Malnutrition at diagnosis of malignancy in childhood: common but mostly missed

A prospective, controlled study of nutritional status in 100 newly diagnosed paediatric oncology patients is repored. Results showed that although patients' height-for-age and weight-for-height were normal, midupper arm circumference (MUAC) and tricepts skinfold thickness (TSFT) were significantly less than reference and control values. Moreover, 20% of patients had MUAC below the 5th percentile (P<0.001) and 23% had TSFT more than 2 SD below the mean (P<0.001). The discrepancy between these assessments is attributed to the effect of large tumour masses masking diminished true body weight. Children with intra-abdominal solid tumours had significantly lower MUAC and TSFT than those with either extra-abdominal solid tumours or leukaemia, and were more likely to be malnourished based on arm anthropometric criteria. Of all subjects, 44% were consuming less than 80% of their recommended daily allowance of energy at diagnosis, compared with 0% of controls (P=0.001).     

Nutritional rickets in African American breast-fed infants

OBJECTIVE: To analyze the characteristics of infants and children diagnosed with nutritional rickets at two medical centers in North Carolina in the 1990s. STUDY DESIGN: The physical and radiographic findings, calcium, phosphorus, alkaline phosphatase, and 25-hydroxyvitamin D levels of infants and children diagnosed with nutritional rickets at two medical centers were reviewed. Breast-feeding data were obtained from the North Carolina Women, Infants and Children Program (WIC). RESULTS: Thirty patients with nutritional rickets were first seen between 1990 and June of 1999. Over half of the cases occurred in 1998 and the first half of 1999. All patients were African American children who were breast fed without receiving supplemental vitamin D. The average duration of breast-feeding was 12.5 months. The age at diagnosis was 5 to 25 months, with a median age of 15.5 months. Growth failure was common: length was <5th percentile in 65% of cases, and weight was <5th percentile in 43%. CONCLUSION: Factors that may have contributed to the increase in referrals of children with nutritional rickets include more African American women breast-feeding, fewer infants receiving vitamin D supplements, and mothers and children exposed to less sunlight. We recommend that all dark-skinned breast-fed infants and children receive vitamin D supplementation.     

Nutritional status of children with leukemia

Children with cancer represent a high-risk group for protein-energy malnutrition due to side effects associated with treatment. Assessment of nutritional status at the time of diagnosis and during treatment is, therefore, essential for planning nutritional intervention. We studied the nutritional status of 25 children with leukemia [9 newly diagnosed/relapsed (D/R) leukemic patients and 16 children with leukemia in remission (REM)], Plasma proteins (prealbumin, PA; albumin, Alb; transferrin, Tr; retinol-binding protein, RBP) and acute phase-reactant proteins (α₁-acid glycoprotein, AGP; C-reactive protein, CRP; ceruloplasmin, CER) were measured by radial immunodiffusion. Results show that there were no significant deficits in anthropometric measurements among leukemic children. In contrast, the mean levels of all plasma proteins, especially PA (P < 0.005), were significantly lower in the D/R group than in the REM group. All D/R children, compared to 59% of those in remission, had PA levels < 20 mg/dl. Only the D/R group had abnormal levels of RBP, Tr, and Alb. Children who were treated with prednisone had significantly higher mean levels of PA, RBP, and AGP than those who were not receiving prednisone. The mean levels of acute phase-reactant proteins in these leukemic children were comparable to those of healthy children. We conclude that mild/moderate malnutrition is common in leukemic patients at D/R and that PA seems to be the most sensitive indicator of visceral protein Status. © 1994 Wiley-Liss, Inc.     

