Oral Beslenme Desteğinin Kanser Tedavisi Gören Çocuklarda Vücut Kitle İndeksi Üzerindeki Etkisi

Year 2021, Volume: 5 Issue: 3, 276 - 279, 01.03.2021

Uğur Demirsoy , Feza Kırbıyık , Ali Doğan , Funda Corapcıoglu

https://doi.org/10.28982/josam.865377

Abstract

Amaç: Kötü beslenme, kanserli çocuklarda kemoterapi ve radyoterapi gibi tedavi yöntemlerinin toleransı etkileyebilen tehlikeli bir komorbiditedir. Aynı zamanda tedavi sonucunu ve genel sağkalımı da olumsuz etkilemektedir. Bu çalışmanın amacı, kanser tedavisi gören yetersiz beslenen çocuklarda oral beslenme desteğinin vücut kitle indeksi (VKİ) üzerindeki etkisini değerlendirmektir.
Yöntemler: Bu çalışma tek merkezli retrospektif bir çalışma olup, çalışmaya dahil edilen malnütriye pediatrik kanser hastaların kayıtları Kocaeli Üniversitesi Tıp Fakültesi, Pediatrik Onkoloji Bölümü (Kocaeli, Türkiye)'nden toplanılmıştır ve analiz edilmiştir. Spesifik anti-kanser rejimlerine ek olarak oral nütrisyonel destek (OND) alan hastaların beslenme durumları takip ziyaretlerinde ölçülen kilo, boy ve VKİ'ye göre 8 aylık bir süre boyunca değerlendirilmiştir. Veriler, tüm hastalar için veya aşağıdaki tümör gruplarına kümelendikten sonra analiz edilmiştir; CNS tümörleri% 13.3 (8 hasta), lenfoma% 18.3 (11 hasta), diğer tümörler% 68.3 (41 hasta).
Bulgular: Çalışmaya beslenme bozukluğu olan 60 pediatrik kanser hastası (% 64,6 erkek,% 35,4 kadın) dahil edilmiştir. OND öncesi ve OND sonrası antropometrik verilerin karşılaştırılması sonrası, 36 hastada (%60) VKİ'de artışa karşın 24 hastada (%40) VKİ'de azalma olduğu görülmüştür (p <0.05). Diğer tümör grubu (p <0.001) ve lenfoma grubu (p = 0.012) için de istatistiksel olarak anlamlı artış gözlenmiştir.
Sonuç: OND, pediatrik kanser hastalarında VKİ'yi artıran ve beslenme durumunu iyileştiren önemli bir müdahaledir. İyileşmenin kapsamı muhtemelen hastalığın türü ve yeri ile ilgilidir.

Keywords

pediatri, malnütrisyon, kanser, vücut kitle indeksi

The impact of oral nutritional supplementation in children treated for cancer

Abstract

Background/Aim: Malnutrition is a dangerous comorbidity in children with cancer that can affect tolerance to treatment modalities such as chemotherapy and radiotherapy. It also adversely affects the treatment outcome and overall survival. It has been known that low Z score of body mass index (BMI) indicates malnutrition. This study aims to underline the effects of oral nutritional supplementation (ONS) on pediatric oncology patients.
Methods: All records were collected from Kocaeli University Hospital, Department of Pediatric Oncology, Kocaeli, Turkey, and analyzed. Weight, height, and BMI status of sixty patients who received ONS with cancer treatment were recorded during visits up to 8 months after the start of ONS. Statistical analyses were maintained on the whole cohort as well as on following tumor sub-groups: CNS tumors (13.3%), lymphoma (18.3%), other tumors (68.3%).
Results: Sixty malnourished pediatric oncology patients (64.6% male, 35.4% female) were included in the study cohort. BMI values of the majority (60%, P<0.05) of patients increased after ONS treatment while those of 40% decreased. BMI values also increased in the case of other tumors and lymphoma sub-groups (P<0.001 and P=0.012, respectively).
Conclusion: This study underlined the benefits of ONS treatment in terms of BMI status among pediatric oncology patients. The recovery rate of nutritional status depends on malignancy, cancer type and location.

