Israëls Trijn, Borgstein Eric, Jamali Monica, de Kraker Jan, Caron Huib N, Molyneux Elizabeth M
Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi.
Pediatr Blood Cancer. 2009 Dec 15;53(7):1221-6. doi: 10.1002/pbc.22158.
Children with cancer in resource limited countries are often malnourished at diagnosis. Acute malnutrition is associated with more infectious complications and an increased risk of morbidity and mortality in major surgery.
All new patients with the clinical diagnosis of a Wilms tumour admitted in the Queen Elizabeth Central Hospital, Blantyre, Malawi from January 2007 until June 2008 were included. We documented anthropometric parameters, tumour size and serum levels of micronutrients at diagnosis. Corrected weight (body weight - tumour weight) was repeated after 4 weeks of preoperative chemotherapy. During therapy oral feeds were encouraged and a locally made ready to use therapeutic peanut butter-based food (chiponde) supplied.
A high rate of acute malnutrition was found in patients with Wilms tumour at diagnosis (45-55%), much higher than in community controls (11%). Patients (40%) and community controls (37%) had a similar, high rate of stunting (low height for age), a sign of chronic malnutrition. Tumour size at diagnosis and the degree of acute malnutrition at diagnosis was correlated; patients with a larger tumour had more severe acute malnutrition (r = -0.88, P < 0.01). With a supply of chiponde, 7 of 18 patients had a >5% increase in corrected weight during preoperative chemotherapy. Patients with a more positive nutritional course had a better tumour response to chemotherapy (r = 0.52, P < 0.05). Surprisingly, few micronutrient deficiencies were found, except for low serum levels of vitamin A (44% of patients).
Acute malnutrition, superimposed on chronic malnutrition, is common in patients with Wilms tumour in Malawi. Earlier presentation needs to be encouraged. Chiponde, a peanut butter based ready-to-use-therapeutic-food, is an attractive means of nutritional support which needs further study.
资源有限国家的癌症患儿在确诊时往往营养不良。急性营养不良与更多的感染性并发症相关，且在大手术中发病和死亡风险增加。
纳入2007年1月至2008年6月在马拉维布兰太尔伊丽莎白女王中央医院临床诊断为肾母细胞瘤的所有新患者。我们记录了确诊时的人体测量参数、肿瘤大小和微量营养素血清水平。术前化疗4周后重复测量校正体重（体重 - 肿瘤重量）。在治疗期间鼓励经口喂养，并提供当地制作的即用型治疗性花生酱类食品（奇波德）。
肾母细胞瘤患者确诊时急性营养不良发生率很高（45 - 55%），远高于社区对照人群（11%）。患者（40%）和社区对照人群（37%）发育迟缓（年龄别身高低）发生率相似，这是慢性营养不良的一个迹象。确诊时的肿瘤大小与急性营养不良程度相关；肿瘤较大的患者急性营养不良更严重（r = -0.88，P < 0.01）。提供奇波德后，18例患者中有7例在术前化疗期间校正体重增加超过5%。营养状况改善更明显的患者对化疗的肿瘤反应更好（r = 0.52，P < 0.05）。令人惊讶的是，除了血清维生素A水平低（44%的患者）外，未发现明显的微量营养素缺乏。
在马拉维，肾母细胞瘤患者中急性营养不良叠加慢性营养不良很常见。需要鼓励更早就诊。奇波德，一种基于花生酱的即用型治疗性食品，是一种有吸引力的营养支持手段，需要进一步研究。
