Dietary Intake among Children with Acute Lymphoblastic Leukemia (ALL)

Children with acute lymphoblastic leukemia (ALL) are at elevated risk for nutrition-related morbidities both during and after therapy. The degree to which dietary intake fluctuates during cancer therapy and possibly contributes to the development of nutrition-related morbidities is unknown. This study presents the results of the first prospective study describing changes in dietary intake in 667 children undergoing treatment for ALL. Dietary intake was evaluated with a food frequency questionnaire at three timepoints reflecting different intensities of cancer therapy: diagnosis (Time 1-no therapy), induction (Time 2- high-dose therapy), and continuation (Time 3- low-dose therapy). Dietary intake was compared to the Dietary Reference Intakes (DRIs) and normative data. Contrary to expectations, total caloric intake in the majority of patients exceeded the DRIs with a smaller percentage of patients below the DRI for calories. The majority of patients were within the DRI for all other macronutrients with an increase in intake of fat at Time 2. Despite adequate caloric intake, the majority of patients had low dietary intakes of calcium, vitamin D, and vitamin E while excess dietary intakes were observed for zinc and niacin. For folate, most patients were either below or above the DRI. In general, dietary intakes were reflective of normative data suggesting intakes are not significantly altered during treatment for ALL. This study was successful in identifying priority nutrients for dietary intervention and scientific inquiry. The effect of these strategies on the development of nutrition-related morbidities in children with ALL may be considered for future research initiatives

Nutritional Counseling in Survivors of Childhood Cancer: An Essential Component of Survivorship Care

There is a growing body of evidence suggesting that nutritional status during treatment for cancer has a significant impact on treatment-related toxicities and outcomes among children and adolescents with cancer. The effects of nutritional status appear to extend into survivorship with a large proportion of survivors at risk for a variety of nutrition-related morbidities. The influence of dietary intake on overall treatment outcomes and long-term morbidities is largely unknown. In adults, evidence suggests that greater adherence to cancer prevention dietary guidelines improves long-term health outcomes among survivors of cancer. Surveys describing dietary intake among survivors of childhood cancer have found that most survivors are not meeting the recommended guidelines for many dietary nutrients and this may have an unfavorable effect on nutrition-related outcomes. However, more research is needed in this area so that well-designed clinical trials may be developed and tested. This review presents an overview of the existing literature describing dietary intake among survivors of childhood cancer, the clinical implications of reported dietary behaviors among survivors, and identifies areas for future research

Burkitt lymphoma – Nutritional support during induction treatment: Effect on anthropometric parameters and morbidity of treatment

Background: Malnutrition is common in children diagnosed with cancer in Africa, and it adds to the morbidity and mortality of treatment. Nutritional support is known to reduce morbidity and mortality of treatment. Aim: The aim of this study was to record changes in anthropometric parameters, morbidity and mortality in patients admitted with Burkitt lymphoma (BL) whose diet was supplemented with protein, vitamins and minerals during induction chemotherapy. Methods: Seventy consecutive newly diagnosed BL patients were enrolled. The diet was supplemented with a daily egg, 200 mL F-75 formula and vitamins. Guardians received 3 cups of dry rice and $1 daily to buy and prepare meals for the patient and themselves whilst in the hospital. Height, weight, triceps skinfold (TSF) and mid-upper arm circumference (MUAC) were recorded on days 1 and 28. Co-morbidities at diagnosis were treated, and neutropenia and febrile episodes managed with a standard protocol. Two patients who died within 24 h after admission were excluded from the anthropometric analyses. Results: The mean age was 8 (range 2–16) years and the male:female ratio was 42:28. The St Jude stage distribution was as follows: Stage I = 6%, II = 4%, III = 69%, IV = 21%. Weight for age was < 10th centile at diagnosis in 18% (but influenced by tumour mass). Weight was unchanged or increased by ≥ 5% in 66% of patients on Day 28. The TSF was < 3rd centile in 47% of patients and increased by ≥ 0.5 cm in 57%. The MUAC was < 3rd centile in 16% of patients at diagnosis and in 10% of patients on Day 28. Febrile episodes in 60% and neutropenia in 18% of patients were successfully treated. Two patients died from presumed renal failure. The overall death rate (including the two deaths within 24 h after admission before chemotherapy was started) was 5.5% (n = 4). Conclusion: The TSF improved in the majority and the MUAC improved in some patients. Febrile neutropenia and febrile episodes could be successfully managed. The death rate during induction was lower than in our previously published results with the same chemotherapy protocol. Dietary supplementation should be a standard component of treatment in paediatric patients with cancer

