Neck Circumference for Identification of Excess Adiposity in Adolescents with Cancer: A Better Parameter for Use in Clinical Practice?

Purpose: Excess weight in adolescents with cancer during treatment does affect cancer outcomes. Neck circumference (NC), an easygoing anthropometric measure, may present greater metabolic risk, and is associated with excess adiposity. The aim of this study was to identify the prevalence of elevated NC in adolescents with cancer and associated factors. Methods: Cross-sectional study with adolescents aged 10-19 years, under antineoplastic treatment, evaluated from 2015 to 2017, at a Pediatric Oncology Institute's outpatient clinic. Anthropometric parameters were collected, besides diagnosis, sex, and age. The classification of elevated NC was carried out considering cutoff values for adolescents, according to sex and age group. A binary logistic regression was used to determine relationships between NC and associated factors. Results: Among 496 eligible cases, most were male (n = 299, 60.3%). A total of 31.9% of cases had high NC. There is significant and moderate correlation between skinfold thickness (TS) and NC (ρ = 0.6; p = 0.000), and a significant but weak correlation between TS and body mass index (ρ = 0.267; p = 0.000). The adjusted analysis for sex, age group, and type of tumor showed that females are more likely to belong to the high NC category, to have excess adiposity. The age group between 10 and 12 years was the most associated with this outcome (2.795 [0.979-7.977]; p < 0.05). TS is also associated with high NC (1.114 [1.050-1.182]; p < 0.05). Conclusion: It was concluded that there is high prevalence of elevated NC and higher risks for this outcome considering type of tumor, sex, age group, besides being an easy and simple measure for use in clinical practice.

Approach to Nutrition in Cancer Patients in the Context of the Coronavirus Disease 2019 (COVID-19) Pandemic: Perspectives.

Coronavirus Disease 2019 (COVID-19) is a new pandemic that originated in China in December 2019. Cancer patients are immunosuppressed and very susceptive to acquiring infections; thus, they are at greater risk of developing more severe forms of COVID-19. People infected with COVID-19 display increased plasma levels of pro-inflammatory cytokines. Excessive inflammation may cause damage to the body's tissues, thereby potentially contributing to alveolar damage and the severity of COVID-19. We hypothesize that since a pro-inflammatory state may worsen COVID-19 prognosis, modulating systemic inflammation through dietary modification may be efficacious in improving the clinical sequelae of COVID-19. The aim of this review is to present current nutritional and dietary approaches in the context of inflammation with a specific focus on cancer patients with and without COVID-19. The main topics reviewed include nutrition in inflammation and immunity. A systematic literature search on Google Scholar, Medline, and PubMed databases was performed between March 22, 2020 and May 6, 2020 using the keywords "COVID-19," "coronavirus," "cancer," "inflammation," "probiotics," "vitamin D," and "nutrition prevention." Healthy dietary habits, omega-3-rich diets, probiotics use, and vitamin D supplementation, as well as obesity prevention, are likely the most efficacious preventive approaches to controlling hyperinflammation, improving immune function, and decreasing the severity of inflammatory diseases.

Undernutrition as an Aggravating Risk for Hospital Death in Critically Ill Children with Cancer.

OBJECTIVES: Undernourished children with cancer are at major risk for adverse outcomes. We intended to model nutritional status as risk factor for hospital death. METHODS: Retrospective analysis of two cohorts of children admitted in an oncology/hematology intensive care unit. Logistic regression was used for model building. RESULTS: The derivation cohort had 155 patients, with a median age of 104.9 mo., and 36 deaths (23.2%). Twenty-eight children (18.1%) had the z score of the body mass index < -2. A multivariate model with the variables "relapse of oncological disease" (Odds Ratio 3.14, P = 0.025), "surgical case" (OR 0.22, P = 0.002), "intubation/mechanical ventilation" (OR 8.38, P = 0.000) and "body mass index z score < -2" (OR 3.21, P = 0.024) generated a logit with good predictive capacity for "hospital death". In the validation cohort, with 450 patients (median age of 92.7 mo.), the model was able to predict 55.5 of the 58 observed deaths (Standardized Mortality Rate = 1.04, 95% CI 0.80-1.34, P = 0.72), with P = 0.68 in the Hosmer test. The AUC was 0.90 (95% CI 0.86-0.93). CONCLUSION: Undernutrition increases the risk of death, and is a variable that should be included in predictive mortality algorithms.

