Nutritional status at diagnosis among children with cancer referred to a nutritional service in Brazil

Abstract

Introduction Children and adolescents with cancer are particularly vulnerable to malnutrition and require special attention on nutritional assessment. An adequate nutritional status during treatment is essential in reducing morbidity and mortality, being a modifiable risk factor for clinical outcomes. This study aims to determine the nutritional status of pediatric patients with cancer assessed by the nutrition team at diagnosis and evaluate its association with the overall survival. Method This is a retrospective cross-sectional study of patients at the time of cancer diagnosis who had nutritional assessments when hospitalized or referred to the nutrition outpatient clinic. Nutritional status was classified by the mid-upper arm circumference (MUAC) and body mass index for age z-score (zBMI/A). The Cox regression analysis was used to determine the association between the nutritional status and overall survival, adjusting for gender, tumor group and age. Results The study included 366 patients. The prevalence of undernutrition varied from 8 to 23% and overweight, from 5 to 20%. The MUAC identified more children as undernourished than the zBMI/A in patients with solid and hematological tumors. There was no significant difference in the overall survival by malnutrition classified by the zBMI/A ( p = 0.1507) or MUAC ( p = 0.8135). When adjusted for gender, tumor group and age, the nutritional status classification by the zBMI/A (hazard ratio [HR], 1.27; 95% confidence interval [CI], 0.88–1.83; p = 0.209) and MUAC (HR, 0.94; 95% CI, 0.61–1.44; p = 0.773) did not impact overall survival. Conclusion The nutritional status at diagnosis did not significantly impact the overall survival, which suggests there may have been a protective effect by successful nutritional intervention during the subsequent care.

Lag time to diagnosis as a predictor of mortality in children with extraocular retinoblastoma: Experience from a developing country

“…About 34.2% of pediatric patients with cancer at diagnosis had undernutrition and malnutrition in Brazil. These findings could indicate patients who are at a high nutritional risk as a result of reduced dietary intake and symptoms like nausea and vomiting, which can cause significant weight loss before diagnosis 37 . Previous research indicated moderate–severe malnutrition during treatment as predictors with HR 2.06 (95% CI: 1.06–4.01) and 3.5 (95% CI: 2.11–5.81), respectively 28 .…”

“…These findings could indicate patients who are at a high nutritional risk as a result of reduced dietary intake and symptoms like nausea and vomiting, which can cause significant weight loss before diagnosis. 37 Previous research indicated moderate-severe malnutrition during treatment as predictors with HR 2.06 (95% CI:…”

Nutritional status at hospital admission and prediction of clinical outcomes in children and adolescents with cancer: Results of the Brazilian survey on oncological nutrition in paediatrics

“…26 T A B L E 2 (a) Model Other studies investigating altered nutritional status in children with cancer in Brazil have not found an association between malnutrition and survival. 14,27 For example, in a study in Southeast Brazil, Viani et al 14 did not find an association between malnutrition at the time of diagnosis, assessed by BMI/A, AP, and overall survival in children with cancer. Similar findings were described by Pedrosa et al 27 in a study in Northeastern Brazil, who also did not find an association between malnutrition (classified by weight for height) at the time of diagnosis and overall survival in paediatric patients with cancer.…”

Dados do Inquérito Brasileiro de Nutrição Oncológica em Pediatria: Estudo Multicêntrico e de Base Hospitalar

“…Na criança com câncer, a incidência de desnutrição varia muito durante o tratamento, pois depende do tipo de neoplasia e modalidade de intervenção, sendo relatada entre 0% e 70% 24 . No Brasil, a prevalência de desnutrição no câncer pediátrico é de 6% a 25% no momento do diagnóstico 25,26 , bem superior à média de desnutrição da população brasileira infantil. O sobrepeso e a obesidade também estão presentes nas crianças e adolescente com câncer ao diagnóstico, com prevalência em torno de em 8,6% a 14,8% 9 .…”