Prevalence of Undernutrition and Effect of Body Weight Loss on Survival among Pediatric Cancer Patients in Northeastern Hungary.

Orsolya Kadenczki,Attila Csaba Nagy,Csongor Kiss

doi:10.3390/ijerph18041478

Orsolya Kadenczki, Attila Csaba Nagy + Show 1 more

Open Access

https://doi.org/10.3390/ijerph18041478

Copy DOI

Abstract

Undernutrition is a prevalent condition in pediatric malignancy patients leading to unfavorable outcomes. The aim of this retrospective study was to determine the nutritional status and rate of undernutrition in 174 Hungarian pediatric patients with malignancies and the impact on 5-year survival based on anthropometric measurements. At the time of diagnosis, 5.0%, 4.6%, and 4.0% of patients were undernourished as determined by body weight (BW), weight-for-height (WFH), and body mass index (BMI) Z-score, respectively. The rate of undernutrition was 30.5% using ideal body weight percent (IBW%). Undernutrition at the time of diagnosis worsened the five-year overall survival only in solid tumor patients as defined by BMI Z-score and IBW%. Furthermore, 26.5% of patients became undernourished based on IBW% during the treatment period. Deterioration of nutritional status during treatment unfavorably influenced overall survival in both hematological and solid tumor subsets. Abnormal BW, WFH, and BMI Z-score were associated with poor prognosis in the hematologic group. The mortality risk was higher among hematologic patients with weight loss exceeding 20%. In conclusion, IBW% seems to be the most sensitive parameter to estimate undernutrition. Furthermore, BMI Z-score in both groups and severe weight loss in the hematological group may influence clinical outcome and play a role in prognosis assessment.

Highlights

IntroductionChildren with undernutrition are at major risk, especially if suffering from cancer and other chronic diseases [1]
Received: 15 November 2020Undernutrition is a big global health problem
The present study is the first in Hungary that assessed the nutritional status of pediatric cancer patients from the time of diagnosis until the end of treatment, and the effects of undernutrition on survival

Summary

Introduction

Children with undernutrition are at major risk, especially if suffering from cancer and other chronic diseases [1]. The etiology of cancer cachexia is multifactorial, and all of those factors may result in increased energy requirements, micro- and macronutrient needs, increased losses, or decreased intake of nutrients. Insufficient growth and worsening organ functions (in particular immunocompromise) increase the risk of infections and, may increase treatment-related morbidity and mortality. Undernutrition can influence the clearance of certain drugs, e.g., methotrexate clearance decreases in undernourished patients increasing toxicity. These complex interactions may explain how nutritional status may affect treatment outcomes of children with cancer, both in terms of morbidity and mortality [6,7]

Objectives

Methods

Discussion

Conclusion