Discussion
This study aimed to describe the dietary intake and dietary quality of
children during their treatment for cancer. The dietary data collected
in this study suggests that children receiving cancer treatment are
consuming diets of reasonable quantity, but poor quality. There were
some potential inadequacies of nutrients, and under-representation of
core food groups were seen amongst most of this childhood cancer
population. This study also found that many parents reported that their
children were able to eat what they liked and did not experience issues
with treatment related side effects such as nausea or vomiting.
Overweight and obesity and its consequent inflammation is linked with
the sequelae of metabolic diseases 41 of particular
concern in childhood cancer survivors as rates of these disease are
higher in this group 15. Our study found half of the
children being treated for cancer were consuming greater than 110% of
their energy requirements. It appears that for some patients, the
excessive energy intake seen at the end of treatment is manifesting
during treatment 19. Excessive energy intakes
resulting in weight gain places a childhood cancer survivor at an even
higher risk of developing a chronic health condition post treatment
completion 42. A recent study has shown that it is
possible to prevent excessive weight gain with a targeted nutrition
intervention during maintenance therapy 43 though it
may be that targeted interventions need to occur during early cancer
treatment 23.
Comparisons to normative data from the Australian Health Survey suggest
that fruit and vegetable intake of childhood cancer patients was greater
than that of Australian children in the general population, primarily
related to intake of discretionary foods, with fruit juice contributing
to more than half of total fruit intake. Vegetable based discretionary
foods including takeaway fries and chips comprised the majority of
discretionary vegetable intake suggesting that total vegetable intake
was of a poor nutrient quality. Given the role that adequate food intake
of core vegetables, fruit and whole grains play in prevention of chronic
disease 44, assisting families to improve diet quality
in these food groups is important. Additionally, consuming a nutrient
rich diet comprised of fruits, vegetables and whole grains may
contribute to long-term weight maintenance among survivors of childhood
cancer 45.
The goal of both parents and clinicians working in paediatric oncology
until now has been the prevention of weight loss through the use of a
high energy diet 46. This may encourage an ‘anything
goes’ approach to intake, particularly intake of high energy foods. (11)
Many nutrition information resources encouraging consumption of
discretionary foods, including those high in saturated fat such as
ice-cream, hot chips and fortification with butter and cream. Given that
these poor dietary habits established during cancer treatment may
persist into adulthood (3), a shift in focus from merely weight and
weight maintenance is required. Specifically, clinical teams need to
assist in establishment of good dietary habits, while managing side
effects and barriers to achieving adequate intake. It may also be that
dietary advice during cancer treatment may need to be targeted depending
on treatment intensity and the potential for nutrition-related side
effects. Focussing on dietary quality 23 while still
avoiding malnutrition, both under- and over-nutrition15,20, is required.
There will still be some patients who receive high intensity treatment
and are therefore known to have a high nutrition risk disease. This
increases their likelihood of requiring supplementary nutrition, and a
continued focus on the prevention of weight loss is required. However,
for other paediatric oncology patients the nutrition therapy may need to
be altered. Specifically, this may require a shift away from monitoring
weight only and instead reviewing the nutritional value of the whole
diet, working with families to manage food related treatment symptoms,
and establishing long-term healthy dietary patterns to avoid risks to
long-term health 15,20. Barriers to intake such as
fussy or picking eating, are often not unique to sick children (27). In
fact, one study found very few differences in eating and mealtime
behaviours between children receiving cancer treatment and healthy
children (27). This suggests that nutrition information for parents of
children with cancer should not necessarily be dissimilar to regular
messages provided to parents including eating a healthy, balanced diet,
establishing good eating habits, and consuming fruits, vegetables, and
wholegrains.