INTRODUÇÃO: O estado nutricional adequado durante o tratamento antineoplasico e essencial na reducao do risco de morbimortalidade, tempo de internacao, abandono de tratamento, custo hospitalar e melhora da qualidade de vida. Estudos em criancas com leucemia linfoide aguda (LLA) tem demonstrado que o estado nutricional e um fator de risco modificavel para desfechos clinicos desfavoraveis. E essencial que o cenario epidemiologico seja reconhecido, entretanto ha uma lacuna importante na literatura no que tange ao estudo do papel da nutricao na oncologia pediatrica no Brasil. OBJETIVO: O objetivo deste trabalho e descrever o estado nutricional de criancas e adolescentes com cancer avaliadas pela equipe de nutricao ao diagnostico e analisar seu impacto na sobrevida global. MÉTODOS: Este e um estudo longitudinal retrospectivo que utilizou avaliacoes nutricionais de criancas e adolescentes com cancer internados bem como ambulatoriais que passaram em consulta com o nutricionista. O diagnostico do estado nutricional foi feito por meio do Z escore de indice de massa corporal (IMC) para idade e circunferencia de braco (CB). RESULTADOS: Foram incluidos na analise ao diagnostico 366 pacientes. Dependendo do indicador nutricional e tipo de tumor, a prevalencia de subnutricao na populacao estudada varia de 8 a 23% e sobrepeso de 5 a 20%. Os dois indicadores nutricionais avaliados foram independentes quanto a classificacao do estado nutricional (p=0,000). Nao houve diferenca estatisticamente significante na sobrevida global quando estratificado por presenca de ma nutricao classificada por CB. Entretanto, quando avaliado por IMC encontrou-se potencial pior sobrevida em pacientes malnutridos (hazard ratio [HR]=1,27; IC95% 0,88-1,83; p=0,209). Pacientes com sobrepeso/obesidade classificados por IMC apresentaram pior sobrevida global (HR=1,53; IC95% 1,02-2,29; p=0,041). Subnutricao por CB (HR=3,90; IC95% 1,28-11,85; p=0,017) ou IMC (HR=12,33; IC95% 1,56-97,85; p=0,017) em pacientes com neuroblastoma tambem foi significativamente associado a pior sobrevida global. A presenca de deficit de estatura ao diagnostico impactou na sobrevida global de pacientes com LLA (HR=5,59; IC95% 1,85-16,85; p=0,002). Foram incluidos 95 pacientes na avaliacao longitudinal. A prevalencia de ma nutricao reduziu de 28,4% ao diagnostico para 24,2% apos mediana de 7 meses de tratamento (p=0,001). Dos pacientes com linfoma nao Hodgkin (LNH) ou LLA, 90,2% apresentaram manutencao ou melhora do estado nutricional, versus 59,1% dos com tumores solidos (p=0,000), porem a manutencao ou melhora do estado nutricional apos 7 meses de tratamento nao impactou na sobrevida global (HR=0,65; IC95% 0,28-1,48; p=0,303). Pacientes com LLA ou LNH tem maior chance de manutencao ou melhora do estado nutricional nos primeiros 7 meses de tratamento versus pacientes com tumores solidos (OR=0,11 IC95% 0,03-0,39 p=0,001). CONCLUSÃO: A presenca de ma nutricao ou subnutricao ao diagnostico nao impactou na sobrevida global, porem pacientes com sobrepeso/obesidade, quando identificados por IMC, apresentaram maior mortalidade. Deficit de estatura ao diagnostico para criancas com LLA e subnutricao em pacientes com neuroblastoma impactaram significativa e negativamente na sobrevida global

INTRODUCTION: An adequate nutritional status during antineoplastic treatment is essential in reducing the risk of morbidity and mortality, length of stay, treatment abandonment, hospital costs and in improving quality of life. Studies in children with acute lymphoblastic leukemia (ALL) have shown that nutritional status is a modifiable risk factor for unfavorable clinical outcomes. It is essential that the epidemiological scenario is recognized; however, there is an important gap in the literature that impairs the study of the role of nutrition in pediatric oncology in Brazil. OBJECTIVE: This study aims to describe the nutritional status of children and adolescents with cancer assessed by the nutrition team at diagnosis and to evaluate its association with overall survival. METHODS: This is a longitudinal retrospective study that used nutritional assessments of hospitalized children and adolescents with cancer, as well as outpatients that consulted with the nutritionist. The diagnosis of nutritional status was made by body mass index (BMI) for age z score and mid-upper arm circumference (MUAC) percentiles. RESULTS: A total of 366 patients were included in the analysis at diagnosis. Depending on the nutritional indicator and tumor type, the prevalence of undernutrition in the population varied from 8 to 23% and overweight from 5 to 20%. The two nutritional indicators used were independent for nutritional status classification (p=0.000). There was no statistically significant difference in overall survival when stratified by presence of malnutrition by MUAC. However, when assessed by BMI, there was potentially worse overall survival for malnourished patients (hazard ratio [HR]=1.27; 95% CI 0.88-1.83; p=0.209). Overweight/obese patients classified by BMI also had worse overall survival (HR=1.53; 95% CI 1.02-2.29; p=0.041). Malnutrition by MUAC (HR=3.90; 95% CI 1.28-11.85; p=0.017) or BMI (HR=12.33; 95% CI 1.56-97.85; p=0.017) in patients with neuroblastoma was also associated with higher mortality, while stunting impacted the overall survival of patients with ALL (HR=5.59; 95% CI 1.85-16.85; p=0.002). Ninety-five patients were included in the longitudinal evaluation. The prevalence of malnutrition reduced from 28.4% at diagnosis to 24.2% after 7 months of treatment (p=0.001). Ninety per cent of patients with non-Hodgkin's lymphoma (NHL) or ALL maintained or improved their nutritional status, compared to 59.1% of patients with solid tumors (p=0.000), but maintenance or improvement of nutritional status did not impact on overall survival (HR=0.65; 95% CI 0.28-1.48; p=0.303). Patients with ALL or NHL were more likely to maintain or improve nutritional status in the first 7 months of treatment versus patients with solid tumors (OR=0.11 95% CI 0.03-0.39 p=0.001). CONCLUSION: The presence of malnutrition or undernutrition at diagnosis did not impact mortality; however, overweight/obesity, when classified by BMI, resulted in inferior overall survival. Stunting for children with ALL and undernutrition for patients with neuroblastoma significantly and negatively impacted overall survival