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. 1979 Dec;190(6):771–781. doi: 10.1097/00000658-197912000-00018

Reversal of protein-energy malnutrition in children during treatment of advanced neoplastic disease.

K A Rickard, J L Grosfeld, A Kirksey, T V Ballantine, R L Baehner
PMCID: PMC1345639  PMID: 229780

Abstract

The effectiveness of enteral and parenteral feeding in supporting a satisfactory nutritional status and/or reversing protein-energy malnutrition was evaluated in 28 children, ages 1-19 (14 female) with advanced malignant disease (21 solid tumors, 7 leukemia-lymphoma). At the onset of treatment, 21 patients received intensive nutritional counseling (INC) and oral supplementation while seven received total parenteral nutrition (TPN). Sixteen of 21 patients who received INC had a decreased intake (x 48 +/- 24%) Recommended Dietary Allowances (RDA) for kilocalories and dramatic weight loss (x 16.4 +/- 12.4%). A total of 18 patients received TPN for a mean of 24 days (7-60); kcal averaged 90 +/- 26% RDA during weight gain. At onset of TPN, the mean serum albumin, transferrin and total lymphocyte counts were 3.06 +/- 0.38 g/dl, 175 +/- 62 mg/dl, and 1102 +/- 966/mm3 respectively, 15/18 children had subnormal anthropometric measurements and 17/18 patients were anergic to recall skin test antigens. TPN for less than 9-14 days neither repleted weight, skinfold reserves, nor serum albumin concentrations (greater than 3.2 g/dl) although an early increase (p less than .02) in transferrin concentration was observed. However, TPN for 28 days supported weight gain (3.27 kg, 16 +/- 6%), increased serum albumin (0.62 +/- 0.43 g/dl, p less than .001) and transferrin (62 +/- 42, p less than .002) to normal concentrations and reversed anergy in 7/11 patients retested. This study documents the severity of protein energy malnutrition which accompanies intense treatment of children with cancer and the nutritional and immunological benefits of a 28 day course of TPN.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Blackburn G. L., Maini B. S., Bistrian B. R., McDermott W. V., Jr The effect of cancer on nitrogen, electrolyte, and mineral metabolism. Cancer Res. 1977 Jul;37(7 Pt 2):2348–2353. [PubMed] [Google Scholar]
  2. Brennan M. F. Uncomplicated starvation versus cancer cachexia. Cancer Res. 1977 Jul;37(7 Pt 2):2359–2364. [PubMed] [Google Scholar]
  3. Chandra R. K. Nutrition as a critical determinant in susceptibility to infection. World Rev Nutr Diet. 1976;25:166–188. doi: 10.1159/000399571. [DOI] [PubMed] [Google Scholar]
  4. Copeland E. M., 3rd, Daly J. M., Dudrick S. J. Nutrition as an adjunct to cancer treatment in the adult. Cancer Res. 1977 Jul;37(7 Pt 2):2451–2456. [PubMed] [Google Scholar]
  5. Copeland E. M., 3rd Intravenous hyperalimentation as an adjunct to cancer patient management. CA Cancer J Clin. 1978 Nov-Dec;28(6):322–330. doi: 10.3322/canjclin.28.6.322. [DOI] [PubMed] [Google Scholar]
  6. Copeland E. M., Fadyen B. V., Jr, Dudrick S. J. Effect of intravenous hyperalimentation on established delayed hypersensitivity in the cancer patient. Ann Surg. 1976 Jul;184(1):60–64. doi: 10.1097/00000658-197607000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Giuliano A. E., Rangel D. M., Holmes E. C., Golub S. H., Morton D. L. Serum-mediated immunosuppression in cancer. Surg Forum. 1977;28:163–165. [PubMed] [Google Scholar]
  8. Issell B. F., Valdivieso M., Zaren H. A., Dudrick S. J., Freireich E. J., Copeland E. W., Bodey G. P. Protection against chemotherapy toxicity by IV hyperalimentation. Cancer Treat Rep. 1978 Aug;62(8):1139–1143. [PubMed] [Google Scholar]
  9. Karlberg P., Taranger J. The somatic development of children in a swedish urban community. Acta Paediatr Scand Suppl. 1976;(258):1–148. [PubMed] [Google Scholar]
  10. Meakins J. L., Pietsch J. B., Bubenick O., Kelly R., Rode H., Gordon J., MacLean L. D. Delayed hypersensitivity: indicator of acquired failure of host defenses in sepsis and trauma. Ann Surg. 1977 Sep;186(3):241–250. doi: 10.1097/00000658-197709000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Rickard K., Farnum S. Food for fun and thought: nutrition education in a children's hospital. J Am Diet Assoc. 1974 Sep;65(3):294–297. [PubMed] [Google Scholar]
  12. Rolley R. T., Widman D., Sterioff S., Jr, Williams G. M. Immunological monitoring of human transplant recipients with recall antigen skin tests. Surg Forum. 1977;28:314–316. [PubMed] [Google Scholar]

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