CT-Based body composition and nutritional status as predictors of early-treatment chemotherapy-related infections and hematologic toxicity in pediatric cancer: a prospective study Beatriz Pereira de Carvalho, Isabella Caroline Santana Aleixo, Nathalia Farache Tostes, Nilian Carla Souza, Danúbia da Cunha Antunes Saraiva, et al. European Journal of Pediatrics, 2026 Chemotherapy-related toxicity has been associated with body composition, yet there is no consensus on which CT-derived muscle parameter or handgrip strength (HGS) best predicts toxicity in pediatric cancer patients. This study evaluated whether CT-derived body composition parameters and nutritional status independently predict early chemotherapy-related infections and hematologic toxicity in children and adolescents with cancer. In this prospective observational cohort, patients aged 7–18 years undergoing chemotherapy with available CT/PET-CT scans were included. Anthropometric data (weight, height, arm circumference, triceps skinfold thickness) and HGS were collected. At the third lumbar vertebra (L3), skeletal muscle mass (SMM), skeletal muscle index (SMI), total adipose tissue, and muscle radiodensity were measured; psoas area was assessed at L4. Associations were analyzed using χ2 tests and logistic regression adjusted for sex, age, tumor stage, and type. Forty-eight patients were included (mean age 12.6 ± 3.3 years; 64.6% male); 64.6% had hematologic malignancies and 53.6% had advanced disease. Most were classified as having normal nutritional status (50–64.6%). Hematologic (100%) and gastrointestinal (85.4%) toxicities were most frequent. Low SMM and SMI were correlated with a higher risk of infection (OR 4.20; 95% CI 1.23–14.27 and OR 3.92; 95% CI 1.17–13.20, respectively) and fever (OR 4.05; 95% CI 1.21–13.54 and OR 5.82; 95% CI 1.67–20.25, respectively). After adjustment, only low SMI remained independently associated with fever (OR 4.74; 95% CI 1.09–20.61; p = 0.038). Conclusions : Low muscle mass was associated with early infection and fever-related toxicity, suggesting a role of muscle quantity in immune function during pediatric cancer treatment. What is Known: • Body composition in children and adolescents changes during chemotherapy is associated with treatment-related toxicity .• Muscle status is crucial for chemotherapy tolerance and treatment response . What is New: • Low skeletal muscle mass was associated with a higher risk of toxicities, including fever .• No association was found between anthropometric parameters, HGS and toxicities, indicating that further studies are needed .
Impact of adherence to oral nutritional supplements on nutrition status and muscle strength in patients with gastrointestinal cancer: A prospective observational longitudinal study Wagner A. Ferreira, Renata B. Martucci, Nilian C. Souza Nutrition in Clinical Practice, 2025 BackgroundGiven the lack of evidence regarding the effects of adherence to oral nutritional supplements (ONS) and the types of formulas used in clinical practice, we aimed to assess the impact of adherence to ONS and the high‐protein formula on the nutrition status and muscle strength in patients with gastrointestinal cancer.MethodsThis study evaluated newly diagnosed outpatients with esophageal, gastric, pancreatic, and colorectal cancer prescribed ONS. Nutrition status was assessed using the Patient‐Generated Subjective Global Assessment (PG‐SGA), and muscle strength was assessed using handgrip strength (HGS) dynamometry. ONS adherence was calculated as the ratio of self‐reported intake to the prescribed amount and categorized as ≥80% or <80%.ResultsA total of 54 patients were included. Most patients were ≥60 years of age (63%), were diagnosed with colorectal cancer (63%), were classified as stage III and IV (83%), and exhibited nutrition risk or malnutrition according to PG‐SGA (89%). Patients with adherence ≥80% to ONS exhibited less weight loss and HGS reduction compared with patients with adherence <80% (P < 0.05). Although patients consuming a high‐protein formula maintained HGS and those on a standard formula experienced a reduction, formula type did not predict HGS change in the multivariate analysis. ONS protein intake, adjusted for adherence, was a predictor of weight change (β: 0.09; 95% CI: 0.02–0.2; P = 0.011).ConclusionPatients with adherence ≥80% to ONS experienced less reduction in both weight and HGS, whereas those consuming a high‐protein formula maintained HGS. Notably, ONS protein intake, adjusted for adherence, was an independent predictor of weight change.
