Parenteral and enteral nutrition for pediatric oncology in low- and middle-income countries.

Although nutritional therapy is essential for the treatment of childhood cancer, it remains a challenge, especially within the developing world, where there are many barriers to optimizing treatment. The oral route is the first approach to nutritional support, however challenging this might be in children with cancer. Oral supplements are indicated in moderate evaluated nutritional risk patients and its use should consider the family's social conditions and access to industrialized oral supplements. If unavailable, homemade oral supplements can be used respecting regional accessibility, local foods, and culture. Nonetheless, many patients cannot sustain nutritional status on oral feeding alone and need to be supported by enteral tube feeding. Enteral feeding may be modified to accommodate the financial constraints of institution in low- and middle-income countries (LMICs). In some oncologic situations, however, enteral nutrition is not possible and parenteral nutrition is indicated, although only if the need for nutritional support is anticipated to be longer than 5-7 days. Nutritional support in pediatric oncology remains a challenge, especially in LMICs, however, it can be undertaken by getting the best out of the available resources.

The development, testing, and preliminary feasibility of an adaptable pediatric oncology nutrition algorithm for low-middle income countries.

BACKGROUND: Survivors of childhood cancer are at increased risk for several cardiometabolic complications. Obesity/overweight and metabolic syndrome have been widely reported in Western literature, but data from India are lacking. AIMS: To perform an objective assessment of nutritional status in a cohort of childhood cancer survivors (CCSs) and to find risk factors for extremes in nutritional status. SETTINGS AND DESIGN: The study was a retrospective chart review of CCSs who attended the late effects clinic of a referral pediatric oncology center over the period of 1 year. MATERIALS AND METHODS: An objective assessment of nutritional status was done, and results were analyzed in two groups: Adult survivors (present age <18 years) and child and adolescent survivors (CASs) (<18 years). The data were then analyzed for possible risk factors. RESULTS: Six hundred and forty-eight survivors were included in the study; of these, 471 were <18 years at follow-up, and 177 were 18 years or older. The prevalence of obesity, overweight, normal, and undernutrition was 2.6%, 10.8%, 62.7%, and 28.8% (CASs) and 0%, 8.5%, 62.7%, and 28.8% (adult survivors), respectively. Factors predictive of overweight/obesity were an initial diagnosis of acute lymphoblastic leukemia, or brain tumor and follow-up duration of >20 years or current age >30 years in adult survivors. CONCLUSIONS: The prevalence of obesity/overweight is lower in our cohort when compared to Western literature. It remains to be clarified whether this reflects the underlying undernutrition in our country, or whether our cohort of survivors is indeed distinct from their Western counterparts. Comparison with age/sex-matched normal controls and baseline parameters would yield more meaningful results.