title: Clinical implications of malnutrition in childhood cancer patients--infections and mortality.
abstract: OBJECTIVE
  In childhood cancer patients, malnutrition has been proposed to increase infection rates and reduce survival. We investigated whether malnutrition at diagnosis and during treatment and weight loss during treatment are prognostic factors for infection rates and survival, within a heterogeneous childhood cancer population.
  
  
  METHODS
  From two previous studies, all children ≤18 years of age diagnosed with cancer between October 2004 and October 2011 were included in this study. Data regarding BMI, infections, and survival were retrieved. Patients with a BMI z-score lower than -2.0 were classified as malnourished. Weight loss more than 5% was considered relevant.
  
  
  RESULTS
  Two hundred sixty-nine childhood cancer patients were included in this study. At diagnosis, 5.2% of all patients were malnourished. These patients showed worse survival than those who were well nourished (hazard ratio (HR) = 3.63, 95% confidence interval (CI) = 1.52-8.70, p = 0.004). Malnourishment at 3 months after diagnosis (3.3% of all patients) also showed worse survival (HR = 6.34, 95% CI = 2.42-16.65, p < 0.001). Weight loss of more than 5% in the first 3 months after diagnosis was related to increased occurrence of febrile neutropenic episodes with bacteremia in the first year after diagnosis (odds ratio (OR) = 3.05, 95 % CI = 1.27-7.30, p = 0.012).
  
  
  CONCLUSIONS
  We found that malnourishment in the initial phase of therapy is associated with worse survival in childhood cancer patients. In addition, we found for the first time that weight loss during treatment is associated with increased presence of febrile neutropenic episodes with bacteremia. This underlines the importance of optimal feeding designs in childhood cancer patients.
authors.affiliation: Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
authors.forename: E A H
authors.initials: EA
authors.lastname: Loeffen
authors.forename: A
authors.initials: A
authors.lastname: Brinksma
authors.forename: K G E
authors.initials: KG
authors.lastname: Miedema
authors.forename: G H
authors.initials: GH
authors.lastname: de Bock
authors.forename: W J E
authors.initials: WJ
authors.lastname: Tissing
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000150:complications; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000150:complications*; D009369:Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D009503:Neutropenia / Q000150:complications; D009752:Nutritional Status / Q000502:physiology*; D016017:Odds Ratio; D011379:Prognosis; D015431:Weight Loss / Q000502:physiology*