Monica Adhikari
Consultant Dietician, Great Ormond Street Hospital, London.

What is cancer?
Cancer is the collective term given to a growth of body cells beyond the control of normal growth regulatory mechanisms (neoplasm or new growth). A neoplasm may then form into a mass of these 'rebel' cells with abnormal cell division pattern (tumour).

What happen to the nutritional status in cancer?
Cancerous cells compete with other bodily cells for nutrients and therefore put the body in a state of hyper metabolism. This condition of increased nutrient requirement that is unsatisfied by an increased food intake in cancer is called cachexia. Cancer cachexia is quite unlike starvation, which is rather hypo metabolism with decreased energy that is reversed with adequate nutrition.
Cancer cachexia is characterized by loss of appetite, progressive tissue wasting, weight loss and anaemia. Commonly experienced is a change in taste, particularly for sweet and bitter sensations.

Why is nutrition important?
Good nutrition is very important when a child is treated for cancer. Children with cancer often have poor appetite due to one or more following reasons:

• The hospital environment
• Side effects of chemotherapy or radiation
• Depression
• Change in cells of mouth which may alter the way food tastes
• Inadequate absorption of calories, vomiting and diarrhoea
  

How do I know if my child is nutritionally at risk?
The dietician assesses the nutritional status by comparing your child's weight with the height. Your child will need nutritional support if: -

• He/she has a 5-10%body weight loss.
• He/she has poor weight gain over 2-3 months
• He/she have poor oral intake.

Nutritional management:
Children with cancer have increased calories and protein needs. Protein is needed for growth and to help the body repair itself. Getting enough calories can help body grow, heal and prevent weight loss.

Following ideas /suggestions on how to increase your calories and proteins:
Fat gives us twice number of calories of proteins and carbohydrates foods therefore using foods high in fat will help.

1. Butter, oil, and ghee: -
   · To spread thickly on bread, toast, paratha, chapattis, to add on rice
   · To cook vegetables, meat with extra ghee or oil
   · To have sweets made with ghee and butter
2. Use fortified milk (making it richer): -
   · To add 4 tsp of milk powder to usual milk to increase its calories and protein.
   · To use this milk to make: kheer, ice cream, milk shake, Vegetables, dhal, soups, Coffee, tea.
3. Always use:
   · Full fat milk (buffalo's milk)
   · Cream (malai)
   · Cheese
   · Dahi (yoghurt)
   · Ghee
   · Eggs
   · Honey sugar
   · Condensed milk
   · Nuts
   · Beans and legumes (dal)