Nutritional status of children with Wilms' tumour on admission to Inkosi Albert Luthuli Central Hospital in Durban, South Africa and its influence on outcome.

Abstract

Introduction: In developing countries the prevalence of malnutrition on admission amongst children with cancer can be as high as 69%. High rates of malnutrition occur due to factors such as poverty, co-morbidities, late presentation and advanced disease process. Weight has been shown to be an inaccurate parameter for nutritional assessment of patients with solid tumours as it is influenced by tumour mass. The importance of nutritional resuscitation and support of children with cancer has been emphasised in the literature, however, nutritional assessment and management of children with cancer is not consistently implemented throughout the centres treating these patients. Malnutrition on admission has been shown to increase the risk of toxicity and infection amongst children with cancer. The influence of malnutrition at the time of admission on outcome has not, however, been conclusively established. Aim: The aims of this study were to determine the prevalence of malnutrition amongst children with Wilms‟ Tumour on admission to hospital, as well as the influence thereof on outcome after two years. Furthermore, it aimed to determine the level of nutritional support that the children received on admission to hospital. Objectives: a) To determine the prevalence of malnutrition using a combination of anthropometric and biochemical markers, defined by the AHOPCA algorithm. b) To determine the influence of nutritional status on admission on the outcome, in terms of overall survival and death, amongst children with Wilms' Tumour admitted to IALCH between 2004 and 2012. c) To determine the level of nutritional support prescribed to children with Wilms‟ Tumour within the first two weeks of admission to IALCH between 2004 and 2012. Methods: Seventy six children diagnosed with Wilms' Tumour and admitted to IALCH between 2004 and 2012 were studied prospectively. Nutritional assessment took place before starting treatment and included weight, height, mid upper arm circumference (MUAC), triceps skinfold thickness (TSFT) and serum albumin. Overall nutritional status was classified using a combination of MUAC, TSFT and albumin. Outcome was determined at two years after the date of admission. Time until commencement of nutritional intervention after admission, and nature thereof, were recorded.

Results: Stunting and wasting was evident in 12 and 15% of patients, respectively. By classifying nutritional status using a combination of MUAC, TSFT and albumin, the prevalence of malnutrition was shown to be 67%. Malnourished children did not have significantly larger tumours than those who were well-nourished on admission. Malnutrition was not a predictor of poor outcome at two years after admission. Eighty four percent of patients received nutritional resuscitation within two weeks of admission, in the form of oral supplements, nasogastric feeds, or a combination thereof. Conclusion: When classifying nutritional status, utilisation of weight and height in isolation can lead to underestimation of the prevalence of malnutrition amongst children with Wilms' Tumour. Nutritional assessment and classification of children with solid tumours should include MUAC and TSFT. Malnutrition at the time of admission was not shown to be related to poorer outcome after two years. This may be due to the effects of early aggressive nutritional resuscitation as part of management by a multidisciplinary team.