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By  Gargee Rai
Consultant Nutritionist
National Cancer Institute, Nagpur
     
On 11 September 2020

Nutrition is an integral part of biological system of any living organism. Human nutrition deals with the provision of essential nutrients in food that are necessary to support human life and good health. A healthy diet throughout life promotes healthy birth, supports normal growth, development and ageing, helps to maintain a healthy body weight, and reduces the risk of chronic disease leading to overall health and well-being.

Similarly, Nutrition is an important part of cancer treatment. Cancer diet, in a nutshell, is eating the right kinds of foods during and after treatment, that can help patient feel better and stay stronger throughout their Cancer journey.

Cancer patients need to maintain a healthy body weight and eat nutritious foods. Sometimes the side effects of cancer treatment can cause a person to eat less and lose weight. However, losing weight without trying can make them weak and malnourished.

The Problem

Poor nutrition is a chronic problem often linked to poverty, poor understanding of nutrition & dietary practices and poor knowledge about nutrients required at various stages of life to prevent deficiency of nutrients which can have adverse effects on body.

Malnutrition in Cancer Patients

The COVID-19 pandemic has posed serious risks to the nutritional status of hundreds of millions of children and adult cancer patients worldwide. Malnutrition and its consequences are large contributors to deaths, physical deformities and disabilities worldwide. In the current crisis, where malnutrition can affect the course of the pandemic, it is highly pertinent that the issue of nutrition in cancer patients is addressed with multi-pronged actions.

Malnutrition is the primary reason behind 69 per cent of deaths of children below the age of five in India, according to a UNICEF’s The State of the World’s Children 2019 report.

The report further goes on to say that every second child in India, belonging to that age group is affected by some form of malnutrition. This includes stunting (low height for age) with 35 per cent of the children, wasting (low weight for height) with 17 per cent and 2 per cent overweight. Malnutrition is not an issue that is new rather it has been a major cause of concern for Indians for decades. (UNICEF, 2019)

What is Malnutrition?

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition covers 2 broad groups of conditions.

One is ‘undernutrition’— which includes

  • stunting (low height for age)
  • wasting (low weight for height)
  • underweight (low weight for age)
  • micronutrient deficiencies or insufficiencies (a lack of important vitamins
    and minerals)

The other is ‘overnutrition’— which includes

  • overweight
  • obesity
  • diet-related non-communicable diseases (such as heart disease, stroke, diabetes and cancer)

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. (WHO, 2020)

National Cancer Institute at Nagpur witnesses a footfall of about 5000 cancer patients per month that seek cancer treatment for various types of Cancers. Out of which, almost 6% accounts for pediatric cancer patients, unfortunately.

To cater to special needs of children with cancer, NCI has created a 27-bedded pediatric cancer ward facility with dedicated pediatric onco-expert team.

The in-house facility has enabled us to get insights on various aspects of childhood cancer - Onco Pediatric Nutrition is one of them. We had been working on awareness & education of the Children as well as parents, ever since.

Nutritional assessment at National Cancer Institute, Nagpur

We have initiated a study to evaluate the nutritional status of pediatric cancer patients in Central India. Through which, our onco-nutrition expert undertakes nutritional assessment of all new pediatric patients - age group 2 years to 14 years - those are being admitted to hospital. The assessment indices are based on WHO growth standards, that includes but does not limit to - Height for Weight, BMI for Age, MUAC (Mid-upper arm circumference), Head Circumference and the like.

Based on this assessment, a nutritional care plan is created for each of the pediatric cancer patient and their development is observed on assessment parameters.

 



Nutritional Status of Pediatric cancer patients at the time of admission at NCI, Nagpur

The data shows that around 70% of newly admitted pediatric patients are falling in malnutrition group when clubbed SAM, MAM and mildly undernourished, together. Out of which 38% showed severe acute malnutrition, around 23.48% exhibited acute malnutrition and around 9.57% were mildly undernourished. Number of pediatric cancer patients that are overweight and obese was very negligent, a total of 1.74%. Only 28% of pediatric cancer patients were well nourished.

At NCI, we have pediatric cancer patients coming from different parts of central India like cities of Gondia, Akola, Amravati etc.; regions like Vidarbha, Marathwada etc. and states like Maharashtra, Madhya Pradesh, Chhattisgarh, Jharkhand etc. These kids suffering from Cancer belong to different socio economic groups having different cultural backgrounds and food choices. However, the one thing which we found common in these children was - ‘Malnutrition’.

That was shocking! Malnutrition is so prevalent in these areas that every second pediatric cancer patient coming to the hospital is found malnourished.

Factors responsible for Malnutrition in Children with Cancer

This could be because of the disease itself, ongoing cancer treatment, their socio-economic status, bad food choices, lack of nutritional awareness or education among their community.

Credit https://unsplash.com

Apparently, the most significant factors are bad food choices and lack of nutritional education. It was evident that -

  • These children eat a lot of biscuits, bread, chips and more of processed outside food items than the nutritious food that is home made, prepared hygienically without preservatives.
  • Irrespective of their socioeconomic status, they lack a basic habit of eating Vegetable, Dal, Chapati, Rice etc. as their daily food intake.
  • Some of them have no access to nutritional food because of poverty.
  • Some of them had no nutritional education or awareness while choosing food to eat.

These findings have encouraged us to map their nutrition specific behavior and plan a study around the issue to understand the nutritional status of these children that are getting cancer treatment at National Cancer Institute, Nagpur.

The Road Ahead

The study has helped us to focus our nutritional intervention plan in the direction where we timely treat malnourishment in these children and make them nutritionally stable before they complete their cancer treatment, here.

Another point of prime focus for us is to bring nutritional awareness in them and their families. To achieve this special emphasis is given to educate pediatric patients and their caregivers about nutrition – How they can make healthy and affordable nutrition choices. every day. Every meal.

#PoshanMaah

With the National Nutrition Month this year, we have pledged to take on multi-pronged approach for awareness & education of the Children as well as parents, technical & implementation support, research and advocacy of Cancer diets and Nutrition.

We support the efforts by government of India and all of society amidst the #Pandemic times for much needed #PoshanMaah initiative. Nutritional education is crucial now, more than ever in our nation for a better and healthy tomorrow.