Keywords

pediatrics, malnutrition, cancer, body mass index

References

• 1. Bundy DA, de Silva N, Horton S, Patton GC, Schultz L, Jamison DT, et al. Investment in child and adolescent health and development: key messages from Disease Control Priorities. The Lancet. 2018;391(10121):687-99.
• 2. Barr RD, Gomez-Almaguer D, Jaime-Perez JC, Ruiz-Argüelles GJ. Importance of nutrition in the treatment of leukemia in children and adolescents. Archives of Medical Research. 2016;47(8):585-92.
• 3. Sala A, Pencharz P, Barr RD. Children, cancer, and nutrition—a dynamic triangle in review. Cancer. 2004;100(4):677-87.
• 4. Brinksma A, Huizinga G, Sulkers E, Kamps W, Roodbol P, Tissing W. Malnutrition in childhood cancer patients: a review on its prevalence and possible causes. Critical reviews in oncology/hematology. 2012;83(2):249-75.
• 5. Gonzalez MC, Pastore CA, Orlandi SP, Heymsfield SB. Obesity paradox in cancer: new insights provided by body composition. The American journal of clinical nutrition. 2014;99(5):999-1005.
• 6. Pribnow AK, Ortiz R, Báez LF, Mendieta L, Luna‐Fineman S. Effects of malnutrition on treatment‐related morbidity and survival of children with cancer in Nicaragua. Pediatric Blood & Cancer. 2017;64(11):e26590.
• 7. Ladas EJ, Arora B, Howard SC, Rogers PC, Mosby TT, Barr RD. A framework for adapted nutritional therapy for children with cancer in low‐and middle‐income countries: a report from the SIOP PODC Nutrition Working Group. Pediatric Blood & Cancer. 2016;63(8):1339-48.
• 8. Sala A, Rossi E, Antillon F, Molina AL, de Maselli T, Bonilla M, et al. Nutritional status at diagnosis is related to clinical outcomes in children and adolescents with cancer: a perspective from Central America. European journal of cancer. 2012;48(2):243-52.
• 9. Amoroso L. The second international conference on nutrition: implications for hidden hunger. Hidden Hunger. 115: Karger Publishers; 2016. p. 142-52.
• 10. Demaio AR, Branca F. Decade of action on nutrition: our window to act on the double burden of malnutrition. BMJ global health. 2018;3(Suppl 1).
• 11. Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chronic Dis. 1972;25(6):329-43. Epub 1972/07/01. PubMed PMID: 4650929.
• 12. Brinksma A, Huizinga G, Sulkers E, Kamps W, Roodbol P, Tissing W. Malnutrition in childhood cancer patients: a review on its prevalence and possible causes. Crit Rev Oncol Hematol. 2012;83(2):249-75. Epub 2012/01/24. doi: 10.1016/j.critrevonc.2011.12.003. PubMed PMID: 22264939.
• 13. Hall DMB, Cole TJ. What use is the BMI? Archives of disease in childhood. 2006;91(4):283-6. doi: 10.1136/adc.2005.077339. PubMed PMID: 16551784.
• 14. Ortega FB, Sui X, Lavie CJ, Blair SN. Body Mass Index, the Most Widely Used But Also Widely Criticized Index: Would a Criterion Standard Measure of Total Body Fat Be a Better Predictor of Cardiovascular Disease Mortality? Mayo Clinic proceedings. 2016;91(4):443-55. Epub 03/02. doi: 10.1016/j.mayocp.2016.01.008. PubMed PMID: 26948431.
• 15. Lange BJ, Gerbing RB, Feusner J, Skolnik J, Sacks N, Smith FO, et al. Mortality in overweight and underweight children with acute myeloid leukemia. Jama. 2005;293(2):203-11.
• 16. Brouwer C, Gietema J, Kamps W, De Vries E, Postma A. Changes in body composition after childhood cancer treatment: impact on future health status—a review. Critical reviews in oncology/hematology. 2007;63(1):32-46.
