Evaluation of Nutritional Status in Pediatrics with Acute Lymphocytic Leukemia in Hematology Unit – Children Welfare Teaching Hospital

Abstract

Background: Acute leukemia is the most cancer has frequency in children, malnutrition is one of the common complications of children with cancer, and malnutrition has been identified as a significant factor in treatment tolerance, increased morbidity, poor prognosis, reduced quality of life, and higher healthcare expenses. Nutritional assessment and early intervention in pediatric cancer patients could minimize the side effects of treatment, improve their survival, and reduce the risk of nutritional morbidity with a positive impact on quality of life.  Objective: Assess the nutritional status of children with newly diagnosed acute lymphoblastic leukemia at time of diagnosis and follow up after 1 and 3 months of chemotherapy. Patients & Methods: a retrospective analysis done on newly diagnosed acute lymphoblastic leukemia patients aged less than 14 years old admitted to hematology unit of Children Welfare Teaching Hospital over a one-year period from 1/1/2021 to 1/1/2022. The patients are divided into two groups: under 5 years and above 5 years. Weight for height WHO Child Growth Standards median was used in the first group (under 5 years) and body mass index /age for children > 5 years of age to interpret their data to define underweight, wasting, overweight and obesity. Anthropometric data were collected from medical records upon diagnosis, at 1, and 3 months of chemotherapy. Results: The total number of patients included in current study was 94; being 52 (55.3%) of them males and 42 of them (44.7%) females. One third of patients was between the age 2-5 years 32 (34%), and 5-10 years 31 (33%) with mean age 2.6 ± 0.953 SD. AT diagnosis, there were 71 patients (75.5%) with normal nutritional status (≥ -2 to ≤ +1) ,18 patients (19.2%) were underweight with further categorization as moderate underweight (≥ -3 to < -2) in 12 patients (12.8%) and 6 patients (6.4%) were severely underweight (< -3). Overweight and obesity were seen in only 5 patients (5.4%). After 1 month of chemotherapy, there is a drop in underweight into 12 patients, in contrast after 3 months, which shows increase to 18 patients (19.2%). Overall wasting rate follows the same pattern of fluctuation of underweight (17,12 ,18 patients) (18%, 12.7%, 19.2%) respectively. The most common age group affected by wasting was (5-10) years old; 9 patients (29.1 %) from total 31 patients with a significant P value (0.052); mostly moderate wasting 6 patients versus 3 patients with severe wasting. Overall unintentional weight loss occurred in half of the patients 47 (50%) at one month which increased to 56 patients (59.6%) after 3 month of chemotherapy. Weight gain developed in 32 patients (34%) after one month which decreased to 28 patients (29.8%) after 3 months. Male gender had higher rate of wasting (< -2SD) 11 patients (21.1%) from total 52 males than female patients 6 (14.2 %) from total 42 females. On the other hand, a female patients developed a dangerous (>10% weight loss) during a period of 3 months of chemotherapy, 8 (19%) than male 6 (11.5%). The most common age group developed (> 10 %) weight loss was (>10) years old with a significant P value (0.08); 13 patients (68.4%) from 19. The majority of patients 80 (85.1%) had normal stature (-2 to +3) while 10 patients (10.7%) were stunted with a higher rate in female (11.9%) than male (9.6%). A higher rate of stunting was in below 2 years’ age group (33.3%) with a significant P value (0.008).Conclusions: malnutrition present in a significant percentage of patients with acute lymphoblastic leukemia, so adequate nutrition is an important in such children, to ensure optimal treatment and outcome.