Nutritional Assessment of Children and Adolescents with Cancer in Various Resource Settings

Background: Malnutrition has bidirectional effects in childhood cancer, as nutrition affects treatment-related adverse effects and outcomes. In turn, the cancer diagnosis and treatment, along with related psychosocial factors, can affect nutritional status. Nutritional evaluation is challenging because of the heterogeneous nutritional risks associated with a patient's cancer diagnosis and socioeconomic status, as well as because of the variation in available resources and capacity in different global settings. Methods: This review summarizes methods for evaluating nutritional status and proposes a structured approach for use across different cancer types and resource settings. Results: Conventional anthropometric measures, including weight, height, and body mass index, along with longitudinal growth curve plotting using World Health Organization or Centers for Disease Control and Prevention growth charts, are widely used but may not adequately detect changes in body composition. In resource-limited (limited-access) countries, where equipment and trained personnel are lacking, history taking, physical examination, and anthropometric measurements should be prioritized, along with basic body composition measures such as mid-upper arm circumference. In partial-access settings, biochemical assessments and bioelectrical impedance analysis may be added to identify micronutrient deficiencies and changes in lean and fat mass, respectively. In full-access settings, advanced body composition imaging techniques (e.g., dual-energy x-ray absorptiometry, computed tomography, and magnetic resonance imaging) can be incorporated. The approaches should also be adjusted based on the cancer diagnosis and treatment. Conclusions: Tailoring nutritional assessment strategies across diverse resource settings and diagnoses would be beneficial for targeted interventions that may improve clinical outcomes. Further research, quality improvement studies, and policy-level initiatives are necessary to develop effective assessments.