Authors :
Lamia Mosleh; Najla Al-Sonboli; Abdullah Bin El-Zoa
Volume/Issue :
Volume 10 - 2025, Issue 9 - September
Google Scholar :
https://tinyurl.com/4m5c4vdp
Scribd :
https://tinyurl.com/6t6xrwfx
DOI :
https://doi.org/10.38124/ijisrt/25sep1493
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Abstract :
Nutritional assessment at the time of diagnosis is significant because it accurately identifies malnutrition or
obesity, allowing for tailored medical nutrition therapy to improve outcomes, reduce complications, shorten recovery times,
and lower healthcare costs. This study aimed to assess the nutritional status of pediatric patients with Acute Lymphoblastic
Leukemia at the time of diagnosis.
Patient & Method:
This is a cross-sectional hospital based study, was conducted at the Leukemia Unit of Al-Kuwait University Hospital
(KUH) in Sana’a, Yemen. Nutritional assessment was performed using the following anthropometric measurements: Body
mass index (BMI), mid upper arm muscle area (MAMA). The prognostic nutritional index (PNI) was determined based on
serum albumin levels and the total lymphocyte counts.
Results:
One hundred and four children were enrolled during the study period, the mean age was 7.144 ± 3.24 years. A total of
79.8 % were aged less than ten years, with male predominance of 62.5%, and patients who lived in rural areas were 68.3%.
Defined by BMI, MAMA, MUAC, and TSFT measurements, malnourished patients were 61.5%,52.9%, 66.3%, and 51%,
respectively. Based on PNI, 41.4 % of patients were at risk of malnutrition.
Conclusion:
Malnutrition emerges as a critical health concern at the time of diagnosis in pediatric ALL.
Keywords :
Pediatric Acute Lymphoblastic Leukemia, Body Mass Index, Mid Upper Arm Muscle Area, Prognostic Nutritional Index.
References :
- Inaba, H. and Pui, C.-H. (2021). Advances in the Diagnosis and Treatment of Pediatric Acute Lymphoblastic Leukemia. Journal of Clinical Medicine, [online] 10(9), p.1926. doi:https://doi.org/10.3390/jcm10091926.
- Al-Shehab, M.A., Alhadi, A.M., Elnemr, M.A.M., Al-Qadasi, F.A., Alabsi, N.A. and Aqlan, M.A. (2020). Epidemiological, Clinical and Paraclinical Characteristics of Childhood Acute Lymphoblastic Leukaemia in Sana’a, Yemen. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:https://doi.org/10.7860/jcdr/2020/43517.13651.
- Malczewska, M., Kośmider, K., Bednarz, K., Ostapińska, K., Lejman, M. and Zawitkowska, J. (2022). Recent Advances in Treatment Options for Childhood Acute Lymphoblastic Leukemia. Cancers, 14(8), p.2021. doi:https://doi.org/10.3390/cancers14082021.
- Lovell, A.L., Gardiner, B., Henry, L., Bate, J.M., Mark and Raquel Revuelta Iniesta (2024). The evolution of nutritional care in children and young people with acute lymphoblastic leukaemia: a narrative review. Journal of Human Nutrition and Dietetics. doi:https://doi.org/10.1111/jhn.13273.
- Geel, J. and Howard, S.C. (2025). Barriers to Achieving Childhood Cancer Cure. Pediatric Surgical Oncology, pp.63–83. doi:https://doi.org/10.1007/978-3-031-76882-8_6.
- Szmigiera, M. (2019). Global Hunger Index 2019: countries most affected by hunger | Statista. [online] Statista. Available at: https://www.statista.com/statistics/269924/countries-most-affected-by-hunger-in-the-world-according-to-world-hunger-index/.
- Salem, A., Rosen, A., Alharazi, I., Gamallat, Y., Aldbyani, A., Amer, B. and Chimpandu, N. (2025). Healthcare accessibility in yemen’s conflict zones: comprehensive review focused on strategies and solutions. Conflict and Health, 19(1). doi:https://doi.org/10.1186/s13031-025-00685-x.
- NRC. (2024). Nine years on: Economic downturn plunges millions into poverty in Yemen. [online] Available at: https://www.nrc.no/news/2024/march/nine-years-on-economic-downturn-plunges-millions-into-poverty-in-yemen.
- Khalid, A. (2017). Evaluation of the nutritional status in children with acute lymphoblastic leukemia and its effect on the outcome of induction in a developing country. Journal of Clinical Oncology, 35(15_suppl), pp.e22004–e22004. doi:https://doi.org/10.1200/jco.2017.35.15_suppl.e22004.
