Recommendations for Nutritional Supplementation in Pediatric Oncology: A Compilation of the Facts

Abstract

Background: As one of the few modifiable risk factors, the importance of dietary patterns for both disease prevention and treatment outcome in pediatric oncology has gained increasing popularity. Malnutrition is associated with lower survival rates, tolerance to treatment, and quality of life. Yet, especially in children with malignancies, nutritional deterioration is common, and pediatric cancer patients often present with inadequate intake of micro- and macronutrients alike. Despite the reported widespread use of dietary supplements, few empirical data provide a basis for clinical recommendations, and evidence for their efficacy is inconsistent. Current literature lacks a systematic approach as to how and which supplements should be recommended for specific patients, types of cancer, or during specific treatments. The aim of this review is to highlight the role of the most frequently used nutrients in pediatric malignant diseases and to give a practical guide based on current scientific evidence. Methods: A comprehensive literature search was conducted on PubMed through April 2023 to select meta-analyses, systematic reviews, observational studies, and individual randomized controlled trials (RCTs) of macro- and micronutrient supplementation in pediatric oncology. The search strategy included the following medical subject headings (MeSH) and keywords: “childhood cancer”, “pediatric oncology”, “nutritional status”, “dietary supplements”, “vitamins”, “micronutrients”, “calcium”, “magnesium”, “vitamin D”, “zinc” “glutamine”, “selen”, and “omega-3 fatty acids”. The reference lists of all relevant articles were screened to include potentially pertinent studies. Results: The present review provides a comprehensive and updated overview of the latest evidence about the role of nutrition and diet in pediatric oncology, also focusing on different nutritional interventions available for the management of the disease. We summarize evidence about the importance of adequate nutrition in childhood cancer and the role of several micronutrients and critically interpret the findings. Possible effects and benefits of supplementation during chemotherapy are discussed, as are strategies for primary and secondary prevention. Conclusions: We here describe the obvious benefits of dietary supplementation for childhood cancer. Further large-scale clinical trials are required to verify the impacts of deficiencies and the possible benefits of supplementation and optimal dosages. (337 words).

Feasibility study of micronutrient status and body mass index of newly diagnosed pediatric oncology patients: Research commentary

“…Cancer survival is affected by micronutrient deficiency in several reports. [4][5][6] Mucositis has been linked to vitamin A and D deficiency. [6][7][8] Vitamin D is the most frequently documented micronutrient associated with a poorer outcome.…”

“…[6][7][8] Vitamin D is the most frequently documented micronutrient associated with a poorer outcome. [4][5][6][9][10][11] Zn deficiency has been linked…”

“…Cancer survival is affected by micronutrient deficiency in several reports 4–6 . Mucositis has been linked to vitamin A and D deficiency 6–8 .…”

“…Mucositis has been linked to vitamin A and D deficiency 6–8 . Vitamin D is the most frequently documented micronutrient associated with a poorer outcome 4–6,9–11 . Zn deficiency has been linked to increased viral infections and poorer outcomes 12 .…”

“…Several studies in the general pediatric population have documented that many children are deficient in numerous micronutrients, which can result in specific clinical pathology 3 . Micronutrient deficiency may affect event‐free survival, exacerbate chemotherapy toxicity, and increase adverse events 4–6 . We conducted a feasibility study measuring six micronutrient levels at diagnosis and after 6 months of chemotherapy.…”