Malnutrition at diagnosis and throughout therapy in pediatric patients with solid tumors: A single‐institution study in a developing country

Sasse, Patricia; Bergmann, Anke; Afonso, Wanélia Vieira; Ladas, Elena J.; Ferman, Sima

doi:10.1002/pbc.29317

Cited by 9 publications

(8 citation statements)

References 25 publications

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“…ANPEDCancer indicates the measurement of MUAC in all patients, with emphasis on those in whom it is not possible to measure body weight and/or height, as occurs in amputations/disarticulations, important edema or large tumor masses. Several studies reinforce MUAC importance as a good indicator of nutrition status, 1,3,10,15,43,44 especially as a predictor of lean body mass. Totadri et al, 44 developed a nutrition algorithm for children with cancer undergoing chemotherapy and observed that <20% of patients were identified as malnourished by the z scores of weight for height and BMI/A.…”

Section: Discussionmentioning

confidence: 89%

Performance of the new nutrition evaluation tool for hospitalized pediatric patients with cancer in Brazil (ANPEDCancer)

2022

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Background There is a lack of specific nutrition assessment tools for pediatric patients with cancer. The aim was to evaluate the performance of the ANPEDCancer assessment tool in a pediatric population with cancer, verifying its ability to detect nutrition inadequacy and predict the length of hospital stay (LOS). Methods Evaluated 111 pediatric patients hospitalized in the National Cancer Institute (INCA) in 2019 to assess nutrition status. Patients were classified as malnourished and well nourished by the ANPEDCancer. Measures of weight, height, anthropometric indicators, body composition, laboratory parameters, LOS, and death were compared between groups. The ANPEDCancer classification was compared with the complete nutrition assessment, calculating sensitivity, specificity, and predictive values, and with the LOS. Results The prevalence of malnutrition was 12.6%, nutrition risk was 48.6%, risk of overweight/obesity was 6.3%, and well‐nourished status was 32.4%. According to ANPEDCancer, malnourished patients showed a higher frequency of inadequacy for all anthropometric indices, percentage of weight loss, serum albumin level, C‐reactive protein (CRP), and longer LOS when compared with well‐nourished patients. There was an association between the tool's diagnosis and measures of body composition, CRP, and LOS. ANPEDCancer validation with the complete nutrition assessment showed a sensitivity of 81.6%, specificity of 55%, positive predictive value of 53.4%, and negative of 82.5%. The LOS was almost twice as long among malnourished patients and was statistically significant (P = 0.002). Conclusion ANPEDCancer is a feasible tool to assess nutrition status and identify the presence of nutrition risk, allowing for targeted assistance in hospitalized pediatric patients with cancer.

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Section: Discussionmentioning

confidence: 89%

Performance of the new nutrition evaluation tool for hospitalized pediatric patients with cancer in Brazil (ANPEDCancer)

2022

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“…19 Patricia reported that the prevalence of different nutritional statuses at diagnosis, calculated according to the Z scores for H/A and BMI/A, was 29.3% malnourished, 49.5% adequate, and 21.2% overweight/ obese in pediatric patients with solid tumors. 24 In Central America, the moderate nutritional depletion proportion reached 18% by arm anthropometry; 45% of patients were severely depleted, and the proportion rose to 59% if serum albumin was added to the assessment criteria. 27 All clinical methods for assessing nutritional status have limitations, particularly in children with cancer, as there is currently no clinical "gold standard."…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of malnutrition according to weight for age, BMI, mid‐upper arm circumference (MUAC), and triceps skin‐fold thickness (TSFT) Z scores were 14.8%, 23.5%, 27.2%, and 21%, respectively 19 . Patricia reported that the prevalence of different nutritional statuses at diagnosis, calculated according to the Z scores for H/A and BMI/A, was 29.3% malnourished, 49.5% adequate, and 21.2% overweight/obese in pediatric patients with solid tumors 24 . In Central America, the moderate nutritional depletion proportion reached 18% by arm anthropometry; 45% of patients were severely depleted, and the proportion rose to 59% if serum albumin was added to the assessment criteria 27 …”

Section: Discussionmentioning

confidence: 99%

Nutritional status associated with clinical outcomes in children with solid tumors: A retrospective cohort study from China

