Nutrition of Children With Cancer in Brazil: A Systematic Review

Abstract

PURPOSE The objective of this systematic review was to describe nutrition-related publications on children and adolescents diagnosed with cancer in Brazil. METHODS The methodology followed that of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Medline, LILACS (the Latin American & Caribbean Health Sciences Literature), and Embase were searched in April 2019, and data extraction and rating of methodologic study quality (according to the National Institutes of Health quality score assessment) were performed independently by reviewers. RESULTS Twenty-seven studies met the inclusion criteria, reporting on 3,509 patients from 1994 to 2018. Most of the studies (74%) were of poor quality in methodology and reporting. Different cancer diagnoses were included in 52% of studies, whereas acute leukemia was the exclusive focus in 41%. The majority of the articles (70%) were from institutions in the Southeast Region of Brazil, mainly the state of São Paulo (74%); no publications were from the North Region of the country. Twelve studies addressed nutritional status and body composition, reporting an abundance of malnourished patients in the Brazilian population of children and adolescents with cancer. Six studies on micronutrients pointed to possible deficiencies in this population, with a yet unclear but promising role for supplementation during treatment. CONCLUSION Evidence indicates that there is great interest in the impact of nutrition on childhood cancer treatment and clinical outcomes in Brazil. However, there is a need to focus on high-quality research, particularly with multicentric/national studies. This will help establish research priorities and better planned clinical interventions, adapted to each region of the country.

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

“…There is an important gap in the literature regarding the study of the role of nutrition in pediatric oncology in developing countries, especially in Brazil, where the number of high-quality publications on the subject is scarce. 13 It has been shown that adequate nutritional status during antineoplastic treatment is essential in reducing the risk of infections, toxicities, length of stay and treatment abandonment and improving survival and quality of life. 8 , 10 , 14 , 15 , 16 , 17 , 18 , 19 Studies in children with acute lymphoblastic leukemia (ALL) have shown that remediation of compromised nutritional status during treatment results in improved survival, corroborating the hypothesis that nutritional status is a modifiable risk factor for clinical outcomes.…”

Malnutrition at diagnosis and throughout therapy in pediatric patients with solid tumors: A single‐institution study in a developing country

“…The variation in the prevalence of nutritional status reflects the lack of standardized methods to define nutritional status, and most of the studies reported on children with acute leukemia. These factors highlight the need for more information on children with solid tumors who are undergoing treatment in developing countries 11 …”

Performance of subjective global nutritional assessment in predicting clinical outcomes: Data from the Brazilian survey of pediatric oncology nutrition

“…23 Considering the particularities of this disease, proper identification of the nutritional status of children hospitalized with cancer is a major challenge that requires a broader and more insightful perspective on nutritional assessment. 23,24 Methods based on subjective criteria have been investigated as viable alternatives, either on their own or to supplement classic methods such as anthropometry. 25 However, most of the instruments available and some instruments validated in Brazil are inadequate for the diagnosis of nutritional status as they are screening instruments for tracking nutritional risk.…”

“…Considering the particularities of this disease, proper identification of the nutritional status of children hospitalized with cancer is a major challenge that requires a broader and more insightful perspective on nutritional assessment 23,24 . Methods based on subjective criteria have been investigated as viable alternatives, either on their own or to supplement classic methods such as anthropometry 25 .…”