Factors Associated with Body Mass Index in Children with Acute Leukemia: A Cross-sectional Study View PDF

Acute leukemia represents the most prevalent malignancy in childhood, accounting for approximately 30% of all pediatric cancers worldwide [1, 2]. ALL is the most common subtype, comprising about 75-80% of childhood leukemia cases, followed by acute myeloid leukemia (AML) [3, 4]. Over recent decades, remarkable advances in treatment protocols have dramatically improved survival rates, with five-year survival now exceeding 85% for ALL in developed countries [5, 6]. However, this success brings increased attention to treatment-related complications and quality of life issues, including nutritional challenges.

Nutritional status is a critical determinant of treatment tolerance, infection risk, and overall prognosis in pediatric oncology patients [7, 8]. Children with acute leukemia face multiple nutritional challenges stemming from both the disease process and its treatment. The malignancy itself can cause anorexia, alter metabolism, and increase nutritional demands [9, 10]. Chemotherapy regimens, while lifesaving, frequently induce adverse effects including nausea, vomiting, mucositis, taste alterations, and gastrointestinal dysfunction, all of which compromise nutritional intake [11, 12]. Additionally, corticosteroids used in treatment protocols can profoundly affect appetite and body composition [13].

The nutritional consequences in pediatric leukemia patients are heterogeneous. While malnutrition and weight loss are commonly recognized complications [14, 15], recent evidence indicates that overweight and obesity are increasingly prevalent in this population, particularly in developed nations [16, 17]. This paradoxical observation may relate to corticosteroid therapy, reduced physical activity during treatment, and changes in dietary patterns [18, 19]. Both undernutrition and overnutrition carry significant clinical implications: malnutrition is associated with increased infection rates, treatment interruptions, and reduced survival [20, 21], whereas obesity may be linked to altered drug pharmacokinetics, increased relapse risk, and long-term metabolic complications [22, 23].

BMI serves as a practical and widely used tool for nutritional assessment in pediatric populations [24]. BMI z-scores, which account for age and sex-specific growth patterns, enable standardized evaluation of nutritional status across different age groups [25]. The WHO growth standards provide internationally recognized reference values for interpreting BMI in children [26].

Despite the recognized importance of nutrition in pediatric oncology, systematic nutritional assessment and monitoring remain inconsistent in many clinical settings [27, 28]. In resource-limited environments, nutritional support services may be particularly inadequate, potentially exacerbating existing vulnerabilities [29, 30]. Understanding the prevalence and patterns of malnutrition in children with leukemia is essential for developing targeted interventional strategies and improving outcomes.

The relationship between nutritional status and various sociodemographic factors in pediatric leukemia patients remains incompletely characterized. Previous studies have suggested associations between nutritional outcomes and factors such as age, SES, parental education, and geographic location [31, 32], though findings have been inconsistent across different populations and settings.

This study was conducted to evaluate the nutritional status of children with acute leukemia through BMI assessment and to explore potential associations with sociodemographic and clinical characteristics. By identifying specific factors associated with nutritional vulnerability, this research aims to inform people about the development of more effective nutritional screening and intervention programs for this high-risk pediatric population.