Sensitive measures of the nutritional status of children with cancer in hospital and in the field.

Sensitive measures of nutritional status exist. Initial assessment must include some measure that is independent of tumour mass, particularly in children with large solid tumours. Arm anthropometry, including triceps and biceps skinfold thickness (SFT), and mid-upper-arm circumference (MUAC) are ideal in this situation, but MUAC is probably the simplest measure to use. In the clinical setting, a direct measure of fat-free body mass (FFBM) does not exist, but bio-electrical impedance (BIA) measures FFBM indirectly, and has many advantages, in particular its ease of use and immediate results. The BIA analyzer is portable and hence can be used in the field as well as by the bedside. Serum proteins and insulin-like growth factors are insufficiently sensitive as nutritional indices and have only a minor role in nutritional assessment.