Low Levels of High-density Lipoprotein in Patients with Pediatric Cancer at Diagnosis / Baixos Níveis de Lipoproteínas de Alta Densidade em Pacientes com Câncer Infantojuvenil ao Diagnóstico / Bajos Niveles de Lipoproteínas de Alta Densidade en Pacientes con Cáncer Juvenil en el Momento del Diagnóstico

Introduction: Cancer patients have metabolic imbalances due to the disease, treatment and their complications. Increases in triglycerides and glucose profile and catabolism of protein have been described and are associated with inflammatory response as result of the tumor activity or necrosis. Objective: To evaluate the blood lipid, lipoproteins, glucose and albumin levels in pediatric cancer patients at diagnosis. Method: Observational cross-sectional study. The inclusion criteria were children and adolescents with newly diagnosed malignancies and blood analysis results. The exclusion criteria were: previous anticancer therapy or surgical treatment, blood sample not collected and patients who refused to participate in the study. Results: It were evaluated 81 children and adolescents with newly diagnosed malignancies. There was decrease of 56% and 41% of high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG), 14% and 10% of albumin and glucose, and 10% and 7.6% of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), respectively, for the patients. HDL-C showed statistical differences between solid and hematological cancer patients (p < 0.05). The means and medians of albumin, glucose, HDL-C and TG demonstrated that hematological patients are more prone to metabolic disturbances. HDL-C in this group was 24 ± 12 versus 40 ± 15mg/dl in other cancers. Conclusion: The primary result found in the present study was in HDL-C, mainly in patients with hematological and metastatic cancer. These disturbances could be associated with cancer-related acute inflammatory response.

Introdução: Pacientes com câncer apresentam desequilíbrios metabólicos em virtude da doença, do tratamento e de suas complicações. Alterações nos triglicerídeos, perfil de glicose e catabolismo de proteínas foram descritas e estão associadas à resposta inflamatória por conta da atividade tumoral ou necrose. Objetivo: Avaliar os níveis de lipídios no sangue, lipoproteínas, glicose e albumina em pacientes com câncer infantojuvenil no momento do diagnóstico. Método: Estudo observacional transversal. Os critérios de inclusão foram crianças e adolescentes com neoplasias recém-diagnosticadas e resultados de exame de sangue; e os critérios de exclusão, terapia anticâncer ou tratamento cirúrgico prévio, amostra de sangue não coletada e pacientes que se recusaram a participar do estudo. Resultados: Foram avaliadas 81 crianças e adolescentes com neoplasias recém-diagnosticadas. Houve decréscimo de 56% e 41% para lipoproteína de alta densidade-colesterol (HDL-C) e triglicerídeos (TG), 14% e 10% para albumina e glicose e 10% e 7,6% para colesterol total (CT) e colesterol de lipoproteína de baixa densidade (LDL-C), respectivamente. O HDL-C mostrou diferenças estatísticas entre pacientes com câncer sólido e hematológico (p <0,05). As médias e medianas de albumina, glicose, HDL-C e TG demonstraram que pacientes com tumores hematológicos são mais propensos a distúrbios metabólicos. O HDL-C neste grupo foi de 24 ± 12 versus 40 ± 15 mg /dl em outros cânceres. Conclusão: A principal alteração encontrada no presente estudo foi no HDL-C, principalmente em pacientes com câncer hematológico e metastático. Essas alterações podem estar associadas à resposta inflamatória aguda relacionada ao câncer.

