الفهرس 
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Abstract
This work carried out to light light the nutritional status of brain and bone
cancers children 1-3 and 4-8 years old. The sample size was 60 patients C30 patients
of each of brain & bone groups; including 15 patients of each of 1-3 and 4-8 y old
children. Patients are visiting (out patients) the Children Cancer Hospital (57357) at
Cairo, Egypt. They consumed the home food before surgery, while after surgery they
consumed the hospital food menu. The patients were followed before as well as after
the surgery.
To assess the nutritional status of patients information were collected about
the dermographic, anthropometric characteristics, and nutritional status score was also
recorded .CBC and serum glucose estimated. Lipids profile of serum glucose
analyzed (TC, TG, HDL, VLDL, LDL & AI). Liver function (serum ALT& AST
activities) and Kidneys function (serum creatinine, urea & uric acid) were estimated.
Intakes of energy, carbohydrates, protein, fat. vitamin (A,C&E) and selenium
were assessed in comparison with the DRI as reference. Information incased both
groups were taken before surgery (Home menu) as well as after month of the surgery
(Hospital menu). The results arrived as ravened the following:
(1) Before surgery mean age of brain cancer children was 2.8±0.98 and 7.5±1.025y
for 1-3 & 4-8y groups respectively . mean weight and height were higher for 4-8
than 1-3y groups being 2.4± 2.54& 11.2±1.87kg and 1.08±0.94& 0.96±1.02m
respectively which is expected based on age difference. Similarly mean BMI
was higher for 4.8y than 1-3y groups which were 19.20±1.45&12.15±1.42kg/m2
respectively. Mean nutritional status score was also higher (97.39±9.87%) for 4-
8 than 1-3y.
(2) Before surgery of brain cancer children (1-3&4.8y groups) mean value of
weight for both groups fell in the Reference Range. This was found for BMI of
4-8y group. Nevertheless mean height for 1-3y group was more than the
Reference Range, while that of 4-8y group less than the Reference Range, Also
BMI of 1-3y group was less than the Reference Range.
(3) After surgery with exception of age and height, all studied parameters improved
showed variable increases; after surgery all values fell in the Reference Range
including BMI and nutritional status score which were less than the ref Range
before the surgery, with exception of BMI less determined for 1-3% groups
being slightly (-2.74%) less than the low limit of Ref, while was evidently lower
(-10%) than the low limit of Ref.
(4) Due to brain cancer surgery. Still all values were higher for 4-8y than 1-3 group,
being close to the higher Ref. Limit Nutritional status score was even slightly
more (101.74±4.21%) than the upper limit of Ref. Also body fat% was higher
for 4-8 than 1-3 y group. Improvements after surgery took place indicating
better health, being due to the operation and possibly due also to the hospital
food. After surgery all children were normal based on nutritional status score.
(5) Before surgery bone cancer children 1-3y group showed less BMI and
nutritional status score than the Ref; BMI was less than normal and nutritional
status score indicated Grade-I. Mild Malnutrition .For 4-8yr group height only
was less than Ref. while BMI indicated normal status and nutritional status
score was even more than 100% of Ref. The body fat% was 65.78% higher for
٤-٨y than 1-3 y children. Anyhow the status of ٤-٨y was better than 1-3y group.
(6) After surgery bone cancer children age and height showed no changes which is
normal. At This stage all parameters fell in the Ref. Range for both group. Only
BMI of 1-3y group was slightly less than the low limit (only 3-6% less).
(7) Due to surgery and, month feeding on hospital food all tested parameters
increased. Percent increases of weight, BMI, nutritional status score & body fat
for 1-3y group were 15.74, 15.84, 15.74& 21.12%, while for ٤-٨y group were
1.78, 1.75, 1.78 &2.38% respectively indicating that the improvement of young
was much greaser than the older children similar trends of change were
previously found for brain cancer children where percent increases due to
surgery for 1-3y group were better being 8.04, 8.07, 9.64 &9.04% and 4.46,
5.05, 4.47 and 6.83% respectively.
(8) Before surgery based on Hb results brain cancer children 1-3y old
(10.3±1.24y/dl) were already anemic, while children 4-8y old were
(11.1±2.01g/dl) at threshold Ref- Range 11-14 g/dl.
(9) WBCs determined before surgery for bone & brain cancer children 1-3y was
slightly less than lowed limit of Ref Range, while that of 4-8y old was more.
(10) Lymphoblasts of brain cancer children before surgery were less than the lower
limit of Ref. Range, while that of 4.8% old patients was higher.
(11) Before surgery, serum glucose of 1-3 & 4-8 brain cancer children was higher
than the Ref Range (70.110mg/dl). Being 1.8±7.45& 101±5.65mg/dl
respectively, provided that it was higher in the former than the latter case.
