title: Nutritional status in children and adolescents with leukemia: An emphasis on clinical outcomes in low and middle income countries.
abstract: OBJECTIVE
  The purpose of this narrative review is to examine the information available on the nutritional status of children with leukemia in low and middle income countries (LMICs), where the great majority of them live and malnutrition is prevalent, in order to identify best practices and remaining deficits in knowledge.
  
  
  METHODS
  Literature relevant to measurement of nutritional status and the impact of nutritional status on important clinical outcomes in this population, and others of relevance, was reviewed.
  
  
  RESULTS
  Arm anthropometry provides more accurate information on nutritional status than measures based on body weight in children with cancer. Both over- and under-nutrition are important determinants of tolerance of chemotherapy, compliance with treatment, relapse of disease, and survival. These relationships are subject to change with nutritional intervention. There are valuable roles for educational tools and 'ready-to-use-therapeutic-foods'.
  
  
  CONCLUSIONS
  Assessment of nutritional status is mandatory in this population and accomplishable at various levels of sophistication according to available resources. Recognition of the fundamental role of nutritional status in affecting outcomes in children with leukemia is expanding, but knowledge gaps remain. An apparently counter-intuitive strategy of caloric restriction may be worthy of exploration. There is a particular need to establish normative data, including measures of body composition, in children in LMICs.
  
  
  CONCLUSIONS
  Developing adaptive clinical practice guidelines for the measurement of nutritional status and for nutritional interventions, incorporating assessment of health-related quality of life, are evident priorities in the care of children with leukemia in LMICs.
authors.affiliation: a Departments of Pediatrics , Pathology and Medicine, McMaster University , Hamilton , Ontario , Canada.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Barr
authors.affiliation: b College of Agriculture and Human Ecology, Tennessee Technological University , Cookeville , USA.
authors.forename: Terezie T
authors.initials: TT
authors.lastname: Mosby
mesh_terms: D000293:Adolescent; D002648:Child; D015362:Child Nutrition Disorders / Q000401:mortality* / Q000628:therapy; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000401:mortality* / Q000628:therapy; D007938:Leukemia / Q000401:mortality* / Q000628:therapy; D008297:Male; D009752:Nutritional Status
keywords: Children; Developing countries; Leukemia; Nutrition; Outcomes