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Schab M, Skoczen S. Nutritional status, body composition and diet quality in children with cancer. Front Oncol 2024; 14:1389657. [PMID: 38706604 PMCID: PMC11066172 DOI: 10.3389/fonc.2024.1389657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
During cancer treatment, nutritional status disorders such as malnutrition or obesity affect the tolerance of cancer treatment, quality of life, but also the pharmacokinetics of drugs. It is hypothesized that changes in fat and lean body mass can modify chemotherapy volume distribution, metabolism and clearance. In children with cancer, lean body mass decreases or remains low during treatment and fat mass increases. Body composition is influenced by the cancer itself, aggressive multimodal-therapies, changes in metabolism, unbalanced diet and reduced physical activity. Due to the side effects of treatment, including changes in the sense of taste and smell, nausea, vomiting, diarrhea, and stress, eating according to recommendation for macronutrients and micronutrients is difficult. Research indicates that throughout cancer treatment, the consumption of fruits, vegetables, and dairy products tends to be insufficient, whereas there is an elevated intake of sugar and unhealthy snacks. Children exhibit a preference for high-carbohydrate, salty, and strongly flavored products. This review revealed the importance of body composition and its changes during cancer treatment in children, as well as eating habits and diet quality.
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Affiliation(s)
- Magdalena Schab
- Doctoral School of Medical and Health Science, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Li Y, Lu Z, Ma A, Yao W, Dong R, Li K, Wu M, Dong K, Qian T. Nutritional status associated with clinical outcomes in children with solid tumors: A retrospective cohort study from China. Cancer Med 2023; 13:e6798. [PMID: 38111308 PMCID: PMC10807599 DOI: 10.1002/cam4.6798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To investigate the long-term changes in nutritional status in children with solid tumors during treatment and the relationship between nutritional status and clinical outcomes. METHODS This study was a retrospective medical records review of data from children who were diagnosed with solid tumors and followed up for more than 3 months from January 2016 to December 2021 in China. Patient demographics and clinical information, including nutritional status, parenteral nutrition use, intensive care unit (ICU) transfers, infection during hospitalization, hospitalization frequency, length of stay, hospitalization costs and antibiotic costs, were collected to analyze the nutritional status of children with different types of solid tumors, the dynamic changes in nutritional status during treatment, and the relationship between nutritional status and clinical outcomes. RESULTS Among the 764 patients (383 males (50.1%); 381 females (49.9%); mean age: 2.58 years), 41.6% of the solid tumors were neuroblastomas, 17.1% were hepatoblastomas, and Wilms tumors as the third most common solid tumors (8.9%). The median follow-up duration was 6 months (range: 3-40 months). At diagnosis, the proportion of children who were undernourished (underweight and wasting) versus overweight or obese were 26.71% versus 5.21% (25.86% vs. 2.89% in the third month; 29.77% vs. 2.28% in the sixth month; 24.77% vs. 3.27% in the 12th month). The body mass index Z scores decreased from the initial values after the first month (-0.56 (-1.47, 0.23) vs. -0.44 (-1.29, 0.41)) but improved later and decreased again at 6 months. The children in the undernutrition group had longer hospital stays (p < 0.001), higher hospitalization costs (p < 0.001), higher antibiotic costs (p < 0.001), a higher risk of neutropenia (OR = 4.781 (95% CI: 1.571-14.553), p = 0.006), and a higher risk of ICU transfers (OR = 1.498 (95% CI: 1.010-2.224), p = 0.044). No significant differences in those associations by malnutrition and infection, ICU duration, or length of parenteral nutrition were observed. CONCLUSION There is a considerable prevalence of malnutrition in children with solid tumors. Malnutrition is related to adverse clinical outcomes and increases in total hospital expenses and antibiotic costs.
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Affiliation(s)
- Yongzhen Li
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
- Child Health Management CentreStarkids Children's HospitalShanghaiChina
| | - Zhongying Lu
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
| | - Ao Ma
- Pediatric Clinical Research Unit, Department of Research ManagementChildren's Hospital of Fudan UniversityShanghaiChina
| | - Wei Yao
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Rui Dong
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Kai Li
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Min Wu
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Kuiran Dong
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Tian Qian
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
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Garg M, Abrol P, Gupta N, Bharti S, Nadda A. Analysis of clinical profile and role of various prognostic factors in early bone marrow response in children with acute lymphoblastic leukemia treated by Modified Multicenter Protocol (MCP) 841 protocol: Experience from a tertiary care center in North India. Indian J Cancer 2023; 60:521-527. [PMID: 38258870 DOI: 10.4103/ijc.ijc_149_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/22/2020] [Indexed: 01/24/2024]
Abstract
BACKGROUND It is important to study the clinical profile of pediatric patients with acute lymphoblastic leukemia (ALL) and assess various prognostic factors implicated in response to induction chemotherapy for optimal treatment outcomes in India. The present study was done to evaluate the clinical profile and to find the correlation of day 7 and day 28 marrow blast response with already established prognostic factors in children with ALL in the region of North India using MCP 841 protocol for all patients. METHODS A total of 60 children up to ages 14 years with ALL were given treatment in the form of induction remission (MCP-841 protocol) I1 cycle (induction 1) therapy for 29 days. Complete hemogram for blast cells and bone marrow examination (bone marrow aspiration and, if required, bone marrow biopsy) was done on days 7 and 28 (completion of I1 cycle) to see early bone marrow response. Early response to induction therapy was compared in patients with and without high-risk factors, and results were analyzed statistically. RESULTS Out of 60 enrolled children, 56 (93.4%) patients were in complete remission at the end of induction 1 cycle. Various risk factors were found to be of prognostic significance in first remission and early response to induction therapy were initial total leukocyte count (TLC) at presentation, immunophenotype of ALL; while other factors including age and sex was not found to be significant. CONCLUSION Prevalence and significance of various prognostic factors implicated in pediatric ALL tend to be different in various populations. A better understanding of such factors in these populations will help in the tailoring of risk-adapted treatment protocols to local needs.
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Affiliation(s)
- Manita Garg
- Department of Peadiatrics, PGIMS, Rohtak, Haryana, India
| | - Pankaj Abrol
- Department of Peadiatrics, PGIMS, Rohtak, Haryana, India
| | - Nishu Gupta
- Department of Peadiatrics, PGIMS, Rohtak, Haryana, India
| | - Shafira Bharti
- Department of Pathology, Govt. Medical College, Sector 32, Chandigarh, India
| | - Anuradha Nadda
- Department of Community Medicine, PGIMS, Rohtak, Haryana, India
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Pedro J, Martucci R, Monteiro G, Saraiva D. Mid-upper arm circumference in hospitalized pediatric patients with cancer: Is there an association with malnutrition? Nutr Clin Pract 2023; 38:1133-1141. [PMID: 37461825 DOI: 10.1002/ncp.11039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/13/2023] [Accepted: 06/11/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Malnutrition is common in children/adolescents with cancer. Mid-upper arm circumference (MUAC) is recommended by the International Society of Pediatric Oncology for measuring nutrition status. The aim was to evaluate the nutrition status of pediatric patients with cancer and verify whether MUAC is associated with malnutrition and length of stay (LOS). METHODS This was an observational study of patients aged 0-19 years with solid and hematological neoplasms. Data included anthropometric measurements of nutrition status by body mass index/age (BMI/A), weight/age, weight/height, height/age, MUAC, mid-arm muscle circumference, triceps skinfold thickness (TSF), and biochemical measurements of characterizing inflammation (serum prealbumin level, serum albumin level, and C-reactive protein [CRP]). Statistical tests such as the Student t test, Mann-Whitney test, and Spearman correlation were employed to analyze the data. Logistic regression was used for multivariate analysis. RESULTS Of 111 patients, 51.7% (n = 57) were male, and solid tumors were prevalent (76.6%, n = 85). The median age was 8.5 years. The anthropometric measurements of the arm revealed a higher prevalence of malnutrition when compared with anthropometric indices. According to the Spearman correlation, a high and positive correlation was observed between MUAC and BMI/A (ρ = 0.800 and P < 0.001). There was an association between MUAC, TSF, and high CRP with LOS (P = 0.025, P = 0.003, and P < 0.001, respectively). Patients with a MUAC (less than the fifth percentile) had almost 2.73 times the chance of having a prolonged LOS. CONCLUSION MUAC was a good parameter for the classification of nutrition status and the assessment of LOS in pediatric patients with cancer.
