Nutritional Considerations in Childhood Acute Lymphoblastic Leukemia

The high prevalence of malnutrition in adult and pediatric cancer patients has been appreciated for decades and continues to be documented. Although the prognostic significance of nutritional status among patients with cancer remains controversial, it is generally accepted that the nutritional support is an important aspect of medical therapy. Children with cancer are particularly vulnerable to malnutrition, because they exhibit elevated substrate needs due to the disease and its treatment. At the same time, children have increased requirements of nutrients to attain appropriate growth and neurodevelopment. Malnutrition in children with cancer should not be accepted at any stage of the disease or tolerated as an inevitable process. The undernourished patients of ALL are more prone to infections, requiring longer duration of hospital stay. Therefore, optimum nutritional support to such patients can help to decrease the chances of infections and ultimately improve the outcome based on a systematic assessment. Nutritional assessment is the first step of nutritional support which will not improve the child's sense of well-being but also maintain normal growth, promote wound healing, improve tumor response to therapy and enable the child to better withstand the effects of therapy. Assessment will also help prevent over nutrition which may in some instances be detrimental to the treatment of cancer. Therefore, nutritional adequate strategies should be considered and integrated as a fundamental feature of pediatric oncology with the same diligence as one does for other supportive care measures to prevent chronic illness and adverse late effects caused by malnutrition in children with ALL.