia is a clonal disease (originally in a single cell) and evokes by the accrual of mutations within a clone. These results in progressive genetic diversication followed by natural selection of dominant mutant sub clones. Chronic myeloid leukaemia is a clonal myleproliferative disorder characterized by overproduction of myeloid cells. These myeloid cells retain the capacity for differentiation and normal bone marrow function is maintained during the early phases (Hoffman et al., 2005). CML is associated with a characteristic chromosomal abnormality (Thirman et al., 1993).

Leaf concentrate is simply a concentrated extract of green leaves. Leaf concentrate is equivalent to cheese in term of protein content. A small portion taken daily will provide the body with all the vitamin A; it needs and also provide good amounts of iron, folic acid, vitamin E and vitamin K and Calcium (www.fao.org/ag/ Age/AGAP/FRG/AFRIS/Data/465.html, www.pronature.org/projects/malnutrition_ en.pdf) (Table I). Studies form various parts of the world have shown positive effect of LC on supplementation on anaemia, vitamin A deciency and mental development (Zanin, 1998). LC is being used in the supplementary nutrition given to children and pregnant women under the Integrated Child Development Scheme in Jaipur city. Keeping in view the nutritional composition of LC especially protein and haemoglobin content, a small study was planned to see the effect of LC supplementation on nutritional status of patients. Materials/methods In the present study 23 patients in the age group of 18-60 years suffering from CML, attending the outpatients ward of Birla Cancer Research Centre, SMS Hospital, Jaipur were enrolled in the study. After taking written consent from the patients, the baseline data on weight, height, haemoglobin, RBC count, WBC, Total Leukocyte count, platelet count and nutrient intake was collected. These patients were provided with 10 gms of Lucerne leaf concentrate daily for a period of three months. After three months, again post-intervention data was collected on all variables to assess the effect of supplementation on different variables (Table II).

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Frequency Variables Sex Male Female Habitat Rural Urban Education Illiterate High school . High school SES LIG MIG Type of family Nuclear Joint n 15 8 9 14 4 11 8 11 12 9 14 % 65.2 34.8 39.1 60.9 17.4 47.8 34.8 47.8 52.2 39.1 60.7 Table I. Baseline characteristics of the subjects

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Results Out of the total 23 patients two patients quit the study. The rest of the 21 subjects were comprised of 13 males and 8 females with mean age 38.0 ^ 10.1 years. Mostly patients were from urban areas (61.9 per cent) and were more than high school (34.8 per cent). At the initiation of the study, patients had mean weight 60.2 ^ 15.8 Kg, height 165.3 ^ 8.9 cms, BMI 21.8 ^ 4.8, haemoglobin 10.8 ^ 1.3 gm, RBC count 3.4 ^ 0.4, leucocyte count 6,134.9 ^ 3,311.7 , and platelet count 211,190.5 ^ 115,402.6 in total. While male and female patients had weight 53.7 ^ 14.9 and 64.2 ^ 15.9 kg, Hb 11.28 ^ 0.69 gm and 10.26 ^ 1.71 gm/dl; RBCs 3.59 ^ 0.36 and 3.22 ^ 0.51; WBC 4,138 ^ 2,035.05 and 6,218.75 ^ 1,353.42 milli/cumm; platelet count 215,846.23 ^ 126,431.38 and 197,125 ^ 38,514.4 Lac/ml respectively. After three months LC supplementation patients had mean weight 61.3 ^ 15.5 Kg, BMI 22.31 ^ 4.7, Hb 11.2 ^ 1.1 gm, total RBC count 3.7 ^ 0.5, total leucocytes count 12,366.6 ^ 23,929.9, platelet count 205,714.3 ^ 6,1601.25. Male and female patients had weight 55.3 ^ 13.7 and 65.1 ^ 15.9 kg; Hb 11.46 ^ 0.88 and 10.8 ^ 1.3 gm/dl; RBCs 3.76 ^ 0.29 and 3.66 ^ 0.92; WBC 5,576.15 ^ 2,655.32 and 5,796.95 ^ 1,575.74 milli/cumm; platelet count 216,000 ^ 6,018.13 and 192,500 ^ 63,351.63 lac/ml for males and females respectively. Statistical analysis revealed that there was increase in weight in patients from baseline but it was not signicant. Although there was signicant increase in Hb among women but not in men. While RBC count increased signicantly in both. Pre- and post-assessment of diet of the patients revealed that there was a signicant increase in the energy, protein, calcium, iron, riboavin, niacin and vitamin C in female patients. While in male patients difference was signicant for niacin only.

Discussion To conclude Lucerne supplementation helped in maintaining or bringing about an increase in body weight, Hb levels thereby, increasing RBC counts. Lucerne also helped in betterment of their health status by contributing to their nutrient intake, thereby enjoying an improved health status.

Variables Weight (kg) BMI Hb (gm/dl) RBC (milli/cumm) Leukocyte (kilo/cumm) Platelet count (Lacs/ml)

Baseline data 60.2 ^ 15.8 21.8 ^ 4.8 10.8 ^ 1.3 3.4 ^ 0.4 5,865.2 ^ 3,572.0 21,1190.5 ^ 115,402.6

Post intervention 61.3 ^ 15.5 22.3 ^ 4.7 11.2 ^ 1.1 3.7 ^ 0.5 12,159.7 ^ 2,4021.3 205,714.3 ^ 61,601.25

% Change 1.8 2.2 3.7 8.8 51.8 22.5

Signicance ( p , 0.05) 0.05 * * 0.050 0.021 * 0.024 * 0.217 0.757

Table II. Comparison of anthropometry and biochemical prole before and after intervention

Notes: *Signicant at 95% level; * *Although not signicant but prevented further weight loss

References Hoffman, R., Benz, E.J. Jr, Shattil, S.J., Furie, B., Cohen, H.J. and Silberstein, L.E. (2005), Hematology: Basic Principles and Practice, 4th ed., Elsevier Churchill Livingstone, St Louis, MO, pp. 1074-5. Thirman, M., Gill, H., Burnett, R., Mbangkollo, D., McCabe, N., Kobayashi, H., Ziemin-van der Poel, S., Kaneko, Y., Morgan, R. and Sandberg, A. (1993), Rearrangement of the MLL gene in acute lymphoblastic and acute myeloid leukemias with 11q23 chromosomal translocations, N. Engl. J. Med., Vol. 329 No. 13, pp. 909-14. Zanin, V. (1998), A New Nutritional Idea for Men: Lucerne Leaf Concentrates, Association for the Promotion of LC in Nutrition, Paris. Corresponding author Aachu Agrawal can be contacted at: jaipur_agrawal@yahoo.com

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