Prevalence of protein-energy malnutrition at diagnosis in children with acute lymphoblastic leukemia

Background: The purpose of the present study was to test the hypothesis tha t protein-energy undernutrition is common in patients with acute lymphoblas tic leukemia at diagnosis. Previous studies have failed to establish whethe r undernutrition is a common feature at diagnosis. Methods: Body mass index (BMI, weight/height(2)), expressed as a standard d eviation score (SDS) relative to contemporary United Kingdom reference data , was used as the index of nutritional status. The index was calculated in a national cohort of standard-risk patients (n = 1019) treated in the same protocol in the United Kingdom. Results: Prevalence of undernutrition (defined as BMI SDS <-2.0) exceeded e xpected frequencies in boys (7.6%) and girls (6.7%). These differences were statistically significant (p < 0.001), with a 95% confidence interval for the prevalence of undernutrition of 5.8% to 9.0%. Conclusions: Undernutrition is relatively common in patients with newly dia gnosed acute lymphoblastic leukemia, with a threefold excess of patients be low the cutoff used to define undernutrition. Screening for undernutrition at diagnosis of acute lymphoblastic leukemia is indicated, and the BMI SDS is a simple index of nutritional status that could be readily calculated us ing measurements routinely made at diagnosis. The same simple screening tec hnique could also be used clinically to detect and manage or prevent overnu trition (obesity), which is common in these patients after diagnosis.