Li,

Lu,

et al. 2023

Cancer Medicine

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ObjectiveTo investigate the long‐term changes in nutritional status in children with solid tumors during treatment and the relationship between nutritional status and clinical outcomes.MethodsThis study was a retrospective medical records review of data from children who were diagnosed with solid tumors and followed up for more than 3 months from January 2016 to December 2021 in China. Patient demographics and clinical information, including nutritional status, parenteral nutrition use, intensive care unit (ICU) transfers, infection during hospitalization, hospitalization frequency, length of stay, hospitalization costs and antibiotic costs, were collected to analyze the nutritional status of children with different types of solid tumors, the dynamic changes in nutritional status during treatment, and the relationship between nutritional status and clinical outcomes.ResultsAmong the 764 patients (383 males (50.1%); 381 females (49.9%); mean age: 2.58 years), 41.6% of the solid tumors were neuroblastomas, 17.1% were hepatoblastomas, and Wilms tumors as the third most common solid tumors (8.9%). The median follow‐up duration was 6 months (range: 3–40 months). At diagnosis, the proportion of children who were undernourished (underweight and wasting) versus overweight or obese were 26.71% versus 5.21% (25.86% vs. 2.89% in the third month; 29.77% vs. 2.28% in the sixth month; 24.77% vs. 3.27% in the 12th month). The body mass index Z scores decreased from the initial values after the first month (−0.56 (−1.47, 0.23) vs. −0.44 (−1.29, 0.41)) but improved later and decreased again at 6 months. The children in the undernutrition group had longer hospital stays (p < 0.001), higher hospitalization costs (p < 0.001), higher antibiotic costs (p < 0.001), a higher risk of neutropenia (OR = 4.781 (95% CI: 1.571–14.553), p = 0.006), and a higher risk of ICU transfers (OR = 1.498 (95% CI: 1.010–2.224), p = 0.044). No significant differences in those associations by malnutrition and infection, ICU duration, or length of parenteral nutrition were observed.ConclusionThere is a considerable prevalence of malnutrition in children with solid tumors. Malnutrition is related to adverse clinical outcomes and increases in total hospital expenses and antibiotic costs.

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“…Multiple studies in pediatric oncology have shown the utility of arm anthropometry in nutritional assessment. 4,6,7,12 The landmark studies from Central America, which showed the adverse clinical implications of malnutrition in children with cancer, incorporated both arm anthropometry and serum albumin as diagnostic criteria. none of these studies conducted a head-to-head comparison of the important clinical outcomes of using the various methods of nutritional assessment.…”

Section: Discussionmentioning

confidence: 99%

Addition of arm anthropometry to body mass index for age, but not serum albumin, improves the accuracy of the nutritional assessment in severely and moderately malnourished children with cancer

Prasad

Ladas

Barr

2022

Pediatric Blood & Cancer

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Arm anthropometry is a more sensitive measure of nutritional status than body mass index for age (BMI) in children with cancer, but the added utility of serum albumin remains uncertain. Concordance was determined among four forms of classifying nutritional status in a cohort of undernourished children with cancer: method 1: BMIfor-age Z score; method 2: method 1 + mid-upper arm circumference (MUAC) percentile; method 3: method 2 + triceps skinfold thickness (TSFT) percentile; and method 4: method 3 + serum albumin. Concordance was highest between methods 2 and 3, followed closely by 3 and 4, indicating that addition of arm anthropometry, but not serum albumin, to BMI increased the sensitivity of baseline nutritional assessment.

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Malnutrition at diagnosis and throughout therapy in pediatric patients with solid tumors: A single‐institution study in a developing country

Cited by 9 publications

References 25 publications

Performance of the new nutrition evaluation tool for hospitalized pediatric patients with cancer in Brazil (ANPEDCancer)

Performance of the new nutrition evaluation tool for hospitalized pediatric patients with cancer in Brazil (ANPEDCancer)

Nutritional status associated with clinical outcomes in children with solid tumors: A retrospective cohort study from China

Addition of arm anthropometry to body mass index for age, but not serum albumin, improves the accuracy of the nutritional assessment in severely and moderately malnourished children with cancer

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