Cancer treatment affects a child's nutritional status. Some children lose a lot of weight during treatment and run the risk of malnutrition, while others gain a lot of weight. But how do children fare after treatment ends? Does their nutritional status recover or are changes that occur during treatment, such as obesity, permanent? These questions were answered in a study by nurse researcher Aeltsje Brinksma and Wim Tissing, pediatric oncologist and head of supportive care of the Princess Máxima Center.
Nutritional status
They conducted their study among children originally treated at the UMCG. This was a group of children aged 0 to 18 years with a hematological disease (such as leukemia), a brain tumor or another solid tumor.
Aeltsje Brinksma explains: ‘We collected data on nutritional status at diagnosis and one year and seven years after diagnosis. The children were measured at these times, they completed questionnaires themselves or together with their parents and kept a nutritional diary. Other data were collected from the patient records. So we got accurate data on weight, height, BMI, fat and fat-free mass and factors such as age, sex, type of cancer, dietary intake and physical activity.'
Extra weight and fat mass
After analysing the data the researchers found striking differences. In children with hematologic cancer or a brain tumor, BMI continued to rise after treatment ended. As a result, the percentage of overweight survivors quadrupled seven years after diagnosis.
‘We calculated that 27.3% of children were overweight after completion of treatment. That is higher than 15.5% and 18.6%, respectively, among children and teenagers in the Netherlands', says Aeltsje Brinksma. 'In the survivors, the acquired extra pounds of weight and fat mass during treatment, did not disappear after completing treatment.’
Risk of being underweight and overweight
An important conclusion from this study: children who gain weight and develop extra fat mass during treatment did not lose it after treatment. Factors that influence weight or fat mass gain are the type of cancer (hematological and brain tumor), lower BMI at diagnosis and higher BMI of the mother.
‘It is important that during treatment attention is paid not only to the risk of malnutrition, but also to the risk of developing obesity’, according to Aeltsje Brinksma. ‘Although we didn’t find a direct relationship between dietary intake (eating a lot or unhealthy food) and weight gain, attention to a healthy diet and sufficient exercise during treatment is important.
‘For children and parents, this is quite a difficult message. Because children sometimes have periods of no appetite and eat little, they may eat tasty ‘unhealthy’ food more often, which is quite logical. It is clearly an art to keep eating 'healthy' when the food tastes different or to keep exercising when you feel tired and miserable.’
Follow-up research
Follow-up research is currently being conducted at the Princess Máxima Center, mapping children's metabolism in addition to dietary intake and physical activity. It is possible that this study will provide even better insight into how obesity occurs and how it can be prevented.
The scientific publication can be found here: Brinksma, A., Sulkers, E., Kouwenberg, D., Lelieveld, O.T.H.M., Boot, A.M., Burgerhof, J.G.M., and Tissing, W.J.E. (2022) Changes in body size and body composition in survivors of childhood cancer; seven years follow-up of a prospective cohort. Clin Nutr 41, 2778-2785