Mid-upper arm circumference in hospitalized pediatric patients with cancer: Is there an association with malnutrition? Jéssica Pedro, Renata Martucci, Gina Monteiro, Danúbia Saraiva Nutrition in Clinical Practice, 2023 BackgroundMalnutrition is common in children/adolescents with cancer. Mid‐upper arm circumference (MUAC) is recommended by the International Society of Pediatric Oncology for measuring nutrition status. The aim was to evaluate the nutrition status of pediatric patients with cancer and verify whether MUAC is associated with malnutrition and length of stay (LOS).MethodsThis was an observational study of patients aged 0–19 years with solid and hematological neoplasms. Data included anthropometric measurements of nutrition status by body mass index/age (BMI/A), weight/age, weight/height, height/age, MUAC, mid‐arm muscle circumference, triceps skinfold thickness (TSF), and biochemical measurements of characterizing inflammation (serum prealbumin level, serum albumin level, and C‐reactive protein [CRP]). Statistical tests such as the Student t test, Mann‐Whitney test, and Spearman correlation were employed to analyze the data. Logistic regression was used for multivariate analysis.ResultsOf 111 patients, 51.7% (n = 57) were male, and solid tumors were prevalent (76.6%, n = 85). The median age was 8.5 years. The anthropometric measurements of the arm revealed a higher prevalence of malnutrition when compared with anthropometric indices. According to the Spearman correlation, a high and positive correlation was observed between MUAC and BMI/A (ρ = 0.800 and P < 0.001). There was an association between MUAC, TSF, and high CRP with LOS (P = 0.025, P = 0.003, and P < 0.001, respectively). Patients with a MUAC (less than the fifth percentile) had almost 2.73 times the chance of having a prolonged LOS.ConclusionMUAC was a good parameter for the classification of nutrition status and the assessment of LOS in pediatric patients with cancer.
Performance of the new nutrition evaluation tool for hospitalized pediatric patients with cancer in Brazil (ANPEDCancer) Danúbia d. C. A. Saraiva, Renata B. Martucci, Gina T. R. Monteiro Nutrition in Clinical Practice, 2023 BackgroundThere is a lack of specific nutrition assessment tools for pediatric patients with cancer. The aim was to evaluate the performance of the ANPEDCancer assessment tool in a pediatric population with cancer, verifying its ability to detect nutrition inadequacy and predict the length of hospital stay (LOS).MethodsEvaluated 111 pediatric patients hospitalized in the National Cancer Institute (INCA) in 2019 to assess nutrition status. Patients were classified as malnourished and well nourished by the ANPEDCancer. Measures of weight, height, anthropometric indicators, body composition, laboratory parameters, LOS, and death were compared between groups. The ANPEDCancer classification was compared with the complete nutrition assessment, calculating sensitivity, specificity, and predictive values, and with the LOS.ResultsThe prevalence of malnutrition was 12.6%, nutrition risk was 48.6%, risk of overweight/obesity was 6.3%, and well‐nourished status was 32.4%. According to ANPEDCancer, malnourished patients showed a higher frequency of inadequacy for all anthropometric indices, percentage of weight loss, serum albumin level, C‐reactive protein (CRP), and longer LOS when compared with well‐nourished patients. There was an association between the tool's diagnosis and measures of body composition, CRP, and LOS. ANPEDCancer validation with the complete nutrition assessment showed a sensitivity of 81.6%, specificity of 55%, positive predictive value of 53.4%, and negative of 82.5%. The LOS was almost twice as long among malnourished patients and was statistically significant (P = 0.002).ConclusionANPEDCancer is a feasible tool to assess nutrition status and identify the presence of nutrition risk, allowing for targeted assistance in hospitalized pediatric patients with cancer.