• 17. Trimpe K, Shaw MR, Wilson M, Haberman MR. Review of the effectiveness of enteral feeding in Pediatric oncology patients. Journal of Pediatric Oncology Nursing. 2017;34(6):439-45.
• 18. Esbenshade AJ, Simmons JH, Koyama T, Koehler E, Whitlock JA, Friedman DL. Body mass index and blood pressure changes over the course of treatment of pediatric acute lymphoblastic leukemia. Pediatric blood & cancer. 2011;56(3):372-8.
• 19. Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 2002;109(1):45-60.
• 20. Nishimura N, Nakano K, Ueda K, Kodaira M, Yamada S, Mishima Y, et al. Prospective evaluation of incidence and severity of oral mucositis induced by conventional chemotherapy in solid tumors and malignant lymphomas. Supportive Care in Cancer. 2012;20(9):2053-9.
• 21. Jones JA, Avritscher EB, Cooksley CD, Michelet M, Bekele BN, Elting LS. Epidemiology of treatment-associated mucosal injury after treatment with newer regimens for lymphoma, breast, lung, or colorectal cancer. Supportive care in cancer. 2006;14(6):505-15.
• 22. Peterson D, Bensadoun R-J, Roila F, Group EGW. Management of oral and gastrointestinal mucositis: ESMO clinical recommendations. Annals of Oncology. 2009;20(suppl_4):iv174-iv7.
• 23. Brouwer CA, Gietema JA, Vonk JM, Tissing W, Boezen HM, Zwart N, et al. Body mass index and annual increase of body mass index in long-term childhood cancer survivors; relationship to treatment. Supportive Care in Cancer. 2012;20(2):311-8.
• 24. Brinksma A, Roodbol PF, Sulkers E, Kamps WA, de Bont ES, Boot AM, et al. Changes in nutritional status in childhood cancer patients: a prospective cohort study. Clinical Nutrition. 2015;34(1):66-73.
• 25. Withycombe JS, Post‐White JE, Meza JL, Hawks RG, Smith LM, Sacks N, et al. Weight patterns in children with higher risk ALL: a report from the Children's Oncology Group (COG) for CCG 1961. Pediatric blood & cancer. 2009;53(7):1249-54.
• 26. Müller HL, Emser A, Faldum A, Bruhnken G, Etavard-Gorris N, Gebhardt U, et al. Longitudinal study on growth and body mass index before and after diagnosis of childhood craniopharyngioma. The Journal of Clinical Endocrinology & Metabolism. 2004;89(7):3298-305.
• 27. Jansen H, Postma A, Stolk R, Kamps W. Acute lymphoblastic leukemia and obesity: increased energy intake or decreased physical activity? Supportive care in cancer. 2009;17(1):103.
• 28. Winter C, Müller C, Hoffmann C, Boos J, Rosenbaum D. Physical activity and childhood cancer. Pediatric blood & cancer. 2010;54(4):501-10.
• 29. Murphy AJ, White M, Davies PS. Body composition of children with cancer. The American Journal of Clinical Nutrition. 2010;92(1):55-60. doi: 10.3945/ajcn.2010.29201.
• 30. van der Sluis IM, van den Heuvel-Eibrink MM, Hählen K, Krenning EP, de Muinck Keizer-Schrama SM. Altered bone mineral density and body composition, and increased fracture risk in childhood acute lymphoblastic leukemia. The Journal of pediatrics. 2002;141(2):204-10.
• 31. Barbosa-Cortés L, Tapia-Rojas M, López-Aguilar E, Mejía-Aranguré JM, Rivera-Márquez H. Body composition by dilution of deuterium oxide in Mexican children with lymphoma and solid tumors. Nutrition. 2007;23(10):739-44.
• 32. Murphy AJ, Hill RJ, Buntain H, White M, Brookes D, Davies PS. Nutritional status of children with clinical conditions. Clinical Nutrition. 2017;36(3):788-92.