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Schab M, Skoczen S. Nutritional status, body composition and diet quality in children with cancer. Front Oncol 2024; 14:1389657. [PMID: 38706604 PMCID: PMC11066172 DOI: 10.3389/fonc.2024.1389657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
During cancer treatment, nutritional status disorders such as malnutrition or obesity affect the tolerance of cancer treatment, quality of life, but also the pharmacokinetics of drugs. It is hypothesized that changes in fat and lean body mass can modify chemotherapy volume distribution, metabolism and clearance. In children with cancer, lean body mass decreases or remains low during treatment and fat mass increases. Body composition is influenced by the cancer itself, aggressive multimodal-therapies, changes in metabolism, unbalanced diet and reduced physical activity. Due to the side effects of treatment, including changes in the sense of taste and smell, nausea, vomiting, diarrhea, and stress, eating according to recommendation for macronutrients and micronutrients is difficult. Research indicates that throughout cancer treatment, the consumption of fruits, vegetables, and dairy products tends to be insufficient, whereas there is an elevated intake of sugar and unhealthy snacks. Children exhibit a preference for high-carbohydrate, salty, and strongly flavored products. This review revealed the importance of body composition and its changes during cancer treatment in children, as well as eating habits and diet quality.
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Affiliation(s)
- Magdalena Schab
- Doctoral School of Medical and Health Science, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Suwannaying K, Ong AA, Dhaduk R, Pei D, Iijima M, Merkle E, Zhuang TZ, Goodenough CG, Brown J, Browne EK, Wolcott B, Cheng C, Wilson CL, Pui CH, Ness KK, Kaste SC, Inaba H. Quantitative computed tomography analysis of body composition changes in paediatric patients with acute lymphoblastic leukaemia. Br J Haematol 2024; 204:1335-1343. [PMID: 38291722 PMCID: PMC11006578 DOI: 10.1111/bjh.19310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
Children with acute lymphoblastic leukaemia (ALL) are at risk for obesity and cardiometabolic diseases. To gain insight into body composition changes among children with ALL, we assessed quantitative computed tomography (QCT) data for specific body compartments (subcutaneous adipose tissue [SAT], visceral adipose tissue [VAT], total adipose tissue [TAT], lean tissue [LT], LT/TAT and VAT/SAT at lumbar vertebrae L1 and L2) at diagnosis and at off-therapy for 189 children with ALL and evaluated associations between body mass index (BMI) Z-score and clinical characteristics. BMI Z-score correlated positively with SAT, VAT and TAT and negatively with LT/TAT and VAT/SAT. At off-therapy, BMI Z-score, SAT, VAT and TAT values were higher than at diagnosis, but LT, LT/TAT and VAT/SAT were lower. Patients aged ≥10 years at diagnosis had higher SAT, VAT and TAT and lower LT and LT/TAT than patients aged 2.0-9.9 years. Female patients had lower LT and LT/TAT than male patients. Black patients had less VAT than White patients. QCT analysis showed increases in adipose tissue and decreases in LT during ALL therapy when BMI Z-scores increased. Early dietary and physical therapy interventions should be considered, particularly for patients at risk for obesity.
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Affiliation(s)
- Kunanya Suwannaying
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, Khon Kaen university, Khon Kaen, Thailand
| | - Adrian A. Ong
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Rikeenkumar Dhaduk
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Deqing Pei
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Mayuko Iijima
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Eric Merkle
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Tony Z. Zhuang
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Chelsea G. Goodenough
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Emily K. Browne
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Bruce Wolcott
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sue C. Kaste
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
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Wadhwa A, Lim S, Dai C, Daniels G, Adams K, Richman JS, McDonald A, Williams GR, Bhatia S. Assessment of longitudinal changes in body composition of children with lymphoma and rhabdomyosarcoma. Cancer 2023; 129:3457-3465. [PMID: 37432057 DOI: 10.1002/cncr.34936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Studies examining changes in skeletal muscle and adipose tissue during treatment for cancer in children, adolescents, and young adults and their effect on the risk of chemotherapy toxicity (chemotoxicity) are limited. METHODS Among 78 patients with lymphoma (79.5%) and rhabdomyosarcoma (20.5%), changes were measured in skeletal muscle (skeletal muscle index [SMI]; skeletal muscle density [SMD]) and adipose tissue (height-adjusted total adipose tissue [hTAT]) between baseline and first subsequent computed tomography scans at the third lumbar vertebral level by using commercially available software. Body mass index (BMI; operationalized as a percentile [BMI%ile]) and body surface area (BSA) were examined at each time point. The association of changes in body composition with chemotoxicities was examined by using linear regression. RESULTS The median age at cancer diagnosis of this cohort (62.8% male; 55.1% non-Hispanic White) was 12.7 years (2.5-21.1 years). The median time between scans was 48 days (range, 8-207 days). By adjusting for demographics and disease characteristics, this study found that patients undergo a significant decline in SMD (β ± standard error [SE] = -4.1 ± 1.4; p < .01). No significant changes in SMI (β ± SE = -0.5 ± 1.0; p = .7), hTAT (β ± SE = 5.5 ± 3.9; p = .2), BMI% (β ± SE = 4.1 ± 4.8; p = .3), or BSA (β ± SE = -0.02 ± 0.01; p = .3) were observed. Decline in SMD (per Hounsfield unit) was associated with a greater proportion of chemotherapy cycles with grade ≥3 nonhematologic toxicity (β ± SE = 1.09 ± 0.51; p = .04). CONCLUSIONS This study shows that children, adolescents, and young adults with lymphoma and rhabdomyosarcoma undergo a decline in SMD early during treatment, which is associated with a risk of chemotoxicities. Future studies should focus on interventions designed at preventing the loss of muscle during treatment. PLAIN LANGUAGE SUMMARY We show that among children, adolescents, and young adults with lymphoma and rhabdomyosarcoma receiving chemotherapy, skeletal muscle density declines early during treatment. Additionally, a decline in skeletal muscle density is associated with a greater risk of nonhematologic chemotoxicities.