Antioxidants and cancer therapy: A systematic review

A B S T R A C T Purpose Many patients with cancer take antioxidant nutritional supplements during cancer treatment to alleviate treatment toxicities and to improve long-term outcomes, but little is known about the efficacy and safety of antioxidant use during cancer treatment. We reviewed English-language manuscripts published in the biomedical literature, reporting the results of observational studies of antioxidant status and cancer outcomes and of intervention trials of antioxidants among patients receiving chemotherapy with or without radiation for various malignancies. Methods We searched the Medline database and the bibliographies of the retrieved manuscripts, reviews, and books on antioxidants and cancer. The retrieved studies are grouped by study design, malignancy, and end points. Results More than 100 citations were retrieved; 52 met our criteria, 31 were observational studies, and 21 were intervention trials. The studies varied in study design, timing of observation/intervention, intervention protocol, malignancy, and anticancer regimen. Conclusion These inconsistencies preclude a definitive conclusion as to the effect of chemotherapy on antioxidant status in patients undergoing anticancer therapy. However, our review suggests that total antioxidant status (measured by total radical antioxidant parameter) declines during cancer treatment. Adequately powered trials or observational studies among patients with a specific cancer diagnosis receiving a specific treatment regimen are needed to address patients&apos; and physicians&apos; concerns regarding these associations

Role of maternal diet in the risk of childhood acute leukemia: a systematic review and meta-analysis

Many studies have investigated the etiology of acute leukemia, one of the most common types of cancer in children; however, there is a lack of clarity regarding preventable risk factors. This systematic review and meta-analysis aimed to summarize the current evidence regarding the role of maternal dietary factors in the development of childhood leukemia. All epidemiological studies published until July 2022 that evaluated maternal dietary risk factors for childhood acute leukemia were identified in two electronic databases (PubMed and Web of Science) without limits of publication year or language. A total of 38 studies (1 prospective cohort study, 34 case-control studies and 3 studies with pooled analysis) were included. The published risk estimates were combined into a meta-analysis, using the Generic Inverse Variance method. The maternal consumption of fruits (two or more daily servings vs. less) was inversely associated with acute lymphoblastic leukemia (odds ratio = 0.71; 95% CI, 0.59–0.86), whereas maternal coffee intake (higher than two cups per day vs. no consumption) was associated with an increased risk of acute lymphoblastic leukemia (odds ratio = 1.45; 95% CI, 1.12–1.89). Despite these findings, more high-quality research from cohort studies and the identification of causal factors are needed to develop evidence-based and cost-effective prevention strategies applicable at the population level. Review Registration: PROSPERO registration no. CRD42019128937

Early Life Nutrition Factors and Risk of Acute Leukemia in Children: Systematic Review and Meta-Analysis

Acute leukemia commonly occurs in young children with peak incidence at the age of 2–5 years. However, the etiology is still unclear and many preventable risk factors still deserve to be reviewed. The focus of this systematic review and meta-analysis is to summarize the evidence concerning early life nourishment (breastfeeding, early life diet), neonatal vitamin K administration and the risk of acute leukemia. All epidemiological studies published up to June 2023 and assessing diet-related risk factors for childhood acute leukemia were identified in two electronic databases (PubMed and Web of Science), with no limits on publication year or language. A total of 38 studies (37 case–control studies and 1 study with pooled analysis) were included. The published risk estimates were combined into a meta-analysis using the Generic Inverse Variance method. The current evidence shows that breastfeeding (yes vs. no) has a protective effect against acute lymphoblastic leukemia (odds ratio = 0.85; 95% CI, 0.76–0.94). Evidence related to the role of other studied factors (foods and supplements) is inconclusive. Further research into the potential role of diet in early life and the risk of acute leukemia is needed to develop prevention strategies at population level. Review Registration: PROSPERO registration no. CRD42019128937

Dietary Intake among Children with Acute Lymphoblastic Leukemia (ALL)

Children with acute lymphoblastic leukemia (ALL) are at elevated risk for nutrition-related morbidities both during and after therapy. The degree to which dietary intake fluctuates during cancer therapy and possibly contributes to the development of nutrition-related morbidities is unknown. This study presents the results of the first prospective study describing changes in dietary intake in 667 children undergoing treatment for ALL. Dietary intake was evaluated with a food frequency questionnaire at three timepoints reflecting different intensities of cancer therapy: diagnosis (Time 1-no therapy), induction (Time 2- high-dose therapy), and continuation (Time 3- low-dose therapy). Dietary intake was compared to the Dietary Reference Intakes (DRIs) and normative data. Contrary to expectations, total caloric intake in the majority of patients exceeded the DRIs with a smaller percentage of patients below the DRI for calories. The majority of patients were within the DRI for all other macronutrients with an increase in intake of fat at Time 2. Despite adequate caloric intake, the majority of patients had low dietary intakes of calcium, vitamin D, and vitamin E while excess dietary intakes were observed for zinc and niacin. For folate, most patients were either below or above the DRI. In general, dietary intakes were reflective of normative data suggesting intakes are not significantly altered during treatment for ALL. This study was successful in identifying priority nutrients for dietary intervention and scientific inquiry. The effect of these strategies on the development of nutrition-related morbidities in children with ALL may be considered for future research initiatives

