ONGOING ASSESSMENT OF NUTRITIONAL-STATUS IN CHILDREN WITH MALIGNANT DISEASE

The nutritional status of a child on cancer therapy influences both to lerance of and response to treatment. However; it is difficult to asse ss nutritional status on a daily basis because an accurate quantitatio n of the calorie intake is difficult Anthropometric and biochemical pa rameters are prone to error and often reflect past rather than current nutritional status. In practice, a subjective clinical assessment is usually relied upon. This study objectively appraises the value of suc h an assessment. Based on clinical symptoms that alter oral intake and absorption of food, a scoring system was designed to assess nutrition al status on a day to day basis. A symptom score (SS) of 10 implied '' normality''; 0 indicated maximum debility. Over a 2-year period 511 da ily scores were recorded in 30 patients aged 0. 7-17.5 years. Patients were studied at presentation and during treatment for acute lymphobla stic leukemia (ALL, n = 14; solid tumors receiving megatherapy with au tologous bone marrow rescue (ABMR, n = 8), and chemotherapy for differ ent tumors (miscellaneous, n = 8). The SS was compared with other nutr itional parameters, including sequential anthropometric indices, serum albumin, insulin-like growth factor-I (IGF-I) IGF binding protein-3 ( IGFBP-3) and whole-body protein turnover (WBPT) using [1(-13) C]leucin e. The mean SS was reduced at diagnosis for all leukemic patients (med ian score = 8), improved during first remission (p < 0.002), fell to a minimum during febrile neutropenia (p = 0.0009), and improved with cl inical and hematological recovery (p = 0.0009). A reduction in SS was related to fever(p < 0.001) and a fall in neutrophil count (p ( 0.001) . There was no correlation with anthropometric indices or IGF-I and IG FBP-3 levels. Paired WBPT studies in 9 patients showed that SS correla ted well with protein breakdown (p = 0.026). The results suggest that the ongoing nutritional status of children with malignancy undergoing chemotherapy is best assessed wing simple clinical parameters.