Introducciòn: Los pacientes con cáncer tienen desequilibrios metabólicos debido a la enfermedad, el tratamiento y sus complicaciones. Los cambios en los triglicéridos y el perfil de glucosa y el catabolismo de las proteínas se han descrito y están asociados con la respuesta inflamatoria debido a la actividad tumoral o la necrosis. Objetivo: Evaluar los niveles de lípidos, lipoproteínas, glucosa y albúmina en sangre en pacientes con cáncer juvenil en el diagnóstico. Método: Estudio transversal observacional. El criterio de inclusión fue niños y adolescentes con neoplasias recién diagnosticadas con análisis de sangre realizado. Criterios de exclusión: terapia anticancerígena previa o tratamiento quirúrgico, muestra de sangre no realizada y pacientes que se negaron a participar en el estudio del protocolo. Resultados: Se evaluaron 81 niños y adolescentes con neoplasias recién diagnosticadas. Se observó un cambio en 56% y 41% para el colesterol de lipoproteínas de alta densidad (HDL-C) y triglicéridos (TG), 14% y 10% para albúmina y glucosa, y 10% y 7,6% para colesterol total (TC) y colesterol de lipoproteínas de baja densidad (LDL-C), respectivamente. HDL-C mostró diferencias entre pacientes con cáncer sólido y hematológico (p <0.05). Las medias y medianas de albúmina, glucosa, HDL-C y TG demostraron que el grupo hematológico tienden a alteraciones metabólicas más importantes. El HDL-C en este grupo fue de 24 ± 12 versus 40 ± 15 mg / dl en otros tipos de cáncer. Conclusión: El cambio primario encontrado en el presente estudio fue en HDL-C, principalmente en pacientes con cáncer hematológico y metastásico. Estos cambios podrían estar asociados con la respuesta inflamatoria aguda relacionada con el cáncer.

Nutritional Characteristics of the Diets of Child and Adolescent Cancer Survivors.

PURPOSE: Diseases associated with prior treatment, such as obesity, have been described in cancer survivors. Recent studies have shown that current estimates of overweight do not differ from that in the general population, suggesting the influence of environmental factors, such as dietary intake. In this context, there is increasing interest in the examination of health behaviors that may modify and reduce the risk of overweight and obesity. This study aimed to evaluate the characteristics of dietary intake among child cancer survivors living in a developing country. METHODS: This retrospective cross-sectional study included children and adolescents up to 18 years of age. Dietary intake of the patients was assessed using 24-hour dietary recall. RESULTS: All age groups showed sufficient carbohydrate and protein consumption levels. The mean percentages of carbohydrate and protein consumption were 54% and 20.8%, respectively. Regarding lipid quality, survivors showed low consumption levels of polyunsaturated and monounsaturated fats. The consumption level of saturated fats was close to the upper limit. Fiber intake was below the recommended level in all patient categories, and its mean was 11.5 g/day. The average daily intake of some vitamins and minerals was below the recommended intake levels for all sexes and age groups, with values below 50% of suitability. CONCLUSION: The imbalance of lipids quality and low consumption of micronutrients demonstrated that the diet quality is poor in child cancer survivors. This favors the development of not only obesity but also other chronic diseases, and potentially predisposes such patients to secondary cancers. IMPLICATIONS FOR CANCER SURVIVORS: this is a relevant issue due to the increased number of childhood cancer survivors who develop obesity and chronic and metabolic complications due to inadequate food consumption. Our study may help understand, prevent, or minimize public health problems.

Obesity in Survivors of Childhood Cancer: a Review.

Obesity is a late effect of antineoplastic treatment in childhood cancer survivors and this correlates with chronic complications. This review examines the data currently available to health professionals, for increasing awareness and identifying strategies to address the treatment and prevention of late effects. The mechanism involved in the pathophysiology of obesity remains unclear. However, damage to the hypothalamus and endocrine disorders (e.g. insulin and leptin resistance) and a positive energetic balance may play a role in increasing obesity rates. A patient's diet during, and after treatment may also influence the weight of survivors. Implementation of an effective educational program by professionals during all stages of treatment enables children to obtain basic knowledge regarding food and nutrition, thereby encouraging them to take responsibility for developing healthy eating behaviors.

