Pediatric Hematology-Oncology unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
ITACI-Hematology-Oncology Department of Instituto da Criança do Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.
Pediatr Blood Cancer. 2019 Dec;66(12):e27980. doi: 10.1002/pbc.27980. Epub 2019 Aug 28.
Undernutrition impacts clinical outcome adversely in children with cancer. This study aimed to validate a nutritional algorithm with specific application to the low- and middle-income country (LMIC) setting.
Fifty children with a new diagnosis of cancer were enrolled in this randomized interventional study. Weight, height/length, and mid-upper-arm circumference (MUAC) were measured at baseline. The study arm was administered nutritional care as per the algorithm and the control arm received the institutional standard of care. Weight was monitored regularly and MUAC was repeated after 3 months. Children were classified based on weight for height if <2 years of age or body mass index if ≥2 years, as normal, wasted, and severely wasted. The algorithmic approach comprised administration of oral supplements, nasogastric feeds, and/or parenteral nutrition based on objective assessment of the nutritional status.
Fifty patients were analyzed (study: 25, control: 25). Four in the study arm (16%) and six in the control arm (24%) had wasting at baseline. MUAC was <5th percentile in 15 (60%) and 13 (52%) patients in the study and control arms, respectively. At the end of 3 months, the median increment in weight was 0.8 kg (interquartile range [IQR]: -0.02; 2.00) and 0.0 kg (IQR: -0.70; 1.25) in the study and control arms, respectively (P = .153). The median increment in MUAC was 1.20 cm (IQR: 0.10; 2.30) and 0.00 cm (IQR: -0.50; 1.10) in the study and control arms, respectively (P = .020).
The application of an algorithm designed for use in LMICs resulted in significant improvement in nutritional status, as measured by MUAC.
营养不良会对癌症患儿的临床预后产生不利影响。本研究旨在验证一种适用于中低收入国家（LMIC）的营养算法。
本随机干预研究纳入了 50 名新诊断为癌症的儿童。在基线时测量体重、身高/长度和上臂中部周长（MUAC）。研究组根据算法接受营养护理，对照组接受机构标准护理。定期监测体重，3 个月后重复测量 MUAC。对于 <2 岁的儿童，根据体重与身高的比值进行分类；对于 ≥2 岁的儿童，根据身体质量指数进行分类，分为正常、消瘦和严重消瘦。算法方法包括根据营养状况的客观评估，给予口服补充剂、鼻胃管喂养和/或肠外营养。
共分析了 50 名患者（研究组：25 名，对照组：25 名）。研究组有 4 名（16%）和对照组有 6 名（24%）儿童在基线时有消瘦。研究组和对照组分别有 15 名（60%）和 13 名（52%）儿童的 MUAC<第 5 百分位数。3 个月后，研究组体重中位数增加 0.8kg（四分位距 [IQR]：-0.02；2.00），对照组增加 0.0kg（IQR：-0.70；1.25）（P=0.153）。研究组和对照组 MUAC 的中位数增量分别为 1.20cm（IQR：0.10；2.30）和 0.00cm（IQR：-0.50；1.10）（P=0.020）。
应用专为 LMIC 设计的算法可显著改善 MUAC 测量的营养状况。