Nutritional status and risk in hospitalized children]

BACKGROUND: A few studies report malnutrition in hospitalized patients. MATERIAL AND METHODS: This one-day cross-sectional survey performed in January 1999 assessed nutritional status and protein-energy intake in a pediatric population hospitalized in medicine or surgery units. Every child older than six months, hospitalized for more than 48 h and free of nutritional support (parenteral, enteral, or special regimens for metabolic diseases) was included. RESULTS: Fifty-eight children among the 183 present the day of the study met the inclusion criteria and were included in the statistical analysis. They were hospitalized in medicine (48%), psychiatry (31%) and surgery (21%). The body mass index (BMI) was below -2 standard deviations (DS) in 21% of them. Excluding patients with anorexia nervosa, BMI was < -2 SD, > +2 SD, or in between these limits in respectively 12, 14 and 74%. Energy intake measured at the hospital was below 75% of the recommended dietary allowances in two-thirds of the children whether malnourished or not. Fifty percent of the malnourished children had been referred to a dietician the day of the study. CONCLUSIONS: Malnutrition is frequent in a population of hospitalized children. Energy intake and referral to a dietician are insufficient.     

Impact of Obesity on the Risk of Venous Thromboembolism in an Inpatient Pediatric Population

Introduction: The incidence of venous thromboembolism in children has increased significantly over the past 20 years. Over the same period of time, there was an increase in the prevalence of obesity in the pediatric population. Obesity is a known risk factor for VTE in adults, but little information is available in children. Methods: This study evaluates the relation between obesity and VTE using a retrospective, case–control design, comparing the body mass index (BMI) of patients admitted with a diagnosis of VTE versus patients admitted with other diagnoses, at a single institution, between 2007 and 2011. Results: We studied 48 inpatients diagnosed with deep venous thrombosis or pulmonary embolism and a control group of 274 age and gender matched patients admitted with other diagnoses. We found obese patients (BMI > 95th percentile) to have significantly higher risk of VTE (odds ratio 2.1, with 95% CI 1.1–4.2) than patients of normal weight (BMI < 85th percentile). Overweight patients (BMI 85th–95th percentile) did not demonstrate a significant change in risk. Most of the VTE patients were adolescents and the majority of them had other identifiable risk factors for thrombosis. Conclusion: This study establishes a correlation between obesity and VTE in a group of hospitalized children, showing a risk for VTE in obese children similar to the one described in much larger adult cohorts.     

Time-Dependent Alterations in Growth and Bone Health Parameters Evaluated at Different Posttreatment Periods in Pediatric Oncology Patients

Bone mineral density (BMD) and anthropometric measurements in pediatric cancer patients were evaluated and compared at early and late posttreatment periods. Sixty-six pediatric cancer patients who recovered completely following treatment longer than at least a 6-month period were included in the study. Patients were evaluated cross-sectionally and prospectively with regard to anthropometric measurements and BMD twice; the first being at a mean period of 2.62 ± 1.44 years and the second of 6.55 ± 1.71 years after the completion of treatment. Rates of osteoporosis and osteopenia at first or second evaluation were 25.8% and 39.4% or 10.6% and 19.7%, respectively. Mean BMD z-scores were (?1.26) ± 1.12 [(?4.3)–2.0] and (?0.48) ± 1.25 [(?3.30)–3.40] at first and second evaluations, respectively. BMD findings obtained at second evaluation revealed statistically significant recovery compared with those obtained at first evaluation (P = .001). BMD z-scores were significantly lower in patients who received, as opposed to those who did not receive, radiotherapy (RT) at both evaluations. Anthropometric parameters of patients such as height, weight, and body mass index (BMI) were increased at both evaluations compared with values obtained at diagnosis (P < .05). Height standard deviation score (SDS) decreased at first evaluation compared with that measured at diagnosis, whereas it increased at second evaluation. Conversely, weight SDS and BMI SDS increased (P < .05) at first evaluation compared with that measured at diagnosis, whereas they decreased at second evaluation. The authors conclude that early impairments in anthropometric measurements recover in the long term, whereas BMD is continually reduced in children who recovered from cancer.     

