A prospective study on changes in body composition and fat percentage during the first year of cancer treatment in children

Abstract

BACKGROUNDS/OBJECTIVES Cancer treatment may lead to significant body composition changes and affect growth and disease outcomes in pediatric cancer patients. This prospective study aimed to evaluate short- and long-term body compositions changes focused on body fat during the first year of cancer treatment in children. SUBJECTS/METHODS A prospective study was conducted in 30 pediatric cancer patients (19 hematologic malignancies and 11 solid tumors) and 30 age- and sex-matched healthy controls. Anthropometric measurements and body composition analysis using whole body dual energy X-ray absorptiometry were performed at baseline and 1, 6, and 12 month(s) of cancer treatment. Kruskal-Wallis tests, Wilcoxon paired t tests, and generalized estimation equation (GEE) were applied for statistical analysis. RESULTS At baseline, no differences in weight, height, body mass index, abdominal circumferences, body fat, and fat-free mass were observed between 30 controls and 30 pediatric cancer patients. Total fat mass ( P < 0.001) and body fat percentage ( P = 0.002) increased significantly during the first month, but no changes were observed from 1 to 12 months; however, no changes in the total mass were observed during the first year of cancer treatment. Meanwhile, the total fat-free mass decreased during the first month ( P = 0.008) and recovered between 6 and 12 months of follow-up ( P < 0.001). According to GEE analysis, there was a significant upward trend in body fat percentage during the first year, especially the first month, of cancer treatment in children with hematologic malignancies, but not in those with solid tumors. CONCLUSIONS Our results indicate that cancer treatment is related to significant body composition changes and rapid body fat gain, particularly during the first month after initiating cancer treatment, in children with hematologic malignancies. Therefore, individualized dietary strategies to prevent excessive fat gain are needed in pediatric cancer patients for better outcomes.

Measuring body composition in children: research and practice

“…Lower lean muscle mass with corresponding accumulation of FM, particularly around the trunk and abdomen, has been observed in children undergoing treatment for paediatric malignancies19 with differences in body composition persisting into young adulthood 20 21. A similar pattern is also observed in young adult survivors of preterm birth 22.…”

Skeletal muscle and childhood cancer: Where are we now and where we go from here

“…However, in children with cancer, muscle mass changes occur independently of changes in bone mineral content, fat mass, and total body mass, suggesting that muscle can and should be considered explicitly and independently from body mass index or adiposity. Yang and Choi 74 illustrated this in a propsective study for longtitudinal assessment of nutritonal status and body composition in newly diagnosed heamatologic malignancy (n = 19) and solid tumor (n = 11) patients. Among 30 children (mean age: 10.9 ± 3.8 years, 70% male), DXA showed that median fat-free mass significantly decreased from 27.4 kg (range, 11.5-53.5 kg) to 26.9 kg (14.4-50.6 kg, p = 0.008) during the first month of cancer treatment, occurring in the absence of total body mass change.…”

“…88 Children with cancer do not seem to return to pretreatment muscle mass amounts, nor recover to the amount of muscle mass of their healthy peers. 74,96 Given limited access to skeletal muscle tissue in children, there is a need for future research to incorporate molecular imaging techniques and animal modeling methods to begin to answer these important mechanistic questions.…”

Different nutritional screening tools and recommended screening algorithm for pediatric oncology patients

“…However, out of the 13 children, 3 did have normal muscle mass at the subsequent assessment, 1 had similarly low muscle mass and we did not have data from the other 9. Existing literature reinforces that during the course of cancer therapy body composition can change considerably [8,9,24,25]. Therefore, longitudinal data would be advantageous to decide whether it is safe to rely on NRS-PC without bio-impedance measures.…”