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Bellini SG, Becker PJ, Abdelhadi RA, Karls CA, Price AL, Puthoff TD, Malone A. Patterns of use of malnutrition risk screening in pediatric populations: A survey of current practice among pediatric hospitals in North America. Nutr Clin Pract 2024. [PMID: 39377665 DOI: 10.1002/ncp.11222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 09/16/2024] [Accepted: 09/16/2024] [Indexed: 10/09/2024] Open
Abstract
Information on the use of validated malnutrition risk screening tools in pediatric facilities to guide malnutrition identification, diagnosis, and treatment is scarce. Therefore, a survey of pediatric healthcare facilities and practitioners to ascertain malnutrition risk screening practices in North America was conducted. A pediatric nutrition screening practices survey was developed and sent to members of the American Society for Parenteral and Enteral Nutrition, the Council for Pediatric Nutrition Professionals and the Academy of Nutrition and Dietetics Pediatric Nutrition Practice Group. Respondents represented 113 pediatric hospitals in the United States and six in Canada, of which 94 were inpatient and 59 were outpatient. Nutrition risk screening was completed in 90% inpatient settings, and 63% used a validated screening tool. Nurses performed most malnutrition risk screens in the inpatient setting. Nutrition risk screening was reported in 51% of outpatient settings, with a validated screening tool being used in 53%. Measured anthropometrics were used in 78% of inpatient settings, whereas 45% used verbally reported anthropometrics. Measured anthropometrics were used in 97% outpatient settings. Nutrition risk screening was completed in the electronic health record in 80% inpatient settings and 81% outpatient settings. Electronic health record positive screen generated an automatic referral in 80% of inpatient and 45% of outpatient settings. In this sample of pediatric healthcare organizations, the results demonstrate variation in pediatric malnutrition risk screening in North America. These inconsistencies justify the need to standardize pediatric malnutrition risk screening using validated pediatric tools and allocate resources to perform screening.
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Affiliation(s)
- Sarah Gunnell Bellini
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, Provo, Utah, USA
| | - Patricia J Becker
- Private Practice Pediatric Neonatal Nutrition, Cincinnati, Ohio, USA
| | - Ruba A Abdelhadi
- Department of Pediatrics, University of Missouri Kansas City, Kansas City, Missouri, USA
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | | | | | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Springs, Maryland, USA
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2
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van den Bosch CH, Grant CN, Brown EG, Morrison ZD, Luques LM, Christison-Lagay ER, Baertschiger RM. Current surgical practice for central venous access to deliver chemotherapy and enteral access for nutritional support in pediatric patients with an oncological diagnosis. Pediatr Blood Cancer 2024:e31206. [PMID: 39030929 DOI: 10.1002/pbc.31206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/22/2024]
Abstract
Central venous access through tunneled central venous catheters (CVCs) are one of the cornerstones of modern oncologic practice in pediatric patients since CVCs provide a reliable access route for the administration of chemotherapy. Establishing best practices for CVC management in children with cancer is essential to optimize care. This article reviews current best practices, including types of devices, their placement, complications, and long-term outcomes. Additionally, nutrition status and nutritional support are also very important determinants of outcomes and care in pediatric surgical oncology patients. We review current nutritional assessment, support, access for enteral and parenteral nutrition delivery, and their complications, mainly from a surgical perspective. Overall, access surgery, whether for CVCs, or for enteral access can be challenging, and best practice guidelines supported by current though limited evidence are necessary to minimize complications and optimize outcomes.
