Low socioeconomic status is a strong independent predictor of relapse in childhood acute lymphoblastic leukemia. Zinc supplementation in children and adolescents with acute leukemia Malnutrition as a prognostic factor in lymphoblastic leukaemia: a multivariate analysis. Enteral nutrition during bone marrow transplantation in patients with pediatric cancer: a prospective cohort study. Longitudinal growth and risk factors for growth deficiency in children treated for acute lymphoblastic leukemia. Nutritional status and clinical outcomes in pediatric patients with solid tumors : A systematic review of the literature. Fluctuations in dietary intake during treatment for childhood leukemia: A report from the DALLT cohort. Estimating the total incidence of global childhood cancer: a simulation-based analysis.
The results of the treatment of acute lymphoblastic leukemia ( ALL ) in children depend not only on the biologic diversity of the leukemia cell , the multi-drug treatment schedule and the individual variability of drug metabolism , but also on the socioeconomic and cultural background of the leukemic child . Social and cultural disparity is very marked in underdeveloped countries and has been increasing in industrialized nations . The prognostic influences of these factors are poorly documented and sometimes mistakenly attributed to differences in ethnic origin . We have investigated in Brazil the relative impact of malnutrition and socioeconomic status on the outcome of ALL , adjusting for the known influence of biologic factors . Children with ALL ( n = 167 ) treated with a Berlin-Frankfurt-Munster-based protocol  were studied prospect ively . At a median follow-up of 1623 days , the estimated probability of disease-free survival was 43 + /- 4 % . The main cause for interruption of remission was bone-marrow relapse . Socioeconomic indicators of poverty ( poor housing conditions , low per capita income and energy consumption ) were significantly associated with a greater risk of relapse in univariate analysis . They were consoli date d in a single index , socioeconomic status ( SES ) , defined by the product of monthly per capita income times mean familial daily energy consumption . Other unfavorable findings included age , z score for the height for age at diagnosis ( HAZ ) below-1.28 and the z score for weight for age below-1.28 . After adjustment in Cox 's multivariate model , only HAZ and poor SES remained as predictive factors for relapse . Poor prognosis for leukemic children of low SES is just another indicator of social ine quality Background / objectives : Zinc is known as an essential micronutrient for human health because of its structural and biochemical functions , influencing growth and affecting multiple aspects of the immune system . Zinc has been extensively studied in neoplastic processes but its role in children with leukemia still remains to be eluci date d in several aspects . The aim of this study was to evaluate the effects of oral zinc supplementation on weight gain and infectious episodes in children and adolescents with acute leukemia . Subjects/ methods : This study included 38 patients , and was carried out as a r and omized , double-blind , placebo-controlled investigation . The dosage of plasma zinc levels and the evaluation of nutritional status were performed during a period of 60 days . Zinc was supplemented orally , 2 mg/kg/day , in the form of amino acid salt . Results : The results showed that plasma zinc concentrations did not increase significantly with the addition of the micronutrient . However , from a clinical point of view , it has become evident that supplementary zinc exerts a positive effect on nutritional status as positive weight gain . Moreover , the number of infection episodes was significantly reduced , possibly because of the immune stimuli . Conclusions : In conclusion , zinc supplementation can prevent some of the chemotherapy adverse effects in children with leukemia , improving their quality of life One hundred and twenty eight Brazilian children with lymphoblastic leukaemia were intensively treated with a Berlin-Frankfurt-Munich based protocol . More children had a white cell count above 50 x 10(9)/l ( 31 % ) then observed in developed countries . After a median follow up of 31 months ( 11 - 58 months ) , the estimated probability of relapse free survival was 41 % ( 7 % ) for the whole group . After adjustment in the Cox 's multivariate model , malnutrition was the most significant adverse factor affecting duration of complete remission . Age above 8 years and high peripheral white cell count were also significant adverse factors . Among the nutritional indices , the height for age and weight for age z scores were both significant , whether the cut off points of z-2 or z = -1.28 were chosen to define malnutrition . A strong statistical association between the two indices was found ; the contribution of height for age z score to the prediction of relapse free survival was more significant . Children with height for age z score < -2 had a relapse risk of 8.2 ( 95 % confidence interval 3.1 to 21.9 ) relative to children with z score > -2 . The results of this study suggest that socioeconomic and nutritional factors should be considered in the prognostic evaluation of children with leukaemia in developing countries CONTEXT AND OBJECTIVE