The chemotherapy or radiotherapy treatment to which children are subjected can often lead to clinical manifestations such as oral mucositis, diarrhea or constipation, as well as vomiting, and nausea. Given this scenario, food intake is affected, undermining nutritional status, quality of life, and the patient survival. The study here in aims to provide functional intake preparations for pediatric oncology patients at a philanthropic hospital, assessing their acceptability for addition to the local menu. The research was performed with 26 patients, both male and female, undergoing chemotherapy and/or radiotherapy treatments. The test was carried out by offering five distinct preparations, each one on a different day, with posterior application the acceptability test, using a mixed hedonic scale. The data collection was performed using the IBM SPSS Statistics 21 software. After this analysis, it was verified that the reduction in food consumption of the cancer patient is multi factorial, being frequently related to consequences of the disease itself. The sensorial aspect of the preparation is often essential for the better acceptance of foods, which aim to arise satisfactory responses through adequate nutrition to the organism. Bearing this in mind, an adequate diet with the necessary nutrients for good nutritional status is fundamental for the clinical prognosis of these patients.

• Food acceptance Oncopediatrics
• Functional foods
• Nutraceuticals

Marinho JD, Menezes KKP, Rodrigues MLMP, Serquiz AC (2018) Functional Dietary Nutrition Applied to Oncopediatrics in a Philanthropic Hospital. J Hum Nutr Food Sci 6(1): 1119.

There is vast evidence that feeding plays an important role in the stages of initiation, promotion and spread of cancer, among other risk factors.

Among the cancer deaths attributed to environmental factors, diet contributes with about 35%, followed by tobacco (30%), and others, such as working conditions and type of work, alcohol, pollution, and food additives, which contribute with less than 5%. It is believed that an adequate diet could prevent three to four million new cases of cancers each year [1].

Childhood cancer is one of the diseases which have most affected children worldwide. There has been an increase in incidence rates, mainly for neoplasias, such as: Acute Lymphocytic Leukemia (ALL), central nervous system tumors, Non-Hodgkin’s Lymphoma (NHL), Wilms Tumor, among others [2].

The chemotherapeutic or radio therapeutic treatment to which children are subjected can often lead to clinical manifestations such as: oral mucositis, diarrhea or constipation, as well as vomiting and nausea. These most frequent manifestations in the pediatric patient can vary widely, considering the age group, the stress condition to which the patient has been subject to, and especially the nutritional condition history [2].

Consequently, loss of weight and body tissues is a frequent condition in cancer patients. This may lead to anorexia, evolving to involuntary weight loss, decreased functional capacity, progressive depletion of lean mass and adipose tissue, characterizing cachexia, a condition of severe protein-energy malnutrition [2].

Under the light of these circumstances, adequate nutritional therapy improves the clinical response, the prognosis and, consequently, the patient’s quality of life.

Most cancer patients are at great risk of developing a worsening of clinical condition at any time during anti-neoplastic treatment, especially because of increased immune system susceptibility and organic weakness associated with drug toxicities and other therapeutic complications.

During this period, there is a need for an intensive supportive treatment, which includes, among others, nutritional support [3].

These nutritional therapies have as objectives: offer favorable conditions for the establishment of the therapeutic plan; provide energy, fluids, and nutrients in adequate amounts to maintain vital functions and homeostasis; recover immune system activity; reduce the risk of hyper alimentation; guarantee the adequate protein and energy supply to minimize protein catabolism and nitrogen loss [3].

For the nutritional condition observed in these children, foods which present functions of providing energy and essential nutrients, further to beneficial physiological effects which may prevent or delay diseases such as cancer are analyzed. The foods containing these properties are called functional foods and can be used as chemo preventive compounds [4].

This paper aims to offer functional based preparations to pediatric oncology patients of a philanthropic hospital, aiming to evaluate their acceptability to be added to the local menu.

In this context, chemoprevention through functional foods emerges as an important tool in the prevention and control of cancer, suggesting anticarcinogenic, antioxidant, antiinflammatory, anti-hormonal, and antiangiogenic mechanisms of action, among others, thus contributing to the improvement of the nutritional status of the pediatric oncology patient.

The present study is of quantitative, descriptive, transversal and exploratory character. The research was conducted at a philanthropic hospital in Natal/RN and the individuals composing the research sample are pediatric patients undergoing oncological treatment and subject to chemotherapy and/or radiotherapy.

The sample was selected for convenience with 26 individuals, male and female, and participation was voluntary, after the investigation and signing of the Free and Informed Consent Form for Children (FICF). The responsible adults were clarified about the study and the methodology applied.

