Applied nutritional investigationComparison of malnutrition and malnutrition screening tools in pediatric oncology patients: A cross-sectional study
Introduction
Maintaining nutrition in pediatric oncology patients is more difficult than ever owing to both the systemic and local tumoral effects as well as the side effects of treatment. The increasing nutritional needs of children also require careful consideration [1]. The clinical condition that causes deterioration of physical and mental functions, and worsening of prognosis, which occurs as a result of the deterioration of the body, is defined as malnutrition [2]. The prevalence of malnutrition in children diagnosed with cancer ranges from 7% to 50% [3]; however, the prevalence varies according to the type of cancer. For example, while malnutrition occurs in 7% of pediatric patients with leukemia, it occurs in >50% of those with solid tumors, such as neuroblastoma, sarcoma, and Wilms’ tumor. Moreover, the risk of malnutrition in children with metastatic disease is >50% [1].
There is a clear link between complications of medical treatment and malnutrition. As the tumor load increases, treatment intensifies, and nutritional problems manifest. Malnutrition is among the less recognized aspects of treatment management in pediatric oncology patients, and unfortunately, medical nutrition therapy is yet to be included as a standard component of cancer care in children; however, there is no doubt that nutritional status has an effect on the prognosis in children with cancer [4]. There is increasing evidence suggesting that nutritional status can affect treatment outcomes in children and adolescents with cancer [5]. Malnutrition has been associated with reduced tolerance to chemotherapy, treatment delay, an increased infection rate, impaired prognosis, and poor quality of life [6].
Children are metabolically different than adults and continue to grow and develop during long-term treatment. It is clear that nutritional support should be an important part of patient treatment and care so as to prevent or reverse malnutrition and improve the well-being of children with cancer [7]. Because of the possible effects of nutritional status on outcome in pediatric oncology patients, it is extremely important to prevent malnutrition during treatment. Regular nutritional evaluation should be performed to determine if there is any deterioration in nutritional status [8]. Although the prevalence of malnutrition in pediatric oncology patients has been reported [3], it has been difficult to standardize its definition and assessment methods and to identify children at risk. There are many methods used for nutritional evaluation, although none is complete and perfect [9]. A clear method of implementation has not been established owing to the lack of a gold standard and inconsistencies between evaluation methods. Nutritional assessment in the pediatric population is multidimensional and can be analyzed base on diet and clinical/anthropometric and biochemical parameters [3,10]. The aim of this study was to determine the prevalence of malnutrition in pediatric oncology patients, to determine the correlation between two nutritional screening tools, and to highlight the importance of nutritional status in pediatric oncology patients.
Section snippets
Materials and methods
This cross-sectional study included all pediatric oncology patients ages 5 mo to 18 y who were hospitalized at the Ege University Hospital Pediatric Oncology Clinic, Izmir, Turkey, between January 2017 and January 2019. Patients were evaluated within the first 24 h of hospitalization, regardless of treatment stage. To evaluate nutritional status by screening tools, age, sex, and anthropometric measurements (height, body weight, midupper arm circumferences [MUAC]), were recorded. The heights of
Results
The study included 170 pediatric oncology patients with a mean age of 8.7 y (range: 5 mo to 18 y). The distribution of the patients according to sex, diagnosis, and nutritional treatment is shown in Table 1. Malnutrition risk status according to the PYMS and SK screening tools, BMI and MUAC percentile classification distribution, and malnutrition assessment according to a weight for age Z score < –2 SD in the patients ages <5 y of age and the BMI for age <5 percentile in those ages >5, are
Discussion
Cancer is predicted to affect >200 000 children annually, especially in countries with limited economic resources, and will increase 30% by 2030 [17]. The disparity in survival between pediatric oncology patients treated in developed and underdeveloped countries depends on a multitude of factors, of which nutrition is among the most important. Malnutrition in pediatric oncology patients is a complex and multifactorial process [5]. Malnutrition associated with poor clinical outcomes is seen in
Conclusion
The present findings highlighted the importance of malnutrition and malnutrition screening, determined the prevalence of malnutrition, and compared nutritional assessment tools in pediatric oncology patients. The present study also showed that malnutrition should not be considered acceptable during any stage of cancer in pediatric patients and should not be considered an inevitability. Timely diagnosis of malnutrition in pediatric oncology patients and its management by a multidisciplinary team
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The authors declare no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
All authors contributed to the conception and design; data curation; statistical analysis and investigation; methodology; project administration; resources; drafting the work, writing and editing the manuscript and revising it critically for important intellectual content; supervision; validation; and visualization. Moreover, all authors validate the final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
The study protocol was approved by the Ege University Non-pharmaceutical Clinical Research Ethics Committee with the approval number E.74225. Additionally, all the patients or their parents provided written informed consent.