Malnutrition is a general phrase that serves to define an inadequate nutritional state.

Malnutrition ensues from an imbalance in consumption (insufficient or excessive), and

utilization of energy, nutrients and/or both. Malnutrition may be a consequence of the cancer
itself and/or its treatment.1 A prospective study in India reported that malnutrition is widely
prevalent in children with ALL and has a significant bearing on the occurrence of life-
threatening complications and short-term outcomes in these children. Malnutrition in children
with cancer causes decreased tolerance to and increased complications of subsequent
chemotherapy. Based on weight-for-height Z score (World Health Organization), 53%
patients with ALL had malnutrition (WHZ score below -2 deviation standards); 26% had
moderate malnutrition and 26% had severe malnutrition. This study also extrapolated each of
the deaths to weight/height data (acute malnutrition) and revealed that all deaths occurred in
children with malnutrition and none occurred in the well-nourished group (x2= 4.03, p =
0.045).2 The episode of febrile neutropeni and treatment delay also higher in ALL children
with malnutrition although not significantly.2 Another study in Iraq also revealed that the
prevalence of under nutrition in ALL children was 50%; wasting was 40%; BMI <5 th centile
was 46.7%; and MUAC <5th centile was 33.3%.3
The pathogenesis of the energy imbalance that underlies the development of malnutrition in
any disease, including malignancies. This imbalance is the result of some combination of
diminished intake, enhanced losses (including malabsorption), and increased needs. Many
patients with cancer suffer anorexia and, thus, have reduced intake; others experience
increased losses, and some have increased energy expenditure. Changes in the metabolism of
fat, carbohydrate, and protein have been demonstrated in the cancer bearing host. These
changes include increased lipid breakdown, resulting in depletion of lipid stores, and
alterations in carbohydrate metabolism, resulting in an energy-losing cycle. In addition, there
is an increased protein turnover and loss of the normal compensatory mechanism seen in
starvation. The final result is weight loss, in particular, loss of lean body mass, which is
manifest clinically as malnutrition.3,4
1 Owens JL, Hanson SJ, McArthur JA, Mikhailov TA. The need for evidence based nutritional
guidelines for pediatric acute lymphoblastic leukemia patients: acute and long-term following
treatment. Nutrients. 2013;5: 4333-46

2 Linga VG, Shreedhara AK, Rau ATK, Rau A. Nutritional assessment of children with hematological
malignancies and their subsequent tolerance to chemotherapy. The Ochsner Journal. 2012;12: 197-201

3 Kadir RAA, Hassan JG, Aldorky MK. Nutritional assessment of children with acute lymphoblastic
leukemia. iMedPub Journals. 2017;5(1): 1-9

4 Sala A, Pencharz P, Barr RD. Children, cancer, and nutrition a dynamic triangle in review. Cancer.
2004;100: 677-87