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Nutritional status in children with acute lymphoblastic leukemia, and its correlation with severe infection
Rimjhim Sonowal1, Vineeta Gupta1
1Department of Pediatrics, Division of Hematology Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Insights
Childhood undernutrition is prevalent in India, impacting survival rates for acute lymphoblastic leukemia (ALL). This study found undernutrition at diagnosis correlates with increased infection risk and mortality in pediatric ALL patients.
Area of Science:
- Pediatric Oncology
- Clinical Nutrition
- Hematology
Background:
- Undernutrition is a significant concern in Indian children, potentially increasing infection risk and reducing survival in acute lymphoblastic leukemia (ALL).
- Assessing nutritional status at diagnosis is crucial for managing pediatric ALL.
- Previous studies highlight the link between malnutrition and adverse outcomes in cancer patients.
Purpose of the Study:
- To determine the prevalence of undernutrition at diagnosis in pediatric ALL patients.
- To correlate nutritional status with severe infection rates and mortality.
- To identify risk factors associated with undernutrition in this population.
Main Methods:
- Retrospective analysis of 101 pediatric ALL patients (age 1-15) who survived induction therapy.
- Nutritional status assessed using weight-for-height, weight-for-age, and BMI criteria at diagnosis.
- Correlation of nutritional status with severe infection and mortality data.
Main Results:
- Over half (52.5%) of pediatric ALL patients presented with acute undernutrition at diagnosis.
- Patients with undernutrition showed a non-significant trend towards higher severe infection rates (10.8% increase).
- Undernutrition was associated with an 11% higher mortality rate, though statistically insignificant (P=0.21). Male gender and low albumin (<3.5 g/dL) increased infection risk in undernourished patients.
Conclusions:
- Undernutrition is highly prevalent at diagnosis in pediatric ALL patients in India.
- Nutritional status at diagnosis is linked to infection risk and mortality in pediatric ALL.
- Early nutritional assessment and intervention are vital for improving outcomes in pediatric ALL.
Background:
Undernutrition is a common childhood problem in India which may contribute to higher risk of infection and lower survival rate in children with acute lymphoblastic leukemia (ALL).
Methods:
In our study, we retrospectively included patients of age group 1-15 years who were treated for ALL and survived induction. Data on weight, height and serum albumin levels recorded at the time of diagnosis of the patients were used in this study. For defining acute undernutrition we used weight-for-height, weight-for-age criteria for children ≤5 years and body mass index for age >5 years. We correlated nutritional status of the patients with severe infection and mortality percentage.
Results:
There were 101 patients with male:female ratio of 2.4:1. Forty-four children were ≤5 years and 57 children were >5 years of age. It was found that 74 children had B-cell ALL and 17 children had T-cell ALL; 54 patients were stratified as high-risk and 47 as standard-risk. In all, 52.5% patients had acute undernutrition at diagnosis. In ALL patients with acute undernutrition, severe infection was found to be 10.8% higher than ALL patients with normal nutrition which was statistically insignificant. Male children and children with serum albumin level <3.5 g/dL in the acute undernutrition group had higher risk of infection. Mortality percentage of patients with baseline acute undernutrition was found to be higher by 11% than normal nutrition group (P-value = 0.21).
Conclusion:
Our study highlights the magnitude of undernutrition at diagnosis in ALL patients in a tertiary care centre. It also correlates nutritional status with severe infection and mortality in follow-up.
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