The role of traditional healers in the diagnosis and management of Burkitt lymphoma in Cameroon : understanding the challenges and moving forward

CITATION: Afungchwi, G. M., Hesseling, P. B. & Ladas, E. J. The role of traditional healers in the diagnosis and management of Burkitt lymphoma in Cameroon : understanding the challenges and moving forward. BMC Complementary and Alternative Medicine, 17:209, doi:10.1186/s12906-017-1719-y.The original publication is available at https://bmccomplementalternmed.biomedcentral.comBackground Burkittlymphoma(BL) is the most common childhood cancer in Cameroon with a reported incidence of 3 per 100,000 children under 15 years in the Northwest region. Treatment at three Baptist mission hospitals has a recorded cure rate of over 50%. Traditional medicine(TM) is recognized by the national health system, but its scope is undefined and entraps children with BL. The aim of this study was to investigate the attitudes and practices of parents and traditional healers (TH) towards TM in children with BL in order to develop recommendations for an integrative approach and improved access to life-saving treatment for children with BL. Methods This is a descriptive case series of children diagnosed with BL treated at Banso, Mbingo, and Mutengene Baptist Hospitals between 2003 and 2014. A questionnaire was used to obtain the following information: demographic information, religion, the rate of use of TM, reasons why guardians chose to use TM, the diagnoses made by the TH, treatment offered, and the type of payment requested, based on the accounts of patient caregivers. Data was analyzed using Center for Disease Control Epi Info 7. Results Three hundred eighty-seven questionnaires were completed by parents/guardians. 55% had consulted a TH, of whom 76.1% consulted the TH as first choice. Common diagnoses provided by TH included liver problem, abscess, witchcraft, poison, hernia, side pain, mushroom in the belly and toothache. Methods of management included massage, cuts, concoctions, and incantations. The fee for these services included chickens, farm tools, and cash ranging from 200FCFA (0.4USD) to 100,000FCFA(200USD). The choice of TM was based on accessibility, failed clinic/hospital attendance, recommendation of relatives, and belief in TM. Conclusions TH are involved in BL management in Cameroon. TH are ignorant about BL, resulting in non-referral, and thus delay in diagnosis and treatment. Collaboration with TH could reduce late diagnosis and improve cure rates of BL and other childhood cancers.https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/s12906-017-1719-yPublisher's versio

The development, testing, and preliminary feasibility of an adaptable pediatric oncology nutrition algorithm for low‑middle income countries

PURPOSE: Despite advances in the field of pediatric oncology, which have contributed to an overall increase in event‑free survival, high rates of malnutrition in low‑middle income countries (LMICs) is still a major concern. This paper aims to describe the multifaceted development process of a nutrition intervention algorithm for pediatric oncology in LMIC. METHODS: The development of evidence‑based algorithm took place over seven developmental phases, utilizing an interdisciplinary process with the clinical review. Phase 1: Collaboration with the International Paediatric Oncology Nutrition Group. Phase 2: Review of peer‑reviewed literature for evidence‑based algorithm. Phase 3: Draft algorithm development. Phase 4: Draft algorithm presented at international meetings for stakeholder feedback. Phase 5: Consultation with LMIC dieticians to identify additional needs and feasibility of the algorithm in resource‑poor settings. Phase 6: Review of the final draft algorithm by an expert panel. Phase 7: Pilot and Preliminary Feasibility. RESULTS: The nutrition algorithm was piloted in three LMIC countries (Brazil, South Africa and India). Overall the LMIC nutrition intervention algorithm was considered feasible for use with a “yes” response to the question “was the algorithm useful to know what nutrition to give the child and when” 90% of the time, rendering to the tool feasible. However, the testing process did identify several limitations that need to be considered in future versions. CONCLUSIONS: This comprehensive collaborative process with interdisciplinary health professionals has successfully developed a pediatric oncology nutrition intervention algorithm for LMIC. Further feasibility testing and a longitudinal study are required

Unmet needs in nutritional care in African paediatric oncology units

BACKGROUND : Up to 50% of children diagnosed with cancer in low- and middle-income countries are malnourished, which likely affects survival. SUBJECTS AND METHODS : An online survey to paediatric oncology units (POUs) in Africa was done regarding nutritional assessment and care. RESULTS : Sixty-six surveys were received from POUs in 31 countries. Only 44.4% had a dedicated dietician for nutritional assessment and support; 29.6% undertook routine nutritional assessment during treatment. None reported defined criteria for nutritional intervention. Total parenteral nutrition was not available for 42.6% of POUs, while 51.8% did not have access to commercial enteral nutrition for inpatients, and 25.9% of the hospitals could not supply any home-based nutritional supplements. CONCLUSION : Nutritional assessment in POUs in Africa is neither routinely undertaken nor are there defined criteria to initiate nutritional interventions. Standardized guidelines for nutritional assessment and interventions are needed for African POUs to enable improved outcome.https://academic.oup.com/tropejhj2020Paediatrics and Child Healt