Risk factors for malnutrition in children with cancer: a prospective, single-center, cohort study
Description
A prospective, single-center, continuous cohort study was conducted from January 2023 to January 2024 at the Research Institute of Pediatric Oncology and Hematology, N.N. Blokhin NMRCO, among children aged 0 to 18 years with malignant neoplasms.
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Nutritional status (NS) assessment was conducted in several stages: 1) NS screening at the outpatient clinic; 2) NS assessment in the hospital. NS diagnosis and monitoring was comprehensive, based on: a) anthropometry; b) laboratory data. The criterion for severe nutritional status (NES) was a Buzby G.P. score of <83.5 points. Current weight <2nd centile for age. 3) Calculation of actual nutritional intake (based on a food diary and prescription sheet). 4) Determination of energy needs and essential nutrient requirements. 5) Formulation of nutritional recommendations. After initiating nutritional therapy, the patient's condition was monitored, its effectiveness was assessed, and recommendations and prescriptions were subsequently adjusted: • If oral nutrition intake was below 50% of the ED (due to mucositis, diarrhea, vomiting, etc.), a nasogastric tube was inserted and analgesic therapy was prescribed. • If nutrition via a nasogastric tube was impossible or inadequate, a nasojejunal tube was inserted (single-lumen/double-lumen nasojejunal tubes Freka® Endolumina (Bad Homburg, Germany)). • If adequate oral nutrition was expected to be impossible to return to within 6 weeks and/or independent feeding was impossible, a gastrostomy tube was inserted. All patients underwent endoscopic examinations using a Pentax EPK-i7010 OPTIVISTA video endoscopic system and a Pentax EG16-K10 video gastroscope (Tokyo, Japan). PULL gastrostomy tubes were used with PEG-XX-PULL-S gastrostomy tube sets from COOK Medical, Winston-Salem, North Carolina, with gastrostomy tube sizes of 20-24 Fr. PUSH gastrostomy tubes were performed with MIC-KEY 0120-X-X low-profile gastrostomies from AVANOS Medical, USA, with sizes ranging from 12 Fr to 20 Fr and lengths ranging from 8 mm to 2 cm. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 25 (Armonk, NY). Data are presented as n (%) or median (with interquartile range). Data were extracted from Microsoft SQL Server 2008 and Microsoft Access 2008, then saved and processed in Microsoft Excel 2011 and IBM SPSS Statistics 27. For normally distributed data, the median (Md) and the 25th and 75th percentiles were calculated. Quantitative data were compared between groups using the Mann-Whitney test for nonparametric data distributions. The Kendall correlation coefficient was used to measure the relationship between qualitative variables between the two groups. The association between significant weight loss and risk factors such as age, initial weight-for-age, BMI, gender, final weight loss, treatment intensity (HSCT and high-dose therapy), and diagnosis was assessed using multivariate logistic regression analysis to calculate odds ratios with 95% confidence intervals. Variables in the regression included age, baseline weight for age, BMI, sex, final weight loss, treatment intensity (HSCT vs. high-dose therapy), and diagnosis (solid cancer vs. hematological).