The influence of antineoplastic treatment on the weight of survivors of childhood cancer / A influência do tratamento antineoplásico sobre o peso de sobreviventes do câncer na infância

Abstract Purpose: Obesity is a late effect in survivors of childhood cancer and correlates with chronic complications. Survivors of leukemia, brain tumors, and hematopoietic stem cell transplantation are more likely to develop obesity resulting from treatment modalities such as radiotherapy and glucocorticoids. This paper analyzes and integrates the current data available to health professionals in order to clarify strategies that can be used to treat and prevent obesity in childhood cancer survivors. Sources: This is a literature review from on scientifically reliable electronic databases. We selected articles published in the last five years and earlier articles of great scientific importance. Data synthesis: The mechanisms involved in the pathophysiology of obesity in cancer survivors are not completely understood, but it is believed that damage to the hypothalamus and endocrine disorders such as insulin resistance, leptin resistance, and hormone deficiency may be involved. The body composition of this group includes a predominance of adipose tissue, especially in those undergoing hematopoietic stem cell transplant and total body irradiation. The use of body mass index in these patients may lead to an underestimation of individuals' risk for metabolic complications. Conclusion: Early identification of groups using accurate anthropometric assessments, interventional treatment, and/or preventative measures and counseling is essential to minimize the adverse effects of treatment. Physical activity and healthy eating to promote adequacy of weight in the whole population should be encouraged.

Resumo Objetivo: A obesidade é um efeito tardio em sobreviventes do câncer na infância e está correlacionada com complicações crônicas. Os sobreviventes da leucemia, tumores cerebrais e transplante de células-tronco hematopoiéticas têm maior probabilidade de desenvolver obesidade como resultado das modalidades de tratamento, como radioterapia e glicocorticoides. Este artigo analisa e integra os dados atuais disponíveis a profissionais da saúde para esclarecer as estratégias que podem ser usadas para tratar e prevenir a obesidade em sobreviventes do câncer na infância. Fontes: Esta é uma análise da literatura de bases de dados eletrônicas cientificamente confiáveis. Selecionamos artigos publicados nos últimos cinco anos e artigos mais antigos de grande importância científica. Resumo dos dados: Os mecanismos envolvidos na fisiopatologia da obesidade em sobreviventes do câncer não são completamente entendidos, porém acredita-se que o dano no hipotálamo e disfunções endócrinas, como resistência à insulina, resistência à leptina e deficiência hormonal, possam estar envolvidos. A composição corporal desse grupo inclui uma predominância de tecido adiposo, principalmente em pacientes submetidos a transplante de células-tronco hematopoiéticas e irradiação de todo o corpo. O uso do índice de massa corporal nesses pacientes poderá levar a uma subestimação do risco de complicações metabólicas nessas pessoas. Conclusão: A identificação precoce de grupos por meio de avaliações antropométricas precisas, o tratamento intervencional e/ou medidas preventivas e aconselhamento são fundamentais para minimizar os efeitos colaterais do tratamento. A atividade física e alimentação saudável devem ser incentivadas para promover a perda de peso na população em geral.

The influence of antineoplastic treatment on the weight of survivors of childhood cancer.

PURPOSE: Obesity is a late effect in survivors of childhood cancer and correlates with chronic complications. Survivors of leukemia, brain tumors, and hematopoietic stem cell transplantation are more likely to develop obesity resulting from treatment modalities such as radiotherapy and glucocorticoids. This paper analyzes and integrates the current data available to health professionals in order to clarify strategies that can be used to treat and prevent obesity in childhood cancer survivors. SOURCES: This is a literature review from on scientifically reliable electronic databases. We selected articles published in the last five years and earlier articles of great scientific importance. DATA SYNTHESIS: The mechanisms involved in the pathophysiology of obesity in cancer survivors are not completely understood, but it is believed that damage to the hypothalamus and endocrine disorders such as insulin resistance, leptin resistance, and hormone deficiency may be involved. The body composition of this group includes a predominance of adipose tissue, especially in those undergoing hematopoietic stem cell transplant and total body irradiation. The use of body mass index in these patients may lead to an underestimation of individuals' risk for metabolic complications. CONCLUSION: Early identification of groups using accurate anthropometric assessments, interventional treatment, and/or preventative measures and counseling is essential to minimize the adverse effects of treatment. Physical activity and healthy eating to promote adequacy of weight in the whole population should be encouraged.