Evaluation of muscle protein mass in children with solid tumors by muscle thickness measurement with ultrasonography, as compared with anthropometric methods and visceral protein concentrations

Abstract

Objective: To compare the merits of regional ultrasonography, anthropometry, and measurement of visceral protein concentrations for determining muscle protein mass and nutritional status. Design: Prospective follow-up study. Subjects: Nineteen children (median age 4.7 y, range, 1.4 ±14.1 y) with malignant solid tumors were examined at diagnosis, monthly during preoperative chemotherapy, and 1±2 months after operation; 19 healthy age-and sex-matched children served as controls. Interventions: We measured the thickness of the quadriceps muscle by ultrasonography (muscle index), and body weight, mid-arm circumference, triceps skinfold thickness, and serum concentrations of albumin, prealbumin, and transferrin. Results: At diagnosis, the muscle index was smaller in the patients (mean 5.6 cm 2 am 2 , 95% CI 4.5 ± 6.7 cm 2 am 2 ) than in the controls (8.5 cm 2 am 2 , 95% CI 7.7±9.3 cm 2 am 2 ) (P 0.0007), whereas the anthropometric measurements did not differ. The sensitivity, speci®city, and predictive value of anthropometry and measurements of visceral proteins were poor in detecting reduced muscle protein reserves when compared with the muscle index as the baseline standard. During the anticancer therapy the mean concentrations of serum albumin and prealbumin increased. Conclusions: In children with cancer, nutritional status should be assessed with methods more sensitive than anthropometry and visceral protein concentration measurements. We advocate regional ultrasonography for the evaluation of nutrition in these patients. Sponsorship: This work was supported by the Foundation for Pediatric Research, Helsinki, Finland.

Attenuation of resting energy expenditure following hematopoietic SCT in children

“…Since chemotherapy is also associated with declines in lean body mass and energy intake 2,3 , maintaining or improving nutrient intake in children undergoing HSCT is an important component of post-transplantation care. Standard practice has suggested energy prescriptions at 130-150% of equation-estimated basal metabolic rate (BMR) 1, 4, 9-11 .…”

Malnutrition and obesity in pediatric oncology patients: Causes, consequences, and interventions

“…Incorporation of arm anthropometric measurement in nutrition algorithms is urged. Femoral quadriceps muscle ultrasonography [5], bioelectrical impedance [6], total body potassium counting [7], and dual energy x-ray absorptiometry scanning [8] have all been used to analyze body composition, but larger studies in groups of children with cancer are lacking.…”

High prevalence of malnutrition among patients with solid non-hematological tumors as found by using skinfold and circumference measurements

“…Taskinen & Saarinen-Pihkala (1998) 23 evaluated the nutritional status of children with solid tumors, at the time of diagnosis and during preoperative and postoperative chemotherapy. They found that the traditional methods (weight-for-height, loss of weight and albumin) for assessing protein energy malnutrition did not detect more than two-thirds of the patients with reduced muscle protein mass, as indicated by muscle thickness ultrasonography.…”