Nutritional status of children during treatment for acute lymphoblastic leukemia in Guatemala

Background: Most children with cancer live in developing countries where the prevalence of malnutrition may reach 50% and influence the course of the disease. This study examined the prevalence and severity of malnutrition at diagnosis, as well as after 3 and 6 months of chemotherapy, in children with acute lymphoblastic leukemia (ALL) in Guatemala. Methods: Triceps skin fold thickness (TSFT) and mid upper arm circumference (MUAC) provided measures of nutritional status (NS) in three categories: adequately nourished (A): TSFT and MUAC>10th percentile; severely depleted (SD): TSFT or MUAC<5th percentile; and moderately depleted (MD): all the remaining patients. Results: Of 331 new patients, 241 had NS assessed at diagnosis. A=113 (46.9%); MD=28 (11.6%); SD=100 (41.5%). At 3 months A=106 (52.2%); MD=25 (12.3%); SD=72 (35.5%). At 6 months A=146 (76.0%); MD=12 (6.3%); SD=34 (17.7%). In multivariate analysis, SD children at 6 months of treatment had a hazard of death that was 2.4-fold the hazard of those A or MD (95% CI: 1.3-4.7) Conclusions: Malnutrition is prevalent in newly diagnosed children with ALL in Guatemala and severe nutritional depletion is apparently predictive of abandonment of therapy and relapse of disease, but if children survive and improve their NS in the first 6 months after diagnosis, their chances of survival may improve significantly to approximate those in children not presenting with nutritional depletion.