Marwa Bebars
Malnutrition is an unspecific term used to define an inadequate nutritional condition. It is characterized by either a deficiency or an excess of energy with measurable adverse effects on clinical outcome. Malnutrition describes the consequences of insufficient protein-energy intake. An adequate protein energy balance is a prerequisite for age-appropriate growth and maintenance. Malnutrition also comprises circumstances of elevated energy supply resulting in overnutrition with an increase in adipose tissue. Even though malnutrition has been defined or described in many ways, no consensus exists regarding a specific definition to identify children at risk. The WHO recommends the weight for- height index to assess the nutritional status of children and adolescents. However, it is proposed that a loss in body weight of 5% constitutes acute malnutrition and a height-for-age value below the 5th percentile may reflect chronic undernourishment in children. Ironically, many children suffering from cancer do not meet these criteria. Particularly those with large solid abdominal masses (e.g embryonal neoplasms such as neuroblastoma, hepatoblastoma, or Wilms tumor) may present with normal weight despite severe malnutrition. Nutritional depletion may furthermore be masked in children by edema due to corticosteroid treatment. Even if no gold standard definition for undernourishment in children exists, concise definitions are needed for the institution of preventive policies. We provide a critical review of the current state of research and knowledge related to the nutritional management in childhood cancer.