Browsing by Author "Kellerman, Ilde-Marie"

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    Changes in anthropometrical status, body composition and basal metabolic rate of paediatric cancer patients during initial intensive onco-chemotherapy therapy
    (Stellenbosch : Stellenbosch University, 2021-12) Kellerman, Ilde-Marie; Blaauw, Renee; Kruger, Mariana; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY: Introduction: Children with cancer require adequate nutritional support to overcome the detrimental impact of malnutrition on survival, yet no consensus exists regarding the timing and optimisation of such nutritional interventions. This study investigated the impact of initial, intensive onco-chemotherapy on anthropometrical status, body composition and resting energy expenditure (REE) and its subsequent pattern of change during the first 6 months. This is to determine when this patient population is most vulnerable for nutritional depletion and how much energy is required to sustain resting energy requirements during this time frame. Additionally, whether predictive equations can accurately predict the REE required to sustain growth and development. Methods: Anthropometrical status, body composition and REE were measured at diagnosis prior to the initiation of chemotherapy utilising standardised protocols and the (validated) S10 InBody bio-electrical impedance (BIA) mobile unit. Baseline values for all variables were compared to subsequent consecutive monthly follow-up measurements to plot changes over time during the first six months of treatment. The agreement and accuracy between predictive energy equations (Schofield (weight, height), WHO and RDA) and measured REE were tested by determining bias and agreement rates and were graphically displayed in Bland Altman plots. Statistical significance was 5% and the a priori limits of agreement were set between 90–110% of measured REE. Results: Forty-three newly diagnosed children (median age 4 years, range 0.3–15 years; 51% male) participated in the study. There were 53% haematological malignancies (n = 23) and 47% solid tumours (n = 20). Prevalence of malnutrition varied among anthropometrical variables, with under-nutrition between 11.7 (weight) – 14% (mid-upper arm circumference (MUAC)), over-nutrition between 4.7 (weight) – 9.3% (body mass index (BMI)) and stunting at 7.1% at diagnosis. MUAC only recognised 33% of those with true underlying muscle store depletion as per BIA. Chemotherapy exposure acutely exacerbated existing nutritional depletion during the first two months after diagnosis for all variables except fat mass (FM). Intensive onco-chemotherapy had contrary effects on cancer type as haematological malignancies were prone to rapid increases in weight, BMI and FM, yet both groups shared a clinically significant, acute loss of skeletal muscle mass during this period. Catch-up growth was achieved for all cancer types with a significant increase in weight (chi2 = 40.43, p < 0.001), height (chi2 = 53.79, p < 0.001), BMI (chi2 = 16.32, p < 0.005)), fat free mass (chi2 = 23.69, p < 0.003) and skeletal muscle mass (chi2 = 24.19, p < 0.001) after six months. Significant differences between measured and calculated REE were found for all equations (p < 0.001), which overestimated measured REE between 23.6% (WHO) and 129% (RDA). The intra-class consistency coefficient indicated good reliability for the Schofield (0.864) and WHO (0.849) equations. Conclusion: Children with cancer requiring initial, intensive onco-chemotherapy are most vulnerable for the development of acute malnutrition and alterations in body composition during the first two months of treatment. Early identification of malnutrition through a minimum of monthly assessments that include anthropometry, especially BIA (body composition) and REE from diagnosis, may result in timely nutritional interventions and nutritional repletion.