title: Nutritional status of children with Wilms' tumour on admission to a South African hospital and its influence on outcome.
abstract: BACKGROUND
  In developing countries up to 77% of children with cancer have been shown to be malnourished on admission. High rates of malnutrition occur due to factors such as poverty and advanced disease. Weight can be an inaccurate parameter for nutritional assessment of children with solid tumours as it is influenced by tumour mass. This study aimed to assess the prevalence of malnutrition amongst children with Wilms tumour (WT), the level of nutritional support received on admission and the influence of nutritional status on outcome.
  
  
  METHODS
  Seventy-six children diagnosed with WT and admitted to Inkosi Albert Luthuli Central Hospital between 2004 and 2012 were studied prospectively. Nutritional assessment was conducted using weight, height, mid-upper arm circumference (MUAC) and triceps skinfold thickness (TSFT) prior to initiating treatment. Outcome was determined 2 years after admission. Time until commencement of nutritional resuscitation and nature, thereof, were recorded.
  
  
  RESULTS
  Stunting and wasting was evident in 12% and 15% of patients, respectively. The prevalence of malnutrition was 66% when MUAC, TSFT and albumin were used. Malnutrition was not a predictor of poor outcome and did not predict advanced disease. The majority of patients (84%) received nutritional resuscitation within 2 weeks of admission.
  
  
  CONCLUSIONS
  When classifying nutritional status in children with WT, the utilisation of weight and height in isolation can lead to an underestimation of the prevalence of malnutrition. Nutritional assessment of children with WT should also include MUAC and TSFT. Early aggressive nutritional resuscitation is recommended.
authors.affiliation: Dietetics and Human Nutrition, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
authors.forename: Lauren F
authors.initials: LF
authors.lastname: Lifson
authors.affiliation: Department of Paediatric Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: G P
authors.initials: GP
authors.lastname: Hadley
authors.affiliation: Dietetics and Human Nutrition, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
authors.forename: Nicola L
authors.initials: NL
authors.lastname: Wiles
authors.affiliation: Dietetics and Human Nutrition, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
authors.forename: Kirthee
authors.initials: K
authors.lastname: Pillay
mesh_terms: D000293:Adolescent; D001132:Arm; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000209:etiology*; D009752:Nutritional Status; D015995:Prevalence; D012885:Skinfold Thickness; D013019:South Africa; D009396:Wilms Tumor
keywords: Wilms tumour; arm anthropometry; cancer; children; malnutrition; nutrition