Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Malignant disease · Bone marrow/stem cell

transplantation · Mucositis · Enteral tube feeding ·

Parenteral nutrition

Key Messages

• Malnutrition is a common complication of malig-
  nant disease and its treatment, and is most likely to
  occur in advanced-stage solid tumours, acute my-
  eloblastic leukaemia and bone marrow/stem cell
  transplantation


• Nutritional support is a major part of therapy; there
  is no evidence that extra nutrients promote tumour
  growth


• The aims of nutritional support are to reverse mal-
  nutrition if present at diagnosis, to prevent deterio-
  ration in nutritional status during treatment, and to
  promote normal growth


• Children at low nutritional risk require high-energy
  supplements that can be taken by mouth; they ben-
  efit from flexibility in mealtimes and menus


• When oral energy intake is inadequate, enteral tube
  feeding should be used; this is usually well tolerat-
  ed and improves wellbeing even in children under-
  going intensive chemotherapy


• Parenteral nutrition is reserved for those children
  with severe gastrointestinal symptoms related to
  underlying disease, chemotherapy or radiotherapy
  © 2015 S. Karger AG, Basel

Introduction

Nutritional status influences prognosis in chil-

dren with cancer and affects treatment tolerance

and susceptibility to infection. Patients often have

significant difficulties with eating during long pe-

riods of treatment and recurrent admissions to

hospital, and have particular nutritional needs

[1]. Malnutrition is common, with estimates of

prevalence ranging up to 50% depending on the

type, stage and metastatic status of the disease as

well as the toxicity of various cancer therapies [2].

Children with large, solid abdominal masses (e.g.

neuroblastoma, hepatoblastoma, Wilms’ tu-

mour) may present with normal weight despite

severe nutritional depletion, so that simple an-

thropometric assessment can be misleading [3].

The highest risk posed to nutritional status comes

from advanced-stage solid tumours, acute my-

eloid leukaemia, multiple-relapse leukaemia,

head and neck cancer, medulloblastoma and

bone marrow or stem cell transplantation. The

pathophysiology of malnutrition is multifactorial

and includes complex interactions between ener-

gy and substrate metabolism, hormonal and in-

flammatory components, and alterations of met-

abolic compartments. These result in accelerated

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 266–270
DOI: 10.1159/000360349

3.23 Haemato-Oncology

John W.L. Puntis