Nutritional differences in neurologically impaired children

OBJECTIVES:

To determine whether the recommended nutritional intake of moderately to severely neurologically impaired children is congruent with current growth parameter expectations.

METHODS:

Observational cross-sectional study at a children’s hospice and a tertiary care children’s hospital. Medically stable enterally fed children followed by the palliative care team underwent anthropometric assessment and chart review for diagnosis, intake and medications. Intakes, guidelines and recommendations were compared.

RESULTS:

Intakes were less than recommended. All children were <50th percentile weight-for-age, with many <3rd percentile. Fourteen of 15 were in higher percentiles for absolute and relative body fat.

CONCLUSIONS:

Recommended dietary intakes were not achieved by these children. Despite this, measures of body fat indicate adequate intake. Low weight values may reflect diagnosis-related growth stunting or decreased muscle mass and bone density from immobility. The Centers for Disease Control and Prevention (Georgia, USA) weight-for-age and body mass index are not suitable measures of adequate intake in this group of children.     

Nutritional status of children with cancer and its effects on survival

In the present study we aimed to determine the nutritional status of our patients and to assess its relationship with survival. The nutritional status of 47 patients with cancer was evaluated at diagnosis, three months after initiation of the treatment and at the end of therapy. Weight for height, height for age, and weight for age of children were expressed as percent of standard. Values for each nutritional index were converted into standard deviation (Z) scores. Three-year overall survival (OS) and event-free survival (EFS) rates of patients were determined according to their nutritional status. The overall prevalence of malnutrition at diagnosis was 29.8%. Three months later the malnutrition ratio reached 38.3% and then decreased again to 18.5% at the end of the therapy. Although the prevalence of malnutrition at the third month of treatment was significantly higher from the prevalence at diagnosis (p: 0.001) and at the end of the therapy (p: 0.009), the mean Z scores of the nutritional indexes before and during the treatment were not significantly different. The survival rates of malnourished patients were not different from those of well nourished patients. In conclusion, malnutrition is one of the main problems in children with cancer; hovewer, nutritional status has no effect on survival.     

Nutritional status at diagnosis in children with cancer I. An assessment by dietary recall--compared with body mass index and body composition measured by dual energy X-ray absorptiometry

The nutritional status of children with cancer is clinically important. In an effort to separate the influences of disease and treatment, we studied children at the time of diagnosis. A total of 99 children underwent assessment by 24 hours dietary recall, measurement of body mass index (BMI), and analysis of body composition by dual energy x-ray absorptiometry (DXA scan). The group averages for calorie intake and BMI were close to the median population norms but ranged widely among individuals. As a group the study participants exceeded the Dietary Reference Intake for protein. Nine children (9%) had a BMI 相似文献   

Nutritional Status of Tribal Children and Adolescents in Rural South India: The Effect of an NGO Delivered Nutritional Programme

Objectives

To investigate the prevalence of malnutrition using anthropometric measures in a cohort of tribal students attending a school in rural south India. Children attending the school were offered three meals a day during attendance. Analysis of anthropometric data obtained aimed to determine the nutritional effect of the food provided.

Methods

The nutritional status of 409 students were assessed by comparing anthropometric measurements to reference values according to WHO/NCHS guidelines. Height for age <3rd percentile was defined as stunting. BMI for age <5th percentile was defined as thinness. ‘New’ students were defined as attending the school for <1 y. ‘Old’ students were defined as being in attendance for ≥1 y. Comparison of thinness and stunting prevalence in these groups enabled evaluation of the meals provided by the organisation.

Results

Four hundred and nine students were included for analysis in the study. The prevalence of thinness was 39.4 %. 59.5 % of ‘new’ and 52.9 % of ‘old’ students at the school demonstrated thinness. 59.4 % of students were classified as stunted. 73.8 % of ‘new’ students and 52.9 % of ‘old’ students demonstrated stunting (p 0.091). Significantly (p 0.010) more ‘new’ female students had stunted growth.

