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Nutritional status of children during treatment for acute lymphoblastic leukemia in Guatemala
Federico Antillon1, Emanuela Rossi, Ana Lucia Molina
1Unidad Nacional de Oncologia Pediatrica, Guatemala City, Guatemala.
Insights
Malnutrition is common in children with acute lymphoblastic leukemia (ALL) in Guatemala. Improving nutritional status during treatment significantly increases survival chances for these young cancer patients.
Area of Science:
- Pediatric Oncology
- Global Health
- Nutritional Science
Background:
- Malnutrition affects up to 50% of children with cancer in developing nations.
- This study investigates malnutrition in Guatemalan children diagnosed with acute lymphoblastic leukemia (ALL).
Purpose of the Study:
- To determine the prevalence and severity of malnutrition at diagnosis and during chemotherapy.
- To assess the impact of nutritional status on treatment outcomes in pediatric ALL.
Main Methods:
- Nutritional status (NS) assessed using triceps skin fold thickness (TSFT) and mid-upper arm circumference (MUAC).
- Classified as adequately nourished (A), moderately depleted (MD), or severely depleted (SD).
- Evaluations conducted at diagnosis, and at 3 and 6 months of chemotherapy.
Main Results:
- At diagnosis, 41.5% were severely depleted (SD) and 11.6% moderately depleted (MD).
- After 6 months, severe depletion decreased to 17.7%, with 76.0% adequately nourished.
- Severe depletion at 6 months increased the hazard of death by 2.4-fold.
Conclusions:
- Malnutrition is highly prevalent in newly diagnosed pediatric ALL patients in Guatemala.
- Severe nutritional depletion predicts therapy abandonment and relapse.
- Improved nutritional status during the first 6 months enhances survival rates, approaching those without initial depletion.
Background:
Most children with cancer live in developing countries where the prevalence of malnutrition may reach 50% and influence the course of the disease. This study examined the prevalence and severity of malnutrition at diagnosis, as well as after 3 and 6 months of chemotherapy, in children with acute lymphoblastic leukemia (ALL) in Guatemala.
Methods:
Triceps skin fold thickness (TSFT) and mid upper arm circumference (MUAC) provided measures of nutritional status (NS) in three categories: adequately nourished (A): TSFT and MUAC > 10th percentile; severely depleted (SD): TSFT or MUAC < 5th percentile; and moderately depleted (MD): all the remaining patients.
Results:
Of 331 new patients, 241 had NS assessed at diagnosis. A = 113 (46.9%); MD = 28 (11.6%); SD = 100 (41.5%). At 3 months A = 106 (52.2%); MD = 25 (12.3%); SD = 72 (35.5%). At 6 months A = 146 (76.0%); MD = 12 (6.3%); SD = 34 (17.7%). In multivariate analysis, SD children at 6 months of treatment had a hazard of death that was 2.4-fold the hazard of those A or MD (95% CI: 1.3-4.7)
Conclusions:
Malnutrition is prevalent in newly diagnosed children with ALL in Guatemala and severe nutritional depletion is apparently predictive of abandonment of therapy and relapse of disease, but if children survive and improve their NS in the first 6 months after diagnosis, their chances of survival may improve significantly to approximate those in children not presenting with nutritional depletion.
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