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Affiliation(s)
- Aman Wadhwa
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shawn Lim
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gabriel Daniels
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kandice Adams
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Joshua S Richman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrew McDonald
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Zamberlan P, Mazzoni BP, Bonfim MAC, Vieira RR, Tumas R, Delgado AF. Body composition in pediatric patients. Nutr Clin Pract 2023; 38 Suppl 2:S84-S102. [PMID: 37721465 DOI: 10.1002/ncp.11061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/26/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023] Open
Abstract
Undernutrition is highly prevalent in children who are critically ill and is associated with increased morbidity and mortality, including a higher risk of infection due to transitory immunological disorders, inadequate wound healing, reduced gut function, longer dependency on mechanical ventilation, and longer hospital stays compared with eutrophic children who are critically ill. Nutrition care studies have proposed that early interventions targeting nutrition assessment can prevent or minimize the complications of undernutrition. Stress promotes an acute inflammatory response mediated by cytokines, resulting in increased basal metabolism and nitrogen excretion and leading to muscle loss and changes in body composition. Therefore, the inclusion of body composition assessment is important in the evaluation of these patients because, in addition to the nutrition aspect, body composition seems to predict clinical prognosis. Several techniques can be used to assess body composition, such as arm measurements, calf circumference, grip strength, bioelectrical impedance analysis, and imaging examinations, including computed tomography and dual-energy x-ray absorptiometry. This review of available evidence suggests that arm measurements seem to be well-established in assessing body composition in children who are critically ill, and that bioelectrical impedance analysis with phase angle, handgrip strength, calf circumference and ultrasound seem to be promising in this evaluation. However, further robust studies based on scientific evidence are necessary.
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Affiliation(s)
- Patrícia Zamberlan
- Instituto da Criança e do Adolescente/Division of Nutrition, Support Team, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Beatriz P Mazzoni
- Instituto da Criança e do Adolescente/Division of Nutrition, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Maria A C Bonfim
- Instituto da Criança e do Adolescente/Division of Nutrition, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Rafaela R Vieira
- Instituto da Criança e do Adolescente/Division of Nutrition, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Rosana Tumas
- Instituto da Criança e do Adolescente/Nutrology Unit, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Artur F Delgado
- Department of Pediatrics - Medical School, Universidade de São Paulo, São Paulo, Brazil
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Odarenko KV, Salomatina OV, Chernikov IV, Salakhutdinov NF, Zenkova MA, Markov AV. Soloxolone Methyl Reduces the Stimulatory Effect of Leptin on the Aggressive Phenotype of Murine Neuro2a Neuroblastoma Cells via the MAPK/ERK1/2 Pathway. Pharmaceuticals (Basel) 2023; 16:1369. [PMID: 37895840 PMCID: PMC10610011 DOI: 10.3390/ph16101369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
Despite the proven tumorigenic effect of leptin on epithelial-derived cancers, its impact on the aggressiveness of neural crest-derived cancers, notably neuroblastoma, remains largely unexplored. In our study, for the first time, transcriptome analysis of neuroblastoma tissue demonstrated that the level of leptin is elevated in neuroblastoma patients along with the severity of the disease and is inversely correlated with patient survival. The treatment of murine Neuro2a neuroblastoma cells with leptin significantly stimulated their proliferation and motility and reduced cell adhesion, thus rendering the phenotype of neuroblastoma cells more aggressive. Given the proven efficacy of cyanoenone-bearing semisynthetic triterpenoids in inhibiting the growth of neuroblastoma and preventing obesity in vivo, the effect of soloxolone methyl (SM) on leptin-stimulated Neuro2a cells was further investigated. We found that SM effectively abolished leptin-induced proliferation of Neuro2a cells by inducing G1/S cell cycle arrest and restored their adhesiveness to extracellular matrix (ECM) proteins to near control levels through the upregulation of vimentin, zonula occludens protein 1 (ZO-1), cell adhesion molecule L1 (L1cam), and neural cell adhesion molecule 1 (Ncam1). Moreover, SM significantly suppressed the leptin-associated phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2) and ribosomal protein S6 kinase A1 (p90RSK), which are key kinases that ensure the survival and proliferation of cancer cells. Further molecular modeling studies demonstrated that the inhibitory effect of SM on the mitogen-activated protein kinase (MAPK)/ERK1/2 signaling pathway can be mediated by its direct interaction with ERK2 and its upstream regulators, son of sevenless homolog 1 (SOS) and mitogen-activated protein kinase kinase 1 (MEK1). Taken together, our findings in murine Neuro2a cells provide novel evidence of the stimulatory effect of leptin on the aggressiveness of neuroblastoma, which requires further detailed studies in human neuroblastoma cells and relevant animal models. The obtained results indicate that SM can be considered a promising drug candidate capable of reducing the impact of adipokines on tumor progression.