- Fan, Y., Yao, Q., Liu, Y., Jia, T., Zhang, J. and Jiang, E. (2022). Underlying Causes and Co-existence of Malnutrition and Infections: An Exceedingly Common Death Risk in Cancer. Frontiers in Nutrition, 9(814095). doi:https://doi.org/10.3389/fnut.2022.814095.
- Meilani Puspasari Simarmata, Rosdiana, N. and Arlinda Sari Wahyuni (2023). Differences in induction phase outcomes of acute lymphoblastic leukemia between well-nourished and malnourished pediatric patients. Paediatrica Indonesiana, 63(3), pp.146–51. doi:https://doi.org/10.14238/pi63.3.2023.146-51.
- Karalexi, M.A., Markozannes, G., Tagkas, C.F., Katsimpris, A., Tseretopoulou, X., Tsilidis, K.K., Spector, L.G., Schüz, J., Siahanidou, T., Petridou, E.Th. and Ntzani, E.E. (2022). Nutritional Status at Diagnosis as Predictor of Survival from Childhood Cancer: A Review of the Literature. Diagnostics, 12(10), p.2357. doi:https://doi.org/10.3390/diagnostics12102357.
- Guzmán-León, A.E., Avila-Prado, J., Bracamontes-Picos, L.R., Haby, M.M., Stein, K., Astiazaran-Garcia, H. and Lopez-Teros, V. (2024). Nutritional interventions in children with acute lymphoblastic leukemia undergoing antineoplastic treatment: a systematic review. BMC Nutrition, 10(1). doi:https://doi.org/10.1186/s40795-024-00892-4.
- Hulst, J.M., Huysentruyt, K., Gerasimidis, K., Shamir, R., Koletzko, B., Chourdakis, M., Fewtrell, M. and Joosten, K.F. (2022). A Practical Approach to Identifying Pediatric Disease-Associated Undernutrition: A Position Statement from the ESPGHAN Special Interest group on Clinical Malnutrition. Journal of Pediatric Gastroenterology & Nutrition, Publish Ahead of Print. doi:https://doi.org/10.1097/mpg.0000000000003437.
- Mullen, J.L., Buzby, G.P., Matthews, D.R., Smale, B.F. and Rosato, E.L. (1980). Reduction of Operative Morbidity and Mortality by Combined Preoperative and Postoperative Nutritional Support. Annals of Surgery, 192(5), pp.604–613. doi:https://doi.org/10.1097/00000658-198019250-00004.
- Zhang, L., Ma, W., Qiu, Z., Kuang, T., Wang, K., Hu, B. and Wang, W. (2023). Prognostic nutritional index as a prognostic biomarker for gastrointestinal cancer patients treated with immune checkpoint inhibitors. Frontiers in Immunology, 14. doi:https://doi.org/10.3389/fimmu.2023.1219929.
- Öztop, H., Hunutlu, F.Ç., Ekizoğlu, S.İ., Gül, Ö.Ö., Cander, S. and Şahin, A.B. (2025). Effect of Hemoglobin, Albumin, Lymphocyte Count, and Platelet (HALP) Score on Survival of Patients with Metastatic Thyroid Cancer Treated with Tyrosine Kinase Inhibitors. Journal of clinical medicine, [online] 14(4), p.1306. doi:https://doi.org/10.3390/jcm14041306.
- Morales, F., Montserrat-de, S., Leon, M.J. and Rivero‐Pino, F. (2023). Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children’s Health Status: A Literature Review. Nutrients, [online] 16(1), pp.1–1. doi:https://doi.org/10.3390/nu16010001.
- Madewell, Z.J., Keita, A.M., Das, P.M.-G., Mehta, A., Akelo, V., Oluoch, O.B., Omore, R., Onyango, D., Sagam, C.K., Cain, C.J., Chukwuegbo, C., Kaluma, E., Luke, R., Ogbuanu, I.U., Bassat, Q., Kincardett, M., Mandomando, I., Rakislova, N., Varo, R. and Xerinda, E.G. (2024). Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia. BMJ Global Health, [online] 9(12), p.e017262. doi:https://doi.org/10.1136/bmjgh-2024-017262.
- Zahran, A.M., Riad, K.F., Elsayh, K.I., Heba Mohammed Elmasry and Rayan, A. (2020). Role of pretreatment inflammatory indicators in pediatric acute leukemias; where do we stand? A prospective cohort study. Cancer Biomarkers, 29(4), pp.553–564. doi:https://doi.org/10.3233/cbm-201790.
- Rimjhim Sonowal and Gupta, V. (2021). Nutritional status in children with acute lymphoblastic leukemia, and its correlation with severe infection. Indian Journal of Cancer, 58(2), pp.190–194. doi:https://doi.org/10.4103/ijc.ijc_110_19.