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Affiliation(s)
- Jéssica Pedro
- Multiprofessional Residency Program in Oncology of the National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Renata Martucci
- Nutrition and Dietetic Section, Cancer Hospital Unit I, National Cancer Institute, Rio de Janeiro, Brazil
- Nutrition Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gina Monteiro
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health Sérgio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Danúbia Saraiva
- Nutrition and Dietetic Section, Cancer Hospital Unit I, National Cancer Institute, Rio de Janeiro, Brazil
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Kellerman I, Blaauw R, Schoeman J, Kruger M. Changes in anthropometrical status and body composition in children with cancer during initial chemotherapy. Pediatr Hematol Oncol 2023; 40:659-672. [PMID: 37092844 DOI: 10.1080/08880018.2023.2201299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/27/2023] [Accepted: 03/09/2023] [Indexed: 04/25/2023]
Abstract
Children with cancer require adequate nutritional support to prevent malnutrition. This study investigated the impact of chemotherapy on anthropometrical status and body composition during the first six months of treatment. Anthropometrical status and body composition were measured at diagnosis, utilizing standardized protocols and validated S10 InBody bio-electrical impedance (BIA) measurements and compared to subsequent consecutive monthly follow-up measurements to plot changes over time during the first six months. Statistical significance was defined as p < 0.05. Forty-three newly diagnosed children (median age 4 years, IQR: 2.0-7.6; male-female ratio 1:0.9; 53% haematological malignancies and 47% solid tumors) were included. Prevalence of malnutrition varied, with under-nutrition 14% (mid-upper arm circumference (MUAC)/body mass index (BMI)), over-nutrition 9.3% (BMI) and stunting 7% at diagnosis. MUAC (14%) identified fewer participants with underlying muscle store depletion than BIA (41.8%). Chemotherapy exposure acutely exacerbated existing nutritional depletion during the first two months after diagnosis for all variables except fat mass (FM), with contrary effects on cancer type. Haematological malignancies had rapid increases in weight, BMI and FM. All patients had an acute loss of skeletal muscle mass. Nutritional improvement experienced by all cancer types during month two to three of treatment resulted in catch-up growth, with a significant increase in weight (chi2=40.43, p < 0.001), height (chi2=53.79, p < 0.001), BMI (chi2=16.32, p < 0.005), fat free mass (chi2=23.69, p < 0.003) and skeletal muscle mass (chi2=24.19, p < 0.001) after six months. Monthly nutritional assessments, including advanced body composition measurements, are essential to provide timely nutritional interventions to overcome the acute decline in nutritional reserves observed during the first two months of chemotherapy exposure.
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Affiliation(s)
- I Kellerman
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J Schoeman
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Barr RD, Antillon-Klussmann F. Cancer and nutrition among children and adolescents in low- and middle-income countries. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:987-993. [PMID: 36094475 DOI: 10.1080/16078454.2022.2115437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE : The primary purpose of this review is to investigate the relationships between cancer and nutrition in children and adolescents living in resource-poor, low- and middle-income countries (LMICs) in order to explore potential opportunities for interventions which could improve clinical outcomes in this population. METHOD : The implications of overlapping age groups of children and adolescents with cancer are examined, as are the adverse influences of under-nutrition and socio-economic deprivation on the efficacy of treatment and cancer survival. Evidence suggestive of novel avenues to enhance prospects for cure, based on increased understanding of the dynamic of nutrition and cancer, is evaluated. RESULT : Cancer adds to the burden of under-nutrition in disadvantaged populations which is reflective, in large measure, on inadequate governmental expenditure on health which demands public-private partnerships and the use of hospital-based foundations. Structured approaches to the measurement of nutritional status and the design of effective programmes of nutritional supplementation are of proven benefit. Initial results from studies of the perturbed gut microbiome hold considerable promise for further gains. CONCLUSION A large minority of children with cancer in LMICs are never diagnosed and the same may be true of adolescents. Investing in the training of nutritionists will have substantial returns as will increasing access to essential medicines. Recognition of these challenges has stimulated WHO and other entities to devise major strategies for comprehensive changes in the care of children and adolescents with cancer in LMICs, offering realistic prospects for improved clinical outcomes.
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Affiliation(s)
- Ronald D Barr
- Departments of Pediatrics and Medicine, McMaster University, Hamilton, Canada
| | - Federico Antillon-Klussmann
- Unidad Nacional de Oncología Pediátrica, and School of Medicine, Francisco Marroquín University, Guatemala, Guatemala
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Gupta H, Pant G, Verma N. Malnutrition in childhood cancer patients: Magnitude, key indicators and outcome. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Prasad M, Ladas EJ, Barr R. Addition of arm anthropometry to body mass index for age, but not serum albumin, improves the accuracy of the nutritional assessment in severely and moderately malnourished children with cancer. Pediatr Blood Cancer 2022; 69:e29718. [PMID: 35441783 DOI: 10.1002/pbc.29718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/12/2022] [Accepted: 03/27/2022] [Indexed: 11/11/2022]
Abstract
Arm anthropometry is a more sensitive measure of nutritional status than body mass index for age (BMI) in children with cancer, but the added utility of serum albumin remains uncertain. Concordance was determined among four forms of classifying nutritional status in a cohort of undernourished children with cancer: method 1: BMI-for-age Z score; method 2: method 1 + mid-upper arm circumference (MUAC) percentile; method 3: method 2 + triceps skinfold thickness (TSFT) percentile; and method 4: method 3 + serum albumin. Concordance was highest between methods 2 and 3, followed closely by 3 and 4, indicating that addition of arm anthropometry, but not serum albumin, to BMI increased the sensitivity of baseline nutritional assessment.
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Affiliation(s)
- Maya Prasad
- Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Elena J Ladas
- Global Integrative Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ronald Barr
- Paediatrics, Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
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Prasad M, Moulik NR, Jatia S, Dhamne C, Parambil BC, Chichra A, Narula G, Banavali SD, Chinnaswamy G. Impact of a pediatric oncology nutrition program: Lessons learnt over a decade. Pediatr Blood Cancer 2022; 69:e29728. [PMID: 35441780 DOI: 10.1002/pbc.29728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The management of malnutrition in children with cancer remains a challenge in low-middle-income countries (LMICs). We describe our pediatric oncology nutrition program and its impact over the past decade. METHODS We evaluated the impact of our nutrition program in accordance with the International Society of Paediatric Oncology-Paediatric Oncology in Developing Countries (SIOP PODC) Nutritional Program Evaluation in the areas of service delivery (number served, increments in delivery, number of trained care providers), patients at-risk (proportion identified with malnutrition at diagnosis/follow-up), and efficiency of nutritional interventions (proportion assessed, proportion achieved healthy weight, clinicians trained). We analyzed available data for trends between 2009 and 2020, and comparisons were made using the Fisher t test. This study was approved by our institutional ethics committee. RESULTS From 2010 to 2020, 17 749 children treated at our center were beneficiaries of the nutritional program, including assessment and intervention. During this period, trained pediatric nutritionists increased from 2 to 8; SIOP PODC level from 2 to 3-4, and nutrition budget increased 15-fold. At diagnosis (n = 5618) and six-month follow-up (n = 2674), 59.6% and 51.2% children were undernourished, 34.8% and 43% well nourished, and 4.7% and 5.7% overnourished. From 2016 onward, fewer children were undernourished at follow-up-69.5% (2016), 60% (2018), 54% (2019), and 55% (2020, P < 0.001). The program helped train over 500 clinicians in nutrition. CONCLUSIONS Improved financial support and capacity building have helped build and sustain an effective nutrition program. Priority areas include implementation of best practices, early nutritional intervention, continued education, and locally relevant research.
