Evaluation of Serum Trace Element and Vitamin Levels in Children With Cancer in the First 6 Months After Diagnosis

Abstract

Adequate nutrient intake should be provided for the cure of children diagnosed with cancer. The aim of this study was to evaluate serum trace elements and vitamins of children with cancer at diagnosis and during treatment. Children with newly diagnosed cancer who were admitted to our center were evaluated for serum selenium, iron, ferritin, C-reactive protein, vitamin B12, folate, and 25-OH vitamin D levels at presentation, and at the third and sixth months of cancer treatment. Forty-two children (male/female: 15/27) with a median age of 8 years (range, 2 to 17) were included in the study. Mean serum B12, folate, and iron levels were within normal ranges, but selenium and 25-OH vitamin D were low at presentation and during the 6-month period. Serum ferritin levels were high in all 3 measures, but they decreased significantly at the sixth month (P=0.04). There was no relation between micronutrient deficiency and sex, or primary disease, or stage, or place of residence of the patient. In conclusion, serum trace element and vitamin deficiencies are common in children with cancer, and there is a need for further studies with larger patient series.

The effect of oral nutrition supplements and appetite stimulants on weight status among pediatric cancer patients: A systematic review

“…All studies were prospective in design, with one being a randomized controlled trial, another being an open‐label phase 2 trial, and the other four studies being either prospective cohort studies or case controlled studies 6,25‐29 . All but one study 26 were single site trials conducted internationally (eg, Turkey, Mexico, China, Spain, and Canada); the multicenter study was completed within the United States 6,25‐29 . The studies all included children with a pediatric malignancy between 0 and 20 years old with an average age of 6–11 years 6,25‐29 .…”

“…All but one study 26 were single site trials conducted internationally (eg, Turkey, Mexico, China, Spain, and Canada); the multicenter study was completed within the United States 6,25‐29 . The studies all included children with a pediatric malignancy between 0 and 20 years old with an average age of 6–11 years 6,25‐29 . Two studies focused on children diagnosed exclusively with acute lymphoblastic leukemia (ALL), whereas the other studies included a combination of pediatric malignancies 28,29…”

“…In the ONS studies, one used a pseudorandomization to either a 1.0‐kcal/ml‐formula or one of the two 1.5‐kcal/ml‐formula options. The allocation was based on meeting 40% of the child's needs 6 . Two studies used liquid supplementation, ranging in caloric density from 1.0 to 1.5 kcal/ml, whereas the third study utilized a 200‐kcal supplement bar 28,29 .…”

“…Those with malnutrition, at any point throughout therapy, have increased infections, higher mortality, and worsened clinical outcomes 3,4 . Malnutrition may progress to cancer cachexia, which is associated with decreased overall survival and is characterized by anorexia, increased inflammation, decreased fat, and decreased muscle mass with subsequent weight loss 1,3‐6 …”

“…To support growth and development in the pediatric oncology population, interventions to mitigate weight loss, including oral nutrition supplements (ONSs), appetite stimulants, and enteral nutrition (EN) or parenteral nutrition (PN) (though not a first‐line option) are often implemented 7‐9 . ONSs, such as complete nutrition supplements or nutritionally dense medical food supplements, are frequently the first intervention used to improve both weight status and calorie and protein intakes 6,7‐9 . These interventions have demonstrated increases in weight status in the general pediatric population and in the adult oncology population, but lack data in the pediatric oncology setting 7‐9 .…”