Finding the right balance: An evaluation of the adequacy of energy and protein intake in childhood cancer patients

Background & aims: Despite a widespread belief that adequate dietary intake is needed to maintain weight during childhood cancer treatment, conclusive data about adequacy of intake are lacking. Therefore, we aimed to assess the adequacy of energy and protein intake in a heterogeneous childhood cancer population against 3 different norms.

Methods: We conducted a prospective cohort study of 115 children diagnosed with cancer and assessed dietary intake after diagnosis and at 3, 6, and 12 months. Intake was assessed against recommended daily allowances (RDA), intake in healthy controls, and calculated individual requirements; and subsequently related to changes in nutritional status.

Results: Energy intake was lower than RDA and lower than in healthy controls at all measurement points; whereas energy intake matched individual requirements at 2 of the 4 measurement points. Protein intake in childhood cancer patients was lower than in healthy children. However, protein intake was almost twice the RDA and one and a half times the individual requirements. During the study period, weight and fat mass (FM) increased significantly while fat free mass (FFM) remained low. Energy intake was negatively associated with weight and FM, and protein intake was not associated with FFM.

Conclusions: The patients' weight increased; whereas their energy intake was lower than RDA and lower than in healthy controls. This indicates that the average intake was more than adequate. Percentage intake of individual requirements matched with increased weight. Therefore, the use of this norm is preferable to RDA or intake in healthy controls when determining the adequacy of dietary intake in both clinical practice and futures studies.