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Affiliation(s)
- Maya Prasad
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Nirmalya Roy Moulik
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Shalini Jatia
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Chetan Dhamne
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Badira Cheriyalinkal Parambil
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Akanksha Chichra
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Gaurav Narula
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Shripad D Banavali
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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Priyanka S, Sandeep J, Gauri K, Gayatri V. Dual-Energy X-Ray Absorptiometry and Anthropometry for Assessment of Nutritional Status at Diagnosis in Children with Cancer: A Single-Center Experience from India. South Asian J Cancer 2022. [DOI: 10.1055/s-0041-1735565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Background The survival of children with cancer has improved owing to advances in chemotherapy and better supportive care, and nutritional support is an important component of the latter especially in low- and middle-income countries like India.
Materials and Methods A prospective observational study of 137 newly diagnosed children with cancer aged less than 18 years was planned. Nutritional assessment was done using dual-energy X-ray absorptiometry (DXA), anthropometry, and serum albumin. Patients were followed for 3 months for assessment of treatment-related morbidity.
Results Lean body mass (LBM; DXA), mid-upper arm circumference (MUAC), and body mass index detected undernutrition in 44, 45, and 14% patients, respectively. Combination of arm anthropometry (MUAC and triceps skinfold thickness) with serum albumin categorized patients as adequately nourished (32%), moderately depleted (18%), and severely depleted (49%). Patients with hematological malignancy had a higher prevalence of undernutrition but there was no difference in morbidities between the undernourished and adequately nourished children by any parameter. Hypoalbuminemia observed in 25% patients was associated with significant chemotherapy delays (p, 0.01) and interval admissions (p, 0.03). Using LBM as a criterion, linear regression analysis revealed MUAC (R
2 = 0.681) as the best predictor of undernutrition with lowest standard error.
Conclusion Our study reports undernutrition among two-fifths of newly diagnosed patients of childhood cancer associated with high prevalence of sarcopenia and adiposity. These findings are of utmost clinical relevance in planning interventional strategies.
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Affiliation(s)
- Soni Priyanka
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Jain Sandeep
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Kapoor Gauri
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Vishwakarma Gayatri
- Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
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Afonso WV, Peres WAF, de Pinho NB, Schilithz AOC, Martucci RB, Rodrigues VD, Nascimento BF, Moreira CFF, de Carvalho Padilha P. Performance of subjective global nutritional assessment in predicting clinical outcomes: Data from the Brazilian survey of pediatric oncology nutrition. Cancer Med 2022; 11:4612-4623. [PMID: 35645320 PMCID: PMC9741974 DOI: 10.1002/cam4.4837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Methods for assessing nutritional status in children and adolescents with cancer is a difficult in clinical practice. The study aimed to evaluate the performance of Subjective Global Nutritional Assessment (SGNA) in predicting clinical outcomes in children and adolescents with cancer in Brazil. METHODS This was a prospective cohort multicenter study. It was included 723 children and adolescents with cancer aged 2-18 years between March 2018 and August 2019. Nutritional assessment was performed according to World Health Organization recommendations and using SGNA within 48h of hospitalization. Unplanned readmission, length of hospital stay, and post-discharge death were analyzed. Cohen's kappa coefficient was used to ascertain the agreement between body mass index for age (BMI/A) and SGNA. The sensitivity, specificity, positive and negative predictive values, and accuracy of SGNA were estimated. Odds ratios (ORs) with 95% confidence intervals (CIs) were evaluated using multiple logistic regression. RESULTS The mean patient age was 9.4 ± 4.9 years. SGNA showed that 29.7% (n = 215) and 6.5% (n = 47) patients had moderate and severe malnutrition, respectively. Considering the concurrent validity criterion, SGNA had an OR (95% CI) of 6.8 (3.1-14.9) for predicting low and very low weight for age at admission, with a sensitivity and specificity of 72.4% (59%-82.1%) and 72% (64.2%-78.9%), respectively. SGNA could predict death in children with severe/moderate malnutrition, with an accuracy of 63.8% (63%-65.1%). Logistic multivariate analysis showed that the adjusted effect of death; hematological tumor; living in the northeast, southeast, and midwest regions of Brazil; and older age was associated with malnutrition according to SGNA. CONCLUSION Based on concurrent validity between SGNA and anthropometry, SGNA performed well and had a good ability to predict death in Brazilian children with cancer.
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Affiliation(s)
- Wanélia Vieira Afonso
- National Cancer Institute José Alencar Gomes da Silva (Instituto Nacional de Câncer José Alencar Gomes da Silva), Brazilian Ministry of Health (Ministério da Saúde do Brasil)Rio de JaneiroBrazil
| | - Wilza Arantes Ferreira Peres
- Josué de Castro Nutrition Institute (Instituto de Nutrição Josué de Castro)Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro)Rio de JaneiroBrazil
| | - Nivaldo Barroso de Pinho
- Brazilian Society of Oncological Nutrition (Sociedade Brasileira de Nutrição Oncológica)Rio de JaneiroBrazil
| | - Arthur Orlando Corrêa Schilithz
- National Cancer Institute José Alencar Gomes da Silva (Instituto Nacional de Câncer José Alencar Gomes da Silva), Brazilian Ministry of Health (Ministério da Saúde do Brasil)Rio de JaneiroBrazil
| | - Renata Brum Martucci
- National Cancer Institute José Alencar Gomes da Silva (Instituto Nacional de Câncer José Alencar Gomes da Silva), Brazilian Ministry of Health (Ministério da Saúde do Brasil)Rio de JaneiroBrazil,Nutrition Institute (Instituto de Nutrição), State University of Rio de Janeiro (Universidade do Estado do Rio de Janeiro)Rio de JaneiroBrazil
| | - Viviane Dias Rodrigues
- National Cancer Institute José Alencar Gomes da Silva (Instituto Nacional de Câncer José Alencar Gomes da Silva), Brazilian Ministry of Health (Ministério da Saúde do Brasil)Rio de JaneiroBrazil
| | - Barbara Folino Nascimento
- Institute of Childcare and Pediatrics Martagão Gesteira (Instituto de Puericultura e Pediatria Martagão Gesteira)Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro)Rio de JaneiroBrazil
| | - Carolina Ferraz Figueiredo Moreira
- Institute of Childcare and Pediatrics Martagão Gesteira (Instituto de Puericultura e Pediatria Martagão Gesteira)Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro)Rio de JaneiroBrazil
| | - Patricia de Carvalho Padilha
- Josué de Castro Nutrition Institute (Instituto de Nutrição Josué de Castro)Institute of Childcare and Pediatrics Martagão Gesteira (Instituto de Puericultura e Pediatria Martagão Gesteira), Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro)Rio de JaneiroBrazil
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Schab M, Skoczen S. The Role of Nutritional Status, Gastrointestinal Peptides, and Endocannabinoids in the Prognosis and Treatment of Children with Cancer. Int J Mol Sci 2022; 23:5159. [PMID: 35563548 PMCID: PMC9106013 DOI: 10.3390/ijms23095159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 12/26/2022] Open
Abstract
Neoplastic diseases in children are the second most frequent cause of death among the young. It is estimated that 400,000 children worldwide will be diagnosed with cancer each year. The nutritional status at diagnosis is a prognostic indicator and influences the treatment tolerance. Both malnutrition and obesity increase the risk of mortality and complications during treatment. It is necessary to constantly search for new factors that impair the nutritional status. The endocannabinoid system (ECS) is a signaling system whose best-known function is regulating energy balance and food intake, but it also plays a role in pain control, embryogenesis, neurogenesis, learning, and the regulation of lipid and glucose metabolism. Its action is multidirectional, and its role is being discovered in an increasing number of diseases. In adults, cannabinoids have been shown to have anti-cancer properties against breast and pancreatic cancer, melanoma, lymphoma, and brain tumors. Data on the importance of both the endocannabinoid system and synthetic cannabinoids are lacking in children with cancer. This review highlights the role of nutritional status in the oncological treatment process, and describes the role of ECS and gastrointestinal peptides in regulating appetite. We also point to the need for research to evaluate the role of the endocannabinoid system in children with cancer, together with a prospective assessment of nutritional status during oncological treatment.