- Frisancho, A.R. and Tracer, D.P. (1987). Standards of arm muscle by stature for the assessment of nutritional status of children. American Journal of Physical Anthropology, 73(4), pp.459–465. doi:https://doi.org/10.1002/ajpa.1330730408.
- Access to services for NCDs and mental health conditions. (2023). doi:https://doi.org/10.37774/9789275126196.
- Khadilkar, A., Mandlik, R., Chiplonkar, S., Khadilkar, V., Ekbote, V. and Patwardhan, V. (2015). Reference centile curves for triceps skinfold thickness for Indian children aged 5–17 years and cut-offs for predicting risk of childhood hypertension: A multi-centric study. Indian Pediatrics, 52(8), pp.675–680. doi:https://doi.org/10.1007/s13312-015-0695-x.
- Shimizu, K., Koga Luhulla, Magreth Msoffe, Chambega Chambega, Salama Mahawi, Ewald, P., Sandi, G., Msirikale, I., Philbert, R., Kabona, R., Chirande, L., Nakiddu, N.J., Scanlan, P., Smith, C., Miyazaki, Y., Maringe, C., Rachet, B. and Hadija Mwamtemi (2025). Clinical characteristics and outcomes of paediatric acute lymphoblastic leukaemia in a tertiary hospital in Tanzania: a single-centre observational study. Tropical Medicine and Health, 53(1). doi:https://doi.org/10.1186/s41182-025-00760-2.
- Ahmad, I., Ghafoor, T., Ullah, A., Naz, S., Tahir, M., Ahmed, S., Arshad, A., Ali, A., Khattack, T.A. and Batool, F. (2023). Pediatric Acute Lymphoblastic Leukemia: Clinical Characteristics, Treatment Outcomes, and Prognostic Factors: 10 Years’ Experience From a Low- and Middle-Income Country. JCO global oncology, [online] 9, p.e2200288. doi:https://doi.org/10.1200/GO.22.00288.
- Aristizabal, P., Sherer, M., Perdomo, B.P., Castelao, E., Thornburg, C.D., Proudfoot, J., Jacobs, E., Newfield, R.S., Zage, P., Roberts, W. and Martinez, M.E. (2020). Sociodemographic and clinical characteristics associated with vitamin D status in newly diagnosed pediatric cancer patients. Pediatric Hematology and Oncology, 37(4), pp.314–325. doi:https://doi.org/10.1080/08880018.2020.1721629.
- Kassa, E., Ayalew, M., Birhan, M., Gelaw, A., Gidey, A.M., Zeleke, T.A., Worku, D.T., Mekonnen, A., Kiflie, A., Yifter, E.T. and Berhane, N. (2025). Clinical profile and treatment outcomes of acute lymphoblastic leukemia among children attending at the University of Gondar comprehensive specialized hospital and Tikur Anbessa Specialized Hospital in Ethiopia. PLOS One, 20(6), p.e0322747. doi:https://doi.org/10.1371/journal.pone.0322747.
- Al, H.A. (2021). Prevalence of Different Types of Leukemia and Associated Factors among Children with Leukemia in Children’s Cancer Units at Al-Kuwait Hospital, Sana’a City: A Cross-Sectional Study. Global Journal of Pediatrics & Neonatal Care, 3(4). doi:https://doi.org/10.33552/gjpnc.2021.03.000569.
- Tabassum, N., Muhammad, S., Mirza, T., Butt, Z. and Mansoor, N. (2024). Clinical Characteristics and Cytogenetics of Childhood Acute Lymphoblastic Leukemia in a Single Center in Pakistan. Global Pediatric Health, 11. doi:https://doi.org/10.1177/2333794x241256863.
- Alnaim, L., Alqub, A., BinSalleeh, R., Alsultan, A.S. and Awwad, S.N. (2023). Health-related quality of life among patients with childhood acute lymphoblastic leukemia in Saudi Arabia: A cross-sectional study. Pediatric Hematology Oncology Journal, [online] 8(1), pp.21–26. doi:https://doi.org/10.1016/j.phoj.2022.12.008.
- Dai, Q., Zhang, G., Yang, H., Wang, Y., Ye, L., Peng, L., Shi, R., Guo, S., He, J. and Jiang, Y. (2021). Clinical features and outcome of pediatric acute lymphoblastic leukemia with low peripheral blood blast cell count at diagnosis. Medicine, [online] 100(4), p.e24518. doi:https://doi.org/10.1097/MD.0000000000024518.