Conclusions

Acute and chronic measures of malnutrition were high amongst adolescent students attending the school. Comparison of ‘new’ and ‘old’ adolescent pupils at the school hints that the ‘old’ students were less malnourished than their ‘new’ counterparts. This study demonstrates the importance for NGOs to develop their nutritional programmes with a special focus on adolescents.     

Nutritional status of children during treatment for acute lymphoblastic leukemia in Guatemala

Background

Most children with cancer live in developing countries where the prevalence of malnutrition may reach 50% and influence the course of the disease. This study examined the prevalence and severity of malnutrition at diagnosis, as well as after 3 and 6 months of chemotherapy, in children with acute lymphoblastic leukemia (ALL) in Guatemala.

Methods

Triceps skin fold thickness (TSFT) and mid upper arm circumference (MUAC) provided measures of nutritional status (NS) in three categories: adequately nourished (A): TSFT and MUAC > 10th percentile; severely depleted (SD): TSFT or MUAC < 5th percentile; and moderately depleted (MD): all the remaining patients.

Results

Of 331 new patients, 241 had NS assessed at diagnosis. A = 113 (46.9%); MD = 28 (11.6%); SD = 100 (41.5%). At 3 months A = 106 (52.2%); MD = 25 (12.3%); SD = 72 (35.5%). At 6 months A = 146 (76.0%); MD = 12 (6.3%); SD = 34 (17.7%). In multivariate analysis, SD children at 6 months of treatment had a hazard of death that was 2.4‐fold the hazard of those A or MD (95% CI: 1.3–4.7)

Conclusions

Malnutrition is prevalent in newly diagnosed children with ALL in Guatemala and severe nutritional depletion is apparently predictive of abandonment of therapy and relapse of disease, but if children survive and improve their NS in the first 6 months after diagnosis, their chances of survival may improve significantly to approximate those in children not presenting with nutritional depletion. Pediatr Blood Cancer 2013; 60: 911–915. © 2012 Wiley Periodicals, Inc.     

Failure of conventional strategies to improve nutritional status in malnourished adolescents and adults with cystic fibrosis

The use of oral dietary supplements was compared with dietary counseling in 13 malnourished patients (3 males, mean age 18.1 years) with cystic fibrosis. Energy intake and nutritional status were evaluated over 3 months. There was no significant change in energy intake or percent ideal body weight in either group.     

Evaluation of the use of the 10th percentile of weight for age as a cut point for detection of children under nutritional risk

OBJECTIVE: To evaluate the use of the 10th percentile of weight for age as a cut off point for detection of children under nutritional risk, especially for programs of alimentary supplementation. METHODS: 841 children with age between 10 days and 60 months were studied in a primary health care center located in the periphery of Ribeir?o Preto, SP, Brazil. It was a cross-sectional study that included age, sex, weight and height, later computing the z scores of weight for age, height for age and weight for height, on the basis of the data of the NCHS. Through 2x2 type tables, where the results in relation with the 10th percentile (above or below this cut off point) and other indices were compared (above or below - 2 z scores), the capacity of 10th percentile of weight for age to detect children with various anthropometric deficits was estimated. RESULTS: The false negative results were always very low, between 0 and 1%, in opposition to the false positive results, that varied from 76.3 to 90.5%. The values of sensitivity/specificity have been 100/85.9%; 93.3/83.8%; 82.9/85.7%, respectively for deficits of weight for age, weight for height and height for age. CONCLUSIONS: The 10th percentile of weight for age was found adequate for population screening of children with weight for the age and weight for the height deficits (high sensitivity), but these children must be better evaluated later on (too many false positive results). For height for age deficits, the 10th percentile resulted inadequate.     

