Path Analysis of the Relationship between Nutritional Status, Maternal Knowledge, Dietary Compliance and Health-Related Quality of Life in Children with Acute Lymphoblastic Leukemia

Arini Tri Lestari; Yulia Lanti Retno Dewi; Harsono Salimo; Nur Hafidha Hikmayani

doi:10.26911/thejmch.2025.10.03.04

Authors

Arini Tri Lestari Master Program in Nutritional Science, Postgraduate School, Universitas Sebelas Maret, Surakarta, Indonesia
Yulia Lanti Retno Dewi Nutrition Departement, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
Harsono Salimo Department of Child Health, Faculty of Medicine, Universitas Sebelas Maret / Dr. Moewardi Hospital, Surakarta, Indonesia
Nur Hafidha Hikmayani Department of Pharmacology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia

DOI:

https://doi.org/10.26911/thejmch.2025.10.03.04

Abstract

Background: Acute Lymphoblastic Leukemia (ALL) is the most common type of blood cancer in children. Treatment for ALL may affect the patient's quality of life. Factors such as nutritional status, maternal knowledge of nutrition, and dietary compliance play a role in determining the quality of life of children with ALL. This study aims to analyze the relationship between nutritional status, maternal knowledge, and dietary compliance with health-related quality of life (HRQoL) in children with ALL.

Subjects and Method: This study used a cross-sectional design with a sample of 52 children with ALL at the Pediatric Hematology Clinic of Dr. Moewardi Surakarta Hospital in October-November 2024. The independent variables were nutritional status, maternal knowledge, and dietary compliance, while the dependent variable was HRQoL. Data were collected using anthropometric instruments and questionnaires, then analyzed with single logistic regression and path analysis.

Results: Single logistic regression analysis showed that nutritional status (OR= 4.60; 95% CI= 1.311 to 16.139; p = 0.017) and dietary compliance (OR= 4.82; 95% CI= 1.39 to 16.78; p= 0.013) were significantly associated with HRQoL. Maternal knowledge had no significant effect (OR= 1.88; 95% CI = 0.35 to 10.18; p = 0.467). Path analysis showed that nutritional status, dietary compliance, and body mass index had a direct positive association with the child's quality of life. The path analysis model showed a good fit with the data (goodness of fit p = 0.594).

Conclusion: Nutritional status and dietary compliance are major factors in improving the quality of life of children with ALL. Although maternal knowledge does not have a direct effect, the mother's role remains important through improving the child's dietary compliance. Multidisciplinary interventions that integrate nutrition education and family support are needed to enhance HRQoL in pediatric patients with ALL.

Keywords:

acute lymphoblastic leukemia, cancer, nutritional status, quality of life

References

Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, Erickson N, et al. (2017). ESPEN expert group recommendations for action against cancer-related malnutrition. Clinical Nutrition. 365: 1187–1196. Available at: https://doi.org/10.1016/j.clnu.2017.06.017.

Argyle M (2017). Social interaction. 2nd edn. New York: Routledge. Available at: https://doi.org/https://doi.org/10.4324/9781315129556.

Barr RD, Ladas EJ (2020). The role of nutrition in pediatric oncology. Expert Review of Anticancer Therapy. 20(2): 109–116. Available at: https://doi.org/10.1080/14737140.2020.1719834.

Black AP, D'Onise K, McDermott R, Vally H, O'Dea K (2017). How effective are family-based and institutional nutrition interventions in improving children’s diet and health? A systematic review’. BMC Public Health. 17(1), pp. 1–19. Available at: https://doi.org/10.1186/s1288901747955.

Diakatou V, Vassilakou T (2020). Nutritional Status of Pediatric Cancer Patients at Diagnosis and Correlations with Treatment, Clinical Outcome and the Long-Term Growth and Health of Survivors. Multidisciplinary Digital Publishing Institute. 7(11): 218. Available at: https://doi.org/10.3390/children7110218.

Ding F, Deng L, Xiong J, Cheng Z, Xu J. (2025). Analysis of global trends in acute lymphoblastic leukemia in children aged 0–5 years from 1990 to 2021. Frontiers in Pediatrics. 13 (March): 1–11. Available at: https://doi.org/10.3389/fped.2025.1542649.

Fardell JE, Vetsch J, Trahair T, Mateos MK, Grootenhuis MA, Touyz LM, Marshall GM, et al. (2017). Health-related quality of life of children on treatment for acute lymphoblastic leukemia: A systematic review. Pediatric Blood and Cancer, 64(9), pp. 1–13. Available at: https://doi.org/10.1002/pbc.26489.

Garniasih D, Susanah S, Sribudiani Y, Hilmanto D (2022). The incidence and mortality of childhood acute lymphoblastic leukemia in Indonesia: A systematic review and meta-analysis. PLoS ONE. 17(6 June): 1–13. Available at: https://doi.org/10.1371/journal.pone.0269706.

Greaney ML, Puleo E, Sprunck-Harrild K, Haines J, Houghton SC, Emmons KM. (2018). Social support for changing multiple behaviors: factors associated with seeking support and the impact of offered support. Health Education and Behavior. 45(2): 198–206. Available at: https://doi.org/10.1177/1090198117712333.

Joffe L, Ladas EJ (2020). Nutrition during childhood cancer treatment: current understanding and a path for future research. The Lancet Child and Adolescent Health. 4(6): pp. 465–475. Available at: https://doi.org/10.1016/S23524642(19)304079.

Kline, RB (2016). Principles and practice of structural equation modeling. 4th edn. New York: Guilford Press.

Lewandowska A, Rudzki G, Lewandowski T, Próchnicki M, Rudzki S, Laskowska B, Brudniak J (2020). Quality of life of cancer patients treated with chemotherapy. International Journal of Environmental Research and Public Health. 17(19): 1–16. Available at: https://doi.org/10.3390/ijerph17196938.

Lippi L, de Sire A, Folli A, Turco A, Moalli S, Marcasciano M, Ammendolia A, et al. (2024). Obesity and cancer rehabilitation for functional recovery and quality of life in breast cancer survivors: a comprehensive review. Cancers. 16(3). Available at: https://doi.org/10.3390/cancers16030521.

Murimi MW, Moyeda-Carabaza AF, Nguyen B, Saha S, Amin R, Njike V (2018). Factors that contribute to effective nutrition education interventions in children: A systematic review. Nutrition Reviews. 76(8): 553–580. Available at: https://doi.org/10.1093/nutrit/nuy020.

Pedretti L, Massa S, Leardini D, Muratore E, Rahman S, Pession A, Esposito S, et al. (2023). Role of nutrition in pediatric patients with cancer. Nutrients. 15(3): 1–22. Available at: https://doi.org/10.3390/nu15030710.

Said L, Gubbels JS, Kremers SPJ (2020). Dietary knowledge, dietary adherence, and bmi of lebanese adolescents and their parents. Nutrients. 12(8):. 1–14. Available at: https://doi.org/10.3390/nu12082398.

Tanrıverdi M, Vural M, Çakır FB (2020). The effects of treatment on nutrition in children with cancer. Journal of Experimental and Clinical Medicine (Turkey). 37(3): 61–65. Available at: https://doi.org/10.5835/jecm.omu.37.03.001.

Wang L, Yao X, Yang L (2025). Global, regional, and national burden of children and adolescents with acute lymphoblastic leukemia from 1990 to 2021: a systematic analysis for the global burden of disease study 2021. Front. Public Health 13:1525751. Available at: https://doi: 10.3389/fpubh.2025.1525751