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Exogenous glutamine application appears to play a role in diminishing the detrimental effects of anticancer drugs on the gastrointestinal mucosa. Furthermore carnitine supplementation has been suggested to improve the cancer fatigue syndrome by influencing nutritional and immunological parameters , Recently, the management of cancer cachexia has been supplemented by new therapeutic strategies that may help increase lean mass or treat the cytokine-induced catabolism of skeletal muscle by distinguishing specific mediators of muscle atrophy and the identification of sensitive biomarkers of protein degradation An interest for the improvement of agents that promote muscle anabolism has recently been verbalized Several agents are under clinical investigation and some of them are in clinical trials for adult patients , Currently available therapeutic approaches are megestrol acetate, a synthetic derivate of progesterone; anabolic steroids, such as testosterone derivatives; and the peptide hormones ghrelin and ghrelin agonists — The use of these agents is critical in children concerning the associated side effects on a growing and immature organism.

However, there are currently no drugs approved for the prevention or treatment of cancer cachexia. Algorithms for nutritional strategies in children and adults with malignancies have been proposed in the literature with the objective to treat rather than to anticipate weight loss 8 , , , , The application of nutritional protocols may be useful in advance for selecting those children who are at high risk for malnutrition during antineoplastic therapies. Energy requirements may be based on published pediatric nutritional guidelines — Specific and scientifically based recommendations for children with cancer are not yet available.

High-energy protein formulas and liquid supplements are offered to increase energy density in pediatric patients, but with less success and poor tolerance because of taste and smell perception. A balanced diet with sufficient proteins and high energy levels is required to prevent an extreme overload of carbohydrate and fat consumption, as seen in many children with cancer. Children with painful sequel e. A percutaneous endoscopic gastrostomy PEG is a successfully used method with high acceptance by oncologists, children, and parents demonstrating somatic improvements and reduced family frustration due to eating problems , The placement of a PEG tube is indicated when oral ingestion is not sufficient to cover the daily energy needs.

Table 4 demonstrates nutritional strategies. The importance of nutrition in children and young adults with cancer is an underestimated topic within pediatric oncology. There are new, inexpensive, and noninvasive techniques for the evaluation of the nutritional status providing evidence for the quality of nutritional interventions for children with a high risk of undernutrition and a tendency for body fat accumulation.

Malnutrition in children with cancer should not be accepted at any stage of the disease or tolerated as an inevitable process. Nutritional strategies should be considered and integrated as a fundamental feature of pediatric oncology with the same diligence as one does for other supportive care measures to prevent chronic illness and adverse late effects caused by malnutrition in this population.

Further clinical and basic research programs are needed to establish guidelines analyzing the efficacy and impact of nutritional interventions, especially in children with cancer. Despite the well-documented need for adequate nutrition in long-term outcome in children with cancer 9 , 10 , 29 , 89 , there are no applicable management strategies or pharmacotherapeutic options available at this time to successfully prevent or treat undernourishment and its associated disorders in this population. One of the main objectives in this field is the early detection of children with preexisting malnutrition and a high risk of substrate depletion before cancer therapies start employing standardized methodologies.

These methods should analyze nutritional status 3 — 5 , 11 , 15 , 64 , 94 , , energy intake 8 , 10 , 14 , 30 , and energy expenditure 29 , 51 as recently proposed. The literature offers few randomized prospective clinical trials that explore short- and long-term consequences of nutritional support 69 , 95 — 99 and the special needs of pediatric cancer patients 71 , 73 , Additional research is required to analyze the impact of nutrition on morbidity, mortality, and quality of life and to prevent chronic illnesses for pediatric cancer survivors. Because cancer malnourishment is not unique to underweight children 96 — 98 , an assessment of body composition is important for the characterization of the severity of the condition.

Furthermore, the effects of malnutrition can be surveyed. In adults with cancer, various agents are in development, including medications that inhibit the mediators inflammatory cytokines and tumor-induced inflammation that occur during cancer cachexia 17 , Current treatment options, including drugs — or anabolic agents, for cancer malnutrition in pediatric oncologic patients are limited due to adverse side effects in a growing and immature child. All authors read and approved the final version of the paper.


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Definition and prevalence of malnutrition in childhood cancer. Etiology and pathophysiology. The metabolic effects of cancer and chemotherapeutic agents. Risk factors for malnutrition in children with malignancies. Consequences of starvation in childhood cancer. Methods to detect and analyze in depth poor nutritional status in children with cancer. Nutritional support for children with cancer.

Literature Cited. Oxford Academic. Google Scholar. Michael C. Author disclosures: J. Bauer, J. Cite Citation.

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Permissions Icon Permissions. ABSTRACT Adequate nutrition during cancer plays a decisive role in several clinical outcome measures, such as treatment response, quality of life, and cost of care. Table 1. Tumor types associated with malnutrition for pediatric oncology patients. Open in new tab. Table 2. Short- and long-term consequences of malnutrition on the pediatric cancer survivor. Table 3. Determination of energy losses using bomb-calorimetry. Open in new tab Download slide. Table 4.

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Quality management within the competence network of paediatric oncology and haematology. Search ADS. Second neoplasms in survivors of childhood cancer: findings from the Childhood Cancer Survivor Study cohort.

Malnutrition at diagnosis of malignancy in childhood: common but mostly missed. Dietary intake and resting energy expenditure in relation to weight loss in unselected cancer patients. Van Eys. Advances in nutrition care of children with neoplastic diseases: a review of treatment, research, and application. Evaluation of the feasibility of international growth standards for school-aged children and adolescents.

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Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: a prospective, randomized study. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Obesity and metabolic changes are common in young childhood brain tumor survivors.

Effects of intravenous nutrition on tumor growth and host immunocompetence in malnourished animals. Role of whole-body lipids and nitrogen as limiting factors for survival in tumor-bearing mice with anorexia and cachexia. The efficacy of total parenteral nutrition in malnourished tumor-bearing rats.

Hormonal and metabolic abnormalities in the malnourished cancer patient: effects on host-tumor interaction. Growth and pituitary function in children treated for brain tumours or acute lymphoblastic leukaemia. Resting energy expenditure in children newly diagnosed with stage IV neuroblastoma.