title: Changes in nutritional status in childhood cancer patients: a prospective cohort study.
abstract: OBJECTIVE
  Under- and overnutrition are linked to adverse outcomes during and after childhood cancer treatment. Therefore, understanding the timing of weight loss and weight gain and their contributory factors is essential for improving outcomes. We aimed to determine in which period of treatment changes in nutritional status occurred and which factors contributed to these changes.
  
  
  METHODS
  A prospective cohort study of 133 newly diagnosed cancer patients with hematological, solid, and brain malignancies was performed. Anthropometric data and related factors were assessed at 0, 3, 6 and 12 months after diagnosis.
  
  
  RESULTS
  Despite initial weight loss at the beginning of treatment in patients with hematological and solid malignancies, body mass index (BMI) and fat mass (FM) increased within 3 months with 0.13 SDS (P < 0.001) and 0.05 SDS (P = 0.021) respectively. Increase continued during the following months and resulted in a doubling of the number of overnourished patients. Fat free mass (FFM), which was already low at diagnosis, remained low. During the entire study period about 17% of the patients were undernourished on the basis of low FFM. Tube feeding and diminished activity level were related to increases in BMI and %FM respectively. No relationship was found between energy intake or corticosteroids and increase in BMI or %FM.
  
  
  CONCLUSIONS
  BMI and FM increased during and after the period of intensive treatment, while FFM remained low. Improvement of nutritional status might be accomplished by increasing physical activity from the early phase of treatment.
authors: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology and Hematology, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, School of Nursing and Health, Groningen, The Netherlands. Electronic address: a.brinksma@umcg.nl.
authors: Aeltsje
authors: A
authors: Brinksma
authors: University of Groningen, University Medical Center Groningen, School of Nursing and Health, Groningen, The Netherlands.
authors: Petrie F
authors: PF
authors: Roodbol
authors: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology and Hematology, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, School of Nursing and Health, Groningen, The Netherlands.
authors: Esther
authors: E
authors: Sulkers
authors: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology and Hematology, Groningen, The Netherlands.
authors: Willem A
authors: WA
authors: Kamps
authors: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology and Hematology, Groningen, The Netherlands.
authors: Eveline S J M
authors: ES
authors: de Bont
authors: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Endocrinology, Groningen, The Netherlands.
authors: Annemieke M
authors: AM
authors: Boot
authors: University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands.
authors: Johannes G M
authors: JG
authors: Burgerhof
authors: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology and Hematology, Groningen, The Netherlands.
authors: Rienk Y J
authors: RY
authors: Tamminga
authors: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology and Hematology, Groningen, The Netherlands.
authors: Wim J E
authors: WJ
authors: Tissing
mesh_terms: D000293:Adolescent; D001823:Body Composition; D015992:Body Mass Index; D049628:Body Size; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D002149:Energy Intake; D015444:Exercise; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D044342:Malnutrition; D009369:Neoplasms / Q000503:physiopathology / Q000628:therapy*; D009752:Nutritional Status; D044343:Overnutrition; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Body composition; Childhood cancer; Malnutrition; Nutritional status; Obesity