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Affiliation(s)
| | - Christa N Grant
- Division of Pediatric Surgery, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Erin G Brown
- Department of Surgery, University of California Davis Children's Hospital, University of California Davis, Sacramento, California, USA
| | - Zachary D Morrison
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Lisandro M Luques
- Division of Pediatric Surgery, Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel
| | - Emily R Christison-Lagay
- Department of Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Reto M Baertschiger
- Division of Pediatric Surgery, Department of Surgery, DHMC, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Children's Hospital at Dartmouth, Lebanon, New Hampshire, USA
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3
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Li Y, Lu Z, Ma A, Yao W, Dong R, Li K, Wu M, Dong K, Qian T. Nutritional status associated with clinical outcomes in children with solid tumors: A retrospective cohort study from China. Cancer Med 2024; 13:e6798. [PMID: 38111308 PMCID: PMC10807599 DOI: 10.1002/cam4.6798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To investigate the long-term changes in nutritional status in children with solid tumors during treatment and the relationship between nutritional status and clinical outcomes. METHODS This 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. RESULTS Among 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. CONCLUSION There 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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Affiliation(s)
- Yongzhen Li
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
- Child Health Management CentreStarkids Children's HospitalShanghaiChina
| | - Zhongying Lu
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
| | - Ao Ma
- Pediatric Clinical Research Unit, Department of Research ManagementChildren's Hospital of Fudan UniversityShanghaiChina
| | - Wei Yao
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Rui Dong
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Kai Li
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Min Wu
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Kuiran Dong
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Tian Qian
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
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Kellerman I, Blaauw R, Schoeman J, Kruger M. Changes in anthropometrical status and body composition in children with cancer during initial chemotherapy. Pediatr Hematol Oncol 2023; 40:659-672. [PMID: 37092844 DOI: 10.1080/08880018.2023.2201299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/27/2023] [Accepted: 03/09/2023] [Indexed: 04/25/2023]
Abstract
Children with cancer require adequate nutritional support to prevent malnutrition. This study investigated the impact of chemotherapy on anthropometrical status and body composition during the first six months of treatment. Anthropometrical status and body composition were measured at diagnosis, utilizing standardized protocols and validated S10 InBody bio-electrical impedance (BIA) measurements and compared to subsequent consecutive monthly follow-up measurements to plot changes over time during the first six months. Statistical significance was defined as p < 0.05. Forty-three newly diagnosed children (median age 4 years, IQR: 2.0-7.6; male-female ratio 1:0.9; 53% haematological malignancies and 47% solid tumors) were included. Prevalence of malnutrition varied, with under-nutrition 14% (mid-upper arm circumference (MUAC)/body mass index (BMI)), over-nutrition 9.3% (BMI) and stunting 7% at diagnosis. MUAC (14%) identified fewer participants with underlying muscle store depletion than BIA (41.8%). Chemotherapy exposure acutely exacerbated existing nutritional depletion during the first two months after diagnosis for all variables except fat mass (FM), with contrary effects on cancer type. Haematological malignancies had rapid increases in weight, BMI and FM. All patients had an acute loss of skeletal muscle mass. Nutritional improvement experienced by all cancer types during month two to three of treatment resulted in catch-up growth, with a significant increase in weight (chi2=40.43, p < 0.001), height (chi2=53.79, p < 0.001), BMI (chi2=16.32, p < 0.005), fat free mass (chi2=23.69, p < 0.003) and skeletal muscle mass (chi2=24.19, p < 0.001) after six months. Monthly nutritional assessments, including advanced body composition measurements, are essential to provide timely nutritional interventions to overcome the acute decline in nutritional reserves observed during the first two months of chemotherapy exposure.
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Affiliation(s)
- I Kellerman
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J Schoeman
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Schab M, Skoczen S. The Role of Nutritional Status, Gastrointestinal Peptides, and Endocannabinoids in the Prognosis and Treatment of Children with Cancer. Int J Mol Sci 2022; 23:5159. [PMID: 35563548 PMCID: PMC9106013 DOI: 10.3390/ijms23095159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 12/26/2022] Open
Abstract
Neoplastic diseases in children are the second most frequent cause of death among the young. It is estimated that 400,000 children worldwide will be diagnosed with cancer each year. The nutritional status at diagnosis is a prognostic indicator and influences the treatment tolerance. Both malnutrition and obesity increase the risk of mortality and complications during treatment. It is necessary to constantly search for new factors that impair the nutritional status. The endocannabinoid system (ECS) is a signaling system whose best-known function is regulating energy balance and food intake, but it also plays a role in pain control, embryogenesis, neurogenesis, learning, and the regulation of lipid and glucose metabolism. Its action is multidirectional, and its role is being discovered in an increasing number of diseases. In adults, cannabinoids have been shown to have anti-cancer properties against breast and pancreatic cancer, melanoma, lymphoma, and brain tumors. Data on the importance of both the endocannabinoid system and synthetic cannabinoids are lacking in children with cancer. This review highlights the role of nutritional status in the oncological treatment process, and describes the role of ECS and gastrointestinal peptides in regulating appetite. We also point to the need for research to evaluate the role of the endocannabinoid system in children with cancer, together with a prospective assessment of nutritional status during oncological treatment.
