The Double Burden: Understanding the Impact of Malnutrition on Childhood Cancer Outcomes in Resource-Limited Settings.

Childhood cancer disproportionately affects low- and middle-income countries (LMICs), where over 80% of cases occur, and malnutrition affects approximately 70% of pediatric oncology patients, substantially compromising treatment tolerance, immune function, and survival. This review integrates current evidence on the impact of malnutrition in LMICs, evaluates assessment methodologies and interventions, and identifies knowledge gaps that hinder optimal nutritional care. The A-B-C-D (anthropometric, biochemical, clinical, and dietary assessments) framework provides a systematic assessment, with mid-upper arm circumference and handgrip dynamometry offering practical evaluation in resource-limited settings. Prealbumin is the most sensitive early biochemical marker (54%-87% sensitivity vs. 7.4%-45.8% for albumin), and nutritional screening tools like SCAN demonstrate high validity for risk identification (> 80% sensitivity and specificity). Interventions such as ready-to-use therapeutic foods improved weight gain (77.8% vs. 64.2%) and reduced severe infections (10.6% vs. 31%) in trials. We emphasize a multidisciplinary approach and research priorities centered on standardized assessments, long-term effects of malnutrition, and culturally appropriate nutritional programs for LMICs.