Prevalence of micronutrient deficiency and its impact on the outcome of childhood cancer: A prospective cohort study.

BACKGROUND & AIMS: Impact of micronutrient deficiency on childhood malignancy is unexplored. We estimated the prevalence of baseline micronutrient deficiency in children with cancer and its impact on event-free survival (EFS) and overall survival (OS). METHODS: A longitudinal cohort study was conducted at a tertiary cancer centre in India. Children (≤18 years) with de novo malignancy were enrolled between October 2012 and May 2014. Baseline levels of vitamin B12, folate, zinc, selenium, copper, and iron were measured and values below 150 pmol/L, 6 ng/mL, International Zinc Nutrition Collaborative Group cut-off, 0.5 µmol/L, 10 µmol/L, and 50 µg/dL, respectively, indicated deficiency. RESULTS: Total 535 children [326 (60.9%) haematological and 209 (39.1%) solid malignancies] were enrolled with median follow-up of 66 months. Vitamin B12, folate, zinc, selenium, copper and iron deficiencies were found in 209 (39.1%), 89 (16.6%), 173 (32.3%), 39 (7.3%), 12 (2.2%), and 231 (43.2%) children, respectively. Selenium deficiency independently predicted poor EFS (hazard ratio [HR] = 1.56; p = 0.038) and OS (HR = 1.65; p = 0.027) in the cohort. In haematological malignancies, selenium deficiency predicted poor EFS (HR = 1.81; p = 0.023) and OS (HR = 2.12; p = 0.004). In solid malignancies, vitamin B12 (HR = 1.55; p = 0.028) and zinc (HR = 1.74; p = 0.009) deficiencies predicted poor EFS, and zinc deficiency predicted poor OS (HR = 1.77; p = 0.009). Multiple micronutrient (≥3) deficiencies also predicted poor EFS (HR = 1.69; p = 0.001) and OS (HR = 1.83; p < 0.001) in the whole cohort. CONCLUSIONS: Selenium deficiency was independently predictive of adverse outcomes in childhood cancer, particularly in haematological malignancies. Zinc deficiency adversely affected solid tumours. The adjunct use of micronutrient supplementation in paediatric malignancies should be explored.

Global Hunger Index does not really measure hunger - An Indian perspective.

The Global Hunger Index (GHI) is calculated and disseminated annually. India, which is the 5th largest economy in the world and has a good ranking in many other indicators, has a poor ranking based on this index. After a critical review of the appropriateness of the indicators used in GHI, the Indian Council of Medical Research has the viewpoint that the indicators of undernourishment, stunting, wasting and child mortality do not measure hunger per se. Referring to this index as a Hunger Index, and thereby ranking countries is not appropriate, since many of the measures that are used to evolve an index that measures hunger are probably contextual. Countries should therefore evolve their own measures that are suitable for their own context.

Micronutrient status of Indian population.

Micronutrients play an important role in the proper growth and development of the human body and its deficiency affects the health contributing to low productivity and vicious cycle of malnutrition, underdevelopment as well as poverty. Micronutrient deficiency is a public health problem affecting more than one-fourth of the global population. Several programmes have been launched over the years in India to improve nutrition and health status of the population; however, a large portion of the population is still affected by micronutrient deficiency. Anaemia, the most common form of micronutrient deficiency affects almost 50 to 60 per cent preschool children and women, while vitamin A deficiency and iodine-deficiency disorders (IDD) have improved over the years. This review focuses on the current scenario of micronutrient (anaemia, vitamin A, iodine, vitamin B12, folate, ferritin, zinc, copper and vitamin C) status in the country covering national surveys as well as recent studies carried out.