Improving the Quality of the Delivery of Nutritional Care Among Children Undergoing Treatment for Cancer in a Low- and Middle-Income Country.

PURPOSE: International twinning programs have been well-established between institutions in childhood cancer and have led to pediatric cancer units in low- and middle-income countries (LMICs) adopting multidisciplinary forms of care. To advance nutritional care in LMICs, the International Initiative for Pediatrics and Nutrition (IIPAN) provided the structural framework and personnel for the delivery of nutritional care. We describe the impact of a newly established nutrition program on the delivery of nutritional care and nutrition-related clinical outcomes in children and adolescents undergoing treatment for cancer in Nicaragua and Honduras. METHODS: A prospective cohort (N = 126) collected clinical data over a 2-year period. Collection of IIPAN's nutritional services received during treatment and clinical data were abstracted from medical charts and registered in Research Electronic Data Capture (REDCap) database. Chi-square, ANOVA, and generalized linear mixed models were used; P < .05 was considered statistically significant. RESULTS: Nutritional assessments led to a higher number of patients receiving recommended standard of care. Children classified as underweight during treatment presented higher number of infections and toxicities, length of hospital stay, and days of treatment delays during treatment. Overall, from the start to end of treatment, 32.5% of patients improved nutritional status, 35.7% maintained it, and 17.5% worsened. On the basis of metrics, the cost per consultation was less than 4.80 US dollars (USD; Honduras) and 1.60 USD (Nicaragua). CONCLUSION: Integration and equitable access of the nutritional care process for all patients needs to be recognized as a component of the basic management in pediatric oncology care. IIPAN's nutritional program demonstrates that nutritional care is economical and feasible in a limited resource setting.

Omega-3 Polyunsaturated Fatty Acids Suplemented Diet and its preventive effect on tumor growth in nude mice / Dieta suplementada en ácidos grasos poliinsaturados omega-3 y su efecto preventivo sobre el crecimiento tumoral en ratones

Cancer is one of the leading causes of morbidity and mortality worldwide according to the WHO. Strong evidence suggests that food and nutrition are important in modification of cancer process. There is increased evidence that specific dietary patterns or constituents such as n-3 PUFAs, may be associated with reduced risk of BC. Female athymic nude mice were fed since weaning to adulthood with a DHA+EPA (4%w/w) diet or with standard diet during 14-week. At week- 7, tumor cell implantation with MDA-MB-231cell line took place, each mice received 5x106 tumor cells. When tumors became palpable, maximum length, width, and diameters were measured twice a week. Incidence of tumor development was observed in all mice (n=4, 100%) in the control diet group; instead, the n-3 PUFAs diet group, only two mice developed tumor (n=2, 50%), and the development time was longer compared to the control group. These differences were significant (p < 0.001). This study establish the potential effect as a preventive measure to BC. This evidence is consentient with epidemiological data about high n-3 PUFAs diet patterns in some populations may lower risk of BC, highlighting the importance of these components in our diet since childhood to promote the preventive effect. Being thus necessary, setting up recommendations for n-3 PUFAs supplementation from fish oil or, for a minimal dietary fatty fish intake/week, in order to attempt modulate carcinogenesis in populations at high risk, particularly those with a high prevalence of obesity

El cáncer es una de las principales causas de morbilidad y mortalidad en todo el mundo según la OMS. Una fuerte evidencia sugiere que la alimentación y la nutrición son importantes en la modificación de proceso de cáncer. Existe una alta evidencia de que patrones dietéticos específicos constituidos por AGPI n-3, pueden estar asociados con riesgo reducido de BC. Ratones atímicos desnudos femeninos fueron alimentados desde el destete hasta la etapa adulta con una dieta con DHA + EPA (4% p / p) o con una dieta estándar durante 14 semanas. En la semana 7, tuvo lugar la implantación de células tumorales de la línea celular MDA-MB-231 y cada ratón recibió 5x106 células tumorales. Cuando los tumores se hicieron palpables, y de longitud, ancho y diámetros máximos, se midieron dos veces por semana. La incidencia del desarrollo tumoral se observó en todos los ratones (n = 4, 100%) en el grupo de la dieta control ; en cambio, en el grupo de dieta de AGPI n-3, solo dos ratones desarrollaron un tumor (n = 2, 50%), y el tiempo de desarrollo fue más largo en comparación con el grupo de control. Estas diferencias fueron significativas (p <0.001). Este estudio establece el efecto potencial como una medida preventiva para BC. Esta evidencia se corrobora con datos epidemiológicos sobre patrones dietéticos altos en AGPI n-3 que en algunas poblaciones puede disminuir el riesgo de BC, destacando la importancia de estos componentes en nuestra dieta desde la infancia para promover el efecto preventivo. Siendo así necesario, establecer recomendaciones para la suplementación con AGPI n-3 del aceite de pescado o, para una ingesta dietética mínima de pescado / semana para intentar modular la carcinogénesis en poblaciones de alto riesgo, particularmente aquellos con una alta prevalencia de obesidad