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. 2020 Aug:38:185-191.
doi: 10.1016/j.clnesp.2020.05.005. Epub 2020 Jun 2.

Normalized measures and patient characteristics to identify undernutrition in infants and young children treated for cancer

Daniel V Runco  1 , Karen Wasilewski-Masker  2 , Courtney E McCracken  3 , Martha Wetzel  3 , Claire M Mazewski  2 , Briana C Patterson  4 , Ann C Mertens  2
Affiliations

Normalized measures and patient characteristics to identify undernutrition in infants and young children treated for cancer

Daniel V Runco et al. Clin Nutr ESPEN. 2020 Aug.

Abstract

Background: Various measures and definitions for undernutrition are used in pediatrics. Younger children treated for cancer are at high risk, but lack well-defined risk-based screening and intervention.

Methods: A retrospective study collected weight longitudinally for patients less than three years-old over two years after initiating cancer treatment. We included those diagnosed 2007-2015 at a large pediatric cancer center. Exclusion criteria included treatment starting outside our system, secondary or relapsed malignancy, or incomplete information. A decrease ≥1 in weight-for-age or weight-for-height z-score signified clinically significant weight loss. Univariate and multivariate models assessed hazards for developing first episode of clinically significant weight loss.

Results: Of 372 patients, only 24.6% of patients lost 10% of weight, but 58.6% lost weight-for-age z-score ≥1 and 64.8% lost ≥1 weight-for-height z-score within two years of treatment initiation. Patients who lost weight were younger (median age 15 vs. 24 months, p < 0.001). Compared to patients diagnosed in the first year of life, those diagnosed 24-35 months were less likely to lose weight (HR 0.62, p < 0.001) and lost weight later (median time to weight loss 144 vs. 35 days). Higher treatment intensity increased weight loss risk (HR 2.30, p < 0.001) and decreased time to weight loss (35 vs. 154 days). No differences were found based on sex, diagnosis, enteral or parenteral nutrition, gastroenterology consults, or intensive care admissions.

Conclusions: Using normalized z-scores is more sensitive for identifying weight loss. Younger children are more likely to lose weight with higher intensity cancer therapy. Patient and treatment specific information should be used in risk stratifying weight loss screening and nutritional interventions.

Keywords: Anthropometric measures; Cancer; Infant; Nutrition; Pediatric oncology; Weight loss.

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Conflict of interest statement

Declaration of Competing Interest The authors do not have a financial relationship with the organizations sponsoring this research that would create a real or perceived conflict of interest. The corresponding author has full control and ownership of the data presented here and can be produced for review by the journal if requested.

Figures

Fig. 1.
Fig. 1.
Weight-loss-free survival based on age at diagnosis.
Fig. 2.
Fig. 2.
Weight-loss-free survival based on treatment intensity.
See this image and copyright information in PMC

References

    1. Ladas EJ, Sacks N, Meacham L, Henry D, Enriquez L, Lowry G, et al. A multi-disciplinary review of nutrition considerations in the pediatric oncology population: a perspective from children’s oncology group. Nutr Clin Pract 2005;20:377–93. - PubMed
    1. Rogers PC, Melnick SJ, Ladas EJ, Halton J, Baillargeon J, Sacks N. Children’s oncology group (COG) nutrition committee. Pediatr Blood Canc 2008;50: 447–50. discussion 51. - PubMed
    1. Brinksma A, Roodbol PF, Sulkers E, Kamps WA, de Bont ES, Boot AM, et al. Changes in nutritional status in childhood cancer patients: a prospective cohort study. Clin Nutr (Edinb) 2015;34:66–73. - PubMed
    1. Zimmermann K, Ammann RA, Kuehni CE, De Geest S, Cignacco E. Malnutrition in pediatric patients with cancer at diagnosis and throughout therapy: a multicenter cohort study. Pediatr Blood Canc 2013;60:642–9. - PubMed
    1. Pena NF, Mauricio SF, Rodrigues AMS, Carmo AS, Coury NC, Correia M, et al. Association between standardized phase Angle, nutrition status, and clinical outcomes in surgical cancer patients. Nutr Clin Pract 2019;34:381–6. - PubMed

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