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Affiliation(s)
- Magdalena Schab
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Krakow, Poland
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13
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Soni P, Jain S, Kapoor G, Vishwakarma G. Dual-Energy X-Ray Absorptiometry and Anthropometry for Assessment of Nutritional Status at Diagnosis in Children with Cancer: A Single-Center Experience from India. South Asian J Cancer 2022. [DOI: 10.1055/s-0041-1736031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Background The survival of children with cancer has improved owing to advances in chemotherapy and better supportive care, and nutritional support is an important component of the latter especially in low- and middle-income countries like India.
Materials and Methods A prospective observational study of 137 newly diagnosed children with cancer aged less than 18 years was planned. Nutritional assessment was done using dual-energy X-ray absorptiometry (DXA), anthropometry, and serum albumin. Patients were followed for 3 months for assessment of treatment-related morbidity.
Results Lean body mass (LBM; DXA), mid-upper arm circumference (MUAC), and body mass index detected undernutrition in 44, 45, and 14% patients, respectively. Combination of arm anthropometry (MUAC and triceps skinfold thickness) with serum albumin categorized patients as adequately nourished (32%), moderately depleted (18%), and severely depleted (49%). Patients with hematological malignancy had a higher prevalence of undernutrition but there was no difference in morbidities between the undernourished and adequately nourished children by any parameter. Hypoalbuminemia observed in 25% patients was associated with significant chemotherapy delays (p, 0.01) and interval admissions (p, 0.03). Using LBM as a criterion, linear regression analysis revealed MUAC (R
2 = 0.681) as the best predictor of undernutrition with lowest standard error.
Conclusion Our study reports undernutrition among two-fifths of newly diagnosed patients of childhood cancer associated with high prevalence of sarcopenia and adiposity. These findings are of utmost clinical relevance in planning interventional strategies.
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Affiliation(s)
- Priyanka Soni
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Sandeep Jain
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Gauri Kapoor
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Gayatri Vishwakarma
- Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
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14
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Priyanka S, Sandeep J, Gauri K, Gayatri V. Dual-Energy X-Ray Absorptiometry and Anthropometry for Assessment of Nutritional Status at Diagnosis in Children with Cancer: A Single-Center Experience from India. South Asian J Cancer 2022; 11:164-171. [PMID: 36466972 PMCID: PMC10501850 DOI: 10.1055/s-0042-1757860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Gauri KapoorBackground The survival of children with cancer has improved owing to advances in chemotherapy and better supportive care, and nutritional support is an important component of the latter especially in low- and middle-income countries like India. Materials and Methods A prospective observational study of 137 newly diagnosed children with cancer aged less than 18 years was planned. Nutritional assessment was done using dual-energy X-ray absorptiometry (DXA), anthropometry, and serum albumin. Patients were followed for 3 months for assessment of treatment-related morbidity. Results Lean body mass (LBM; DXA), mid-upper arm circumference (MUAC), and body mass index detected undernutrition in 44, 45, and 14% patients, respectively. Combination of arm anthropometry (MUAC and triceps skinfold thickness) with serum albumin categorized patients as adequately nourished (32%), moderately depleted (18%), and severely depleted (49%). Patients with hematological malignancy had a higher prevalence of undernutrition but there was no difference in morbidities between the undernourished and adequately nourished children by any parameter. Hypoalbuminemia observed in 25% patients was associated with significant chemotherapy delays ( p , 0.01) and interval admissions ( p , 0.03). Using LBM as a criterion, linear regression analysis revealed MUAC ( R 2 = 0.681) as the best predictor of undernutrition with lowest standard error. Conclusion Our study reports undernutrition among two-fifths of newly diagnosed patients of childhood cancer associated with high prevalence of sarcopenia and adiposity. These findings are of utmost clinical relevance in planning interventional strategies.
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Affiliation(s)
- Soni Priyanka
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Jain Sandeep
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Kapoor Gauri
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
| | - Vishwakarma Gayatri
- Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
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15
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González HR, Mejía SA, Ortiz JOC, Gutiérrez APO, López JEB, Quintana JEF. Malnutrition in paediatric patients with leukaemia and lymphoma: a retrospective cohort study. Ecancermedicalscience 2022; 15:1327. [PMID: 35211196 PMCID: PMC8816504 DOI: 10.3332/ecancer.2021.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Paediatric cancer is a potentially curable disease and its prognosis has been linked to several factors, such as nutritional status. The impact of malnutrition on these patients, either by overnutrition or undernutrition, varies and its relationship with outcomes is inconsistent. This study was conducted in order to determine the frequency of malnutrition in children with haematolymphoid malignancies at the time of diagnosis, as well as during treatment and to also investigate its relationship with the development of infections and death. Materials and Methods A retrospective cohort study of 191 children with a recent diagnosis of a haematolymphoid malignancy. The risks and nutritional classification were determined using anthropometry, follow-ups were conducted for up to 24 months and the presentation and frequency of infections and/or death were also recorded. Bivariate and multivariate analyses were conducted using binomial logistic regressions, for death and infection outcomes during follow-up. Survival analysis was conducted for various factors and types of cancer. Results 83.7% of children had a sufficient nutritional classification at diagnosis, 6.8% had malnutrition by undernutrition and 9.4% by overnutrition. 83.8% had at least one infectious complication during follow-up and 47.1% had ≥ 3. This percentage increased to 69.2% when configuring it in the malnutrition by undernutrition group. 18.3% of patients died. When configuring the mortality, the percentage was greater in patients with Acute Myeloid Leukaemia (AML) (57.1%) and malnutrition by undernutrition (30.7%). The multivariate analysis for the outcome of death, only showed a statistically significant variable (AML odds ratio = 26.52; confidence interval = 1.09–643.24; p = 0.04). Conclusion No statistically significant relationship was found between the nutritional status of children with haematolymphoid neoplasms, and outcomes such as infections or death. The differences in the results obtained in these investigations may be related to the varied nutritional status definitions and the ways of measuring them, thus limiting comparisons between them.
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Affiliation(s)
| | - Sergio Andrade Mejía
- University of Antioquia, Carrera 51d #62-29, Medellín 050010, Colombia.,https://orcid.org/0000-0001-5823-6110
| | - Javier Orlando Contreras Ortiz
- Paediatrics and Child Health Department, University of Antioquia, Calle Barranquilla #51b-22, Medellín 050010, Colombia.,https://orcid.org/0000-0001-8568-5421
| | - Adriana Patricia Osorno Gutiérrez
- Paediatrics and Child Health Department, University of Antioquia, Calle Barranquilla #51b-22, Medellín 050010, Colombia.,https://orcid.org/0000-0003-3513-7659
| | - Jorge Eliécer Botero López
- An tioquia School of Engineering, Universidad EIA, Vda. El Penasco, Envigado, Antioquia 055428, Colombia.,https://orcid.org/0000-0003-2907-5500
| | - Javier Enrique Fox Quintana
- San Vicente Children's Hospital Foundation, Calle Barranquilla #51b-22, Medellín 050010, Colombia.,https://orcid.org/0000-0002-1014-9402
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16
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Ringwald-Smith K, Hill R, Evanoff L, Martin J, Sacks N. When Reality and Research Collide: Guidelines Are Essential for Optimal Nutrition Care in Pediatric Oncology. J Pediatr Hematol Oncol 2022; 44:e144-e151. [PMID: 34001795 DOI: 10.1097/mph.0000000000002200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/28/2021] [Indexed: 11/26/2022]
Abstract
Nutritional problems are common in pediatric oncology due to the side effects of the disease and treatment. Nutrition intervention can be challenging, and little is known about the current clinical practice of registered dietitian nutritionists. An online questionnaire emailed to members of the pediatric, oncology nutrition, and clinical manager practice groups of the Academy of Nutrition and Dietetics, consisted of items related to current nutrition practice. Our questionnaire results suggest that the field of pediatric oncology is employed with relatively new dietitians (62% had <5 y of experience). Many registered dietitian nutritionists (60%) are providing care across the cancer care continuum (standard therapy, transplant, and survivorship) versus specializing in a particular area. Approximately half (52%) felt that their center had inadequate staffing, many reporting little in the outpatient setting. Barriers to providing optimal patient care included inadequate staffing, lack of time for research initiatives, and lack of evidence-based guidelines. Future studies should determine follow-up guidelines and appropriate staffing ratios for nutrition care in pediatric oncology. Approaches should be developed to support less experienced dietitians. Collaboration between dietitians at different facilities will likely be key in developing essential evidence-informed guidelines.
