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Malnutrition at diagnosis of malignancy in childhood: common but mostly missed
D E Smith1, M C Stevens, I W Booth
1Institute of Child Health, University of Birmingham, UK.
Insights
Newly diagnosed pediatric cancer patients often show normal height and weight but reduced arm measurements, indicating malnutrition. Intra-abdominal tumors correlate with worse nutritional status and lower energy intake at diagnosis.
Area of Science:
- Pediatric Oncology
- Nutritional Science
- Anthropometry
Background:
- Nutritional status is critical for pediatric cancer patients' outcomes.
- Standard anthropometric measures may not fully capture malnutrition in this population.
- Tumor burden and type can significantly impact nutritional reserves.
Purpose of the Study:
- To assess the nutritional status of newly diagnosed pediatric oncology patients.
- To identify discrepancies in anthropometric measurements.
- To evaluate energy intake relative to recommended daily allowances.
Main Methods:
- Prospective, controlled study of 100 newly diagnosed pediatric oncology patients.
- Measured height-for-age, weight-for-height, mid-upper arm circumference (MUAC), and triceps skinfold thickness (TSFT).
- Compared patient data to reference and control values; assessed energy intake.
Main Results:
- Patients exhibited normal height-for-age and weight-for-height but significantly reduced MUAC and TSFT.
- 20% of patients had MUAC below the 5th percentile; 23% had TSFT more than 2 SD below the mean.
- Children with intra-abdominal tumors showed poorer anthropometric measures and lower energy intake (44% consuming <80% RDA) compared to controls.
Conclusions:
- Standard height and weight metrics may mask malnutrition in pediatric cancer patients due to tumor mass effects.
- MUAC and TSFT are sensitive indicators of diminished nutritional status in this cohort.
- Early nutritional assessment and intervention are crucial, especially for patients with intra-abdominal malignancies.
Abstract:
A prospective, controlled study of nutritional status in 100 newly diagnosed paediatric oncology patients is reported. Results showed that although patients' height-for-age and weight-for-height were normal, mid-upper arm circumference (MUAC) and triceps skinfold thickness (TSFT) were significantly less than reference and control values. Moreover, 20% of patients had MUAC below the 5th percentile (P less than 0.001) and 23% had TSFT more than 2 SD below the mean (P less than 0.001). The discrepancy between these assessments is attributed to the effect of large tumour masses masking diminished true body weight. Children with intra-abdominal solid tumours had significantly lower MUAC and TSFT than those with either extra-abdominal solid tumours or leukaemia, and were more likely to be malnourished based on arm anthropometric criteria. Of all subjects, 44% were consuming less than 80% of their recommended daily allowance of energy at diagnosis, compared with 0% of controls (P = 0.001).