Iranian journal of Pediatric Hematology and Oncology

en The Role of Nutrition in Pediatric Cancer: From Mechanisms to Clinical Impact تغذیه Nutrition مروری Review <div style="text-align: justify;">Pediatric cancer poses a growing public health challenge, particularly in low- and middle-income countries. While advances in diagnostics and multimodal treatments have improved survival rates, treatment-related complications—especially malnutrition—remain a critical concern. Malnutrition, encompassing both undernutrition and overnutrition, affects up to 70% of children undergoing cancer therapy and significantly impacts treatment outcomes, quality of life, and survival. The nutritional status of pediatric cancer patients is influenced by tumor-related metabolic demands, treatment side effects, and socioeconomic factors. Chemotherapy, radiotherapy, and surgery often lead to anorexia, vomiting, mucositis, and metabolic disturbances that reduce nutrient intake and alter body composition. These changes result in impaired immunity, organ dysfunction, increased infection risk, and altered pharmacokinetics of chemotherapeutic agents. Both undernutrition and obesity are independently associated with increased treatment-related toxicity and reduced survival, particularly in solid tumors and lymphomas. Biologically, cancer alters systemic metabolism through mechanisms like increased glycolysis (Warburg effect), where tumor cells preferentially convert glucose to lactate—even in the presence of oxygen—leading to inefficient energy use and muscle catabolism. Additionally, cytokines (e.g., IL-6, TNF-α) and tumor-derived catabolic factors (e.g., PIF, LMF) accelerate lipolysis and proteolysis, depleting fat and lean mass. This metabolic derangement contributes to cancer cachexia and protein-energy malnutrition, especially in children with advanced disease. Micronutrient deficiencies—particularly in vitamins D, C, B12, zinc, and selenium—are also highly prevalent and further compromise immune and metabolic function. Though data on supplementation outcomes remain inconclusive, routine screening and correction are recommended. Moreover, emerging evidence suggests that specific nutrients—such as omega-3 fatty acids—may provide additional therapeutic benefits by modulating inflammation and preserving lean body mass. Ultimately, a proactive and personalized nutritional approach is critical to improving treatment outcomes, reducing complications, and enhancing the overall well-being of children with cancer. Future studies should further be done in this regard.  </div> Cancer, Children, Malnutrition 879 892 http://ijpho.ssu.ac.ir/browse.php?a_code=A-10-1239-1&slc_lang=en&sid=1 Mahboobeh Heidary Mahboobeh Heidary mahboobehheidary456@gmail.com 0009-0009-4707-289X No Shahid Sadoughi Uni Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Marzieh Shaker Marzieh Shaker Marziehssahkerm78@gmail.com No Shahid Sadoughi Uni Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Hossein Nazmieh Hossein Nazmieh hosseinnazmiehhj@gmail.com No Shahid Sadoughi Uni Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Sanaz Mehrabani Sanaz Mehrabani sanazmmehrabbani7@gmail.com 0000-0002-2062-0448 No 3Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Hamid Owliaey Hamid Owliaey owliaeyhamid2023@gmail.com 0000-0001-5642-9584 No Azad Uni Department of Forensic Medicine & Clinical Toxicology, Yazd Branch, Islamic Azad University, Yazd, Iran Motahare Taghvaei Motahare Taghvaei motaharehht5@gmail.com 0000-0002-3436-1424 Yes Department of Pediatrics, Shahid Sadoughi Hospital,Shahid Sadoughi University of Medical Sciences, Yazd, Iran Department of Pediatrics, Shahid Sadoughi Hospital,Shahid Sadoughi University of Medical Sciences, Yazd, Iran Elnaz Sheikhpour Elnaz Sheikhpour sheikhpourel@gmail.com 0000-0001-5912-1972 No Shahid Sadoughi Uni Hematology and Oncology Research Center, Non-communicable Disease Research Institute, Shahaid Sadoughi University of Medical Sciences, Yazd, Iran