Lifson Lauren F, Hadley G P, Wiles Nicola L, Pillay Kirthee
Dietetics and Human Nutrition, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
Department of Paediatric Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Pediatr Blood Cancer. 2017 Jul;64(7). doi: 10.1002/pbc.26382. Epub 2016 Dec 27.
In developing countries up to 77% of children with cancer have been shown to be malnourished on admission. High rates of malnutrition occur due to factors such as poverty and advanced disease. Weight can be an inaccurate parameter for nutritional assessment of children with solid tumours as it is influenced by tumour mass. This study aimed to assess the prevalence of malnutrition amongst children with Wilms tumour (WT), the level of nutritional support received on admission and the influence of nutritional status on outcome.
Seventy-six children diagnosed with WT and admitted to Inkosi Albert Luthuli Central Hospital between 2004 and 2012 were studied prospectively. Nutritional assessment was conducted using weight, height, mid-upper arm circumference (MUAC) and triceps skinfold thickness (TSFT) prior to initiating treatment. Outcome was determined 2 years after admission. Time until commencement of nutritional resuscitation and nature, thereof, were recorded.
Stunting and wasting was evident in 12% and 15% of patients, respectively. The prevalence of malnutrition was 66% when MUAC, TSFT and albumin were used. Malnutrition was not a predictor of poor outcome and did not predict advanced disease. The majority of patients (84%) received nutritional resuscitation within 2 weeks of admission.
When classifying nutritional status in children with WT, the utilisation of weight and height in isolation can lead to an underestimation of the prevalence of malnutrition. Nutritional assessment of children with WT should also include MUAC and TSFT. Early aggressive nutritional resuscitation is recommended.
在发展中国家，高达77%的癌症患儿在入院时被证明存在营养不良。由于贫困和疾病晚期等因素，营养不良发生率很高。对于实体瘤患儿，体重可能是营养评估的不准确参数，因为它受肿瘤大小影响。本研究旨在评估肾母细胞瘤（WT）患儿中营养不良的患病率、入院时接受的营养支持水平以及营养状况对预后的影响。
对2004年至2012年间在因科西·阿尔伯特·卢图利中心医院确诊为WT并入院的76名儿童进行前瞻性研究。在开始治疗前，使用体重、身高、上臂中部周长（MUAC）和三头肌皮褶厚度（TSFT）进行营养评估。入院2年后确定预后。记录开始营养复苏的时间及其性质。
分别有12%和15%的患者存在发育迟缓及消瘦。当使用MUAC、TSFT和白蛋白时，营养不良的患病率为66%。营养不良不是预后不良的预测因素，也不能预测疾病晚期。大多数患者（84%）在入院2周内接受了营养复苏。
在对WT患儿进行营养状况分类时，单独使用体重和身高可能会低估营养不良的患病率。对WT患儿的营养评估还应包括MUAC和TSFT。建议早期积极进行营养复苏。