- None Dheyaa Aldeen Nawfal Al-khateeb, Hussein, A. and Hadi, A. (2022). Assessment of the Nutritional Status of the Children with Acute Leukemia on Chemotherapy in Karbala City. Journal of Techniques, 4(3), pp.70–80. doi:https://doi.org/10.51173/jt.v4i3.643.
- Sala, A., Pencharz, P. and Barr, R.D. (2004). Children, cancer, and nutrition?A dynamic triangle in review. Cancer, 100(4), pp.677–687. doi:https://doi.org/10.1002/cncr.11833.
- Sigita Gustaitė, Everatt, V., Ignė Kairienė, Ramunė Vaišnorė, Rascon, J. and Goda Elizabeta Vaitkevičienė (2023). Changes in Nutritional Status during Induction Phase and Their Association with Fever and Minimal Residual Disease in Paediatric Acute Lymphoblastic Leukaemia. Medicina-lithuania, [online] 59(6), pp.1008–1008. doi:https://doi.org/10.3390/medicina59061008.
- Egnell, C., Närhinen, H., Merker, A., Jonsson, Ó.G., Lepik, K., Riitta Niinimäki, Kjeld Schmiegelow, Stabell, N., Albertsen, B.K., Goda Vaitkeviciene, Ranta, S. and Arja Harila‐Saari (2022). Changes in body mass index during treatment of childhood acute lymphoblastic leukemia with the Nordic ALL2008 protocol. European Journal Of Haematology, 109(6), pp.656–663. doi:https://doi.org/10.1111/ejh.13848.
- Hu, W., Cheung, Y.T., Tang, Y., Hong, L., Zhu, Y., Chen, J., Wang, Z., Zhou, M., Gao, Y., Chen, J., Li, B., Xue, H., Gu, L., Shen, S., Tang, J., Pui, C., Inaba, H. and Cai, J. (2022). Association between body mass index at diagnosis and outcomes in Chinese children with newly diagnosed acute lymphoblastic leukemia. Cancer Medicine. doi:https://doi.org/10.1002/cam4.5188.
- Guzmán-León, A.E., Gallegos-Castorena, S., Romo-Rubio, H., Casillas-Toral, E., Lopez-Teros, V. and Stein, K. (2025). Nutritional status at diagnosis and its relationship with survival and relapse in Mexican children with acute lymphoblastic leukemia: a retrospective study. BMC Cancer, 25(1). doi:https://doi.org/10.1186/s12885-025-13729-5.
- Callahan, E.A. (2023). The science, strengths, and limitations of body mass index. [online] www.ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK594362/.
- Nordqvist, C. (2022). Why BMI is inaccurate and misleading. [online] www.medicalnewstoday.com. Available at: https://www.medicalnewstoday.com/articles/265215.
- Zhang, X., Li, J.-H., Zhang, Q., Li, Q.-Q., Zhang, K.-P., Tang, M., Ge, Y.-Z., Li, W., Xu, H.-X., Guo, Z.-Q. and Shi, H.-P. (2021). Relationship Between Prognostic Nutritional Index and Mortality in Overweight or Obese Patients with Cancer: A Multicenter Observational Study. Journal of Inflammation Research, Volume 14, pp.3921–3932. doi:https://doi.org/10.2147/jir.s321724.
Nutritional assessment at the time of diagnosis is significant because it accurately identifies malnutrition or
obesity, allowing for tailored medical nutrition therapy to improve outcomes, reduce complications, shorten recovery times,
and lower healthcare costs. This study aimed to assess the nutritional status of pediatric patients with Acute Lymphoblastic
Leukemia at the time of diagnosis.
Patient & Method:
This is a cross-sectional hospital based study, was conducted at the Leukemia Unit of Al-Kuwait University Hospital
(KUH) in Sana’a, Yemen. Nutritional assessment was performed using the following anthropometric measurements: Body
mass index (BMI), mid upper arm muscle area (MAMA). The prognostic nutritional index (PNI) was determined based on
serum albumin levels and the total lymphocyte counts.
Results:
One hundred and four children were enrolled during the study period, the mean age was 7.144 ± 3.24 years. A total of
79.8 % were aged less than ten years, with male predominance of 62.5%, and patients who lived in rural areas were 68.3%.
Defined by BMI, MAMA, MUAC, and TSFT measurements, malnourished patients were 61.5%,52.9%, 66.3%, and 51%,
respectively. Based on PNI, 41.4 % of patients were at risk of malnutrition.
Conclusion:
Malnutrition emerges as a critical health concern at the time of diagnosis in pediatric ALL.
Keywords :
Pediatric Acute Lymphoblastic Leukemia, Body Mass Index, Mid Upper Arm Muscle Area, Prognostic Nutritional Index.