From the Guidelines
Prevalence of Nutritional Issues in Pediatric Brain Tumor Patients
The prevalence of stunting, wasting, and obesity in pediatric brain tumor patients is significant, with various factors contributing to these nutritional issues.
- Stunting: Can result from treatments affecting growth hormone production, such as cranial-spinal irradiation, which is a significant risk factor for reduced bone mineral density (BMD) in up to one-third of survivors of childhood brain tumors 1.
- Wasting: May occur due to increased energy expenditure, decreased appetite, or malabsorption, with studies indicating that children with brain tumors are at risk due to factors like decreased physical activity and glucocorticoid treatment.
- Obesity: Can be a consequence of decreased physical activity, steroid treatment, or hypothalamic damage, with cranial radiation being a predictive factor for obesity, especially in females and those treated at a young age 1.
Risk Factors and Associations
Several risk factors and associations have been identified:
- Cranial Radiation: Exposure to cranial radiation, especially at a young age, is a significant risk factor for obesity in childhood cancer survivors, including those with brain tumors 1.
- Genetic Variants: Certain genetic variants, such as the Q223R SNP in LEPR, have been investigated for their association with obesity in childhood cancer survivors, although results have been inconsistent 1.
- Hormonal Imbalances: Hormonal imbalances, such as growth hormone deficiency and hypogonadotropic hypogonadism, can contribute to nutritional issues in pediatric brain tumor patients 1.
Assessment and Management
Assessment and management of nutritional issues in pediatric brain tumor patients are crucial:
- Body Mass Index (BMI): BMI is a commonly used measure to assess adiposity and weight in adults and children, although other measures like waist circumference and dual-energy x-ray absorptiometry (DEXA) may provide additional information 1.
- Lifestyle Modifications: Lifestyle modifications, including dietary changes and physical activity, are essential for managing weight and reducing the risk of long-term health consequences in childhood cancer survivors 1.
From the Research
Prevalence of Stunting, Wasting, and Obesity
- The prevalence of stunting, wasting, and obesity in pediatric patients with brain tumors is not directly addressed in the provided studies, as they focus on the prevalence of overweight and obesity in childhood brain tumor survivors.
- However, the studies suggest that childhood brain tumor survivors are at risk of developing obesity, which can negatively influence cardiometabolic health 2, 3.
- One study found that 14.2% of childhood brain tumor survivors were overweight, and 3.8% were obese at diagnosis 2.
- Another study reported that 28.7% of childhood brain tumor survivors between 4 and 20 years of age were overweight or obese, compared to 13.2% of the general population in the same age range 3.
- A third study found that 19% of childhood brain tumor survivors were overweight, and 8% were obese, with 35% having obesity according to dual-energy X-ray absorptiometry (DXA) measurements 4.
Association with Hypothalamic-Pituitary Dysfunction
- The studies suggest that hypothalamic-pituitary dysfunction may be associated with weight gain, overweight, or obesity in childhood brain tumor survivors 2, 3.
- One study found that being overweight or obese at diagnosis was not associated with anterior pituitary deficiency or diabetes insipidus at diagnosis or during follow-up, but being obese at diagnosis was associated with central precocious puberty in children with suprasellar tumors 2.
- Another study reported that the prevalence of hypothalamic-pituitary dysfunction was higher in overweight and obese childhood brain tumor survivors compared to normal-weight survivors 3.
- A third study found that cranial irradiation, hypothalamic/hypophyseal damage, growth hormone deficiency, and impaired mobility were associated with overweight/obesity and central obesity in childhood brain tumor survivors 4.
Risk Factors
- The studies identify several risk factors for weight gain, overweight, or obesity in childhood brain tumor survivors, including: