Incidence of malnutrition as measured using specific anthropometric and biochemical parameters and its relationship with chemotoxicity in children with nephroblastoma admitted to Inkosi Albert Luthuli Central Hospital between 2004-2012.

Abstract

Introduction: The prevalence of malnutrition in children with cancer in developing countries is reported to be as high as 69%. Malnutrition is worse in developing countries as the diagnosis of cancer may be delayed due to poor access to health care. The assessment of the nutritional status of paediatric oncology patients on admission to hospital is crucial as nutritional status is known to influence treatment and clinical outcomes. Several studies suggest that concurrent malnutrition and cancer in children leads to reduced chemotherapy delivery due to impaired tolerance and increased toxicity. The influence of malnutrition on the prevalence, frequency and duration of chemotoxicity in South African children with nephroblastoma has not been well researched. Aim: This study aimed to determine the incidence of malnutrition as measured using specific anthropometric and biochemical parameters and its relationship with chemotoxicity in children with nephroblastoma admitted to IALCH between 2004-2012. Objectives: a) To determine the incidence of malnutrition as measured using specific anthropometric and biochemical parameters in children with nephroblastoma admitted to IALCH between 2004-2012. b) To determine the influence of malnutrition as measured using specific anthropometric and biochemical parameters on the prevalence of chemotoxicity. c) To determine the influence of malnutrition as measured using specific anthropometric and biochemical parameters on the frequency and duration of chemotoxicity Methods: Seventy-seven children between the ages of 1-12 years diagnosed with nephroblastoma and admitted to IALCH between 2004 and 2012 were studied prospectively. Nutritional assessment took place before treatment was started and included weight, height, mid upper arm circumference (MUAC), triceps skinfold thickness (TSFT) and serum albumin. The administration of Neupogen® was used as a surrogate for haemotoxicity and the frequency and duration of its use was recorded. Results: When patients were classified by weight for age (WFA), height for age (HFA), weight for height (WFH) and body mass index (BMI) for age, malnutrition was seen in 37.5%, 39.5%, 28.4% and 30.3% of patients respectively. When the parameters MUAC and TSFT were used the prevalence of malnutrition was 56% and 52.7% respectively. There was a significant relationship between the prevalence of toxicity and MUAC. The mean frequency and duration of chemotoxicity was significantly higher in those defined as malnourished using MUAC. Frequency and duration of chemotoxicity were positively correlated. Serum albumin, when used alone, showed that 86% of the cohort had a normal nutritional status. Conclusions: Nutritional assessment in children with solid tumours should include MUAC, TSFT as well as weight and height. This is because the use of weight and height alone could underestimate the prevalence of malnutrition. Children with nephroblastoma who have malnutrition according to their MUAC are more likely to experience more frequent and longer periods of chemotoxicity. Serum albumin should not be used in isolation to identify malnutrition.