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Affiliation(s)
- Magdalena Schab
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Krakow, Poland
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González HR, Mejía SA, Ortiz JOC, Gutiérrez APO, López JEB, Quintana JEF. Malnutrition in paediatric patients with leukaemia and lymphoma: a retrospective cohort study. Ecancermedicalscience 2022; 15:1327. [PMID: 35211196 PMCID: PMC8816504 DOI: 10.3332/ecancer.2021.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Paediatric cancer is a potentially curable disease and its prognosis has been linked to several factors, such as nutritional status. The impact of malnutrition on these patients, either by overnutrition or undernutrition, varies and its relationship with outcomes is inconsistent. This study was conducted in order to determine the frequency of malnutrition in children with haematolymphoid malignancies at the time of diagnosis, as well as during treatment and to also investigate its relationship with the development of infections and death. Materials and Methods A retrospective cohort study of 191 children with a recent diagnosis of a haematolymphoid malignancy. The risks and nutritional classification were determined using anthropometry, follow-ups were conducted for up to 24 months and the presentation and frequency of infections and/or death were also recorded. Bivariate and multivariate analyses were conducted using binomial logistic regressions, for death and infection outcomes during follow-up. Survival analysis was conducted for various factors and types of cancer. Results 83.7% of children had a sufficient nutritional classification at diagnosis, 6.8% had malnutrition by undernutrition and 9.4% by overnutrition. 83.8% had at least one infectious complication during follow-up and 47.1% had ≥ 3. This percentage increased to 69.2% when configuring it in the malnutrition by undernutrition group. 18.3% of patients died. When configuring the mortality, the percentage was greater in patients with Acute Myeloid Leukaemia (AML) (57.1%) and malnutrition by undernutrition (30.7%). The multivariate analysis for the outcome of death, only showed a statistically significant variable (AML odds ratio = 26.52; confidence interval = 1.09–643.24; p = 0.04). Conclusion No statistically significant relationship was found between the nutritional status of children with haematolymphoid neoplasms, and outcomes such as infections or death. The differences in the results obtained in these investigations may be related to the varied nutritional status definitions and the ways of measuring them, thus limiting comparisons between them.
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Affiliation(s)
| | - Sergio Andrade Mejía
- University of Antioquia, Carrera 51d #62-29, Medellín 050010, Colombia.,https://orcid.org/0000-0001-5823-6110
| | - Javier Orlando Contreras Ortiz
- Paediatrics and Child Health Department, University of Antioquia, Calle Barranquilla #51b-22, Medellín 050010, Colombia.,https://orcid.org/0000-0001-8568-5421
| | - Adriana Patricia Osorno Gutiérrez
- Paediatrics and Child Health Department, University of Antioquia, Calle Barranquilla #51b-22, Medellín 050010, Colombia.,https://orcid.org/0000-0003-3513-7659
| | - Jorge Eliécer Botero López
- An tioquia School of Engineering, Universidad EIA, Vda. El Penasco, Envigado, Antioquia 055428, Colombia.,https://orcid.org/0000-0003-2907-5500
| | - Javier Enrique Fox Quintana
- San Vicente Children's Hospital Foundation, Calle Barranquilla #51b-22, Medellín 050010, Colombia.,https://orcid.org/0000-0002-1014-9402
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Wells SJ, Austin M, Gottumukkala V, Kruse B, Mayon L, Kapoor R, Lewis V, Kelly D, Penny A, Braveman B, Shkedy E, Crowder R, Moody K, Swartz MC. Development of an Enhanced Recovery Program in Pediatric, Adolescent, and Young Adult Surgical Oncology Patients. CHILDREN 2021; 8:children8121154. [PMID: 34943351 PMCID: PMC8700533 DOI: 10.3390/children8121154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 01/02/2023]
Abstract
Enhanced recovery after surgery (ERAS) protocols are standardized perioperative treatment plans aimed at improving recovery time in patients following surgery using a multidisciplinary team approach. These protocols have been shown to optimize pain control, improve mobility, and decrease postoperative ileus and other surgical complications, thereby leading to a reduction in length of stay and readmission rates. To date, no ERAS-based protocols have been developed specifically for pediatric patients undergoing oncologic surgery. Our objective is to describe the development of a novel protocol for pediatric, adolescent, and young adult surgical oncology patients. Our protocol includes the following components: preoperative counseling, optimization of nutrition status, minimization of opioids, meticulous titration of fluids, and early mobilization. We describe the planning and implementation challenges and the successes of our protocol. The effectiveness of our program in improving perioperative outcomes in this surgical population could lead to the adaptation of such protocols for similar populations at other centers and would lend support to the use of ERAS in the pediatric population overall.