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Affiliation(s)
- Karen Ringwald-Smith
- Department of Clinical Nutrition, St. Jude Children's Research Hospital, Memphis, TN
| | - Rachel Hill
- Department of Pediatric Hematology/Oncology, Cook Children's Health Care System, Fort Worth, TX
| | - Lisa Evanoff
- Department of Clinical Nutrition, St. Jude Children's Research Hospital, Memphis, TN
| | - Jenna Martin
- Department of Clinical Nutrition, St. Jude Children's Research Hospital, Memphis, TN
| | - Nancy Sacks
- Center for Childhood Cancer Research and Division of Oncology and Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, PA
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17
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Sasse P, Bergmann A, Afonso W, Ladas EJ, Ferman S. Malnutrition at diagnosis and throughout therapy in pediatric patients with solid tumors: A single-institution study in a developing country. Pediatr Blood Cancer 2021; 68:e29317. [PMID: 34490992 DOI: 10.1002/pbc.29317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Changesin nutritional status can constitute a risk factor for reduced tolerance and effectiveness of antineoplastic treatment. Knowledge of the nutritional status of pediatric patients is important for implementing interventions to improve outcomes. We aimed to evaluate nutritional status at diagnosis and throughout therapy in pediatric patients with solid tumors. OBJECTIVES To study the prevalence of malnutrition at diagnosis, compare different assessment tools, and examine longitudinal changes in nutritional status during the treatment of pediatric patients with solid tumors in a Brazilian institution. METHODS This prospective single-center study enrolled patients with solid tumors (age <19 years) from June 2017 to May 2018. Nutritional evaluations were performed at diagnosis and after 3 and 6 months of treatment. z-Scores for height for age (H/A) and body mass index for age (BMI/A) were calculated using the Anthro/AnthroPlus software and mid-upper arm circumference (MUAC) percentile was used for nutritional classification. RESULTS The prevalence of nutritional status at diagnosis was 29.3% malnourished, 49.5% adequate, and 21.2% overweight/obese. Nutritional status improved during the first 3 months of treatment, with a reduction in the proportion of malnourished patients and an increased number of patients with adequate nutritional status. CONCLUSIONS The two combined indices, BMI/A and MUAC, facilitated the diagnosis of a greater number of patients with solid tumors who had nutritional alterations. A high prevalence of malnutrition was present at diagnosis. Nutritional status improved in the first 3 months of treatment and could be related to the multidisciplinary institutional approach following the diagnosis.
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Affiliation(s)
- Patricia Sasse
- Department of Pediatric Oncology, Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil
| | - Anke Bergmann
- Clinical Research Division, Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil
| | - Wanelia Afonso
- Department of Nutrition, Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, New York, USA
| | - Sima Ferman
- Department of Pediatric Oncology, Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil
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18
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Does sarcopenia affect outcomes in pediatric surgical patients? A scoping review. J Pediatr Surg 2021; 56:2099-2106. [PMID: 33500162 DOI: 10.1016/j.jpedsurg.2021.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/06/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Adults with sarcopenia have a greater risk of postoperative complications, a higher rate of ICU admission, and an increased length of hospital stay. Few studies have explored the prevalence or importance of sarcopenia in the pediatric population. This study reviews the published literature on sarcopenia in the pediatric population, including pediatric surgery. METHODS Original studies related to sarcopenia in children were identified using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and the PubMed database. RESULTS A total of 390 articles were screened, with 28 meeting inclusion criteria. Twenty (71%) studies provided a means to define abnormal and 18 studies (64%) showed that a specific disease process could impact lean muscle mass in children. Only 4 (14%) studies associated the change in muscle mass with an outcome. Two studies investigated sarcopenia and outcomes in the pediatric surgical patient and demonstrated associations with worse outcomes. CONCLUSION Despite studies showing an association between sarcopenia and negative outcomes in the adult surgical population, there remains a paucity of evidence regarding the impact of sarcopenia on the pediatric population. Future studies are needed to ascertain the relationship between muscle mass and outcomes in pediatric surgical patients.
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19
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Vieira RR, de Campos MMS, Zamberlan P, Viani K. Can calf circumference be a viable option for nutritional assessment in the PICU? Clin Nutr ESPEN 2021; 45:356-362. [PMID: 34620340 DOI: 10.1016/j.clnesp.2021.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children admitted to paediatric intensive care units (PICUs) often need specialised nutritional intervention. Nutritional assessments provide specific data to support such interventions. Body composition measures, such as mid-upper arm circumference (MUAC), can complement nutritional assessment. However, MUAC has limitations. Calf circumference (CC) is an easy and common measure of muscle loss in the elderly; however, there are still very few studies on CC in children. AIMS To evaluate the viability of using CC for nutritional monitoring of children under intensive care, compared with MUAC and weight. METHODS Patients aged 2-10 years admitted to the PICU between December 2018 and August 2019 were included in the study. Two MUAC, CC, and weight measurements were performed: one in the first 24 h after PICU admission and another after 7 days. As there are no reference values for CC in children, this measure was used solely to observe the patient's individual progress. The nutritional status, both according to body mass index and MUAC, was used to characterise samples. Percentage changes in these measures were compared using the Wilcoxon signed-rank test for comparison between medians and Spearman's correlation test. Information from medical records regarding hospitalisation was also collected and analysed. RESULTS Thirty patients were included in the study. During hospitalisation week 1, CC decreased significantly (p = 0.001), whereas MUAC (p = 0.427) and weight (p = 0.315) did not change significantly. Percentage changes in CC and MUAC were statistically different (p = 0.0449), with a positive correlation between the changes in both measures (p = 0.0333; r = 0.3896); conversely, although the percentage changes in CC and weight significantly differed (p = 0.0066), no correlation was found between them (p = 0.9382; r = 0.0148). The percentage changes in MUAC and weight were not different (p = 0.1880) or correlated (p = 0.1691; r = 0.2577). No statistically significant relationship was found between percentage changes in CC and clinical outcomes (length of stay, fasting time, and mechanical ventilation time). CONCLUSIONS CC appears to be a viable measure for use in PICUs. Although positively correlated with MUAC, a measure proven useful in critically ill children, CC decreased significantly in the first week of intensive care, whereas MUAC remained unchanged, indicating that CC may show signs of depletion earlier than MUAC in these patients. Our study reinforces the importance of alternative measures for anthropometric assessment of critically ill children.
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Affiliation(s)
- Rafaela Rodrigues Vieira
- Instituto da Criança do Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | | | - Patrícia Zamberlan
- Instituto da Criança do Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Karina Viani
- ITACI - Haematology-Oncology Department of Instituto da Criança do Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.