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Affiliation(s)
- Kirill V. Odarenko
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia; (K.V.O.); (O.V.S.); (I.V.C.); (M.A.Z.)
| | - Oksana V. Salomatina
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia; (K.V.O.); (O.V.S.); (I.V.C.); (M.A.Z.)
- N.N. Vorozhtsov Novosibirsk Institute of Organic Chemistry, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia;
| | - Ivan V. Chernikov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia; (K.V.O.); (O.V.S.); (I.V.C.); (M.A.Z.)
| | - Nariman F. Salakhutdinov
- N.N. Vorozhtsov Novosibirsk Institute of Organic Chemistry, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia;
| | - Marina A. Zenkova
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia; (K.V.O.); (O.V.S.); (I.V.C.); (M.A.Z.)
| | - Andrey V. Markov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 630090 Novosibirsk, Russia; (K.V.O.); (O.V.S.); (I.V.C.); (M.A.Z.)
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AlQahtani S, Aldisi D. Muscle Wasting among Hospitalized Children: A Narrative Review of the Feasibility and Accuracy of Diagnostic Methods. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050795. [PMID: 37238343 DOI: 10.3390/children10050795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Muscle wasting is associated with a worse quality of life and increased morbidity and mortality among hospitalized children, especially those with chronic diseases. This review was conducted to summarize the data available on the most feasible and accurate diagnostic methods for detecting muscle wasting among hospitalized children, especially to review the evidence of the accuracy and feasibility of conducting assessments using handgrip strength (HGS). Many diagnostic methods are used in hospital settings to assess muscle wasting, by evaluating either muscle mass or strength, with evidentiary support for assessing muscle mass provided using ultrasonography, magnetic resonance imaging, computed tomography, dual-energy X-ray, bioelectrical impedance analysis, and anthropometry measurements. Currently, the most common diagnostic method used to detect muscle strength loss is the handheld dynamometer. Studies support using HGS among healthy and hospitalized children to assess the overall nutritional status and especially muscle function. However, almost all of these studies have been conducted in hospital settings and recruited children with different chronic diseases using a small sample size. More longitudinal cohort studies with large sample sizes are needed to assess the accuracy and feasibility of using HGS among hospitalized children.
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Affiliation(s)
- Sheikha AlQahtani
- Department of Community Health Sciences, Collage of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Dietetics, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
| | - Dara Aldisi
- Department of Community Health Sciences, Collage of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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Sarcopenia in Children with Solid Organ Tumors: An Instrumental Era. Cells 2022; 11:cells11081278. [PMID: 35455957 PMCID: PMC9024674 DOI: 10.3390/cells11081278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/22/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Sarcopenia has recently been studied in both adults and children and was found to be a prognostic marker for adverse outcome in a variety of patient groups. Our research showed that sarcopenia is a relevant marker in predicting outcome in children with solid organ tumors, such as hepatoblastoma and neuroblastoma. This was especially true in very ill, high-risk groups. Children with cancer have a higher likelihood of ongoing loss of skeletal muscle mass due to a mismatch in energy intake and expenditure. Additionally, the effects of cancer therapy, hormonal alterations, chronic inflammation, multi-organ dysfunction, and a hypermetabolic state all contribute to a loss of skeletal muscle mass. Sarcopenia seems to be able to pinpoint this waste to a high degree in a new and objective way, making it an additional tool in predicting and improving outcome in children. This article focuses on the current state of sarcopenia in children with solid organ tumors. It details the pathophysiological mechanisms behind sarcopenia, highlighting the technical features of the available methods for measuring muscle mass, strength, and function, including artificial intelligence (AI)-based techniques. It also reviews the latest research on sarcopenia in children, focusing on children with solid organ tumors.
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