# Nutritional Assessment of Children and Adolescents with Cancer in Various Resource Settings

## TL;DR

This paper reviews how to assess nutrition in children with cancer, considering different healthcare resources and cancer types to improve treatment outcomes.

## Contribution

The paper provides a structured approach for nutritional assessment tailored to resource availability and cancer types.

## Key findings

- Conventional anthropometric measures may not detect body composition changes effectively.
- Resource-limited settings should prioritize history, physical exams, and basic body composition measures.
- Advanced imaging techniques are feasible in full-access settings for detailed body composition analysis.

## Abstract

Nutrition has bidirectional effects in children with cancer. It influences, and is influenced by, the disease and treatment, starting from the diagnosis and continuing through therapy into survivorship. Therefore, a longitudinal comprehensive nutritional assessment is essential to define the patient’s nutritional status and to guide management. Assessment strategies should be tailored not only to specific cancer types but also to the available health care resources. In this review, we discuss practical methods for evaluating malnutrition, including their advantages and limitations. We also provide a structured approach for use in various resource settings. This approach will guide nutritional management that can enhance treatment outcomes for children with cancer.

Background: Malnutrition has bidirectional effects in childhood cancer, as nutrition affects treatment-related adverse effects and outcomes. In turn, the cancer diagnosis and treatment, along with related psychosocial factors, can affect nutritional status. Nutritional evaluation is challenging because of the heterogeneous nutritional risks associated with a patient’s cancer diagnosis and socioeconomic status, as well as because of the variation in available resources and capacity in different global settings. Methods: This review summarizes methods for evaluating nutritional status and proposes a structured approach for use across different cancer types and resource settings. Results: Conventional anthropometric measures, including weight, height, and body mass index, along with longitudinal growth curve plotting using World Health Organization or Centers for Disease Control and Prevention growth charts, are widely used but may not adequately detect changes in body composition. In resource-limited (limited-access) countries, where equipment and trained personnel are lacking, history taking, physical examination, and anthropometric measurements should be prioritized, along with basic body composition measures such as mid-upper arm circumference. In partial-access settings, biochemical assessments and bioelectrical impedance analysis may be added to identify micronutrient deficiencies and changes in lean and fat mass, respectively. In full-access settings, advanced body composition imaging techniques (e.g., dual-energy x-ray absorptiometry, computed tomography, and magnetic resonance imaging) can be incorporated. The approaches should also be adjusted based on the cancer diagnosis and treatment. Conclusions: Tailoring nutritional assessment strategies across diverse resource settings and diagnoses would be beneficial for targeted interventions that may improve clinical outcomes. Further research, quality improvement studies, and policy-level initiatives are necessary to develop effective assessments.