Abstract
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. Cross-sectional study at Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo. 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. 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%). 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.
Highlights
Malnutrition in cancer patients is related to factors associated with the treatment and with the disease itself, and others such as the economic and social conditions
The comparative analysis of deficits according to z-scores and triceps skinfold thickness (TSFT), mid-upper arm circumference (MUAC) and arm muscle circumference (AMC) demonstrated significant differences between z-score and TSFT, and z-score and MUAC (p < 0.05)
It was further observed that TSFT, MUAC and AMC identified greater numbers of malnourished patients than did the z-score, in the hematological disease group
Summary
Malnutrition in cancer patients is related to factors associated with the treatment and with the disease itself, and others such as the economic and social conditions. It has been shown that the weight losses that occur in cachexia lead to reductions in lean body tissue.[3,4] Among children and adolescents, the treatment itself, and chemotherapy and radiotherapy, seems to be an important nutritional risk factor Their treatment is associated with nausea and vomiting, oral mucositis, constipation, xerostomia, dysgeusia and food aversion, and it plays an important role in decreased food intake, nutrient loss, energy expenditure alterations and weight loss, lean body mass.[5] These conditions predispose such patients towards malnutrition, especially when there are frequent periods of chemotherapy treatment.[6] Because of weight variations that are associated with tumor size, other methods should be utilized to identify malnutrition, in addition to the weight-for-age and weightfor-height methods. The present study was carried out with the objective of evaluating and comparing two simple anthropometrical methods for assessing the nutritional status in children and adolescents with cancer, with comparison of the deficits between solid non-hematological and hematological malignancy diseases at the beginning of the induction therapy
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