Resting Energy Expenditure in Children Newly Diagnosed With Stage IV Neuroblastoma

Abstract

Children with stage IV neuroblastoma (NBIV) are often malnourished at time of diagnosis, observed as high as 50%. The emphasis of this study was to determine whether an increased resting energy expenditure (REE) is a causative factor. Our hypothesis was that children diagnosed with NBIV have an increased REE, which normalizes with cancer treatment. Changes in nutritional status from time of diagnosis in response to nutritional support were examined. REE and nutritional evaluation were obtained three times: at diagnosis before starting treatment, where tumor burden is expected to be highest; after two courses of chemotherapy, where some response to treatment is expected; and after surgical excision of the primary tumor, where there was presumably minimal residual disease. Ten subjects completed the study. Results showed that REE was not increased, and there was no significant difference between phases (p ϭ 0.29). Fifty percent of our subjects were malnourished at diagnosis. Because REE is not increased in NBIV, it is concluded that malnutrition seen in NBIV is not due to increased energy needs, but is likely due to decreased intake because of the intra-abdominal mass and malignant malaise. are frequently cachectic. Cachexia occurs in the setting of uncontrolled growth of tumor, which places a demand on the host for essential nutrients. The mechanisms underlying cachexia are unclear (1). The typical clinical picture is one of weight loss, decreased muscle mass and diminished fat stores, anorexia, and fatigue. Several articles have indicated that an increase in energy expenditure and/or altered metabolism is a plausible explanation for this energy imbalance (2-4). In addition, tumor burden may be responsible for a multitude of metabolic abnormalities observed (2-4). Alterations in energy expenditure, protein, carbohydrate, and lipid metabolism have been reported (2-8). Factors such as fever, infection, stress, cold exposure, physical activity, and catecholamine release have been shown to elevate resting energy expenditure (REE) (9).Several authors suggest that an increase in REE contributes to the weight loss seen in malignancy. Patients with malignant disease have been reported to have reduced normal or increased energy expenditure (4). Increases in REE have been reported in patients with sarcomas, lung/bronchial cancer, pancreatic cancer and gastric tumors, lymphoma, leukemia, whereas decreased or normal REE has been reported in other types of malignancy (10 -16). Data describing the effect of cancer on energy expenditure of children are limited and mainly involve children with leukemia or lymphoma. Convincing data on the effect of the presence of a solid tumor on energy expenditure of children is lacking.Neuroblastoma is a malignant solid tumor, which originates from the primitive neural crest cell that gives rise to the sympathetic nervous system (17). Neuroblastoma primary tumors can arise from anywhere where normal sympathetic nervous system structures are found (17). Approximately 90 -95% of all pa...

Revised antiemetics guidelines and the impact on nutritional status during induction chemotherapy in children with high‐risk neuroblastoma

“…12 A lower incidence of malnutrition at time of diagnosis was found in our cohort compared with previous studies. 4,5 This may be as a result of using WAz as a marker for malnutrition as opposed to a combination of indices such as weight-for-height z score, mid-arm circumference, and/or tricep skinfold. Weight loss >10% occurred between 11% and 25% for children with HR NBL undergoing induction in a study published in 2010.…”

“…The prevalence of malnutrition in children with cancer varies across studies with an estimated range of 0% to 30% of patients with solids tumors . This rate increases to 50% for children with HR NBL . The typical age of presentation with HR NBL is under 6 years of age, a period of rapid growth and development in childhood, which requires a good nutritional intake.…”

“…3 This rate increases to 50% for children with HR NBL. 4,5 The typical age of presentation with HR NBL is under 6 years of age, a period of rapid growth and development in childhood, which requires a good nutritional intake. The combination of reduced oral intake coupled with enhanced losses at a time where a child may have increased nutritional needs to support expected growth and development may lead to the development of malnutrition in cancer.…”

Weight and height in children newly diagnosed with cancer

“…This weight loss prior to diagnosis may be due to diminished energy intake, increased energy requirements, or altered metabolism. Tumor mass causes alterations in metabolism which can result in increased energy expenditure . These alterations may particularly concern children with advanced cancer.…”

Malnutrition: Causes and Strategies

“…Malnutrition in pediatric patients with cancer is mainly due to an inadequate intake of food and desorption of nutrients. This is because of the gastrointestinal side effects of cancer therapy, primary effects of cancer itself, and changes in metabolism [31][32][33][34][35]. Chemotherapy, high infection rates and overall reduction of body defense mechanisms have been associated with malnutrition [36,37].…”