(12) After surgery for brain cancer patients, Hb & WBC improved for 1-3y children
being no longer less than Ref. Range (11-14g/d). After surgery 1-3y children
became not anemic. On the contrary 4-8y children because anemic due to
reduction of Hb from 11.1 to 10.4g/dl; also WBC (103ml)which was more than
Ref. Range (4.5-10.5) before surgery become loss than Ref.(4.1) after surgery.
Considering the serum glucose both brain cancer groups were sensitive to
surgery indicating reductions.
(13) Before surgery 4-8y bone cancer children were anemic (Hb 10.8±2.05 g/dl)
while younger group (12.3±1.45 g/dl) were not. Meanwhile WBCs (103/ml) for
1-3& 4-8yr cancer bone groups, which were 5.2±0.14 and 7.3±0.47 103/ml
respectively. The reverse recorded for lymphoblasts (2.3&3.1% respectively)
which showed values less than the lower limit of Ref Range (6.9%) for both
group.
(14) Serum glucose for bone cancer 1-3 & 4.8y groups was fell in the Ref. Range
provided that value was higher in the latter than the former groups; this was also
recorded for lymphobtasts, meanwhile the reverse recorded for Hb& WBCs
values which were higher for 1-3 than 4-8y groups before surgery.
(15) Due to surgery for bone cancer children Hb & WBCs more or less decreased
while lymphoblasts and serum glucose more or less increased. After surgery 4-
8y group was still anemic, while that of 1-3y children was not WBCs decreased
in both group, but was still higher than the Ref Range.
(16) Due to decrease of Hb by surgery, more care may be given to supply brain &
bone cancer patients with iron.
17) By calculation of percent change it was shown that improvement due to surgery
was less pronounced for 4-8 than 1-3y group as regards CBC parameters, as
well as the biological parameters. But no conclusion could be done definitely
about severity of either brain or bone cancer and about better improvement due
to surgery.
(18) Lipids profile assessment indicated for brain cancer children before surgery
indicated higher TC, LDL &AI for 1-3 y group and less TG HDL& VLDL as
compared to 4-8y patients. According AI followed the levels of TC& LDL,
while reversely related to the HDL level. Before surgery values of lipids profile
(TC, TG, VLDL, HDL& LDL)for both groups fell in the Ref. Range suggesting
normal status, but AI was higher than the upper limit, indicating disturbance of
lipids profile, specially for 1-3y group.
(19) After the surgery. TC, TG, HDL& VLDL were higher for 4-8y than 1-3y group.
TC which was less for 1-3y group before surgery, reversed its level after the
surgery. AI was worst (higher) after surgery for 1-3y group which was also
recorded before surgery due to higher LDL and less HDL (compared to 4-8y
children). As before surgery, after the surgery TC, TG, HDL, LDL & VLDL fell
in the Ref. Range suggesting normal status. AI also fell in the Ref Range
indicating normal lipids profile; the reverse however recorded before surgery.
(20) Percent changes of lipids profiles 1-3 & 4-8y brain cancer children due to
surgery (% respectively) were: TC- 13.17, 8.88; TG 41.60; +20.91; HDL
+35.95, 48.40; LDL- 32.92, -32.19; VLDL+ 41.60,+20.91; AI- 48.64, 52.52
Based on AI values the improvement due to surgery was much more for 4-8y
than 1-3y group.
(21) For bone cancer children values of lipids profile before surgery (TC, TG,
VLDL, LDL as well as AI) were higher for 4-8y than 1-3y group, while the
reverse was observed for HDL. This indicated that lipid profile status was worst
for 4-8y group. TC, TG& VLDL values fell in the Ref. Range, LDL of 1-3y
group fell also in the Ref. Range, while that of 4-8y group was more than the
higher limit of Ref Range , AI of both as groups was higher than the upper limit
of Ref. Range.
22) After surgery, bone cancer children 4-8 group resealed higher TC Level (HDL)
was also higher). On the contrary 1-3y group recorded higher TG, VLDL &
LDL levels. A.I was higher for the 1-3 children following the higher LDL &
VLDL and the lower HDL in this group, All recorded values for lipid profile
after surgery fell in the Ref Range for 1-3& 4-8y children.
(23) After surgery for bone cancer children the AI was still higher than the upper
limit of Ref. Range (1.78-2.13). Although pronounced, improvement took place,
from 2.7±1.02, 3.96±1.12 to 2.49±0.98, 2.33±0.54 for 1-3& 4-8y groups
respectively percent decrease of AI was more for 4-8 than 1-3 groups regardless
of that 4-8y group absolute AI value was higher.
