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EDITORIAL
Year : 2016  |  Volume : 53  |  Issue : 2  |  Page : 211-212
 

Importance of nutrition in pediatric oncology


Department of Foods and Nutrition, M.S.University of Baroda, Vadodara, India

Date of Web Publication6-Jan-2017

Correspondence Address:
R Bhoite
Department of Foods and Nutrition, M.S.University of Baroda, Vadodara
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.197738

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How to cite this article:
Bhoite R. Importance of nutrition in pediatric oncology. Indian J Cancer 2016;53:211-2

How to cite this URL:
Bhoite R. Importance of nutrition in pediatric oncology. Indian J Cancer [serial online] 2016 [cited 2017 Oct 20];53:211-2. Available from: http://www.indianjcancer.com/text.asp?2016/53/2/211/197738


All kinds of cancer progress in the same way: Cells grow out of control, develop abnormal sizes and shapes, exceed their typical boundaries inside the body, and destroy neighboring cells. At the time, cancerous cells can spread (metastasize) to other organs and tissues. As cancer cells grow, they demand more and more of the body's nutrition. Cancer takes a person's strength, destroys organs and bones, and weakens the body's defenses against other illnesses.

At present, no universally agreed specific substrate requirements, criteria for, the timing of, and duration of nutritional interventions exist in pediatric oncology. There is an ample array of dissimilar approaches with limited efficacy for prevention and early treatment of growth failure in children with cancer.[1],[2],[3] Several nutritional recommendations are based on ideal body weight, body mass index, and estimated energy needs without considering changes in body compartments to capture muscle wasting and body mass depletion. Weight loss is a rather poor predictor of undernourishment that reflects past rather than current nutritional status. The primary objectives of nutritional interventions in pediatric oncology should be the maintenance of body stores as close to the ideal as possible, minimization of wasting, promotion of appropriate growth development, and providing a good quality of life.

A number of pathophysiological mechanisms contribute to the development of malnutrition and growth failure in childhood cancer. The causes are multifactorial, including: (1) Complex interactions between energy and substrate metabolism; (2) hormonal and inflammatory components; and (3) alterations of metabolic compartments. These result in accelerated mobilization, oxidation of energy substrates, and loss of body proteins.[4],[5] Some patients lose their appetite and find it hard to eat well. In addition, the common side effects of treatment, such as nausea, vomiting, mouth sores, can make it difficult to eat. For some patients, foods taste different. Furthermore, children may not feel like eating when they are uncomfortable or tired. Patients who eat well during cancer treatment often feel better and have more energy. In addition, they may be better able to handle the side effects of treatment. Eating well helps in getting enough calories and protein to help prevent weight loss and regain strength.

Changes in the metabolism of fat, carbohydrate and protein have been demonstrated in the cancer-bearing host.[6] These changes include increased lipid breakdown, resulting in depletion of lipid stores,[7] and alterations in carbohydrate metabolism, hence resulting in an energy-losing cycle.[8] In addition, there is an increased protein turnover [9] and loss of the normal compensatory mechanism seen in starvation. The final result is weight loss, particularly, loss of lean body mass which is manifest clinically as malnutrition, i.e., protein energy malnutrition (PEM). Some patients with cancer have a higher caloric expenditure than patients without cancer.[10] In fact, cancer patients use both dietary glucose as well as glucose produced by gluconeogenesis and from amino acids.[11] Glucose is transformed into lactate by the tumor. The lactate must then be recycled by the liver, at a large energy cost. This process, the  Cori cycle More Details, is increased significantly in patients with advanced cancer.[12] It requires the use of muscle proteins, as well as a large proportion of amino acid intake, for gluconeogenesis. At the same time, there is a severe decrease in total body fat that also may be ascribed to the production of cachectin and tumor necrosis factor by the normal macrophages in response to the tumor.[13],[14] Other monocyte mediators, such as interleukin 1 and interleukin 6, can cause metabolic changes, including a breakdown of protein and decreased synthesis of albumin.[15] The most common risk factors associated with the development of PEM include irradiation to the gastrointestinal tract, intense, frequent courses of chemotherapy in the absence of corticosteroids, major abdominal surgery, advanced disease, and lack of a family or health care support system.[16]

Alterations in taste, anorexia, mucositis, emesis and diarrhea are other important contributory factors.[17] Nutrient deficiency develops over a period, depending on the degree of negative balance and the amount of energy reserve available.

Foods, including meat, dairy, grains, fruits and vegetables, fats, and legumes (beans) make up the main parts of child's diet. Many foods and nutrients have long been studied for cancer prevention, but finding a specific link between a food or macronutrient and cancer is difficult. There are many challenges, including:

  • Foods contain many components, macronutrients, micronutrients (vitamins and minerals), and nonnutrients (phytonutrients from plants, such as beta carotene), that may contribute to cancer prevention
  • Most people eat and drink a variety of foods, creating interactions that are challenging to study
  • Sometimes, macronutrients have different effects on the body, depending on how much of the macronutrient you ate or drank and whether you are eating more or less than your body needs
  • Some research shows that food preparation may influence the risk or benefits of a food. For example, frying chicken in fat or making beans with lard adds additional fat and could influence your overall energy balance.


