Malnutrition in children with malignant solid tumours

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Abstract
Forty‐eight children with newly diagnosed malignant solid tumours underwent prospective longitudinal anthropometric assessment. At diagnosis there was a marked discrepancy between the results of conventional assessment, which relies on height‐for‐age and weight‐for‐height and the results of arm anthropometry: the study group did not differ from controls or from reference standards in height‐for‐age or weight‐for‐height, but had significantly lower mid‐upper‐arm circumference and triceps skinfold thickness. Only 7% of patients were identified as malnourished by conventional assessment, compared with 26% by arm anthropometry. Conversely, during therapy, change in weight‐for‐height appeared to over‐estimate deterioration in nutritional status.We suggest that these observations are largely accounted for by the effects of tumour mass, which by adding to body weight at diagnosis, inevitably elevates weight‐for‐height and by decreasing during therapy exaggerates any loss of true body weight.At diagnosis the prevalence of malnutrition identified by arm anthropometry was 27%. During therapy this increased to 46% (P= 0.04), despite supplementary enteral or parenteral feeding in one third of patients.Patients with abdominal primary disease were the most likely to be malnourished, both at diagnosis and during therapy. Patients with Wilm's tumour were particularly poorly nourished.These results suggest that there is a greater need than previously realized for nutritional support in children with malignancy. There are also implications for the assessment and monitoring of nutritional status, not only in children with cancer but also in children with malnutrition secondary to other causes.