Nutritional status of children at cancer diagnosis and during treatment, with a focus on the association with their clinical outcome

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dc.contributor.advisorKruger, Marianaen_ZA
dc.contributor.advisorLadas, Elenaen_ZA
dc.contributor.advisorRogers, Paulen_ZA
dc.contributor.authorSchoeman, Judithen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.en_ZA
dc.date.accessioned2023-11-25T12:36:36Zen_ZA
dc.date.accessioned2024-01-08T11:42:10Zen_ZA
dc.date.available2023-11-25T12:36:36Zen_ZA
dc.date.available2024-01-08T11:42:10Zen_ZA
dc.date.issued2023-09en_ZA
dc.descriptionThesis (PhD)--Stellenbosch University, 2023.en_ZA
dc.description.abstractENGLISH ABSTRACT: Up to 50% of children diagnosed with cancer in low-middle-income countries are malnourished, while in paediatric oncology units (POUs) in Africa, less than half had a dedicated dietician, and only a third undertook routine nutritional assessment. Newly diagnosed children with cancer were longitudinally assessed for nutritional status in South Africa, including micronutrient assessment at diagnosis. The majority of the 320 children were well-nourished at diagnosis, while less than 15% had either stunting (14.3%), underweight (11.6%), wasting (8.1%), while a quarter (24.3%) had moderate acute malnutrition (MAM). Girls were more prone to being underweight (12.2% versus 4.5%; P = 0.027), while children five years and older had a higher prevalence of MAM (33.5% versus 14.5%; P < 0.001), with significant improvement six months after diagnosis (P < 0.001). Stunting was significantly associated with poor overall survival one year after a cancer diagnosis (HR 1.9; 95% CI 1.1, 3.3; P = 0.029). Nearly a third (27.8%) of patients had a high poverty risk that was significantly associated with stunting (P = 0.009), food insecurity (P < 0.001), and residential province (P < 0.001). Most children lived in households with a high risk of food insecurity (80%) and had an increased odds ratio for treatment abandonment (OR 4.5; 95% CI 1.0; 19.4; P = 0.045) and hazard for death (HR 3.2; 95% CI 1.02, 9.9; P = 0.046) compared to those with food security. Of 261 patients assessed for micronutrient status in two POUs, half had iron deficiency (47.6%), a third Vit A (30.6%), Vit D (32.6%), or folate (29.7%) deficiencies. There were significant associations between MAM and low levels of Vit A (48.4%; P = 0.005), Vit B12 (29.6%; P < 0.001), and folate (47.3%; P = 0.003). Male patients (40.9%; P = 0.004) and those with wasting (63.6%;P < 0.001) are associated with Vit D deficiency. Folate deficiency is significantly associated with children five years and older (39.8%; P = 0.002), residing in provinces Mpumalanga (40.9%) and Gauteng (31.5%) (P = 0.032); food insecurity (46,3%; P < 0.001), or haematological malignancy (41.4%; P = 0.004). The South African-adapted childhood cancer-specific nutritional algorithm was implemented in an intervention group versus a control group that received standard nutritional support protocol. The implementation of the algorithm led to a significant improvement in nutritional status for the malnourished patients in the intervention group, while it was insignificant for the control group. Determining socio-economic status and micronutrients at childhood cancer diagnosis in South Africa is crucial to plan appropriate nutritional interventions. Of note, stunting is associated with a poor one-year overall survival. The South African-developed algorithm successfully managed children with malnutrition at cancer diagnosis.