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Nutritional status at admission of children with cancer in Malawi
Trijn Israëls1, Chawanangwa Chirambo, Huib N Caron
1Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi. trijnisraels@hotmail.com
Insights
More than half of Malawian children with cancer are acutely malnourished at diagnosis. This severe malnutrition, alongside stunting, complicates treatment and requires tailored nutritional support for pediatric oncology patients.
Area of Science:
- Pediatric Oncology
- Nutritional Science
- Global Health
Background:
- Malnutrition affects 10-50% of children with cancer in industrialized nations.
- In developing countries, undernutrition is common, and late-stage cancer presentation exacerbates malnutrition in children.
- Malnutrition is linked to increased chemotherapy toxicity and infectious complications in pediatric cancer patients.
Purpose of the Study:
- To assess the prevalence of malnutrition in pediatric oncology patients in Malawi.
- To compare anthropometric measures for detecting acute malnutrition in this population.
Main Methods:
- A prospective study included 128 new pediatric oncology patients at Queen Elizabeth Central Hospital, Malawi (2007-2008).
- Data collected included age, diagnosis, HIV status, weight, height, mid-upper-arm-circumference (MUAC), and triceps skinfold (TSF).
- Arm muscle area (AMA) was calculated, and nutritional data were compared against 1978 NCHS growth curves.
Main Results:
- Over half of the children (55.1%) had low arm muscle area, and 59.3% had low triceps skinfold and MUAC, indicating acute malnutrition.
- Forty-four point five percent of patients were stunted (height-for-age <-2 SD).
- Weight-for-height <-2 SD was observed in 17.2% of patients.
Conclusions:
- Arm anthropometry reveals severe acute malnutrition in over 50% of Malawian children with cancer at diagnosis.
- Arm measurements are more sensitive than weight-for-height for detecting acute malnutrition, especially with large tumors.
- High rates of stunting (45%) complicate the interpretation of weight-for-age in this population.
Background:
Malnutrition at diagnosis is found in 10-50% of children with cancer in industrialized countries. In developing countries a large proportion of the normal paediatric population is undernourished and children with cancer often present late with advanced disease. Therefore it would be expected that many children with cancer are malnourished at admission. Malnutrition is associated with more severe chemotherapy toxicity and infectious complications.
Methods:
All new paediatric oncology patients admitted in the Queen Elizabeth Central Hospital, Blantyre, Malawi between 1, January 2007 and 1, January 2008 were included. We documented age, clinical diagnosis, HIV status, weight, height, mid-upper-arm-circumference (MUAC) and triceps skinfold (TSF), and calculated arm muscle area (AMA). Nutritional data were compared with the 1978 NCHS growth curves.
Results:
Of 128 children, 70 (55.1%) had an AMA for age <5th percentile and 76 (59.3%) had a TSF and MUAC below the 5th percentile, both parameters indicating acute malnutrition. Fifty seven patients (44.5%) had a height for age <-2 SD (indicative of stunting), and 22 patients (17.2%) had a weight for height (WFH) <-2 SD.
Conclusion:
Arm anthropometry shows that more than half of Malawian children with cancer are severely acutely malnourished at diagnosis. WFH, in children with large tumour masses, is less sensitive than arm anthropometry in detecting acute malnutrition. Forty-five percent of paediatric oncology patients in Malawi are stunted, making interpretation of weight for age (WFA) very difficult.
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