High prevalence of malnutrition among patients with solid non-hematological tumors as found by using skinfold and circumference measurements

Abstract

CONTEXT AND OBJECTIVE: Malnutrition in cancer patients has many causes. Nutritional status is usually assessed from weight/height indices. These present limitations for the nutritional assessment of cancer patients: their weights include tumor mass, and lean mass changes are not reflected in weight/height indices. The objective was to evaluate differences between two anthropometric methods and compare deficits, in non-hematological tumor patients and hematological disease patients. DESIGN AND SETTING: Cross-sectional study at Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo. METHODS: Children and adolescents were evaluated between March 1998 and January 2000. Traditional anthropometric measurements were obtained in the first month of treatment (induction therapy), by weight-for-height (W/H) using z-scores index for children and body mass index (BMI) for adolescents. Body composition evaluations consisted of specific anthropometric measurements: triceps skinfold thickness (TSFT), mid-upper arm circumference (MUAC) and arm muscle circumference (AMC). Data were analyzed to compare nutritional assessment methods for diagnosing malnutrition prevalence. The chi-squared test was used for comparative analyses between tumor patients and hematological disease patients. RESULTS: Analysis was done on 127 patients with complete data. Higher percentages of deficits were found among tumor patients, by W/H z-scores or BMI and by MUAC and AMC. Higher percentages of deficits were shown by TSFT (40.2%) and MUAC (35.4%) than by W/H z-scores or BMI (18.9%). CONCLUSION: Non-hematological tumor patients presented higher malnutrition prevalence than did hematological disease patients. Body composition measurements by TSFT and MUAC detected more patients with malnutrition than did W/H or BMI.

Comparação de métodos de avaliação nutricional empregados no acompanhamento de pacientes submetidos a transplante de células-tronco hematopoéticas alogênico

“…22 Pela sua baixa sensibilidade, a medida de IMC não é indicada para avaliar nutricionalmente esse tipo de paciente, nem em pacientes com tumores sólidos, que apresentam maior risco de desnutrição que pacientes com neoplasias hematológicas. 16 Apesar disso, muitos protocolos utilizam o IMC como parâmetro, tanto para o início quanto para o fim, do uso de NPT. 20,23,25 O %PP também é utilizado como parâmetro para o uso de suporte nutricional.…”

“…11,[13][14][15] Nossos resultados se assemelham a outros estudos, como o de Garófolo, realizado em crianças, porém mostrando variações maiores entre DCT, CMB e CB que em IMC. 16 Apesar de pouco indicado para pacientes com hiperhidratação 4,5,25 foi utilizada a bioimpedância em nosso estudo e encontramos diminuição de massa gorda e aumento de massa magra em 94% (n=16) dos pacientes.…”

“…Nossos resultados também se assemelham a outros estudos, como o de Garófolo,16 realizado em crianças, porém mostrando variações maiores entre DCT, CMB e CB que em IMC. Encontramos diminuição de massa gorda e aumento de massa magra em 94% (n=16) dos pacientes, a variação média está descrita na Tabela 2).…”

The Effectiveness of Enteral Nutrition Support in the Growth of Children Patients with Cancer

“…This assessment includes medical history, physical examination, biochemical and hematological data, such as visceral proteins, blood glucose levels, and lipid profiles, hemoglobin, hematocrit and lymphocyte counts, anthropometric measurements, and food and nutrition history. Visceral proteins such as prealbumin, transferrin and retinol-binding protein have emerged as indicators of nutritional status [4,5]. Anthropometric measurements are a primary component of the nutrition assessment process in pediatric oncology patients.…”

“…Anthropometric measurements are a primary component of the nutrition assessment process in pediatric oncology patients. The most sensitive indices for growth in children include weight, height for age and body mass index (BMI) [5]. Anthropometric measurements, including middle upper arm circumference, triceps, biceps, suprailiac and subscapular skinfolds and arm muscle mass, are preferred indicators of body composition in oncology patients [1,3].…”