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20
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Prasad M, Tandon S, Gala R, Kannan S, Chinnaswamy G, Narula G, Vora T, Banavali S, Mehta S, Paradkar A, Goswami S, Ghadge M, Jagiasi D, Sharma S, Fernandes L, Manglani M, Jadhav A, Barr R, Ladas E. Efficacy of ready-to-use therapeutic food in malnourished children with cancer: Results of a randomized, open-label phase 3 trial. Pediatr Blood Cancer 2021; 68:e29197. [PMID: 34212474 DOI: 10.1002/pbc.29197] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The adverse influence of undernutrition in children with cancer may be remediated by early nutritional intervention. This study assessed the efficacy of ready-to-use therapeutic food (RUTF) in improving nutritional status and reducing treatment-related toxicities (TRTs) in such children. METHODS In a randomized controlled phase-3 open-label trial, severely and moderately undernourished children with cancer were randomized 1:1 to receive standard nutritional therapy (SNT) or SNT+RUTF for 6 weeks. The primary outcome (weight gain >10%) and secondary outcomes (improved/maintained nutritional status, improved body composition) were assessed after 6 weeks. TRTs were assessed over 6 months. RESULTS Between July 2015 and March 2018, 260 subjects were enrolled, 126 were analyzable in both arms at 6 weeks. More children on RUTF had weight gain (98 [77.8%] vs. 81 [64.2%], p = .025) with a greater increase in fat mass as a percentage of body mass (median 2% [IQR -0.12 to 4.9] vs. 0.5% [IQR -1.45 to 2.27, p = .005]) but a greater loss of lean mass (median -1.86% [IQR -4.4 to 0.50] vs. -0.4% [IQR -2.4 to 1.4, p = .007]) compared to the SNT arm. Fewer subjects on the RUTF arm had episodes of severe infection (10.6% vs. 31%, p < .0001), treatment delays (17.7% vs. 39%, p < .0001), and severe mucositis (11% vs. 23.8%, p = .006) compared to the SNT arm. The odds of developing TRTs on the RUTF arm were lower even after adjusting for improvement in nutritional status. CONCLUSIONS RUTF is efficacious in improving weight gain and nutritional status in undernourished children with cancer and decreases TRTs. Incorporating RUTF into a healthy, balanced diet should be considered in undernourished children with cancer.
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Affiliation(s)
- Maya Prasad
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Sneha Tandon
- Division of Paediatric Oncology, Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rajul Gala
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sadhna Kannan
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Biostatistics, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Gaurav Narula
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Tushar Vora
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Shripad Banavali
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Medical Oncology, Tata Memorial Centre Parel, Mumbai, Maharashtra, India
| | - Shaesta Mehta
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Digestive Disease and Clinical Nutrition, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Amey Paradkar
- Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.,Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Savita Goswami
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Psycho-Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Meera Ghadge
- Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.,Department of Biochemistry, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Sujata Sharma
- Department of Pediatrics, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Lavina Fernandes
- Department of Pediatrics and Nutrition Rehabilitation Research and Training Centre, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Mamta Manglani
- Paediatric Haematoology Oncology, Comprehensive Thalassemia Care and Bone Marrow Transplant Centre, Mumbai, Maharashtra, India
| | - Alka Jadhav
- Department of Pediatrics and Nutrition Rehabilitation Research and Training Centre, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elena Ladas
- Division of Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
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21
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Khadilkar AV, Khadilkar VV, Gondhalekar KM, Kajale NA, Karkera PH, Prasad M, Trehan A, Barr RD, Ladas EJ. Reference centile curves for mid-upper arm circumference for assessment of under- and overnutrition in school-aged Indian children and adolescents. Nutrition 2021; 91-92:111401. [PMID: 34364267 DOI: 10.1016/j.nut.2021.111401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Malnutrition is common in developing countries and is not restricted to young children. It has been suggested that measuring mid-upper arm circumference (MUAC) is an easy, accurate, and low-cost method of identifying malnutrition in the early stages. The aims of this study were to construct age- and sex-specific MUAC reference centiles, and to define and validate cutoffs for assessment of under- and overnutrition in Indian children 5 to 17 y of age. METHODS This was a cross-sectional, multicentric, observational study conducted in seven schools in seven states from June 2018 to November 2019. The study included 6680 healthy 5- to17-y-old children. MUAC was measured using non-stretch tapes (UNICEF). Sex-specific MUAC percentiles were computed for age and height. Cutoffs for MUAC z-scores for thinness and overnutrition were defined and validated for healthy school children (n = 726) and children with cancer (n = 500). RESULTS Reference centiles for MUAC for age (and height) for boys and girls are presented. Cutoffs defined for thinness and for obesity were -0.7 and +1.5 z-score, respectively (corresponding to 25th and 95th percentiles of the MUAC for age/height). For ease of use, rounded cutoffs for thinness were 16 and 18.5 cm from 5 to 9 and 10 to 14 y of age, respectively, in both sexes, and a cutoff of 22 cm in boys and 20 cm in girl from 15 to 17 y of age. For obesity, 20 and 25.5 cm from 5 to 9 and 10 to 14 y of age, respectively, in both girls and boys and a rounded cutoff of 29 cm in boys and 27 cm in girls from 15 to17 y are proposed. CONCLUSIONS We presented MUAC percentiles and cutoffs for screening for thinness and overnutrition in Indian children from 5 to 17 y of age. These data may also be used in children with cancer and other chronic disorders with growth failure.
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Affiliation(s)
- Anuradha V Khadilkar
- Paediatric Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital. Pune University, Pune, India.
| | - Vaman V Khadilkar
- Paediatric Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital. Pune University, Pune, India
| | - Ketan M Gondhalekar
- Paediatric Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital. Pune University, Pune, India
| | - Neha A Kajale
- Paediatric Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital. Pune University, Pune, India
| | - Priya H Karkera
- Fitterfly Health Technologies, Mumbai, India; Department of Nutrition, Surya Children's Hospital, Mumbai, India
| | - Maya Prasad
- Paediatric Oncology, Tata Memorial Hospital, Mumbai, India
| | - Amita Trehan
- Paediatric Haematology Oncology Unit, Advanced Pediatric Center, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ronald D Barr
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Irving Medical Center, New York, New York, USA
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Kadenczki O, Nagy AC, Kiss C. Prevalence of Undernutrition and Effect of Body Weight Loss on Survival among Pediatric Cancer Patients in Northeastern Hungary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041478. [PMID: 33557419 PMCID: PMC7914605 DOI: 10.3390/ijerph18041478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 11/16/2022]
Abstract
Undernutrition is a prevalent condition in pediatric malignancy patients leading to unfavorable outcomes. The aim of this retrospective study was to determine the nutritional status and rate of undernutrition in 174 Hungarian pediatric patients with malignancies and the impact on 5-year survival based on anthropometric measurements. At the time of diagnosis, 5.0%, 4.6%, and 4.0% of patients were undernourished as determined by body weight (BW), weight-for-height (WFH), and body mass index (BMI) Z-score, respectively. The rate of undernutrition was 30.5% using ideal body weight percent (IBW%). Undernutrition at the time of diagnosis worsened the five-year overall survival only in solid tumor patients as defined by BMI Z-score and IBW%. Furthermore, 26.5% of patients became undernourished based on IBW% during the treatment period. Deterioration of nutritional status during treatment unfavorably influenced overall survival in both hematological and solid tumor subsets. Abnormal BW, WFH, and BMI Z-score were associated with poor prognosis in the hematologic group. The mortality risk was higher among hematologic patients with weight loss exceeding 20%. In conclusion, IBW% seems to be the most sensitive parameter to estimate undernutrition. Furthermore, BMI Z-score in both groups and severe weight loss in the hematological group may influence clinical outcome and play a role in prognosis assessment.
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Affiliation(s)
- Orsolya Kadenczki
- Department of Pediatrics, University of Debrecen, 4032 Debrecen, Hungary;
- Correspondence:
| | - Attila Csaba Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, 4032 Debrecen, Hungary;
| | - Csongor Kiss
- Department of Pediatrics, University of Debrecen, 4032 Debrecen, Hungary;
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Yaprak DS, Yalçın B, Pınar AA, Büyükpamukçu M. Assessment of nutritional status in children with cancer: Significance of arm anthropometry and serum visceral proteins. Pediatr Blood Cancer 2021; 68:e28752. [PMID: 33034161 DOI: 10.1002/pbc.28752] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/26/2020] [Accepted: 09/13/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Arm anthropometry is a better indicator of nutritional status in children with cancer. The value of serum albumin and prealbumin in nutritional assesment is debatable. We investigated the nutritional status of children with cancer and their serum albumin and prealbumin levels. PATIENTS AND METHODS At diagnosis and following induction therapies, weight, height, body mass index (BMI), mid-upper arm circumference (MUAC), and triceps skin-fold thickness (TSFT) were measured; serum albumin and prealbumin levels were determined. Prevalences of malnutrition defined by anthropometric indices were calculated. Correlations of anthropometric indices with each other, with serum albumin/prealbumin levels, and clinicopathological parameters were analyzed. RESULTS In 81 patients, median age was 7.5 years (males/females = 50/31), tumors were located mostly in the abdomen, and abdominal tumors were more common under 5 years. Prevalence of malnutrition according to weight for age, BMI, MUAC, TSFT z scores were 14.8%, 23.5%, 27.2%, 21%, respectively. Defined by combined BMI/MUAC/TSFT measurements, 33/81 cases (40.7%) had malnutrition (z scores < -1, 23 mild; z scores < -2, 10 moderate). Malnutrition was more prevalent under 5 years (P = .03), also in abdominal tumors (P = .03) and advanced disease (P < .001). Younger age and advanced disease were risk factors for malnutrition. At diagnosis, prevalences of low serum albumin and prealbumin levels were 7.4% and 54%, respectively. Cases with malnutrition had significantly lower survival rates. CONCLUSIONS Nutritional status is assessed best by MUAC and TSFT measurements. Serum prealbumin levels can be used to identify patients at risk of undernutrition. Presence of malnutrition is a significant poor prognostic factor. All children with cancer should undergo nutritional evaluation and active nutritional support.
