Viani Karina, Alves Jullyana, Damasco-Avila Erika, Murra Mariana S, Schoeman Judy, Walters Michelle, Ladas Elena J
Department of Pediatrics, School of Medicine, Instituto de Tratamento do Câncer Infantil, University of São Paulo, São Paulo, Brazil.
Department of Pediatrics, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil.
Front Nutr. 2025 Jun 26;12:1605632. doi: 10.3389/fnut.2025.1605632. eCollection 2025.
Malnutrition (under- and over-nutrition) is a critical challenge in pediatric oncology, particularly in low- and middle-income countries (LMIC), where supportive care resources are scarce. It negatively impacts treatment toxicity, survival rates, and quality of life. Despite the availability of broad guidelines, there is a lack of practical, context-adapted protocols for nutritional assessment and intervention in LMIC. The International Initiative for Pediatrics and Nutrition (IIPAN) developed adapted consensus-based protocols to address this gap.
A multidisciplinary panel of experts in pediatric oncology and nutrition from high-income and LMIC settings collaborated to develop adapted nutrition assessment and intervention manuals. The process involved literature reviews, iterative expert consultations, field testing in LMIC hospitals, and subsequent revisions based on real-world application feedback. Training programs were designed to ensure implementation, including in person and virtual mentorship.
Two comprehensive manuals and one complementary material were developed: (1) Nutritional Assessment: A Training Manual in Anthropometry, (2) Nutritional Intervention: A Training Manual for Pediatric Oncology, and (3) Appendix for Nutritional Intervention. These resources provide structured detailed guidance on nutrition assessment, interventions, and the management of nutrition-related complications. Their scalability and accessibility are crucial for optimizing nutritional management and improving clinical outcomes in limited resource settings.
These evidence-based, expert-designed adapted protocols address critical gaps in nutritional care for children with cancer in LMIC.
营养不良（营养不足和营养过剩）是儿科肿瘤学面临的一项严峻挑战，在中低收入国家（LMIC）尤为如此，这些国家的支持性护理资源匮乏。营养不良会对治疗毒性、生存率和生活质量产生负面影响。尽管有广泛的指南，但在中低收入国家，缺乏针对营养评估和干预的实用、因地制宜的方案。国际儿科与营养倡议（IIPAN）制定了基于共识的适应性方案，以填补这一空白。
来自高收入和中低收入国家的儿科肿瘤学和营养领域的多学科专家小组合作，制定适应性营养评估和干预手册。该过程包括文献综述、反复的专家咨询、在中低收入国家医院进行实地测试，以及根据实际应用反馈进行后续修订。设计了培训项目以确保方案的实施，包括面对面指导和虚拟指导。
制定了两本综合手册和一份补充材料：（1）《营养评估：人体测量培训手册》，（2）《营养干预：儿科肿瘤学培训手册》，以及（3）《营养干预附录》。这些资源为营养评估、干预以及营养相关并发症的管理提供了结构化的详细指导。它们的可扩展性和可及性对于在资源有限的环境中优化营养管理和改善临床结果至关重要。
这些基于证据、由专家设计的适应性方案填补了中低收入国家癌症儿童营养护理方面的关键空白。
