Sensitive measures of nutritional status in children in hospital and in the field

Protein-energy malnutrition and obesity are the most common nutritional dis orders that complicate the clinical course of children with neoplastic dise ases. Sensitive measures of nutritional status should be used to detect the se problems in children with cancer. Height and weight measurements are the mainstay of the nutritional assessment of the child. These measurements ca n be converted to growth velocities or to height-for-age and weight-for-hei ght Z-scores or percent of expected values to provide a measure of the degr ee of under- or over-nutrition in the child, Skinfold thickness and circumf erence measurements of the arms, legs and/or trunk may be useful to charact erize the changes in peripheral fat depots and muscle mass, respectively. H owever, the assessments of body composition using these measurements are su bject to methodological error because selected skinfold sites are excluded, Whole-body potassium, measured by K-40 counting, and total body water, mea sured by deuterium or O-18 dilution, serve as "gold standards" to determine the lean body mass and body fat status of the child, but these techniques may not be practical in all settings. The assessment of the nutritional sta tus of the child serves as a guide to early nutritional intervention. Indic ators for early nutritional intervention include: (I) height-for-age and we ight-for-height or -age Z-scores more than 2 SD below the mean for age, (2) height-for-age measurements less than 95% of expected, (3) weight-for-heig ht measurements less than 90% or greater than 120% of expected and (4) heig ht velocities less than 5 cm/year after 2 years of age. Early nutritional i ntervention is essential to restore normal body composition, reverse linear growth arrest, promote tolerance to chemotherapeutic and radiation regimen s and improve the quality of life in children with cancer. (C) 1998 Wiley-L iss, Inc.