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A Global Approach Addressing the Double Burden of Malnutrition in Pediatric Oncology: A Bench to Bedside Paradigm. A Report from the State of the Science Meeting, Children’s Oncology Group

A Global Approach Addressing the Double Burden of Malnutrition in Pediatric Oncology: A Bench to... Scientific interest in the role of nutrition in cancer treatment and prevention was fueled largely by the success of the treatment of acute lymphoblastic leukemia (ALL) in children (1). Improvements in survival prompted parents to seek information about nutritional care during treatment as they battled through fluctuations from extreme wasting to overweight or obesity throughout the course of therapy. These experiences attracted advocacy groups such as Candlelighters who were instrumental in the establishment of The Diet, Nutrition, and Cancer Prevention program within the National Cancer Institute. Although the The Diet, Nutrition, and Cancer Prevention program expanded its scope beyond that of cancer in children, its establishment prompted some of the earliest work in nutrition and pediatric oncology (2–4). These initial investigations established that the provision of nutritional therapy is safe and that nutritional staging and monitoring should be an integral and essential component of supportive care in pediatric oncology (5). Subsequent decades focused on the role of enteral and parenteral nutrition, firmly establishing the safety, efficacy, and improvement in quality of life of providing nutritional therapy to a child undergoing treatment for cancer. As the nutritional landscape changed within the United States, overweight and obesity reignited interest in nutrition and childhood cancer (6). The detrimental effect was first reported by Lange et al. who found that both under- and overnutrition were associated with statistically significantly poorer outcomes in acute myelogenous leukemia (7). This finding fostered the establishment of the Nutrition Committee within Cancer Control in the Children’s Oncology Group, a consortium that has provided a critical forum to identify compelling research questions in nutritional science and an effective structure to advance high-quality, pioneering research in pediatric oncology (8). Most recently, the committee held a workshop to identify the next generation of compelling scientific areas in nutritional science with the overarching goal to further improve supportive care, quality of life, and survival in children with cancer. This monograph summarizes the outcome of the workshop and identifies the most scientifically compelling areas in nutritional science to meet this directive. The availability of metabolomics, microbiome, genomics, and advances in the evaluation and understanding of body composition have revolutionized nutritional science by enhancing investigators’ ability to understand the underlying mechanisms of nutritional therapy and identify biological targets that are modifiable through nutritional intervention, a considerable void in earlier investigations. With obesity proving to be a persistent clinical challenge, Orgel et al. illustrate the protective role of adipose cells in pediatric ALL and put forth plausible mechanisms underlying the association of overweight and obesity with survival in pediatric ALL. Grimes et al. offer another perspective on the role of nutrition in pediatric cancer care through highlighting advances in glucose monitoring, thereby providing novel opportunities for glycemic control, particularly in pediatric ALL. Joffe et al. discuss the role of routinely obtained computerized tomography to assess body composition and the role of body composition on the tumor vasculature, proposing a novel approach to future chemotherapy dosing trials in children with solid tumors. Finally, Roma et al. provide a perspective on leveraging our knowledge on the microbiome as well as metabolomics and its application to supportive care in pediatric oncology. The importance of lifestyle during and after cancer care has been recognized over several decades of cancer research and was highlighted most recently in the World Cancer Research Fund’s 3rd report on Diet and Lifestyle in Cancer. Esbenshade et al. provide a review of lifestyle interventions and opportunities for their development in pediatric oncology, and Runco and Yoon highlight the importance of nutritional care and physical activity in neuro-oncology. Additionally, we address the global aspects of nutritional care in pediatric oncology with members from the Global Childhood Cancer Initiative led by the World Health Organization. Application of our knowledge in the less resourced settings has further fostered survival and improved overall supportive care for children with cancer undergoing treatment in low- and middle-income countries. Lastly, this monograph addresses the continued importance of nutritional surveillance. Dietz et al. and Phillips and Pollock put forth the role of meta-data in advancing nutritional surveillance programs and their importance to health policy, quality improvement, and establishment of supportive care programs within pediatric oncology. Collectively, this monograph provides a compilation of pioneering work in nutritional science, much of which may further improve outcomes and reduce morbidity during and after treatment for cancer in children. Notes Affiliation of author: Columbia University Irving Medical Center, Department of Pediatrics, Institute of Human Nutrition, Mailman School of Public Health, New York, New York. (EJL). There are no conflicts of interest to disclose. References 1 Cantor D. Between prevention and therapy: Gio Batta Gori and the National Cancer Institute's Diet, Nutrition and Cancer Programme, 1974-1978 . Med Hist . 2012 ; 56 4 : 531 – 561 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Van Eys J. Malnutrition in children with cancer: incidence and consequence . Cancer . 1979 ; 43 ( 5 suppl ): 2030 – 2035 . Google Scholar PubMed WorldCat 3 Rickard KA , Coates TD , Grosfeld JL , Weetman RM , Baehner RL. The value of nutrition support in children with cancer . Cancer . 1986 ; 58 ( 8 suppl ): 1904 – 1910 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Donaldson SS , Wesley MN , DeWys WD , Suskind RM , Jaffe N , vanEys J. A study of the nutritional status of pediatric cancer patients . Arch Pediatr Adolesc Med . 1981 ; 135 12 : 1107 – 1112 . Google Scholar Crossref Search ADS WorldCat 5 Rickard KA , Loghmani ES , Grosfeld JL , et al. . Short- and long-term effectiveness of enteral and parenteral nutrition in reversing or preventing protein-energy malnutrition in advanced neuroblastoma. A prospective randomized study . Cancer . 1985 ; 56 12 : 2881 – 2897 . Google Scholar Crossref Search ADS PubMed WorldCat 6 Ogden CL , Carroll MD , Kit BK , Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010 . JAMA . 2012 ; 307 5 : 483 – 490 . Google Scholar Crossref Search ADS PubMed WorldCat 7 Lange BJ , Gerbing RB , Feusner J , et al. . Mortality in overweight and underweight children with acute myeloid leukemia . JAMA . 2005 ; 293 2 : 203 – 211 . Google Scholar Crossref Search ADS PubMed WorldCat 8 Sung L , Zaoutis T , Ullrich NJ , Johnston D , Dupuis L , Ladas EJ. Children's Oncology Group's 2013 blueprint for research: cancer control and supportive care . Pediatr Blood Cancer . 2013 ; 60 6 : 1027 – 1030 . Google Scholar Crossref Search ADS PubMed WorldCat © The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JNCI Monographs Oxford University Press