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Affiliation(s)
- Deniz Sül Yaprak
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bilgehan Yalçın
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aslı Akhun Pınar
- Department of Medical Biochemistry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Münevver Büyükpamukçu
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Diakatou V, Vassilakou T. Nutritional Status of Pediatric Cancer Patients at Diagnosis and Correlations with Treatment, Clinical Outcome and the Long-Term Growth and Health of Survivors. CHILDREN-BASEL 2020; 7:children7110218. [PMID: 33171756 PMCID: PMC7694979 DOI: 10.3390/children7110218] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Abstract
Malnutrition is caused either by cancer itself or by its treatment, and affects the clinical outcome, the quality of life (QOL), and the overall survival (OS) of the patient. However, malnutrition in children with cancer should not be accepted or tolerated as an inevitable procedure at any stage of the disease. A review of the international literature from 2014 to 2019 was performed. Despite the difficulty of accurately assessing the prevalence of malnutrition, poor nutritional status has adverse effects from diagnosis to subsequent survival. Nutritional status (NS) at diagnosis relates to undernutrition, while correlations with clinical outcome are still unclear. Malnutrition adversely affects health-related quality of life (HRQOL) in children with cancer and collective evidence constantly shows poor nutritional quality in childhood cancer survivors (CCSs). Nutritional assessment and early intervention in pediatric cancer patients could minimize the side effects of treatment, improve their survival, and reduce the risk of nutritional morbidity with a positive impact on QOL, in view of the potentially manageable nature of this risk factor.
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Affiliation(s)
- Vassiliki Diakatou
- Children’s & Adolescents’ Oncology Radiotherapy Department, Athens General Children’s Hospital “Pan. & Aglaia Kyriakou”, GR-11527 Athens, Greece;
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 196 Alexandras Avenue, GR-11521 Athens, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 196 Alexandras Avenue, GR-11521 Athens, Greece
- Correspondence: ; Tel.: +30-213-2010-283
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Chheda E, Prasad M. Focused nutrition clinic for severely malnourished children with cancer is feasible and effective in high-volume, resource-constrained settings. Expert Rev Anticancer Ther 2020; 20:919-920. [PMID: 32924649 DOI: 10.1080/14737140.2020.1823225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ekta Chheda
- Division of Pediatric Oncology, Tata Memorial Hospital , Mumbai, India
| | - Maya Prasad
- Division of Pediatric Oncology, Tata Memorial Hospital , Mumbai, India
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Behling EB, Camelo Júnior JS, Ferriolli E, Pfrimer K, Monteiro JP. NUTRITIONAL STATUS IN CHILDREN WITH CANCER: COMPARISON OF DEUTERIUM OXIDE DILUTION WITH BIOELECTRIC IMPEDANCE ANALYSIS AND ANTHROPOMETRY. ACTA ACUST UNITED AC 2020; 39:e2019209. [PMID: 32756757 PMCID: PMC7401501 DOI: 10.1590/1984-0462/2021/39/2019209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/22/2019] [Indexed: 11/22/2022]
Abstract
Objective: To explore changes in the nutritional status of pediatric cancer patients
before and after chemotherapy and evaluate the correlation between deuterium
oxide dilution, bioelectric impedance analysis, and anthropometry for
assessment of body composition. Methods: This study included 14 children (aged 5.6 to 13.6 years) and classified them
as having hematologic or solid tumors. They had their body composition
analyzed according to deuterium oxide, bioelectric impedance, and
anthropometric measurements before the first chemotherapy cycle and after
three and six months of therapy. Results: The patients in the hematologic tumor group had an increase in weight,
height, body mass index, waist, hip, and arm circumference, subscapular
skinfold thickness, and fat mass with the isotope dilution technique during
chemotherapy. In the solid tumor group, the children showed a reduction in
fat-free mass when assessed by bioimpedance analysis. We found a positive
correlation between the triceps skinfold thickness and fat mass determined
by bioimpedance analysis and deuterium oxide. The arm muscle circumference
correlated with the fat-free mass estimated by bioimpedance analysis and
deuterium oxide. Conclusions: Patients with hematologic tumors had an increase in body weight, height, and
fat mass, which was not identified in the solid tumor group. The positive
correlation between anthropometry (triceps skinfold thickness and arm muscle
circumference), deuterium oxide dilution, and bioelectric impedance analysis
shows the applicability of anthropometry in clinical practice.
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Nutritional screening and assessment of paediatric cancer patients: A quality improvement project (baseline results). Clin Nutr ESPEN 2020; 38:242-252. [DOI: 10.1016/j.clnesp.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 03/09/2020] [Accepted: 04/05/2020] [Indexed: 12/23/2022]
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Nutritional status at diagnosis among children with cancer referred to a nutritional service in Brazil. Hematol Transfus Cell Ther 2020; 43:389-395. [PMID: 32631810 PMCID: PMC8573002 DOI: 10.1016/j.htct.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/15/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Children and adolescents with cancer are particularly vulnerable to malnutrition and require special attention on nutritional assessment. An adequate nutritional status during treatment is essential in reducing morbidity and mortality, being a modifiable risk factor for clinical outcomes. This study aims to determine the nutritional status of pediatric patients with cancer assessed by the nutrition team at diagnosis and evaluate its association with the overall survival. Method This is a retrospective cross-sectional study of patients at the time of cancer diagnosis who had nutritional assessments when hospitalized or referred to the nutrition outpatient clinic. Nutritional status was classified by the mid-upper arm circumference (MUAC) and body mass index for age z-score (zBMI/A). The Cox regression analysis was used to determine the association between the nutritional status and overall survival, adjusting for gender, tumor group and age. Results The study included 366 patients. The prevalence of undernutrition varied from 8 to 23% and overweight, from 5 to 20%. The MUAC identified more children as undernourished than the zBMI/A in patients with solid and hematological tumors. There was no significant difference in the overall survival by malnutrition classified by the zBMI/A (p = 0.1507) or MUAC (p = 0.8135). When adjusted for gender, tumor group and age, the nutritional status classification by the zBMI/A (hazard ratio [HR], 1.27; 95% confidence interval [CI], 0.88–1.83; p = 0.209) and MUAC (HR, 0.94; 95% CI, 0.61–1.44; p = 0.773) did not impact overall survival. Conclusion The nutritional status at diagnosis did not significantly impact the overall survival, which suggests there may have been a protective effect by successful nutritional intervention during the subsequent care.
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Murphy-Alford AJ, Prasad M, Slone J, Stein K, Mosby TT. Perspective: Creating the Evidence Base for Nutritional Support in Childhood Cancer in Low- and Middle-Income Countries: Priorities for Body Composition Research. Adv Nutr 2020; 11:216-223. [PMID: 31529044 PMCID: PMC7442409 DOI: 10.1093/advances/nmz095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/04/2019] [Accepted: 08/13/2019] [Indexed: 01/07/2023] Open
Abstract
There is a striking disparity in survival rates for children in low- and middle-income countries (LMICs) compared with high-income countries (HICs). Many of the contributing factors are preventable, including the comorbidity of malnutrition. There are emerging data that malnutrition, as reflected in body composition changes, impacts survival of cancer. However, not enough priority is given to nutrition management of children with cancer, particularly in LMICs. The primary purpose of this article is to review the current knowledge on childhood cancer and body composition in LMICs and identify priorities for future research into the interlinking associations between cancer, body composition, and clinical outcomes for childhood cancer patients. Evidence will ensure feasible and effective nutrition management is prioritized in childhood cancer centers in LMICs and contribute to improving outcomes for children with cancer.