Inconsistent determination of overweight by two anthropometric indices in girls with Turner syndrome

Aim: To evaluate the prevalence of overweight in girls with Turner syndrome (TS) as classified by the two major anthropometric indices, body mass index (BMI) and weight-for-height (WFH) and to make growth reference charts of them for comparison with those of the normal population.
Method: The samples for analysis were obtained from a retrospective cohort. In total, 1447 girls' cross-sectional data were analysed. Subjects were divided into four groups by ages: group A (0–5.99 years), B (6–10.99 years), C (11–15.99 years) and D (16–20.99 years). The cut-off values of overweight by BMI and WFH were those of the 90th percentile and 120 percent, respectively and the prevalence was calculated. For constructing growth reference charts, the LMS method was used.
Results: The prevalence of overweight differed between the two indices. The proportions of the coincidental classification in all subjects, group A, B, C and D were 82.53%, 89.96%, 91.79%, 69.98% and 60.61%, respectively. These differences corresponded to the difference of age-dependent patterns of the two indices from those of the normal population, as judged from the growth charts constructed with all subjects.
Conclusion: A discrepancy in the prevalence of overweight as classified by BMI and WFH for girls with TS was detected.     

Nutritional Management bei schwerstbehinderten Kindern

Children with severe neurodevelopmental disabilities are often malnourished due to oral-motor impairment and intestinal dysmotility. Growth failure, micronutrient deficiencies, and infrequently overweight are nutritional comorbidities. Discomfort caused by gastroesophageal reflux disease, pulmonary symptoms or chronic constipation is common. Monitoring for and treating these comorbidities should be part of the general care of neurologically impaired children. If oral feeding interventions are insufficient to promote weight gain, growth and adequate hydration or to prevent aspirations, enteral tube feeding should be considered. Nutritional management should prevent malnutrition, overweight, vomiting, pain and complications due to gastroesophageal reflux disease, chronic lung disease due to aspiration and should optimize care for these patients and therefore increase the quality of life of these children and their parents.     

Trace elements in the hair of healthy and malnourished children

Pre-school age children from the metropolitan area of Guadalajara, Mexico, consisting of 47 malnourished children were evaluated for mineral status by hair samples and nutritional status by anthropometric measurements and haemoglobin levels. Hair minerals were determined by either atomic absorption spectroscopy or instrumental neutron activation analysis. Malnourished children had significantly lower hair zinc while the iron and copper levels were significantly higher. Hair concentrations of calcium, magnesium, and manganese were not significantly different between healthy and malnourished children. Sixty per cent of the malnourished children's haemoglobin values were either marginal or deficient while 45 per cent of the haematocrits readings were either marginal or deficient. Malnourished children in weight-for-age category were 81 per cent malnourished; by weight-for-height 55 per cent were malnourished and by height-for-age 59 per cent were malnourished. The overall nutritional status of malnourished children can be characterized as mild to severe malnutrition with a chronic stunting of growth. Hair zinc values were a good indicator of nutritional status.     

Waist circumference predicts cardiovascular risk in young Australian children

Aim: It has been shown that compared with healthyweight children, overweight and obese primary school‐aged children have a higher incidence of hyperinsulinism, dyslipidaemia and hypertension. It is therefore important to investigate clinically relevant markers of cardiovascular risk in children. Waist circumference is a simple, non‐invasive anthropometric measure, but its association with cardiovascular risk profile in young Australian children is not clear. Methods: This study presents cross‐sectional data from the Growth and Development Study. The sample included 70 healthy weight children, 50 overweight children and 28 obese children (n = 148, 9.6 ± 1.9 years). All children had a medical assessment which included a physical examination (waist circumference, blood pressure), and investigations including glycated haemoglobin, total cholesterol, high‐density lipoprotein, low‐density lipoprotein, triglycerides, insulin, glucose and total homocysteine levels. An oral glucose tolerance test was performed in a subgroup of children (n = 119). Body mass index (BMI) was determined and BMI Z‐scores calculated. Results: In a multilevel model, waist circumference was the only significant anthropometric predictor of lipid profile (high‐density lipoprotein β = ?0.01, P < 0.05; triglycerides β = 0.01, P < 0.005), systolic blood pressure (β = 0.29, P < 0.05), fasting insulin (β = 0.16, P < 0.005), insulin concentrations throughout the oral glucose tolerance (60 min β = 1.07, P < 0.005; 120 min β = 1.42, P < 0.001) and insulin resistance (homeostasis model assessment (HOMA‐IR): β = 0.03, P < 0.05), with increasing waist circumference associated with increasing cardiovascular risk. In contrast, BMI Z‐score was only predictive of 120‐min glucose concentrations during the OGTT (β = 0.34, P < 0.05). Conclusions: Waist circumference is a better anthropometric indicator than BMI Z‐score of cardiovascular risk in Australian primary school‐aged children. Even in young children, measurement of waist circumference represents a simple, non‐invasive screening tool to identify children with an increased cardiovascular risk profile.     