Few of the nutrients having evidence and proven to be linked with cancer are as follows:

Carbohydrates: Carbohydrates are the body's major source of energy. Carbohydrates give the body the fuel (calories) it needs for physical activity and proper organ function. How many calories a child needs depends on their age, size, and level of physical activity. Healthy infants, children, and adolescents need more calories per pound than adults to support growth and development. Children being treated for cancer may need even more calories for tissue healing and energy. In fact, a child being treated for cancer may need anywhere from 20% to 90% more calories than a child who is not getting cancer treatment. This varies from child to child, and some kids have a problem with unwanted weight gain during treatment.

The best sources of carbohydrates – fruits, vegetables, and whole grains – give the body's cells the vitamins and minerals, fiber, and phytonutrients (key nutrients from plants) they need.

Fats: Fats play an important role in nutrition. Fats and oils are made of fatty acids and serve as a rich source of energy (calories) for the body. The body breaks down fats and uses them to store energy, insulate body tissues, and carry some types of vitamins through the blood. You may have heard that some fats are better than others. For the most part, unsaturated fats (monounsaturated and polyunsaturated) should be chosen more often than saturated fats or trans fats. Certain fatty acids, such as linoleic acid and alpha-linolenic acid, are called essential fatty acids. They are needed to build cells and make hormones, but because the body cannot make them, we must get them from foods. Soybean, canola, and walnut oils are good sources of essential fatty acids.

Water: Water and liquids or fluids are vital to health. All body cells need water to function. If your child does not take in enough fluids or loses fluids from vomiting or diarrhea, he may become dehydrated (his body does not have as much fluid as it needs). If this happens, the fluids and minerals that help keep the body working can become dangerously out of balance.

Children get some water from foods, especially fruits and vegetables, but they need liquids to be sure that all the body cells get the fluid they need.

Vitamins and minerals: The body needs small amounts of vitamins and minerals for normal growth and development, and to help it function properly. Vitamins and minerals also help the body use the energy (calories) it gets from food. Children who eat a balanced diet usually get plenty of vitamins and minerals. However, studies have shown that even healthy kids often do not get enough calcium and Vitamin D, which are especially important for bone growth. Some of the drugs used to treat cancer can lower calcium and Vitamin D levels too, so extra amounts may be needed. It may be hard for a child getting cancer treatment to eat a balanced diet. Common treatment side effects, such as nausea, vomiting, and mouth sores (mucositis) can make it hard to eat.

Protein: The body uses protein to grow, repair tissues; and to maintain the skin, blood cells, the immune system, and the lining of the digestive tract. Children with cancer who do not get enough protein might have muscle break down to meet the body fuel requirements. This makes it take longer to recover from illness and can lower resistance to infection. After a child has surgery, chemo, or radiation treatments, they may need extra protein to heal tissues and to help prevent infection. Protein is also a key to child's growth and development. During illness, a child's need for protein goes up.

Good sources of protein include fish, poultry, lean red meat, eggs, dairy products, nuts and nut butter, dried beans, peas and lentils, and soy foods. Meat, fish, shellfish, cheese, and eggs are the major sources of animal protein in most diets. Of those, red meat and processed meat are often studied as risk factors for cancer. Most of the studies suggest that people who eat more red meat have higher risk for developing colorectal cancer than those who eat less red meat, but avoiding processed meats is even more important.[18]

To conclude, the importance of nutrition in children and young adults with cancer is an underestimated topic within pediatric oncology. 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.

 
  References Top

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Han-Markey T. Nutritional considerations in pediatric oncology. Semin Oncol Nurs 2000;16:146-51.  Back to cited text no. 1
    
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Mehta NM, Compher C; A.S.P.E.N. Board of Directors. A.S.P.E.N. Clinical Guidelines: Nutrition support of the critically ill child. JPEN J Parenter Enteral Nutr 2009;33:260-76.  Back to cited text no. 2
    
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Fusch C, Bauer K, Böhles HJ, Jochum F, Koletzko B, Krawinkel M, et al. Neonatology/Paediatrics – Guidelines on Parenteral Nutrition, Chapter 13. Ger Med Sci 2009;7:Doc15.  Back to cited text no. 3
    
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Tisdale MJ. Mechanisms of cancer cachexia. Physiol Rev 2009;89:381-410.  Back to cited text no. 5
    
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Fossel ET, Carr JM, McDonagh J. Detection of malignant tumors. Water-suppressed proton nuclear magnetic resonance spectroscopy of plasma. N Engl J Med 1986;315:1369-76.  Back to cited text no. 7
    
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Holroyde CP, Gabuzda TG, Putnam RC, Paul P, Reichard GA. Altered glucose metabolism in metastatic carcinoma. Cancer Res 1975;35:3710-4.  Back to cited text no. 8
    
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Yu LC. Nutrition and childhood malignancies. In: Suskin RM, Lewinter-Suskind L, editors. Textbook of Pediatric Nutrition. 2nd ed. New York: Raven Press Ltd.; 1993. p. 417-24.  Back to cited text no. 10
    
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Bruera E, MacDonald RN. Nutrition in cancer patients: An update and review of our experience. Issues in symptom control. Part 3. J Pain Symptom Manage 1988;3:133-40.  Back to cited text no. 11
    
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Bechard LJ, Adiv OE, Jaksic T, Duggan C. Nutritional supportive care. In: Pizzo PA, Poplack DG, editors. Principles and Practice of Pediatric Oncology. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. p. 1285-300.  Back to cited text no. 18
    




 

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