Prevalence of vitamin and iron deficiencies at cancer diagnosis at two pediatric oncology units in South Africa

Abstract

This study investigates the prevalence of vitamin and iron deficiencies at cancer diagnosis. Newly diagnosed children between October 2018 and December 2020 at two South African pediatric oncology units (POUs) were assessed for nutritional and micronutrient status (Vit A, Vit B12, Vit D, folate, and iron). A structured interview with caregivers provided information regarding hunger and poverty risks. There were 261 patients enrolled with a median age of 5.5 years and a male-to-female ratio of 1:0.8. Nearly half had iron deficiency (47.6%), while a third had either Vit A (30.6%), Vit D (32.6%), or folate (29.7%) deficiencies. Significant associations existed between moderate acute malnutrition (MAM) and low levels of Vit A (48.4%; p = .005), Vit B12 (29.6%; p < .001), and folate (47.3%; p = .003), while Vit D deficiency was associated with wasting (63.6%) (p < .001). Males had significantly lower Vit D levels (respectively, 40.9%; p = .004). Folate deficiency was significantly associated with patients born at full term (33.5%; p = .017), age older than five years (39.8%; p = .002), residing in provinces Mpumalanga (40.9%) and Gauteng (31.5%) (P = .032); as well as having food insecurity (46.3%; p < .001), or hematological malignancies (41.3%; p = .004). This study documents the high prevalence of Vit A, Vit D, Vit B12, folate, and iron deficiency in South African pediatric cancer patients, demonstrating the need to include micronutrient assessment at diagnosis to ensure optimal nutritional support for macro-and micronutrients.

Keywords:

• Cancer
• Childhood cancer
• nutritional status
• iron deficiency
• vitamin

Acknowledgments

The authors acknowledge the children and parents/caregivers who participated in the study. They want to thank the pediatric registrars, dieticians, and nursing staff of the POU at Steve Biko Academic Hospital and Tygerberg Children’s Hospital for supporting this study.

Special thanks to the Pediatric Hematology-Oncology team at Steve Biko Academic Hospital, especially Ané Büchner, Fareed Omar, and David Reynders, for identifying patients for the study and their support toward the study.

Conflict of interest

None.

Contribution to the manuscript

Judy Schoeman and Mariana Kruger conceptualized the study. Judy Schoeman, a Ph.D. student, designed the study, developed the Redcap database, enrolled patients, collected, cleaned, analyzed, and wrote the manuscript. Mariana Kruger, Elena Ladas, and Paul Rogers assisted with the design of the study and critically reviewed the manuscript. Ilde-Marié Kellerman and Ronelle Uys enrolled patients, collected the data, and reviewed the manuscript. Carl Lombard conducted the statistical analysis of the data and reviewed the manuscript.

Data availability statement

The data supporting this study’s findings are available on request from the corresponding authors. The data are not publicly available due to ethical restrictions.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.