Protein Energy Malnutrition and Skeletal Muscle Wasting at Diagnosis and After Induction of Remission Chemotherapy in Childhood ALL

Abstract

Malnutrition is a common problem among children in developing countries. The nutritional status of a child on cancer therapy influences both tolerance of and response to treatment especially acute lymphoblastic leukemia. The aim of study to assess the nutritional status in children with acute lymphoblastic leukemia (ALL) initially at presentation and to determine the change in body weight and amount of skeletal muscle wasting after induction of remission chemotherapy. A prospective observation study in Central Teaching Hospital of Children in Baghdad, Iraq for the period (July 2005 – May 2006). Thirty-five cases of newly diagnosed ALL underwent somatometric measurement and subcutaneous fat at initial presentation and after completion of induction chemotherapy. Malnutrition (weight for age <80%) was documented in 20 cases (57%) but cumulative incidence of malnutrition (weight for age <80%, height for age <95%, weight for height <90%, triceps skin fold thickness < 5th centile, mid arm circumference < 5th centile) was found in 28 cases (77.1%). Eight cases (26%) lose weight during induction range (0.5-3 kg), most of them had complicated course (infection and bleeding) during induction chemotherapy. Seventeen cases (48%) had muscle wasting during induction. Malnutrition exists in a significant proportion of children with ALL; especially in children with complicated induction phase lose significant weight and have significant muscle wasting, while increase in subcutaneous fat occurs in almost all children which probably due to oral steroids