Metabolic Disturbances in Children Treated for Solid Tumors

Abstract

Metabolic disturbances are among the most common disorders diagnosed in pediatric patients after anti-cancer therapy (ACT). The aim of our study was to evaluate the prevalence of metabolic disturbances among patients after ACT. The study group comprised 44 patients (31 boys) treated for solid tumors and 31 patients in the control group. Body weight, height, body mass index (BMI) values, lipid parameters are expressed in Standard Deviation Score (SDS), based on centile charts. Indicators of risk to atherosclerosis were calculated. Obesity/overweight was observed in one third of the patients. Hypercholesterolemia occurred in half of them, elevated tryglicerides (TG) SDS in 11, and elevated low-density lipoprotein cholesterol (LDL-C) SDS in nine of the patients. Increased levels of both cholesterol SDS and LDL SDS were found in nine patients and four of them also showed elevated levels of TG SDS. There were significant differences in lipid parameters between the sexes. Risk indicators of lipid disorders defined by statistical distances (τ) were determined for the study group and the control group. The sum of the risk ratios of lipid disorders in the study group was 150 times higher than in the control group. Patients after ACT require special monitoring of lipids profiles and thyroid function as they are at higher risk for dyslipidemia and atherosclerosis than healthy people.

Endocrine Complications in Children and Adolescents With Non-Central Nervous System Solid Tumors

“…A high risk of obesity was associated with female gender and the initiation of cancer treatment at a young age ( 52 ). Thus, it is recommended that lipid profiles should be monitored in childhood cancer survivors ( 53 ).…”

Role of Nutrition in Pediatric Patients with Cancer

“…Long-term consequences of toxic cancer therapies and consequent undernutrition represents an issue to be considered among pediatric cancer survivors. Dyslipidemia, overweight/obesity, and metabolic syndrome are common disorders in surviving patients, and care providers are increasingly having to deal with these problems [ 57 , 58 ]. The sequelae of dyslipidemia have health-related physical outcomes such as high blood pressure, type 2 diabetes, metabolic syndrome, fatty liver disease, orthopedic problems, sleep apnea, and psychological or social problems.…”

“…Hypothyroidism is the most frequently encountered thyroid disorder, and it can be either in primary form, in the case of direct irradiation to the neck, or in secondary form, after craniospinal irradiation. A study conducted by Barg et al evaluated the prevalence of long-term metabolic disorders in pediatric patients with solid tumors [ 58 ]. Lipid disorders, overweight/obesity and thyroid dysfunctions were analyzed in patients who had received their last anti-cancer therapy after at least 1 year (some patients were above 5 years).…”

“…All the findings reported above highlight that metabolic status, with a focus on lipid profiles, should be closely monitored in pediatric cancer survivors, as they are at higher risk for dyslipidemia and atherosclerosis than healthy individuals [ 58 ]. Additionally, thyroid function should be closely monitored, especially in patients who had received radiation therapy and pediatric transplant recipients, in whom thyroid function and associated antibodies must be assessed at least 4 years after HSCT [ 58 , 59 ].…”

“…Several studies have compared EN and PN in pediatric cancer patients [ 21 , 58 ]. A multicenter prospective observational study and international survey investigated nutritional support in pediatric cancer patients with CHT-induced GI mucositis [ 21 ].…”