Nutritional status at hospital admission and prediction of clinical outcomes in children and adolescents with cancer: Results of the Brazilian survey on oncological nutrition in paediatrics Wanélia Vieira Afonso, Wilza Arantes Ferreira Peres, Nivaldo Barroso de Pinho, Arthur Orlando Corrêa Schilithz, Renata Brum Martucci, et al. Journal of Human Nutrition and Dietetics, 2023 BackgroundChanges in nutritional status are recognised as predictors of unfavourable outcomes in children and adolescents with cancer, particularly in developing countries. There have been no studies on children and adolescents with cancer from every region of Brazil or on the impact of nutritional status on clinical outcomes. The aim of this study is to assess the association between the nutritional status of children and adolescents with cancer and the prediction of clinical outcomes.MethodsThis was a longitudinal, multicentre, hospital‐based study. An anthropometric nutritional assessment was performed, and the Subjective Global Nutritional Assessment (SGNA) was administered within 48 h of admission. Seven hundred and twenty‐three patients (aged 2–18 years) were included in the sample, undergoing cancer treatment. They were recruited in 13 reference centres in the five macro‐regions of Brazil between March 2018 and August 2019. The outcomes evaluated were readmission within 30 days and death within 60 days of admission. To identify predictors of 60‐day survival, Cox regression and log‐rank statistics were used to compare Kaplan–Meier curves between the strata.ResultsAbout 36.2% (n = 262) of the samples were malnourished according to the SGNA. Severe malnutrition by the SGNA (relative risk [RR] = 8.44, 95% confidence interval [CI]: 3.35–21.3, P = 0.001) and living in the North region (RR = 11.9, 95% CI: 3.34–42.7, P = 0.001) were associated with the poorest survival. The North (RR = 5.77, 95% CI: 1.29–25.8, P = 0.021), Northeast (RR = 1.46, 95% CI: 1.01–2.11, P = 0.041), Midwest (RR = 0.43, 95% CI: 0.20–0.095, P = 0.036), age group 10–18 years (RR = 0.65, 95% CI: 0.45– 0.94, P = 0.022) and haematologic malignancy (RR = 1.52, 95% CI: 1.10–2.10, P = 0.011) were predictors of readmission within 30 days.ConclusionsThe prevalence of malnutrition was high and related to death. These results highlight the need to use the SGNA in clinical practice alongside classic anthropometric methods for the diagnosis of malnutrition, and the need to standardise care across all Brazilian regions, which should include nutritional care for children and adolescents with cancer.
Predictive validity of GLIM malnutrition diagnosis in patients with colorectal cancer Andresa da Silva Couto, Maria Cristina Gonzalez, Renata Brum Martucci, Patrícia Moreira Feijó, Viviane Dias Rodrigues, et al. Journal of Parenteral and Enteral Nutrition, 2023 BackgroundConsidering that the validation of the Global Leadership Initiative on Malnutrition (GLIM) remains unclear in patients with colorectal cancer, the present study aimed to assess the agreement, accuracy, sensitivity, specificity, and prognostic effect of the GLIM on survival when compared with the Patient‐Generated Subjective Global Assessment (PG‐SGA).MethodsPatients with colorectal cancer who were scheduled to undergo a routine abdominal computed tomography (CT) scan were recruited. Using the GLIM two‐step approach, the patients were first screened for malnutrition by using the PG‐SGA Short Form (score ≥3). The malnutrition diagnosis was based on the etiologic (disease burden [cancer] or reduced food intake) and phenotypic GLIM criteria, including weight loss, body mass index, and skeletal muscle index at the third lumbar vertebra when using the CT scans. The food intake was assessed by the PG‐SGA.ResultsThis study included 191 patients (age, 60.5 ± 11.3 years; 57% men), and 23% and 32% were malnourished according to the GLIM and the PG‐SGA, respectively. The GLIM revealed fair sensitivity (64%), good agreement (kappa = 0.65), specificity (96%), and diagnostic accuracy for detecting malnutrition (area under the receiver operating characteristic curve = 0.80; 95% CI, 0.72–0.88) when compared with the PG‐SGA. The malnutrition value according to the GLIM and the PG‐SGA was associated with short‐term survival. However, only the PG‐SGA was associated with long‐term survival.ConclusionsAlthough showing fair sensitivity, the GLIM had good agreement, specificity, and diagnostic accuracy for malnutrition detection and was an independent predictor of short‐term survival in patients with colorectal cancer.