Cancer patients undergoing bone marrow transplantation ( BMT ) often require nutritional therapy due to treatment toxicities . The aim here was to evaluate the use of tube feeding and its applicability , indications , contraindications and complications in these patients . DESIGN AND SETTING Prospect i ve observational study conducted at a public university in São Paulo between January 2002 and August 2007 . METHODS The patients were followed up daily in the BMT unit by a research dietitian . Tube feeding was indicated when oral supplementation proved to be insufficient , when the patient had severe malnutrition or there was an impediment to use of oral feeding . It was contraindicated in the presence of gastrointestinal toxicity of grade 3 and 4 or other conditions that implied a risk or hindered its use or placement . Complications of tube feeding were divided into minor and major , according to whether they had life-threatening implication s. RESULTS Forty-two ( 47.2 % ) patients had indications for tube feeding : the main reasons were transplantation inadequate food and supplement intake , insufficient intake with malnutrition or weight loss , severe malnutrition or need for oral fasting . Thirty-one ( 73.8 % ) received tube feeding : 11 autologous and 20 allogenic patients ( P = 0.04 ) . The main contraindications were severe gastrointestinal toxicities and sinusitis . Minor complications from tube feeding were more prevalent in patients with allogenic BMT , but no major complications were observed . CONCLUSION Enteral nutrition is a feasible procedure in patients undergoing BMT and should be encouraged . The main difficulty in BMT patients , in relation to tube feeding , is gastrointestinal toxicities BACKGROUND Growth deficit has been reported as a frequent complication of the treatment of acute lymphoblastic leukemia ( ALL ) . PROCEDURE Longitudinal analysis of the growth of 129 children , from a total of 351 cases diagnosed between 1987 and 1994 in Brazil , was determined . Height data were converted into st and ard deviation Z scores . Only girls younger than 10 and boys younger than 12 years old at diagnosis were included . Patients were treated according to a German BFM-83 based protocol . Fifty-eight children received 18 Gy cranial irradiation , four 12 Gy , and two 24 Gy . Patients were aggregated into five non-excluding groups according to availability of height data at diagnosis , during the treatment , at the end of it , and several years after ; 35 children reached their final height . RESULTS Height deficit at the end of the therapeutic treatment was evident ( P < 0.0001 ) . Catch-up occurred 1 year after stopping treatment ( P = 0.016 ) . At the last follow-up , over 5 years after the end of treatment ( n = 83 ) or at final height ( n = 35 ) , impressive height deficits were recorded ( P < 0.0001 for both end points ) . Multivariate analysis demonstrated that growth impairment was more severe in children younger than 4 years at diagnosis and in those who received cranial irradiation . No significant effect of gender was observed . Children who were treated solely with chemotherapy also had significant height loss . CONCLUSIONS Treatment of ALL in children is associated with growth deficit during the treatment and several years after it , affecting the final height negatively , particularly in patients younger than 4 and in those who received cranial irradiation INTRODUCTION Nutritional status ( NS ) , defined by undernutrition ( body mass index [ BMI ] < 5th percentile ) or overnutrition ( BMI ≥ 85th percentile ) , is a poor prognostic indicator in pediatric oncology patients . The impact of NS has been primarily studied in hematologic malignancies . This review is intended to summarize literature reporting on the association of NS and treatment-related outcomes in pediatric solid tumors . METHODS We search ed four electronic data bases from inception through August 2018 without language restriction , and included studies of children with cancers arising from renal , bone , liver , eye , muscle , vascular , germ cell , and neural crest tissues , reporting on NS as a predictor for toxicity , survival or relapse . Due to data heterogeneity and limited availability of studies , formal statistical analysis was not achievable . Descriptive statistics were summarized in table format . RESULTS Of 8,991 reports identified , 75 full-text articles were evaluated , 10 of which met inclusion criteria . Up to 62 % of patients were over- or undernourished at diagnosis . Abnormal BMI was associated with worse overall survival in Ewing sarcoma ( hazard ratio ( HR ) : 3.46 , P = .022 ) , osteosarcoma ( HR : 1.6 , P < .005 ) , and a trend toward poorer overall survival in rhabdomyosarcoma ( HR : 1.70 , P = .0596 ) . High BMI in osteosarcoma was associated with increased nephrotoxicity ( odds ratio : 2.8 , P = .01 ) and postoperative complications . NS was not a significant predictor of outcomes in other included disease categories . CONCLUSIONS Existing literature supports the prognostic significance of NS in pediatric solid tumor patients and underscores the need for prospect i ve studies to better eluci date underlying physiological changes in this population BACKGROUND Acute lymphoblastic leukemia ( ALL ) is the most common pediatric malignancy . Nutritional morbidities are a persistent problem facing pediatric patients during and after treatment and age-gender groups that are at risk for nutritional conditions have not been clearly identified . Therapy is a contributing factor ; however , the role of dietary intake remains largely unknown . Prior to conduct of interventional trials , an underst and ing of the effects of treatment on fluctuations in dietary intake is necessary . METHODS We enrolled 794 children with ALL in a prospect i ve clinical trial .  