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Establishing the Use of Body Mass Index as an Indicator of Nutrition Risk in Children With Cancer

Joshua Nething, BS, Karen Ringwald-Smith, RD, MS, LDN^*, Ruth Williams, MS, RD, EdD, LDN^*, Michael L. Hancock, MS and Gregory A. Hale, MD

From the ^* Clinical Nutrition Services, Department of Biostatistics, and Division of Stem Cell Transplantation, Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee

Correspondence: Karen Ringwald-Smith, RD, MS, LDN, Clinical Coordinator, Clinical Nutrition Services, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105. Electronic mail may be sent to Karen.Smith{at}STJUDE.org.

Background: The negative health consequences of malnutrition in the pediatric oncology patient are well known. The purpose of this study was to determine the usefulness of body mass index (BMI) for age as a tool to prospectively identify pediatric cancer patients at risk for malnutrition and to determine the BMI percentile that would be required to identify at-risk patients. Methods: This study was conducted by a retrospective chart review of 1839 newly diagnosed acute lymphoblastic leukemia patients at St. Jude Children's Research Hospital. Those falling below the 10^th percentile on any one category of height for age (HFA), weight for age (WFA), or weight for height (WFH) were classified with regard to nutrition risk and compared with those identified as at risk by BMI for age (BFA). The BMI percentiles of the lower 9^th–11^th percentile patients on the HFA, WFA, and WFH growth charts were averaged in an attempt to determine a useful value to identify nutrition risk. Results: Lack of agreement was found to exist between BFA and HFA in identifying patients at risk for malnutrition, and also between BFA and WFA. Significant agreement was found to exist between BFA and WFH. The BMI percentile required to identify those at risk for malnutrition by the other growth charts would classify too many patients as being at risk for malnutrition to be considered clinically useful. Conclusions: Although research has shown BMI is appropriate to use in the nutrition assessment of children, its usefulness has not been confirmed in the pediatric oncology patient; therefore, further study is warranted. BFA assessment should be included in the nutrition survey of new pediatric oncology patients, along with other parameters, but it cannot be recommended as the sole indicator of nutrition status at this time.

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