Development and validation of a nutrition risk screening for patients with childhood cancer in Brazil (NUTRICCAN)

Diagnosing malnutrition in patients with pediatric cancer is challenging because tumor masses can interfere with anthropometric measurements. STRONGkids considers cancer a general risk factor, whereas Screening Tool for Childhood Cancer (SCAN) classifies patients as at risk or not, potentially missing those who need nutrition monitoring. This study describes development and validation of a new nutrition risk screening tool for childhood cancer in Brazil.

Nutrition Risk Screening for Childhood Cancer (NUTRICCAN) underwent online expert content validation. Twelve nutritionists applied it to oncology inpatients (0-19 years old) at the Pediatric Oncology Institute at Federal University of São Paulo from June to August 2024. Nutrition risk was assessed using NUTRICCAN, STRONGkids, and SCAN. Logistic regression identified screening variables associated with malnutrition (body mass index-for-age z score < -2, mid-upper arm circumference [MUAC] <5^th percentile, calf circumference below cutoff, or met any of the criteria for malnutrition). Receiver operating characteristic analysis determined cutoff scores, and sensitivity/specificity analyses allowed comparisons among instruments.

Patients not receiving intensive care were almost three times more likely to have an inadequate MUAC (odds ratio [OR], 4.505; 95% confidence interval [CI], 1.446-14.033; P = 0.009). Low socioeconomic status or caregiver education increased the risk of malnutrition (OR, 2.845; 95% CI, 1.070-7.566; P = 0.036). Dietitians' subjective assessments were associated with a fourfold increased risk of malnutrition. NUTRICCAN was 70% accurate (area under the curve, 0.701; 95% CI, 0.617-0.785), outperforming the other tools.

NUTRICCAN better stratifies nutritional risk, considering clinical and socioeconomic factors, and may allow for more targeted interventions, especially in resource-limited settings.