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Food insecurity prior to hematopoietic stem cell transplant is associated with malnutrition and worse outcomes

Bone Marrow Transplantation volume 60, pages 857–863 (2025)Cite this article

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Abstract

Food insecurity (FI), defined as the lack of continuous access to adequate food, affects 17–55% of cancer patients. Effects may be exacerbated in hematopoietic stem cell transplant (HSCT) patients, who face nutritional challenges due to treatment side effects, leading to weight loss and malnutrition. We hypothesize that pre-HSCT FI increases the risk of malnutrition, requiring nutrition support, and adverse psychosocial outcomes. Between February 2018 and August 2022, 284 patients were screened before HSCT for FI. 71 (25%) were excluded due to missing data. Of the remaining 213, 20 (9.4%) reported pre-HSCT FI. Patients with FI were more likely to develop malnutrition during HSCT (70% vs. 45.1%, p = 0.034) and need total parenteral nutrition compared to those without FI (65% vs. 34.2%, p = 0.013). Patients with FI also were more likely to screen positive for depression (40% vs. 10.4%, p = 0.002) and financial toxicity (75% vs. 25%, p < 0.001). There were no significant differences in survival or other secondary outcomes. Our study demonstrates that pre-HSCT FI significantly increases likelihood of malnutrition, the need for total parenteral nutrition, and adverse psychosocial outcomes in HSCT patients. These findings highlight the critical importance of early identification and interventions to address FI as part of comprehensive cancer care.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. These authors contributed equally: Matthew A. Bergens, Yen P. Lowder.

Authors and Affiliations

  1. Duke University School of Medicine, Durham, NC, USA

    Matthew A. Bergens

  2. Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA

    Yen P. Lowder, Ernaya J. Johnson, Hilary M. Winthrop, Amy T. Bush, Lauren Hill, Isabella Gorski, Bethany Weaver, S. Yousuf Zafar, Edwin P. Alyea, Nelson J. Chao, Taewoong Choi, Cristina Gasparetto, Sanghee Hong, Mitchel E. Horwitz, Chenyu Lin, Gwynn D. Long, Richard D. Lopez, Sendhilnathan Ramalingam, Stefanie Sarantopoulos & Keith M. Sullivan

  3. Duke Cancer Institute Biostatistics Shared Resource, Duke University, Durham, NC, USA

    Yan Li

  4. Duke University, Durham, NC, USA

    Angela Xiong

  5. Division of Hematologic Malignancies and Cellular Therapy, University of Kansas Medical Center, Westwood, KS, USA

    Anthony D. Sung

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Contributions

Conception and design: MAB, YPL, EJJ, HMW, IJ, BW, YZ, ADS. Financial support: ADS. Administrative support: MAB, YPL, EJJ, ATB, AX, LH, IG, BW, YZ. Provision of study materials or patients: MAB, YPL, EJJ, HMW, ATB, LH, IG, BW, YZ, EPA, NJC, TC, GC, MEH, GDL, RDL, SR, SS, KMH, PEW, ADS. Collection and assembly of data: MAB, YPL, EJJ, HW, ATB, AX, LH. Data analysis and interpretation: MAB, EJJ, YL, ADS. Manuscript writing: All authors. Final approval of manuscript: All authors. Accountable for all aspects of the work: All authors. Manuscript revision: MAB, EJJ, HMW, ADS.

Corresponding author

Correspondence to Anthony D. Sung.

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Competing interests

Dr Sung’s work has been funded by Merck, Novartis, Enterome, and Seres. He has received research product for studies from DSM/iHealth, Clasado, and BlueSpark Technologies. He has consulted for Targazyme, Acrotech, Geron, and Janssen.

Ethics approval and consent to participate

All methods were performed in accordance with the relevant guidelines and regulations. CPOP was implemented as a standard of care program. Therefore, patients were not consented as data was collected as part of routine care. The Duke Health Institutional Review Board approved the analysis of data collected as a quality improvement (QI) study (Pro00111631).

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Bergens, M.A., Lowder, Y.P., Li, Y. et al. Food insecurity prior to hematopoietic stem cell transplant is associated with malnutrition and worse outcomes. Bone Marrow Transplant 60, 857–863 (2025). https://doi.org/10.1038/s41409-025-02587-1

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