DOI: https://doi.org/10.53350/pjmhs2115123222 ORIGINAL ARTICLE 3222 P J M H S Vol. 15, No.12, DEC 2021 Nutritional Status of Children with Pediatric Acute Lymphoblastic Leukemia WASILA SHAMIM, SAADIA ANWAR, MAHWISH FAIZAN Department of Pediatric Hematology Oncology, University of Child Health Sciences & The Children’s Hospital Lahore, Pakistan Correspondence to Dr. Wasila Shamim, E-mail: wslshamim@yahoo.com cell 0331-4093971 ABSTRACT Aim: To analyze the nutritional status of children with pediatric Acute Lymphoblastic Leukemia (ALL) at presentation. Study design: Descriptive prospective study Place and duration of study: Department of Paediatric Haematology Oncology, Children Hospital, Lahore from March 2018 to April 2019. Methodology: A total of 195 children diagnosed as acute lymphoblastic leukemia on bone marrow biopsy were included. Anthropometric measurements were taken for each patient. Results: Out of 195 diagnosed patients with ALL, majority were having B-cell ALL 165(84.6%) and 30(15.4%) T-cell ALL. There was almost equal number of both standard and high risk patients (49% vs 51%) respectively. Mean age of children was 6.79±3.78 years and there was male predominance 120(61.5%). The percentage of children having weight for age <5 th centile was 91(47), only 8(4%) were overweight or obese. Children under the age of five years had a slightly higher propensity of weight <5 th centile i.e. 47(51.6%) as compared to older age group 5-10 years 26(28.7%) and >10 years 18(19.7%) (p=0.295).Similarly height for age was <5 th centile in 50(26%) children in total, and in under 5 year age group 26(13.3%) but there was no statistically significant difference related to age above 5 years (p=0.547). Conclusion: Pediatric ALL has overall high prevalence of under nutrition and both weight for age and height for age is lower in under-five children as compared to older age group. Keywords: Children, cancer, nutrition, malnutrition, Acute Lymphoblastic leukemia INTRODUCTION Acute Lymphoblastic Leukemia is considered as the most common childhood cancer. Over last 50 years there is a dramatic change in the treatment of ALL. Now with advancement in treatment almost 90% of children are cured of this deadly disease which was once fatal before the invent of latest chemotherapeutic medicines 1 .The identification of various factors on presentation like age, white cell count and cancer immune-phenotype which influence outcome and survival are crucial before starting the treatment .In addition to these factors, nutritional status of the child plays a decisive role and under-nourished children are more prone to develop treatment related toxicity and poor outcome. 2,3 .In the resource limited countries as compared to the rich countries, the survival of children with ALL is dismal and contributing factors include under nutrition, higher risk of infection in these immunocompromised children, insufficient supportive care and poor adherence to treatment 4 .Worldwide malnutrition in children is a major public health concerns and it is more prevalent in poorly resourced countries. The children suffering from cancer have severe weight loss and also have multiple nutritional deficiencies. These are due to inadequate intake of energy and proteins which often leads to increased toxicity of chemotherapy 5 . It has been seen that children with various cancers develop signs and symptoms of malnutrition during the course of disease and the frequency varies according to the type of malignancy. The relationship between childhood ALL and nutritional status has not been extensively studied in our country. As nutritional status of children with cancer on presentation has great impact on the disease course and ultimate response to the chemotherapy 6 . The aim of our study was to analyze the nutritional status of newly diagnosed ALL on presentation. METHODOLOGY The target population was children diagnosed as ALL and admitted in the Oncology ward of The Children’s Hospital & the Institute of Child Health (ICH) Lahore from March 2018 to April 2019 with permission from Ethical Review Board. Sample size of 195 was ----------------------------------------------------------------------------------------- Received on 13-06-2021 Accepted on 27-11-2021 calculated by using Open Epi statistical calculator and taking the prevalence of ALL in children as 15% with 95% confidence interval and 5% margin of error. The data was collected after taking approval from the Institutional Review Board of ICH and verbal informed consent from the care taker of the child. The data included age, gender and anthropometric measurements of the child. Weight-for-age (underweight) and height-for-age (stunting) was calculated using WHO charts. SPSS-22 was used for data analysis. The quantitative variables like age was presented as mean and SD. Qualitative variables like gender, risk stratification and type of leukemia was presented as frequency and percentages. The association between ALL, child’s nutritional status with age and gender of children was sought by using chi- square test and p-value of < 0.05 is considered as significant. Operational definitions: Malnutrition: defined according to WHO is the cellular imbalance between the supply of nutrients and the body’s demand for them to ensure growth, maintenance, and specific functions. This pathological state may result from inadequate nutrition causing under nutrition (<5 th centile), or over nutrition resulting in obesity (95 th centile). It is classified according to Gomez classification as follows: -Median Weight for Age (WFA %): Mild 75-90% WFA; Moderate 60-74%; Severe <60% -Median Height for Age (HFA %): Mild 90-94%HFA; Moderate 85- 90%; Severe < 85% Risk Stratification: According to NCI UKALL Criteria, children with ALL at diagnosis are categorized into Standard or High Risk, based on Age, ALL subtype, initial TLC count. Standard Risk: Pre-B ALL, age between 1-10 years and TLC less than 50,000 High Risk: Pre- T ALL, age less than 1 year or more than 10 years, TLC more than 50,000 RESULTS One hundred and ninety-five children were diagnosed with pediatric acute lymphoblastic leukemia between March 2018 and April 2019. The mean age of children was 6.79±3.78 years and there was male predominance 120(61.5%). Majority were having B-cell ALL 165(84.6%) and almost equal distribution of both standard and high risk groups (49% vs 51%) respectively (Table 1). Relationship of age groups and the risk stratification with the