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Tot 50% van kinders in lae-middel-inkomste lande wat met kanker gediagnoseer is, is ondervoed. Minder as die helfte van Afrika se pediatriese onkologie-eenhede (POE's) het 'n toegewyde dieetkundige, terwyl slegs 'n derde van hierdie eenhede gereeld antropometrie assesserings doen. Pas gediagnoseerde kinders met kanker in Suid Afrika is longitudinaal geassesseer vir voedingstatus terwyl mikronutrient status bepaal is by diagnose. Die meerderheid van die 320 kinders was goed gevoed by diagnose, terwyl minder as 15% óf te kort was (14.3%), ondergewig (11.6%) of te skraal (8.1%) was, en 'n kwart (24.3%) matige akute wanvoeding (MAW) gehad het. Meisies was meer geneig om ondergewig te wees (12,2% teenoor 4.5%; P = 0,027), terwyl kinders van vyf jaar en ouer 'n hoër voorkoms van MAW gehad het (33,5% teenoor 14.5%; P <0,001) met aansienlike verbetering ses maande na diagnose (P < 0.001). Lengte (kort) was betekenisvol geassosieer met swak algehele oorlewing een jaar na 'n kankerdiagnose (HR 1.9; 95% CI 1.1, 3.3; P = 0.029). Byna 'n derde (27.8%) van pasiënte het 'n hoë risiko vir armoede wat betekenisvol geassosieer word met lengte (P = 0.009), voedselsekuriteit (P < 0.001) en residensiële provinsie (P < 0.001). Die meeste kinders het in huishoudings gewoon met 'n hoë risiko van voedselonsekerheid (80%) en het 'n verhoogde risiko gehad om behandeling te laat vaar (OR 4.5; 95% CI 1.0; 19.4; P = 0.045) en mortaliteit (HR 3.2; 95% CI 1,02, 9.9; P = 0.046) in vergelyking met dié met voedselsekerheid. In twee POE is 261 pasiënte se mikronutrient status beoordeel, en het die helfte ystertekort (47.6%), 'n derde Vit A (30.6%), Vit D (32.6%) of folaat (29.7%) tekorte gehad. Daar was betekenisvolle assosiasies tussen MAW en lae vlakke van Vit A (48.4%; P = 0.005), Vit B12 (29.6%; P < 0.001) en folaat (47.3%; P = 0.003). Manlike pasiënte (40.9%; P = 0.004) en diegene met MAW (63.6%; P < 0.001) word geassosieer met Vit D-tekort. Folaattekort word betekenisvol geassosieer met kinders vyf jaar en ouer (39,8%; P = 0.002), of wat woon in Mpumalanga (40,9%) en Gauteng (31,5%) (P = 0,032); voedselonsekerheid (463%; P < 0.001), of hematologiese maligniteit (41,4%; P = 0.004). Die Suid-Afrikaans-aangepaste kinderkanker-spesifieke voedingsalgoritme is geïmplementeer in 'n intervensiegroep teenoor 'n kontrolegroep wat ‘n standaard voedings protokol ontvang het. Die implementering van die algoritme se resultate was 'n betekenisvolle verbetering in voedingstatus vir die ondervoede pasiënte in die intervensiegroep, terwyl dit nie betekenisvol was vir die kontrolegroep. Die bepaling van sosio-ekonomiese status en mikronutrient vlakke met die diagnose van kinderkanker in Suid-Afrika is van kardinale belang om toepaslike voedingsintervensies te beplan. Let wel, lengte (belemmerde groei) word geassosieer met 'n swak algehele oorlewing een jaar na diagnose. Die Suid-Afrikaans-ontwikkelde algoritme het kinders met wanvoeding by kankerdiagnose se voedingstatus suksesvol verbeter.af_ZA
dc.description.versionDoctorateen_ZA
dc.format.extentxi, 276 pages : illustrationsen_ZA
dc.identifier.urihttps://scholar.sun.ac.za/handle/10019.1/128803en_ZA
dc.language.isoen_ZAen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.rights.holderStellenbosch Universityen_ZA
dc.subject.lcshCancer in children -- South Africaen_ZA
dc.subject.lcshNutrition -- Evaluation -- South Africaen_ZA
dc.subject.lcshMalnutrition in children -- South Africaen_ZA
dc.subject.lcshChildren -- Economic conditionsen_ZA
dc.titleNutritional status of children at cancer diagnosis and during treatment, with a focus on the association with their clinical outcomeen_ZA
dc.typeThesisen_ZA
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