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Affiliation(s)
- Alexia J Murphy-Alford
- Nutritional and Health-Related Environmental Studies Section, International Atomic Energy Agency, Vienna, Austria,Address correspondence to AJM-A (e-mail: )
| | - Maya Prasad
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Jeremy Slone
- Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Katja Stein
- Civil Hospital of Guadalajara Dr Juan I Menchaca, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
| | - Terezie T Mosby
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University, Mississippi State, MS, USA
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BELIN CHS, BUENO MDC, CRUZ LBDA, SELISTRE SGDA, BEHLING EB. Changes in nutritional status in adolescents surviving leukemia and lymphoma. REV NUTR 2020. [DOI: 10.1590/1678-9865202033e190194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
ABSTRACT Objective To examine the changes in the nutritional status of adolescents aged 10-19 years after a minimum 12 months interval following oncological treatment for leukemias and lymphomas. Methods Longitudinal design quantitative study conducted at Hospital de Clínicas, Porto Alegre. Adolescents aged 10-19 years after a minimum 12 months interval following oncological treatment for leukemias and lymphomas were included. The measures of weight, height, brachial circumference, triceps skinfold thickness, arm muscle circumference and abdominal circumference were collected. Results The sample comprised 50 adolescents who had survived leukemias and lymphomas. In the follow up 38% of the patients were classified as overweight according to the body mass index for their age. There was a significant increase in body mass index for age between the beginning and the end of treatment and follow up (p=0.013) in female individuals, compared to males. The results indicate a reduction in the Z-score means of height for age, with significant differences between the beginning of treatment and follow up (p=0.016); and end of treatment and follow up (p=0.006) in patients of both genders Conclusion The anthropometric indicators show an important frequency of excess weight and increased tricipital skinfold, as well as a significant increase of the body mass index for age and also a growth deficit among the survivors.
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Evaluation of Baseline Cardiac Function by Echocardiography and its Association With Nutritional Status in Pediatric Cancer Patients at The Indus Hospital in Karachi, Pakistan. J Pediatr Hematol Oncol 2019; 41:e388-e394. [PMID: 30870387 DOI: 10.1097/mph.0000000000001437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Evidence on conducting baseline echocardiogram before starting chemotherapy in pediatric cancer patients is limited from developing countries where malnutrition and infections are common and which may result in cardiac dysfunction. MATERIALS AND METHODS A prospective, observational study was conducted from October 2016 to May 2017 at The Indus Hospital, Karachi, Pakistan, among children 1 to 16 years of age suffering from cancer. Echocardiography was performed before starting chemotherapy. Associations between body mass index and cardiac abnormalities were studied. RESULTS A total of 384 children met the inclusion criteria. The median (interquartile range) age was 8.0 (5.0 to 12.0) years and 62.0% (n=238) were male individuals. Twenty-two of 384 (5.7%) children had systolic dysfunction. Four of 22 had moderate-systolic and one of 22 had mild systolic dysfunction, for whom the therapy was altered, and they were treated without anthracyclines. Four of these 5 patients died, and only 1 of 5 survived through high-risk protocol. Seventeen of 22 children had low-normal systolic dysfunction. We found no evidence of an association between body mass index for age and abnormal left ventricular ejection fraction and abnormal fractional shortening (P-trend=0.587; 0.487, respectively). No associations were found of weight-for-age and height-for-age with these outcomes. CONCLUSIONS In developing countries, echocardiograms should be expeditiously performed and technology made more accessible to rule out cardiac dysfunction and avoid delay in chemotherapy. Malnutrition was not associated with cardiac dysfunction.
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Enteral Nutrition in Pediatric High-risk Head and Neck Cancer Patients Receiving Proton Therapy: Identifying Risk Factors and Quality of Life Concerns to Optimize Care. J Pediatr Hematol Oncol 2019; 41:e247-e253. [PMID: 31026252 DOI: 10.1097/mph.0000000000001364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Radiotherapy for pediatric head and neck tumors often results in mucositis and pain, limiting oral intake and compromising patients' nutrition. There are little pediatric data available regarding enteral tube use and risk factors. Our objective was to estimate nutrition needs, identify risk factors contributing to nutritional decline and explore quality of life measures regarding enteral nutrition during proton radiotherapy. PROCEDURE Nutritional metrics and status were collected throughout radiation treatment for 32 patients. We surveyed patients/caregivers about their perceptions of enteral nutrition. Risk factors for progression to non-oral nutrition or >5% weight loss were evaluated using univariate analysis. RESULTS Patients who received any esophageal radiation or >30 Gy mean dose to the pharyngeal constrictors were more likely to experience >5% weight loss. These patients, as well as those who received a mean dose >30 Gy to the oropharynx or concurrent chemotherapy, were also more likely to require non-oral supplementation. Patients expressed the importance of maximizing nutrition and feared pain associated with a tube placement. CONCLUSIONS Pediatric patients with head and neck cancer can be risk-stratified based on clinical and dosimetric factors. This data, combined with parent and patient perceptions, is key to the development of rational guidelines.
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Chaber R, Latos-Grażyńska E, Ciebiera K, Łach K, Tokar B, Cebulski J, Trybucka K, Mazur A. Body Mass Index (BMI) and Infectious/Febrile Episodes in Children with Intermediate Risk Acute Lymphoblastic Leukemia (IR ALL). Nutr Cancer 2018; 71:701-707. [PMID: 30407874 DOI: 10.1080/01635581.2018.1516792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The incidence of treatment related mortality in children with acute lymphoblastic leukemia (ALL) is reported to be between 2% and 4% with infections being the leading cause. AIM To establish a relationship between body mass index at diagnosis (BMI 0), after protocol I therapy completion (BMI I) and the incidence rate ratio (IRR) of infectious/febrile episodes in children with ALL intermediate risk. METHODS Thirty one consecutive patients (2-18 years old, with a male to female ratio of 19/12) with newly diagnosed ALL that were treated uniformly according to ALL IC 2009 protocol were included in this analysis. RESULTS A BMI decrease of at least 5% during protocol I therapy and BMI 1 under 15th percentile score corresponds significantly with higher IRR (with P-values 0.04 and 0.006 respectively) during the whole intensive therapy. CONCLUSION Some relationships between BMI reduction and higher IRR in ALL patients were found, but their significance is limited by the size of the group analyzed.
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Affiliation(s)
- Radosław Chaber
- a Clinic of Paediatric Oncology and Haematology, Faculty of Medicine , University of Rzeszow , Rzeszow , Poland
| | - Elżbieta Latos-Grażyńska
- b Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology , Wroclaw Medical University , Wroclaw , Poland
| | | | - Kornelia Łach
- a Clinic of Paediatric Oncology and Haematology, Faculty of Medicine , University of Rzeszow , Rzeszow , Poland
| | - Barbara Tokar
- b Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology , Wroclaw Medical University , Wroclaw , Poland
| | - Józef Cebulski
- d Center for Innovation and Transfer of Natural Sciences and Engineering Knowledge, University of Rzeszow , Rzeszow , Poland
| | - Katarzyna Trybucka
- a Clinic of Paediatric Oncology and Haematology, Faculty of Medicine , University of Rzeszow , Rzeszow , Poland
| | - Artur Mazur
- e Clinic of Paediatric Endocrinology, Faculty of Medicine , University of Rzeszow , Rzeszow , Poland
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Barr RD, Gomez-Almaguer D, Jaime-Perez JC, Ruiz-Argüelles GJ. Importance of Nutrition in the Treatment of Leukemia in Children and Adolescents. Arch Med Res 2016; 47:585-592. [DOI: 10.1016/j.arcmed.2016.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/23/2016] [Indexed: 11/28/2022]
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