Dietary intake was collected with a food frequency question naire at diagnosis and throughout the course of treatment for pediatric ALL . Reported values were compared to the Dietary Recommended Intake ( DRI ) , and normative values ( NHANES ) . Hierarchical linear models and multilevel mixed-effects ordered logistic regression models were used to evaluate longitudinal changes in dietary intake ; independent sample s t-test with Bonferroni correction was performed to compare to NHANES . RESULTS Of the evaluable participants at each timepoint , dietary intake was obtained on 81 % ( n = 640 ) , 74 % ( n = 580 ) and 74 % ( n = 558 ) at diagnosis , end of induction phase of treatment , and continuation , respectively . Despite exposure to corticosteroids , caloric intake decreased over therapy for most age-gender groups . Predictive models of excess intake found reduced odds of over-consuming calories ( OR 0.738 , P < 0.05 ) ; however , increased odds of over-consuming fat ( OR 6.971 , P < 0.001 ) . When compared to NHANES , we consistently found that ≥1/3 of children were consuming calories in excess of normative values . For select micronutrients , a small proportion of participants were above or below the DRI at each time evaluated . CONCLUSIONS Our study suggests that dietary intake fluctuates during treatment for ALL as compared to age-gender recommended and normative values . Improving our underst and ing of nutrient fluctuations and dietary quality will facilitate subsequent analyses addressing relationships of dietary intake , toxicity , and survival BACKGROUND Accurate estimates of childhood cancer incidence are important for policy makers to inform priority setting and planning decisions . However , many countries do not have cancer registries that quantify the incidence of childhood cancer . Moreover , even when registries do exist , they might substantially underestimate the true incidence , since children with cancer might not be diagnosed . We therefore aim ed to provide estimates of total childhood cancer incidence accounting for underdiagnosis . METHODS We developed a microsimulation model to simulate childhood cancer incidence for 200 countries and territories worldwide , taking into account trends in population growth and urbanicity , geographical variation in cancer incidence , and health system barriers to access and referral that contribute to underdiagnosis . To ensure model results were consistent with epidemiological data , we calibrated the model to publicly available cancer registry  data using a Bayesian approach in which the observed data are fixed and the model parameters ( cancer incidence and probabilities of health system access and referral ) are r and om variables . We estimated the total incidence of childhood cancer ( diagnosed and undiagnosed ) in each country in 2015 and projected the number of cases from 2015 to 2030 . FINDINGS Our model estimated that there were 397 000 ( 95 % uncertainty interval [ UI ] 377 000 - 426 000 ) incident cases of childhood cancer worldwide in 2015 , of which only 224 000 ( 95 % UI 216 000 - 237 000 ) were diagnosed . This finding suggests that 43 % ( 172 000 of 397 000 ) of childhood cancer cases were undiagnosed globally , with substantial variation by region , ranging from 3 % in western Europe ( 120 of 4300 ) and North America ( 300 of 10 900 ) to 57 % ( 43 000 of 76 000 ) in western Africa . In south Asia ( including southeastern Asia and south- central Asia ) , the overall proportion of undiagnosed cases was estimated to be 49 % ( 67 000 of 137 000 ) . Taking into account population projections , we estimated that there will be 6·7 million ( 95 % UI 6·3 - 7·2 ) cases of childhood cancer worldwide from 2015 to 2030 . At current levels of health system performance , we estimated that 2·9 million ( 95 % UI 2·7 - 3·3 ) cases of childhood cancer will be missed between 2015 and 2030 . INTERPRETATION Childhood cancer is substantially underdiagnosed , especially in south Asia and sub-Saharan Africa ( including western , eastern , and southern Africa ) . In addition to improving treatment for childhood cancer , health systems must be strengthened to accurately diagnose and effectively care for all children with cancer . As countries exp and universal health coverage , these estimates of total incidence will hopefully help guide efforts to appropriately increase health system capacity to ensure access to effective childhood cancer care . FUNDING Boston Children 's Hospital , Dana-Farber Cancer Institute , Harvard T H Chan School of Public Health , Harvard Medical School , National Cancer Institute , SickKids , St Jude Children 's Research Hospital , and Union for International Cancer Control
PURPOSE The objective of this systematic review was to describe nutrition-related publications on children and adolescents diagnosed with cancer in Brazil .