Risk factors for malnutrition in children with cancer: a prospective cohort study

INTRODUCTION: Malnutrition is detected in 10–50 % of children with cancer. Providing adequate nutritional therapy in pediatric oncology is a complex task that requires systematic screening, timely nutritional interventions and assessment of their effectiveness at different stages of antitumor treatment. OBJECTIVE: To determine the prevalence of severe protein-energy malnutrition (PEM) in children receiving treatment for malignant neoplasms and to identify factors associated with the development of severe PEM. MATERIALS AND METHODS: 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 National Medical Research Center of Oncology, among children aged 0 to 18 years with malignant neoplasms. RESULTS: Data from 3,455 children were analyzed, including 1,754 (50.8 %) boys and 1,701 (49.2 %) girls. Moderate or mild PEM was diagnosed in 635 (18 %) patients at stage 1 nutritional screening. At stage 2 screening, after the start of antitumor treatment, severe PEM was identified in 102 (3 %) children. There was a strong positive correlation between moderate and mild PEM at stage 1 and the subsequent development of severe PEM after treatment initiation (Kendall’s Τ = 0.69, Tcrit = 0.23). The odds of severe PEM were higher in children under 1 year of age than in those aged 1–18 years (odds ratio [OR] 5.868; 95 % confidence interval [CI] 2.985–11.500; standard error [SE] 0.345). Severe PEM was more likely in patients with solid malignant tumors than in those with hematologic malignancies (OR 3.14; 95% CI 1.60–6.08; SE 0.337). Among patients after hematopoietic stem cell transplantation, the probability of developing severe PEM was also higher (OR 5.3; 95% CI 2.80–9.76; SE 0.3). CONCLUSIONS: Severe PEM after the start of treatment was observed in 3 % of pediatric patients with cancer. Factors contributing to its development were: first moderate and mild PEM, age under 1-year, solid tumors, hematopoietic stem cell transplantation.