Effectiveness of two methods of parenteral nutrition support in improving muscle mass of children with neuroblastoma or Wilms' Tumor. A randomized study

Abstract

The short-term and long-term effectiveness of central parenteral nutrition (CPN) versus peripheral parenteral nutrition (PPN) in improving muscle mass (arm muscle area [AMA]) was evaluated for 24 malnourished children with newly diagnosed Stage IV neuroblastoma (n = 14) or Stages II-V Wilms' tumor (n = 10). Patients were randomized to either CPN or PPN plus enteral nutrition (EN: intense nutrition counseling, oral foods, and supplements) for 4 weeks followed by EN until week 10. Oncologic treatment was similar for each tumor type. Dietary, anthropometric, and biochemical measurements were obtained at weeks 0, 4, and 10. During weeks 1 through 4, energy (CPN: means 100 +/- 4; PPN: means 96 +/- 4% of healthy children) and protein (CPN: means 2.5 +/- 0.1; PPN means 2.7 +/- 0.2 g/kg) intakes of the two groups did not differ. The AMA increased (P less than 0.05) with 4 weeks of CPN but not with PPN; changes thereafter with EN were not significant. Weight (P less than 0.05) and triceps skinfolds (P less than 0.01) increased with 4 weeks of PN in both groups and decreased with EN thereafter (P less than 0.01) but were higher at week 10 than diagnosis. Increases in albumin in both groups reached significance at week 10 (P less than 0.05). These data show that CPN improves AMA in malnourished children with neuroblastoma or Wilms' tumor when energy and protein intakes are adequate. The AMA gains can be maintained thereafter with EN.

Acute malnutrition is common in Malawian patients with a Wilms tumour: A role for peanut butter

“…It has been described in resource rich settings that nutritional support either with parenteral nutrition or via a gastric tube can improve nutritional status of patients with Wilms tumour during therapy 25, 26. Different protocols and guidelines exist as to when to start this type of nutritional support 27.…”

Nutritional considerations in children undergoing bone marrow transplantation

“…Some researchers claim that children with cancer have a high incidence of wasting and stunting (Rickard et al, 1983a,b;Kibirige et al, 1988;Rickard et al 1989a;(Berry et al, 1983), even at the time of diagnosis, compared to a healthy population. Others do not support the above ®nding (Donaldson et al, 1981;Carter et al, 1983b;Besscho 1986;Tamminga et al, 1990).…”

Influence of Nutritional Status of Children with Acute Lymphoblastic Leukemia (ALL) on Treatment Outcome after Completion of Induction

“…6 Similar observations were found in other studies 19,[21][22][23] We studied the impact of nutritional status on the disease pattern i.e., incidence of relapse, treatment 6 Various other studies have also found similar results of malnourished child by WFH. [24][25][26][27] Roy et al found that under nutrition adversely affect the final outcome, treatment tolerance and treatment complications in children with ALL. 14 Zalina et al did not find significant differences in the nutritional status among a sample of children with leukemia at different stages of treatment.…”