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Children diagnosed with soft tissue sarcoma,
被诊断有软组织肉瘤、神经母细胞瘤、
neuroblastoma, non Hodgkin’s lymphoma, brain tumors,
非霍奇金淋巴瘤、脑瘤的孩子
male survivors of leukemia, non amputated females
白血病的幸存男士，患有骨癌
with bone cancer, Wilms tumors and survivors of
但没被截肢的女士和肾母细胞瘤、霍奇金病
Hodgkin’s disease are more likely to be underweight
幸存者在以后的生活中更有可能消瘦不已
later in life whereas children diagnosed with acute
而患有严重的淋巴细胞性白血病的孩子
lymphoblastic leukemia and those receiving cranial
和接受颅放射治疗的脑瘤患者
radiation therapy for brain tumors were at a higher
极有可能会变得
risk of becoming overweight and even obese.
超重甚至肥胖
The reasons behind these trends are still being
造成这些趋势的原因
researched however possible implications associated
还在研究之中
with being underweight include being malnourished
但是，与消瘦有关的可能原因有
while receiving total body radiation, treatment with
一是在接受全身辐射和腹部辐射治疗时
abdominal radiation and being at a very young age
营养不良，二是在很小的时候
when treatment begins.
就接受治疗
The use of aranthrocyclenes and atinomyasin
后期的生活中变得消瘦
which are powerful chemotherapy drugs are also
可能与药效大的化学药物—
associated with becoming underweight later in life
aranthrocyclenes和atinomyasin有关
because they cause structural and functional injuries
因为他们会造成胃肠道的结构和功能损伤
to the gastro intestinal tract preventing an adequate
以致在后来的生活中
oral intake even later in life.
口服食物得不到充足的营养
This chart gives an overall comparison of the short
这个图表对在儿童癌症时期营养不良的
term and long term consequences of malnutrition during
短期和长期影响做了全面的比较
childhood cancer. The ones that we have already
我们上面讨论过的那些副作用是粗体的
discussed are bolded and some other important
另外一些重要的结果包括
consequences include the wasting of muscle and
消耗掉肌肉和脂肪量
fat mass, drug dose alterations, retardation of
药物用量改变、阻滞了骨骼肌的发展
skeletal muscles and even an increased risk for
甚至增加了二次癌症的危险
secondary cancers. So clearly avoiding malnutrition
显而易见，在治疗期间避免营养不良
during treatment is extremely important. We will now
是极其重要的
turn our focus to the nutritional interventions that
我们将把注意力转移到
can be used to avoid malnutrition. We will now turn
可以避免营养不良的
our attentions to the nutritional interventions
营养干预上 这种营养干预最常用在
most commonly used in a clinical setting.
临床环境中
There are 3 main feeding practices used in healthcare
在医疗保健设施中有三种主要的喂养方式
facilities, supplemental or oral feeding, enteral or
补授法或经口喂养，肠内管饲和
tube feeding and parenteral or IV feeding.
肠内或静脉注射
Oral feeding is the best method of support for
对营养缺乏不严重的病人，
patients with a low nutritional risk. Some children
口服喂养是最好的方式
will still need dietary supplements due to an increase
由于对营养的需求增大，如钙
in nutrient needs such as calcium. Ideally there
一些孩子通常需要膳食补充剂 理想状况下
should be flexibility in menu choice and meal times.
对菜单的选择和吃饭时间应该灵活安排
Studies have shown that a more flexible meal service
研究表明，相比而言灵活的进餐服务对
can lead to a significant increase in children’s food,
孩子们的食物、蛋白质和能量吸收
protein and energy intakes.
有重要的作用
Enteral nutrition is a practical method when oral
儿童在口服营养，体重仍然持续下降时
intake and the weight of a child continue to decrease.
肠内营养是个很实用的方式
Enteral nutrition works well if the child’s gut is
如果儿童的肠道功能如果仍然很好的话
still functioning properly. Enteral feeding also has
那么肠内营养就能起到很好的作用
the advantage of preserving the integrity of the
肠道喂养对于保持肠道粘液的完整也是
intestinal mucousa. Parenteral nutrition is best used
非常有益的 而在儿童肠道功能不再正常
when the child’s gut is no longer functioning
的情况下，肠胃外的营养则是最好的方法
correctly. This bypassing the usual process of eating
这种肠胃外营养是避开正常的进食及消化
and digestion and feeding the child intravenously.
通过对儿童进行静脉注射来喂养他们
Research has indicated that when normal oral intake
研究表明，在不能正常口服时，肠内营养
is not possible enteral nutrition has more
在生理上比肠胃外营养更具有优势
physiological benefits compared to parenteral nutrition
这优势包括保持小肠绒毛
including the maintenance of the heightened activity of
及小肠刷状缘酶活性的提高
intestinal villi and brush border enzymes,
能更好地保护
better preservation of specific gut nutrients such as
小肠营养内特殊物质
glutamine and short chain fatty acids and an upholding
比如像谷酰酶、短链脂肪酸
of the mucosal membrane surrounding the intestine.
和支撑小肠周围黏膜的薄膜
Enteral nutrition is also associated with fewer
肠内营养也和不少的传染病
infections and complications however many studies are
以及并发症相关
continuing to show that parenteral nutrition is more
许多研究不断表明，肠胃外营养
successful at preventing and correcting malnutrition.
在预防和改善营养不良这方面做的比较成功
