The article describes the model of complex rehabilitation of children treated for cancer, developed by specialists of the Research Clinical Rehabilitation Center "Russkoe Pole" Federal Research Clinical Center of Pediatric Hematology, Oncology and Immunology named after D.Rogachev. Two areas of assistance have been proposed: a retrospective based on identifying potential health risks posed by anamnestic events and a prospective one that reflects the identification of relevant factors related to health and social functioning, the impact on these factors and the tracking of future effects. Methods batteries are described that allow studying and influencing different aspects of the health-related quality of life of patients: physical, psychological and social functioning, as well as an algorithm for directed diagnostics of toxic effects.
Background. Antineoplastic treatment can have late toxic manifestations that can often appear after end of treatment. Children after treatment for acute lymphoblastic leukemia (ALL) have a risk of developing both obesity and undernutrition, which may be concealed by increased fat mass.Objective: to explore the incidence of obesity and hidden undernutrition in children with ALL and to describe the effect of enteral feeding using in these children.Materials and methods. In a retrospective study the data of 62 children with obesity that was revealed by standard examination was analyzed. The criterion of obesity was increased value of fat mass received by bioimpedance analysis. For this evaluation Russian bioimpedance analysis standards were used. Additionally, the included data were following: presence of endocrine pathology, weight change during latter 6 months before admission, physical activity and alimentary characteristics (usual regimen and structure of daily feed).Results. Only 54.8 % of patients with an actual excess of fat body mass index detected obesity (Z‑score higher than +2.00) and another 29 % body mass index was within the normal range (Z‑score from –1.00 to +1.00). This was the result of a tissue imbalance: reduce fat‑free mass. Some patients were diagnosed with insulin resistance and hyperinsulinemia. 83.7 % have a completely passive lifestyle. 49.0 % almost do not eat fruits and berries, 79.6 % – vegetables and 91.8 % – fish and seafood. Frequent intake of sweet dishes – 22.4 %, sausage products – 49.0 %, bakery products – 42.9 %, dishes from fast food restaurants – 42.9 %. 55.1 % of patients had more than 5 meals a day, while 18.4 % – less than 3. In or‑ der to correct hidden nutritional deficiencies, 22 patients received artificial nutritional formulas. They had a significant increase in fat‑free mass and a decrease in fat, in comparison with those who did not receive enteral feeding.Conclusion. Treatment‑associated factors, physical activity and alimentary causes play an important role in formation of not only obesity, but also hidden nutritional insufficiency in children with ALL after treatment. Enteral feeding using artificial polymeric formulas showed its effectiveness. An integrated and multidisciplinary approach to solving the problem is appropriate of prevention and treatment of obesity.
The paper presents the results of the analysis of associations between motor skills (MS) and nutritional status (NS) in 102 children who have received treatment of CNS tumors (n=53) and ALL (n=49). Median of remission interval was 2 years (from 3 month to 10 years). MS was evaluated by Bruininks-Oseretsky Test of Motor Proficiency. NS was assessed using anthropometry and bioimpedance analysis. As a result, it was found that children after cancer treatment have motor and nutritional deficiencies. Low values of NS indicators (lean body mass, cell mass, mid-arm muscle circumference (MAMC)) are associated with a decrease in MS parameters. There was no dependence between the value, dynamics of body fat mass and MS. In those children who had a positive dynamics (+3%) of the phase angle and MAMC for 3 weeks of the observation changes in MS were also significantly positive - in contrast to the overall sample, where any reliable dynamics of MS parameters was not revealed.
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