Inclusion and exclusion criteria

Among the eligibility criteria are: be a patient at the respective institution; be an oncopediometric patient with a proven diagnosis of malignant neoplasia; be hospitalized; be in chemotherapy and/or radiotherapy treatment; and be available for involvement in the research. The exclusion criteria would be: no diagnosis of neoplasia; not being treated at the hospital; not to show availability and interest in the research; and to present impossibilities to participate in some stage of the research during the research period.

Selections of functional recipes

The preparations offered to the patients were selected by the Nutrition and Dietetics Service staff of the hospital. Therefore, five preparations were elaborated, namely: mini hamburger, mini yam pizza, vegetable Popsicle, yam chicken croquette, and vegetable cake, included in the recipes with functional ingredients. Only one preparation was offered to the pediatric oncology patients under treatment each day. Thus, all of them could taste the five preparations through the hospitalization period. The meals were elaborated by the Nutrition and Dietetics Service of the hospital themselves.

Obtaining the data

To obtain the data, the medical records of the pediatric patients admitted to the hospital ward were used. Considering the patient’s responses, collected through the hedonic scale applied after each recipe offered the data tabulation was performed using the sum of the answers: hated it, did not like it, indifferent, liked it, and liked it a lot. Some questions were also made about the preparation offered, such as: what they liked most about the preparation, and what they liked least about the preparation. These responses were related to the organoleptic sensorial characteristics, among them: flavor, odor, texture, and color, also emphasizing the presentation. After this tabulation, the analysis was submitted to statistical treatment for the elaboration of the representative tables.

Sensitization

During the sensitization stage, parents and caregivers were sensitized about the importance of adequate food for health promotion. It occurred in the form of direct (verbal) enlightenment performed by the researchers prior to offering the preparations.

Recipe preparation

The elaboration of the functional recipes was carried out with a practical and dynamic approach in the kitchen of the hospital. The aim is to teach and clarify the parents and caregivers on how to prepare the chosen recipes. All the preparations elaborated by the researchers followed the recommendations of the Technical Regulation of Good Practices for Food Services, approved by Resolution - RDC nº 216, from September 15, 2004, in order to guarantee hygienic-sanitary conditions of the prepared foods.

In the elaborated recipes the practicality, ingredients available in the nutrition sector, and food preferences of pediatric oncology patients were observed. Such preparations were previously tested by the researchers at the Potiguar University technical and dietary laboratory to ensure the quality, presentation, and palatability of the preparations. The preparations were sent to the patient after obtaining the data and the sensitization process.

Acceptance test

The mixed hedonic scale was used in order to make the research results more reliable, aiming to follow the adherence to the preparation by the patients through the acceptability test. This was recorded after recipes were tried. The figures responses sum as well as the discursive questions were tabulated and analyzed through the IBM SPSS Statistics 21 software.

Ethical aspects

Those responsible for the subjects were previously informed about the research objectives and signed the Free and Informed Consent Form (FICF), in accordance with resolution 196/96, authorizing its accomplishment. The data were collected after approval by the Research Ethics Committee of the LIGA Norte Rio-grandense Contra o Câncer.

In the acceptance test, the participation N for the preparations was as follows: 14 participants, being 10 female and 4 male tasted the vegetable cake; 12 children were analyzed for the chicken croquette, being 8 female and 4 male; 16 volunteers tasted the mini pizza, being 11 female and 5 male subjects; the mini-hamburger was tried by 11 subjects, being 7 female and 4 male; the vegetable Popsicle was tried by 12 participants, being 7 female and 5 male subjects.

During the course of the research, the variables suffered alterations due to instability of the periods of hospitalization, displacement of patients for clinical and surgical procedures or other complications to the treatment, further to the commemorative dates. In this way, some preparations were adapted and some of them were offered at a later date.

For the acceptability criterion from the hedonic scale (Table 1) it was observed that all the preparations showed good acceptance between “liked it” and “liked it a lot”. Many of the available preparations are sources of protein. Chalamaiah et al. [5], report that hydrolysates or peptides of proteins derived from foods with immunomodulatory and anticancer activities were observed from a variety of sources of dietary proteins, such as milk, eggs, fish, rice, soy, peas, spirulina, oyster and mussel. In Brazil, the Ministry of Health through the National Health Surveillance Agency - ANVISA characterizes functional food as: “Food or ingredient with alleged functional or health properties which can, in addition to basic nutritional functions, when a nutrient, produce metabolic and/or physiological effects, and/or beneficial effects to health, which should be safe for consumption without medical supervision.”Many of the foods used for the preparations are classified and already known as functional foods. Milk, for instance, has high levels of conjugated linoleic acid, which may help prevent cancer [6]. Milk and eggs are among the ingredients of the preparations.