(24) Alt activity of both 1-3& 4-8y brain cancer children fell in the Ref. Range,
being less than values recorded for Alt activity. Nevertheless values were wear
the upper limit of leaf – Range indicating risk of liver function discarder; values
were slightly higher for 1-3y group. On the contrary, AST mean values were
somewhat higher for 4-8y group and for both age groups activities were more
than the upper limit of Ref. Range, indicating already disorder of liver function
for this group of brain cancer patients.
(25) Surgery for brain cancer children deteriorated the liver function as indicated by
the increase of ALT& AST activities, which were evidently more than the upper
limit of Ref. Range. As compared with before surgery, after surgery percent
increases of activities for 1-3& 4-8y groups were: ALT + 73.82%, + 120.33%
and for AST +109.48, 1.03% respectively. This calls for much care to avoid
deterioration of liver function due to surgery for brain cancer children.
(26) Before surgery of bone children Alt& AST activities were higher for 1-٣y than
4-8y patients. While ALT activity was more than the upper limit of Ref Range
considering 1-3y groups it fell in the Ref Range for 4-8y children. Never the
less for AST values were more than the upper limit of Ref Range, indicating
that both groups were suffering of liver disorder.
(27) After surgery carried out for bone cancer all values of ALT and ALT activities
were more than the upper limit of Ref- Range regardless of age. As incase of
brain cancer, surgery carried out for bone cancer patients, aggravated the liver
function disorder, calling for much medical care in surgeries of both types of
children cancer.
(28) After surgery for bone cancer children, percent increases of both enzymes
activities were higher for 4-8y in comparison with 1-3y group, which was
recorded for Alt only in brain cancer patients.
(29) Before surgery creatinine, urea and uric acid levels of brain cancer children
were more for 4-8y compared to 1-3y group, but all values fell in the Ref.
Range, indicating that renal function was acceptable for both groups , being
relatively better for 1-3y children.
(30) Due to surgery carried out to brain cancer children creatinine and urea
increased, with the decline of uric acid, provided that all values still fell in Ref.
Range indicating acceptable renal function. In this connection, after surgery
creatinine and uric acid were higher for 4-8y children than 1-3y group which
was also noticed before surgery while urea was less for 4-8y group after
surgery; the reverse was found however, before surgery.
(31) Before surgery, renal function may be considered not acceptable due to that uric
acid for both the upper limit of Ref. Ranges. Nevertheless creatinine of both
groups and urea of 4-8y group fell in the Ref. Range for bone cancer children.
(32) Due to surgery for bone cancer children creatinine, urea and uric acid levels
were raised. Uric acid level was raised due to surgery, being more to the upper
limit of Ref. Range, calling for more medical care + avoid loss of renal
function.
(33) As indicated by percent changes due to surgery, some loss in renal function took
place, provided that loss was less pronounced of 4-8y group incase of brain
cancer, while it was more pronounced for 4-8y group in case of bone cancer.
Percent changes for 1-3y & 4-8y group due to surgery brain cancer were
creatinine +66.67%, 20.0%; urea + 124.33% + 30.65%, uric acid -32.76%,
53.85%; for bone cancer – creatinine + 33.33%, 40%; urea + 12.50%+ 161.14’
uric acid 0 , + 3.30% respectively.
(34) Before surgery, brain cancer 1-3y & 4-8y children were inflicted with
malnutrition. This due to deficiently (except for T. calories of 4-8y Ref.) in all determined nutrients (T.protein, T.fat, Vits. A,C,E and selenium). Highest
intake was noticed for T.fat and less west for selenium.
(35) Due to more age, body weight and height in case of 4-8y age group DRI Ref.
was higher compared to 1-3y children. Moreover for 5 of total light determined
nutrient actual intakes compared to DRI were higher for 4-8y than 1-3y group.
(36) After surgery of brain cancer children all nutrient were raised in both groups.
Nevertheless with exception of T. calories for 1-3 and 4-8 y group, and vit.E of
1-3 and 4.8y group, all nutrients were still less than DRI, calling for much care
in feeding brain cancer children after care in feeding brain cancer children after
surgery to avoid malnutrition and deficient in nutrients intakes.
(37) For bone cancer children all nutrients intakes were raised indicated much great
adequacy of hospital food, compared to food intake before surgery out of the
hospital. After surgery all nutrients intakes as percent of DRI were raised,
specially for T. calories which showed evidently higher percent intake than
RDA after surgery. But all other percents of intake were mostly less than DRI
after surgery the imbalanced food menu may not be the reason because of
distinguishable nutritionists of the hospital dealing with such a dangerous
disease and most probable is due to loss of appetite by patients, which was also
more after surgery.
(38) Percent improvement of food intakes calculation revealed it was mostly for 4-8y
than 1-3y groups , and in case of bone than brain cancer.