EVALUATION OF MUSCLE PROTEIN MASS IN CHILDREN WITH SOLID TUMORS BY MUSCLE THICKNESS MEASUREMENT WITH ULTRASONOGRAPHY, AS COMPARED WITH ANTHROPOMETRIC METHODS AND VISCERAL PROTEIN CONCENTRATIONS

Objective: To compare the merits of regional ultrasonography, anthropo metry, and measurement of visceral protein concentrations for determin ing muscle protein mass and nutritional status. Design: Prospective fo llow-up study. Subjects: Nineteen children (median age 4.7 y, range, 1 .4-14.1 y) with malignant solid tumors were examined at diagnosis, mon thly during preoperative chemotherapy, and 1-2 months after operation; 19 healthy age-and sex-matched children served as controls. Intervent ions: We measured the thickness of the quadriceps muscle by ultrasonog raphy (muscle index), and body weight, mid-arm circumference, triceps skinfold thickness, and serum concentrations of albumin, prealbumin, a nd transferrin.Results: At diagnosis, the muscle index was smaller in the patients (mean 5.6cm(2)/m(2), 95% CI 4.5-6.7 cm(2)/m(2)) than in t he controls (8.5 cm(2)/m(2), 95% CI 7.7-9.3 cm(2)/m(2)) (P = 0.0007), whereas the anthropometric measurements did not differ. The sensitivit y, specificity, and predictive value of anthropometry and measurements of visceral proteins were poor in detecting reduced muscle protein re serves when compared with the muscle index as the baseline standard. D uring the anticancer therapy the mean concentrations of serum albumin and prealbumin increased. Conclusions: In children with cancer, nutrit ional status should be assessed with methods more sensitive than anthr opometry and visceral protein concentration measurements. We advocate regional ultrasonography for the evaluation of nutrition in these pati ents.