Nutritional status of children with cystic fibrosis measured by total body potassium as a marker of body cell mass: lack of sensitivity of anthropometric measures

OBJECTIVE: To investigate measures aimed at defining the nutritional status of cystic fibrosis (CF) populations, this study compared standard anthropometric measurements and total body potassium (TBK) as indicators of malnutrition. METHODS: Height, weight, and TBK measurements of 226 children with CF from Royal Children's Hospital, Brisbane, Australia, were analyzed. Z scores for height for age, weight for age, and weight for height were analyzed by means of the National Centre for Health Statistics reference. TBK was measured by means of whole body counting and compared with predicted TBK for age. Two criteria were evaluated with respect to malnutrition: (1) a z score < -2.0 and (2) a TBK for age <80% of predicted. RESULTS: Males and females with CF had lower mean height-for-age and weight-for-age z scores than the National Centre for Health Statistics reference (P <.01), but mean weight-for-height z score was not significantly different. There were no significant gender differences. According to anthropometry, only 7.5% of this population were underweight and 7.6% were stunted. However, with TBK as an indicator of nutritional status, 29.9% of males and 22.0% of females were malnourished. CONCLUSION: There are large differences in the percentage of patients with CF identified as malnourished depending on whether anthropometry or body composition data are used as the nutritional indicator. At an individual level, weight-based indicators are not sensitive indicators of suboptimal nutritional status in CF, significantly underestimating the extent of malnutrition. Current recommendations in which anthropometry is used as the indicator of malnutrition in CF should be revised.     

C-reactive protein and body mass index in children: findings from the Third National Health and Nutrition Examination Survey, 1988-1994

OBJECTIVES: To examine the relationship between C-reactive protein (CRP) concentration and body mass index (BMI) in children. STUDY DESIGN: With the use of data from 5305 children aged 6 to 18 years in the Third National Health and Nutrition Examination Survey (1988 to 1994), a cross-sectional health survey, we examined whether CRP concentrations were elevated among overweight children. RESULTS: Among children whose BMI was below the age- and sex-specific 15th percentile, 6.6% of boys and 10.7% of girls had an elevated CRP concentration (>2.1 mg/L) compared with 24.2% of boys and 31.9% of girls whose BMI was > or =95th percentile. After adjustment was done for age, sex, race or ethnicity, poverty income ratio, high-density lipoprotein cholesterol concentration, white blood cell count, and history of chronic bronchitis, the adjusted odds of having an elevated CRP concentration were 2.20 (95% CI 1.30, 3.75) for children with a BMI of 85th to <95th percentile and 4.92 (95% CI 3.39, 7.15) for children with a BMI of > or =95th percentile compared with children who had a BMI of 15th to <85th percentile. The associations did not differ significantly by age, sex, or race or ethnicity. CONCLUSIONS: In a large representative sample of US children, CRP concentration was significantly elevated among children with a BMI > or=85th percentile, thus confirming previous findings of this association in children and extending previous research in adults to children. Excess body weight may be associated with a state of chronic low-grade inflammation in children.