Nutrition Support in Pediatric Cancer

Cancer is the second leading cause of death among children aged five to 14 years (Murphy et al., 2013). The most recent data indicate leukemias and brain/central nervous system cancers are the most prominent forms of cancer among children under the age of 19 (CDC, 2014).

According to the Centers for Disease Control and Prevention, there are four major interventions that can decrease the onset of cancer among children and that may reduce the risk of developing cancer later in life. One of those interventions focuses on a healthy lifestyle and good eating habits coupled with adequate exercise to maintain appropriate weight for age.

Based on this intervention, one would expect malnutrition to contribute to the susceptibility to cancer and insufficient immune competency among children. In fact, many forms of malnutrition and metabolic disorders mask symptoms associated with childhood cancer (Plank and Hill, 2003; Sala et al., 2003). Thus it is important to recognize various stages and metabolic consequences of malnutrition in the diagnosis of metastatic disease in order to determine the avenue of nutrition intervention (Coates et al., 1986; Barron and Pencharz, 2007).

Evidence indicates that at least 60% of pediatric cancer patients present a spectrum of biological disturbances associated with malnutrition following various courses of cancer therapy (Montgomery et al., 2013). These poor health outcomes are complicated with efforts to achieve normal growth and development of these patients. Clinical nutrition support intervention dictates the application of enteral feeds when there is a healthy gut. However, many perceive parenteral administration of nutrition support is better tolerated among these patients. Yet there is limited evidence to suggest parenteral nutrition is more effective than enteral nutrition support (Jones et al., 2010).

Surgical intervention among cancer patients is often necessary. This calls into question the potential value to perioperative nutrition support strategies and their impact on convalescence (Powell-Tuck, 2000). The continued development and administration of enteral feeds that meet the nutrient and energy needs of these patients have proven to be critical in addressing consequences of undernutrition as frequently observed among children (Bauer et al., 2011).

The 2015 Dietary Guidelines Advisory Committee (DGAC) report noted that some dietary patterns and specific foods may increase the risk of various forms of cancer, including breast, colorectal, prostate, and lung cancers. This report supports a Mediterranean-style dietary pattern that contains red and processed meat. As indicated in earlier DGAC reports, the evidence indicates lower consumption of red and processed meat may reduce the risk of cardiovascular disease and colorectal cancer. However, according to the American Institute for Cancer Research, these same foods may or may not increase the risk of colorectal cancer (AICR/WCRF, 2014). In addition, the PREDIMED study in Spain indicated dietary patterns with foods such as olive oil and nuts can include some red and processed meats as part of a healthy diet (Estruch et al., 2013).

Processed foods, in general, have been implicated in an increased risk of some forms of cancer. In the totality of evidence with respect to food processing, Erdman et al. (2014) reported that various processing technologies may improve digestibility and nutrient bioavailability of some foods. It is important to recognize that various forms of food preparation, including high-temperature cooking methods, whether in a food production facility or at home, may introduce potential carcinogens. At the same time, many forms of food processing protect foods from microbial hazards and innate degradation so that these foods, including fruits and vegetables—which may reduce the risk of some forms of cancer—are available throughout the year.

Clearly there is a strong need to encourage lifestyles that may reduce the risks associated with cancer development. Let us not forget, there are environmental and genetic factors that are part of the equation. While children inherit genetic changes (aka DNA mutations) that may increase their risk of cancer, most childhood cancers are not caused by inherited DNA changes (American Cancer Society, 2015). Cancer-reducing lifestyles for children, as well as adults, include maintaining a healthy weight, participating in regular exercise, and eating a healthy diet. National Health and Nutrition Examination Survey data indicate fruit and vegetable intake among children is low (Lorson et al., 2009). Interestingly, the bioavailability of alleged bioactives in these foods is generally quite low, and their metabolism is poorly understood (Del Rio et al., 2013). Critical to our understanding of nutrient bioavailability is that these kinds of compounds have been associated with a decreased risk of cancer development. Thus it is essential when examining dietary factors relative to cancer risk that the entire diet and whole foods be considered instead of a single component



Roger Clemens, DrPH, CFS, Contributing Editor, 
Adjunct Professor, Univ. of Southern California School of Pharmacy,
Los Angeles, Calif.
[email protected]