Nutritional Status and Treatment Tolerance in Children Undergoing Leukemia Induction Therapy

Abstract

Nutritional status at diagnosis predicts survival in childhood leukaemia, and the literature disagrees about how much. A large part of that disagreement is not biological: body mass index performs poorly in a child whose weight includes tumour bulk and steroid-driven fluid, and arm measurements detect what it misses. Objectives: To review the published evidence on nutritional status in children undergoing induction therapy for acute leukaemia: how often malnutrition is present, how it is measured, what it predicts for treatment tolerance and survival, and how status changes across induction itself. Material and Methods: Narrative review of observational cohorts, retrospective analyses, systematic reviews and nutritional assessment guidance indexed in PubMed and the major haematology, paediatric and nutrition journals. Studies were eligible if they reported the prevalence, measurement or clinical
consequences of nutritional status in a defined paediatric acute leukaemia population. No new patient data were generated and no patients were recruited; every estimate quoted is one published by the original investigators. Results: Reported malnutrition at diagnosis ranges from 0 to 70 per cent across settings, with around 50 per cent in low and middle-income countries, 58.4 per
cent in a Mexican cohort and 45.3 per cent classified underweight in an Indian cohort. In the Mexican series, survival differed by body mass index category at 76 against 63 per cent (p = 0.049), while relapse differed more sharply by triceps skinfold, at 41 against 12 per cent below and above minus two standard deviations (p = 0.007). Stunting carried a hazard ratio for mortality of 6.214 (95% CI 1.372-28.154) and low triceps skinfold 2.91 (95% CI 1.27-6.68), while higher mid-upper arm circumference was protective at 0.85 (95% CI 0.73-1.00). Across induction in a European cohort of 50 children, the proportion with an abnormal body mass index rose from 6 to 20 per cent. Conclusion: Arm anthropometry outperforms weight-based measures in this population and produces the stronger associations wherever both have been reported. Nutritional status also deteriorates measurably during induction, so a single assessment at diagnosis describes a moving target. Abbreviations: ALL – Acute Lymphoblastic Leukaemia, AML – Acute Myeloid Leukaemia, BMI – Body Mass Index, MUAC – Mid-Upper Arm Circumference, TSF – Triceps Skinfold Thickness, SD – Standard Deviation, HR – Hazard Ratio, LMIC – Low and Middle-Income Country, HIC – High-Income Country, WHO – World Health Organization, MRD – Minimal Residual Disease, FM – Fat Mass, FFM – Fat-Free Mass.