Glover-Amengor [7] in his study, fortified a lunch preparation with dry leaves of the moringaoleifera at a school where children were vulnerable to malnutrition in the district of Ada-East. The leaf was a source of copper, manganese, iron, zinc and β-carotene, the latter being rich in antioxidant properties, important at cellular level. An acceptability test was also applied on a 5-point scale, ranging from “I loved it” to “I really disliked it”, and the result that it was very well accepted. Akther et al. [8], highlighted that Korea has a long tradition of daily adding fermentation to foods, since these have a differentiated nutritional value. This habit was used to add fermented samples of jeotgal (common fermented food with salty taste made with squid) with a small amount of soy milk, presenting excellent anticancer activity, as well as nutritional enrichment. As for palatability, no undesirable bitterness or astringency was noted in the preparation. Therefore, the method of enriching foods in order to bring functional benefits is used in different countries, both locally and nationally. This enrichment is seen primarily in situations of more vulnerable life cycle, and the oncopediatric group of the study fits this condition.

Pediatric patients who receive chemotherapy and/or radiation therapy against cancer have developed aversion to familiar foods in their usual diet, especially when these foods are consumed before the treatment. These aversions are observed due to the association that the children make when consuming food and then presenting symptoms such as nausea and vomiting. In addition, the psychological aspects regarding the hospital environment and negative attitudes can also be envisaged [9,10]. In the study by Skolin et al. [10], it was possible to notice a dual viewpoint, in which the children and parents reported that the predominant cause of food rejection was altered taste. This conclusion was made through the taste test, which presented higher threshold for the bitter taste, producing flavor error when compared to the control group. When Bernstein et al. [9], offered an innovative flavored ice cream, noted that there was no increase in rejections and suggested that the ice cream may have blocked the development of aversions to the diet. Also, when up to two items were consumed a few hours before treatment it helped to reduce aversion when compared to consumption of three to five items. This change in taste may be justified by the fact that the body associates the internal effects of unbalanced toxins and nutrients with the taste of the foods consumed, and the change in taste is an attempt at adjustment. However, this mechanism may occur at inappropriate times, as in the case of patients being treated for cancer.

Therefore, some simple interventions can be effective to improve this acceptability, some of them giving priority to presentations in a playful way, using different colors, offering innovative flavor and taking advantage of multiple combinations. It is known that these techniques facilitate the adherence and food consumption of healthy children [11]. Thus, children on cancer treatment may also benefit from these nutritional methods. The flavor and presentation of the preparations (Table 2) were the organoleptic characteristics best identified by the studied children.

These sensory criteria are combined in view of their potential for acceptability and reduction of aversion levels as to the diet offered at the hospital level. Odor and color are among the features liked by few children. This fact may be associated with treatment, since alterations in smell are due to changes at the cellular level. Surgeries, nausea and vomiting can also be negative factors. The coloration may be associated with the fact that the innovative preparations would be modified as to the color which they are normally accustomed to being in contact with, arising the non-recognition of the preparation.

The majority of the children did not indicate the food they least liked, subtending that most accepted well the offered preparations. Flavor was the main characteristic which was not well accepted (Table 3).

This fact is justified by the taste change in the taste buds level, derived from a side effect of the cancer treatment. Some foods may have different taste, not have much flavor or simply the taste can be similar for different foods. These individuals may taste flavors than they did before treatment, and may even recognize metallic or chemical taste in the mouth [12]. Bernstein [13] in his study with children exhibiting neoplastic diseases offered an unusual ice cream prior to their drug treatments and noted that patients with gastrointestinal toxicity due to drugs were less likely to choose this ice cream than the control groups. This suggests that symptom-induced aversions derived from drug use may contribute to the loss of appetite experienced by cancer patients.

The reduction in food consumption by the cancer patient is multifactorial, being related to the own disease, its treatment and anorexia. The meals consumed in hospitals are usually evaluated in a negative way and the therapeutic meal is often prioritized, disregarding the individual’s acceptability, often indispensable for the consumption of foods bringing satisfactory answers. Among the functional preparations made for children undergoing cancer treatment, good acceptability and adherence were observed. Thereby, it is a good alternative to use well-known and well-accepted preparations for the insertion of functional foods in the children’s diet.

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