Schoeman Judy, Kellerman Ilde-Marié, Ndlovu Sandile, Ladas Elena J, Rogers Paul C, Naidu Gita, Rowe Biance, Du Plessis Jan, Herholdt Mariechen, Thomas Karla, Vanemmenes Barry, Mathews Rema, Uys Ronelle, Büchner Ané, Omar Fareed E, Reynders David T, Kruger Mariana
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
Department of Paediatrics and Child Health, Division of Paediatric Oncology and Haematology, Faculty of Medicine and Health Sciences, University of Pretoria, Pretoria, South Africa.
J Hum Nutr Diet. 2025 Aug;38(4):e70082. doi: 10.1111/jhn.70082.
This study investigated the prevalence of malnutrition at childhood cancer diagnosis in South Africa and the association with 1-year post-diagnosis overall survival (OS).
Nutritional status was prospectively assessed for newly diagnosed children with cancer. Chronic undernutrition was defined as two standard deviations (SDs) or more below zero for height/length-for-age (HAZ), and acute as underweight (weight-for-age [WAZ], and wasted as body mass index for age [BAZ] and mid-upper arm circumference for age [MUAC/A]). The association between the nutritional status at diagnosis and age, sex, disease group and 1-year post-diagnosis OS was analysed with Cox regression and hazard ratios (HRs).
Less than 15% were chronically malnourished (stunted: 14.3%) and up to 24.3% acutely undernourished (wasted: 24.3% MUAC-Z and BAZ 8.1%), 11.6% underweight, of 320 patients at cancer diagnosis). More females than males were underweight (12.2% vs. 4.5%; p = 0.027). Children of 5 years of age and older had a higher prevalence of wasting (18.7%) than children under 5 years of age (3.9%) (p < 0.001) at diagnosis, with significant improvement 6 months after diagnosis. Stunting was significantly associated with poorer OS at 3 years after a cancer diagnosis (HR 1.8; 95% CI 1.1, 2.8; p = 0.011).
MUAC/A identified more children with undernutrition than other nutritional parameters. Stunting was significantly associated with poorer OS 3 years and EFS 2 years after a cancer diagnosis. Optimal nutritional support should be provided for South African children, especially those with acute and chronic malnutrition, to improve OS.
本研究调查了南非儿童癌症诊断时营养不良的患病率及其与诊断后1年总生存率（OS）的关联。
对新诊断的癌症儿童进行前瞻性营养状况评估。慢性营养不良定义为身高/年龄别身长（HAZ）低于零两个标准差（SDs）或更多，急性营养不良定义为体重不足（年龄别体重[WAZ]），消瘦定义为年龄别体重指数[BAZ]和年龄别上臂中部周长[MUAC/A]。采用Cox回归和风险比（HRs）分析诊断时营养状况与年龄、性别、疾病组及诊断后1年OS之间的关联。
在320例癌症诊断患者中，不到15%为慢性营养不良（发育迟缓：14.3%），高达24.3%为急性营养不良（消瘦：MUAC-Z为24.3%，BAZ为8.1%），11.6%体重不足。体重不足的女性多于男性（12.2%对4.5%；p = 0.027）。5岁及以上儿童在诊断时的消瘦患病率（18.7%）高于5岁以下儿童（3.9%）（p < 0.001），诊断后6个月有显著改善。癌症诊断后3年，发育迟缓与较差的OS显著相关（HR 1.8；95% CI 1.1，2.8；p = 0.011）。
与其他营养参数相比，MUAC/A识别出更多营养不良儿童。癌症诊断后3年发育迟缓与较差的OS显著相关，2年无事件生存率（EFS）也较差。应为南非儿童，尤其是那些患有急慢性营养不良的儿童提供最佳营养支持，以改善OS。