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Affiliation(s)
- Stephanie J. Wells
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Mary Austin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.A.); (L.M.)
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (V.G.); (R.K.)
| | - Brittany Kruse
- Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Lauren Mayon
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.A.); (L.M.)
| | - Ravish Kapoor
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (V.G.); (R.K.)
| | - Valerae Lewis
- Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (V.L.); (A.P.)
| | - Donna Kelly
- Department of Rehabilitation Services, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.K.); (B.B.)
| | - Alexander Penny
- Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (V.L.); (A.P.)
| | - Brent Braveman
- Department of Rehabilitation Services, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.K.); (B.B.)
| | - Eliana Shkedy
- Department of Clinical Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.S.); (R.C.)
| | - Rebekah Crowder
- Department of Clinical Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.S.); (R.C.)
| | - Karen Moody
- Department of Patient Care, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maria C. Swartz
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
- Correspondence: ; Tel.: +1-713-745-3763
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Ventura JC, Silveira TT, Bechard L, McKeever L, Mehta NM, Moreno YMF. Nutritional screening tool for critically ill children: a systematic review. Nutr Rev 2021; 80:1392-1418. [PMID: 34679168 DOI: 10.1093/nutrit/nuab075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Nutritional screening tools (NSTs) are used to identify patients who are at risk of nutritional status (NS) deterioration and associated clinical outcomes. Several NSTs have been developed for hospitalized children; however, none of these were specifically developed for Pediatric Intensive Care Unit (PICU) patients. OBJECTIVE A systematic review of studies describing the development, application, and validation of NSTs in hospitalized children was conducted to critically appraise their role in PICU patients. DATA SOURCES PubMed, Embase, Web of Science, Scopus, SciELO, LILACS, and Google Scholar were searched from inception to December 11, 2020. DATA EXTRACTION The review included 103 studies that applied NSTs at hospital admission. The NST characteristics collected included the aims, clinical setting, variables, and outcomes. The suitability of the NSTs in PICU patients was assessed based on a list of variables deemed relevant for this population. DATA ANALYSIS From 19 NSTs identified, 13 aimed to predict NS deterioration. Five NSTs were applied in PICU patients, but none was validated for this population. NSTs did not include clinical, NS, laboratory, or dietary variables that were deemed relevant for the PICU population. CONCLUSION None of the available NSTs were found to be suitable for critically ill children, so a new NST should be developed for this population. AQ6. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020167898.
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Affiliation(s)
- Julia C Ventura
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Taís T Silveira
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Lori Bechard
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Liam McKeever
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Nilesh M Mehta
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Yara M F Moreno
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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9
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Yaprak DS, Yalçın B, Pınar AA, Büyükpamukçu M. Assessment of nutritional status in children with cancer: Significance of arm anthropometry and serum visceral proteins. Pediatr Blood Cancer 2021; 68:e28752. [PMID: 33034161 DOI: 10.1002/pbc.28752] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/26/2020] [Accepted: 09/13/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Arm anthropometry is a better indicator of nutritional status in children with cancer. The value of serum albumin and prealbumin in nutritional assesment is debatable. We investigated the nutritional status of children with cancer and their serum albumin and prealbumin levels. PATIENTS AND METHODS At diagnosis and following induction therapies, weight, height, body mass index (BMI), mid-upper arm circumference (MUAC), and triceps skin-fold thickness (TSFT) were measured; serum albumin and prealbumin levels were determined. Prevalences of malnutrition defined by anthropometric indices were calculated. Correlations of anthropometric indices with each other, with serum albumin/prealbumin levels, and clinicopathological parameters were analyzed. RESULTS In 81 patients, median age was 7.5 years (males/females = 50/31), tumors were located mostly in the abdomen, and abdominal tumors were more common under 5 years. Prevalence of malnutrition according to weight for age, BMI, MUAC, TSFT z scores were 14.8%, 23.5%, 27.2%, 21%, respectively. Defined by combined BMI/MUAC/TSFT measurements, 33/81 cases (40.7%) had malnutrition (z scores < -1, 23 mild; z scores < -2, 10 moderate). Malnutrition was more prevalent under 5 years (P = .03), also in abdominal tumors (P = .03) and advanced disease (P < .001). Younger age and advanced disease were risk factors for malnutrition. At diagnosis, prevalences of low serum albumin and prealbumin levels were 7.4% and 54%, respectively. Cases with malnutrition had significantly lower survival rates. CONCLUSIONS Nutritional status is assessed best by MUAC and TSFT measurements. Serum prealbumin levels can be used to identify patients at risk of undernutrition. Presence of malnutrition is a significant poor prognostic factor. All children with cancer should undergo nutritional evaluation and active nutritional support.
