Nutritional Status at Diagnosis as Predictor of Survival from Childhood Cancer: A Review of the Literature

Maria A. Karalexi, Georgios Markozannes, Christos F. Tagkas, Andreas Katsimpris, Xanthippi Tseretopoulou, Konstantinos K. Tsilidis, Logan G. Spector, Joachim Schüz, Tania Siahanidou, Eleni Th Petridou, Evangelia E. Ntzani

Research output: Contribution to journalReview articlepeer-review


Few studies so far have examined the impact of nutritional status on the survival of children with cancer, with the majority of them focusing on hematological malignancies. We summarized published evidence reporting the association of nutritional status at diagnosis with overall survival (OS), event-free survival (EFS), relapse, and treatment-related toxicity (TRT) in children with cancer. Published studies on children with leukemia, lymphoma, and other solid tumors have shown that both under-nourished and over-nourished children at cancer diagnosis had worse OS and EFS. Particularly, the risk of death and relapse increased by 30–50% among children with leukemia with increased body mass index at diagnosis. Likewise, the risk of TRT was higher among malnourished children with osteosarcoma and Ewing sarcoma. Nutritional status seems to play a crucial role in clinical outcomes of children with cancer, thus providing a significant modifiable prognostic tool in childhood cancer management. Future studies with adequate power and longitudinal design are needed to further evaluate the association of nutritional status with childhood cancer outcomes using a more standardized definition to measure nutritional status in this population. The use of new technologies is expected to shed further light on this understudied area and give room to person-targeted intervention strategies.

Original languageEnglish (US)
Article number2357
Issue number10
StatePublished - Oct 2022

Bibliographical note

Funding Information:
The present study is co-financed by Greece and the European Union (European Social Fund-ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning» in the context of the project “Reinforcement of Postdoctoral Researchers—2nd Cycle” (MIS-5033021), implemented by the State Scholarships Foundation (ΙΚΥ). None of the funders had any influence on the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. All authors had access to the data in the study and had final responsibility for the decision to submit for publication. Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization.

Publisher Copyright:
© 2022 by the authors.


  • childhood cancer
  • event-free survival
  • nutritional status
  • obesity
  • overall survival
  • relapse
  • review
  • treatment-related toxicity
  • undernutrition

PubMed: MeSH publication types

  • Journal Article
  • Review


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