A Global Approach Addressing the Double Burden of Malnutrition in Pediatric Oncology: A Bench to Bedside Paradigm. A Report from the State of the Science Meeting, Children’s Oncology Group

JNCI Monographs , Volume 2019 (54) – Sep 1, 2019

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Oxford University Press
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© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com
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1052-6773
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1745-6614
DOI
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Abstract

Scientific interest in the role of nutrition in cancer treatment and prevention was fueled largely by the success of the treatment of acute lymphoblastic leukemia (ALL) in children (1). Improvements in survival prompted parents to seek information about nutritional care during treatment as they battled through fluctuations from extreme wasting to overweight or obesity throughout the course of therapy. These experiences attracted advocacy groups such as Candlelighters who were instrumental in the establishment of The Diet, Nutrition, and Cancer Prevention program within the National Cancer Institute. Although the The Diet, Nutrition, and Cancer Prevention program expanded its scope beyond that of cancer in children, its establishment prompted some of the earliest work in nutrition and pediatric oncology (2–4). These initial investigations established that the provision of nutritional therapy is safe and that nutritional staging and monitoring should be an integral and essential component of supportive care in pediatric oncology (5). Subsequent decades focused on the role of enteral and parenteral nutrition, firmly establishing the safety, efficacy, and improvement in quality of life of providing nutritional therapy to a child undergoing treatment for cancer. As the nutritional landscape changed within the United States, overweight and obesity reignited interest in nutrition and childhood cancer (6). The detrimental effect was first reported by Lange et al. who found that both under- and overnutrition were associated with statistically significantly poorer outcomes in acute myelogenous leukemia (7). This finding fostered the establishment of the Nutrition Committee within Cancer Control in the Children’s Oncology Group, a consortium that has provided a critical forum to identify compelling research questions in nutritional science and an effective structure to advance high-quality, pioneering research in pediatric oncology (8). Most recently, the committee held a workshop to identify the next generation of compelling scientific areas in nutritional science with the overarching goal to further improve supportive care, quality of life, and survival in children with cancer. This monograph summarizes the outcome of the workshop and identifies the most scientifically compelling areas in nutritional science to meet this directive. The availability of metabolomics, microbiome, genomics, and advances in the evaluation and understanding of body composition have revolutionized nutritional science by enhancing investigators’ ability to understand the underlying mechanisms of nutritional therapy and identify biological targets that are modifiable through nutritional intervention, a considerable void in earlier investigations. With obesity proving to be a persistent clinical challenge, Orgel et al. illustrate the protective role of adipose cells in pediatric ALL and put forth plausible mechanisms underlying the association of overweight and obesity with survival in pediatric ALL. Grimes et al. offer another perspective on the role of nutrition in pediatric cancer care through highlighting advances in glucose monitoring, thereby providing novel opportunities for glycemic control, particularly in pediatric ALL. Joffe et al. discuss the role of routinely obtained computerized tomography to assess