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Affiliation(s)
- Deniz Sül Yaprak
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bilgehan Yalçın
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aslı Akhun Pınar
- Department of Medical Biochemistry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Münevver Büyükpamukçu
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Diakatou V, Vassilakou T. Nutritional Status of Pediatric Cancer Patients at Diagnosis and Correlations with Treatment, Clinical Outcome and the Long-Term Growth and Health of Survivors. CHILDREN-BASEL 2020; 7:children7110218. [PMID: 33171756 PMCID: PMC7694979 DOI: 10.3390/children7110218] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Abstract
Malnutrition is caused either by cancer itself or by its treatment, and affects the clinical outcome, the quality of life (QOL), and the overall survival (OS) of the patient. However, malnutrition in children with cancer should not be accepted or tolerated as an inevitable procedure at any stage of the disease. A review of the international literature from 2014 to 2019 was performed. Despite the difficulty of accurately assessing the prevalence of malnutrition, poor nutritional status has adverse effects from diagnosis to subsequent survival. Nutritional status (NS) at diagnosis relates to undernutrition, while correlations with clinical outcome are still unclear. Malnutrition adversely affects health-related quality of life (HRQOL) in children with cancer and collective evidence constantly shows poor nutritional quality in childhood cancer survivors (CCSs). Nutritional assessment and early intervention in pediatric cancer patients could minimize the side effects of treatment, improve their survival, and reduce the risk of nutritional morbidity with a positive impact on QOL, in view of the potentially manageable nature of this risk factor.
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Affiliation(s)
- Vassiliki Diakatou
- Children’s & Adolescents’ Oncology Radiotherapy Department, Athens General Children’s Hospital “Pan. & Aglaia Kyriakou”, GR-11527 Athens, Greece;
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 196 Alexandras Avenue, GR-11521 Athens, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 196 Alexandras Avenue, GR-11521 Athens, Greece
- Correspondence: ; Tel.: +30-213-2010-283
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Alves DS, Assunção DT, Silva NCD, Oliveira CM, Amaral ABCN, Rinaldi AEM, Pena GDG. Nutritional Status and Growth Deficit in Children and Adolescents with Cancer at Different Moments of Treatment. Nutr Cancer 2020; 73:1668-1675. [PMID: 32838574 DOI: 10.1080/01635581.2020.1810714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Nutrition deficits are common in children and adolescents undergoing cancer treatment and can contribute to a worse prognosis. There are scarce studies regarding this context considering different moments of treatment. The aim of this study was to evaluate the association between moment of treatment and nutritional status in children and adolescents with cancer. METHODS A retrospective study was performed from January 2013 to December 2015, including data from all clinical records of patients under 18 years old with cancer. Clinical, nutritional support and anthropometric data were collected at four moments of treatment from cancer diagnosis: diagnosis (t0), 3 mo, (t1), 6 mo, (t2) and 1 year (t3). In addition, nutritional indicators were evaluated. Generalized Estimating Equation models were performed to analyze changes on anthropometric indices throughout four moments of treatment. RESULTS The sample comprised 73 patients and frequency of nutritional deficits ranged from 13.0% to 18.6%. All nutritional indicators decreased at t1, showed a modest recovery at t2 and a stronger recovery at t3 (p < 0.001). Growth was also impacted during treatment, mainly on patients under 2 years in the first three months of treatment. CONCLUSIONS Moment of treatment was associated with growth deficit and decreased percentiles in development indicators.
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Affiliation(s)
- Débora Santana Alves
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Brazil
| | - Dayane Tonaco Assunção
- School of Medicine, Nutrition Course, Federal University of Uberlandia, Uberlandia, Brazil
| | | | - Cássia Maria Oliveira
- Food and Nutrition Service of Clinical Hospital, Federal University of Uberlandia, Uberlandia, Brazil
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