Prevalence of Undernutrition and Effect of Body Weight Loss on Survival among Pediatric Cancer Patients in Northeastern Hungary

Abstract

Undernutrition is a prevalent condition in pediatric malignancy patients leading to unfavorable outcomes. The aim of this retrospective study was to determine the nutritional status and rate of undernutrition in 174 Hungarian pediatric patients with malignancies and the impact on 5-year survival based on anthropometric measurements. At the time of diagnosis, 5.0%, 4.6%, and 4.0% of patients were undernourished as determined by body weight (BW), weight-for-height (WFH), and body mass index (BMI) Z-score, respectively. The rate of undernutrition was 30.5% using ideal body weight percent (IBW%). Undernutrition at the time of diagnosis worsened the five-year overall survival only in solid tumor patients as defined by BMI Z-score and IBW%. Furthermore, 26.5% of patients became undernourished based on IBW% during the treatment period. Deterioration of nutritional status during treatment unfavorably influenced overall survival in both hematological and solid tumor subsets. Abnormal BW, WFH, and BMI Z-score were associated with poor prognosis in the hematologic group. The mortality risk was higher among hematologic patients with weight loss exceeding 20%. In conclusion, IBW% seems to be the most sensitive parameter to estimate undernutrition. Furthermore, BMI Z-score in both groups and severe weight loss in the hematological group may influence clinical outcome and play a role in prognosis assessment.

Nutritional Status in Childhood Cancer Survivors with Solid Tumors: A Longitudinal Study

“…11 No information was provided beyond the 12 month study period. As reported by Kadencski et al, 35 prevalence of undernutrition at diagnosis, based on % ideal body weight (<90%) and BMIZ <-2, was 32.4% and 5.1%, respectively. Undernutrition was much lower in this study based on BMIZ compared to the current study.…”

“…In addition, location, reference standards, study duration and methods used to assess NS make it difficult to compare studies. 3,12 The following studies 11,18,35 were conducted in pediatric oncology patients with mixed cohorts (hematological, brain and solid), but findings will only be presented on patients with solid tumors. Comparable to the current study, Yourk et al 18 reported prevalence rates at diagnosis, for undernutrition (BMIZ <-2) and overnutrition (BMIZ >2.0) at 16.7% and 5.5%, respectively.…”

Nutritional Status at Diagnosis as Predictor of Survival from Childhood Cancer: A Review of the Literature

“…Likewise, a study on 139 children with Ewing sarcoma and osteosarcoma reported high proportions of malnutrition 2 years after treatment initiation (43% of osteosarcoma and 25% of Ewing sarcoma) [ 36 ]; again, malnutrition had non-significant effects on survival outcomes. A more recent study assessed the prognostic effect of sarcopenia, defined by the BMI-z score, the prognostic nutritional index (PNI), and the total psoas muscle area (tPMA), on the survival of children with bone and soft tissue sarcomas [ 37 ]. This study showed that the decrease in PNI ( p = 0.03) and tPMA of more than 25% ( p = 0.04) were associated with worse one-year OS; yet, more research is needed to evaluate the prognostic significance of tPMA in children with sarcomas.…”

Disease Activity Is Associated with Obesity in Newly Diagnosed Pediatric Patients with Ulcerative Colitis

“…Body weight (BW), weight-for-height (WFH) percentiles and Z-scores, and ideal body weight percent (IBW%) are less frequently used anthropometric tools among children with IBD to characterize nutritional status. However, in addition to BMI, some of these indices were successfully used to characterize nutritional status of children with cancer, cystic fibrosis, and chronic liver disease [ 21 , 22 , 23 ]. IBW has an important role in the accurate definition of chemotherapeutic drug dosages among obese children [ 24 ].…”

“…IBW has an important role in the accurate definition of chemotherapeutic drug dosages among obese children [ 24 ]. IBW% was found more sensitive than BMI to characterize nutritional status in children with cancer [ 21 ].…”