body composition and the role of body composition on the tumor vasculature, proposing a novel approach to future chemotherapy dosing trials in children with solid tumors. Finally, Roma et al. provide a perspective on leveraging our knowledge on the microbiome as well as metabolomics and its application to supportive care in pediatric oncology. The importance of lifestyle during and after cancer care has been recognized over several decades of cancer research and was highlighted most recently in the World Cancer Research Fund’s 3rd report on Diet and Lifestyle in Cancer. Esbenshade et al. provide a review of lifestyle interventions and opportunities for their development in pediatric oncology, and Runco and Yoon highlight the importance of nutritional care and physical activity in neuro-oncology. Additionally, we address the global aspects of nutritional care in pediatric oncology with members from the Global Childhood Cancer Initiative led by the World Health Organization. Application of our knowledge in the less resourced settings has further fostered survival and improved overall supportive care for children with cancer undergoing treatment in low- and middle-income countries. Lastly, this monograph addresses the continued importance of nutritional surveillance. Dietz et al. and Phillips and Pollock put forth the role of meta-data in advancing nutritional surveillance programs and their importance to health policy, quality improvement, and establishment of supportive care programs within pediatric oncology. Collectively, this monograph provides a compilation of pioneering work in nutritional science, much of which may further improve outcomes and reduce morbidity during and after treatment for cancer in children. Notes Affiliation of author: Columbia University Irving Medical Center, Department of Pediatrics, Institute of Human Nutrition, Mailman School of Public Health, New York, New York. (EJL). There are no conflicts of interest to disclose. References 1 Cantor D. Between prevention and therapy: Gio Batta Gori and the National Cancer Institute's Diet, Nutrition and Cancer Programme, 1974-1978 . Med Hist . 2012 ; 56 4 : 531 – 561 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Van Eys J. Malnutrition in children with cancer: incidence and consequence . Cancer . 1979 ; 43 ( 5 suppl ): 2030 – 2035 . Google Scholar PubMed WorldCat 3 Rickard KA , Coates TD , Grosfeld JL , Weetman RM , Baehner RL. The value of nutrition support in children with cancer . Cancer . 1986 ; 58 ( 8 suppl ): 1904 – 1910 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Donaldson SS , Wesley MN , DeWys WD , Suskind RM , Jaffe N , vanEys J. A study of the nutritional status of pediatric cancer patients . Arch Pediatr Adolesc Med . 1981 ; 135 12 : 1107 – 1112 . Google Scholar Crossref Search ADS WorldCat 5 Rickard KA , Loghmani ES , Grosfeld JL , et al. . Short- and long-term effectiveness of enteral and parenteral nutrition in reversing or preventing protein-energy malnutrition in advanced neuroblastoma. A prospective randomized study . Cancer . 1985 ; 56 12 : 2881 – 2897 . Google Scholar Crossref Search ADS PubMed WorldCat 6 Ogden CL , Carroll MD , Kit BK , Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010 . JAMA . 2012 ; 307 5 : 483 – 490 . Google Scholar Crossref Search ADS PubMed WorldCat 7 Lange BJ , Gerbing RB , Feusner J , et al. . Mortality in overweight and underweight children with acute myeloid leukemia . JAMA . 2005 ; 293 2 : 203 – 211 . Google Scholar Crossref Search ADS PubMed WorldCat 8 Sung L , Zaoutis T , Ullrich NJ , Johnston D , Dupuis L , Ladas EJ. Children's Oncology Group's 2013 blueprint for research: cancer control and supportive care . Pediatr Blood Cancer . 2013 ; 60 6 : 1027 – 1030 . Google Scholar Crossref Search ADS PubMed WorldCat © The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Journal

JNCI MonographsOxford University Press

Published: Sep 1, 2019

References