{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T17:30:13Z","timestamp":1781803813085,"version":"3.54.5"},"reference-count":59,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T00:00:00Z","timestamp":1741305600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Given the limited research on folate and ferritin status in children with cancer undergoing treatment, we investigated the prevalence of abnormalities and their impact on clinical outcomes and treatment complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective cohort study enrolled children &lt;18 years diagnosed with cancer between August 2010 and February 2014. Data collection occurred at diagnosis, 3, 6, 9, 12 and 18 months. Clinical outcomes were classified as event\u2010free survival or events (relapse, death, the development of new metastasis, becoming palliative) and treatment complications. Micronutrient status was assessed through clinical and nutritional analyses. Binary logistic regression, multilevel model analysis explored relationships between micronutrient status and clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighty\u2010two patients (median [interquartile range] 3.9 (1.9\u20138.8) years, 56% males) were recruited. Excess ferritin (85%) and folate deficiency (25.5%) were prevalent micronutrient abnormalities throughout the study. Decreased ferritin levels reduced the odds of events by 83.9% (odd ratios\u00a0=\u00a00.161, 95% CI\u00a0=\u00a01.000\u20131.002, <jats:italic>p\u00a0<\/jats:italic>=\u00a00.032). Higher ferritin was associated with increased number of treatment\u2010related complications (<jats:italic>B<\/jats:italic>\u00a0=\u00a07.3E\u22125, 95% CI\u00a0=\u00a01.5E\u22125\u20130.000, <jats:italic>p\u00a0<\/jats:italic>=\u00a00.013). Folate status showed significant association with body mass index category (<jats:italic>\u03c7<\/jats:italic><jats:sup>2\u00a0<\/jats:sup>=\u00a09.564, <jats:italic>p\u00a0<\/jats:italic>=\u00a00.008), indicating that overweight and obese patients were more prone to deficiency, and methotrexate (<jats:italic>F<\/jats:italic>(2.9); <jats:italic>p<\/jats:italic>\u00a0=\u00a00.06; \u22122LL (1381)). Haematological malignancies (<jats:italic>F<\/jats:italic>(2.8); <jats:italic>p<\/jats:italic>\u00a0=\u00a00.05; \u22122LL (4244)) and medium and high treatment intensity (<jats:italic>F<\/jats:italic>(2.4); <jats:italic>p<\/jats:italic>\u00a0=\u00a00.09; \u22122LL 4262)) were associated with higher ferritin levels over 18 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Paediatric cancer patients undergoing treatment exhibit high ferritin and reduced folate levels. Elevated ferritin is linked to increased toxicity and negative clinical outcomes, highlighting the importance of regular assessment and monitoring of both folate and ferritin. Implementing routine monitoring for these biomarkers could help mitigate adverse effects associated with treatment. Large\u2010scale population\u2010based studies and clinical trials are now warranted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.31645","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T21:24:45Z","timestamp":1741728285000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Associations of Ferritin and Folate Status With Clinical Outcomes in Childhood Cancer Patients: A Prospective Cohort Study"],"prefix":"10.1002","volume":"72","author":[{"given":"Kalum","family":"Withey","sequence":"first","affiliation":[{"name":"Department of Public Health and Sports Sciences Medical School Children's Health and Exercise Research Centre, University of Exeter, St Luke's Campus, University of Exeter  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8048-7362","authenticated-orcid":false,"given":"Mark F. H.","family":"Brougham","sequence":"additional","affiliation":[{"name":"Department of Paediatric Haematology and Oncology Royal Hospital for Children and Young People  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilenia","family":"Paciarotti","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Queen Margaret University  Musselburgh Scotland"},{"name":"Child Life and Health, University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane M.","family":"McKenzie","sequence":"additional","affiliation":[{"name":"Child Life and Health, University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0879-1129","authenticated-orcid":false,"given":"David C.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Child Life and Health, University of Edinburgh  Edinburgh UK"},{"name":"Department of Paediatric Gastroenterology and Nutrition Royal Hospital for Children and Young People  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5534-7146","authenticated-orcid":false,"given":"Raquel","family":"Revuelta Iniesta","sequence":"additional","affiliation":[{"name":"Department of Public Health and Sports Sciences Medical School Children's Health and Exercise Research Centre, University of Exeter, St Luke's Campus, University of Exeter  Exeter UK"},{"name":"Child Life and Health, University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3945\/an.110.000141"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2021.03.020"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnesp.2019.04.006"},{"key":"e_1_2_10_5_1","first-page":"823","volume-title":"Disease\u2010Related Malnutrition: An Evidence\u2010based Approach to Treatment","author":"Borum P. R.","year":"2003"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11833"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/79.6.1029"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15143239"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27895"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2022.05.010"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.30936"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/08880018.2023.2188920"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114516004074"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2014.12.023"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnesp.2020.04.003"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002688"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/jhn.13273"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102482\u201013\u2010s2\u2010s16"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/129.4.779"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/129.1.25"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753\u20104887.2004.tb00070.x"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/fpc.0b013e328343dd93"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0221591"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2008.08.001"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508\u2010015\u20100842\u20103"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1039\/c3mt00347g"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.7150\/jca.26853"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.4103\/aam.aam_56_18"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.614294"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0000000000000712"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20910"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.23320"},{"key":"e_1_2_10_34_1","unstructured":"Government T.S. Scottish Index of Multiple Deprivation.2012 Available at:https:\/\/www.data.gov.uk\/SIMD."},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39238.399444.55"},{"key":"e_1_2_10_36_1","unstructured":"NHS (2014).Test Directory | Edinburgh and Lothians Laboratory Medicine. [online] edinburghlabmed.co.uk. Available at: https:\/\/edinburghlabmed.co.uk\/node\/1878."},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1079\/bjn2001449"},{"key":"e_1_2_10_38_1","unstructured":"A.Wise WinDiets.Robert Gordon University 2018."},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1079\/phn2005801"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1159\/000207609"},{"key":"e_1_2_10_41_1","unstructured":"Department of Health.Dietary Reference Values.1991Available at: DRVs 1991."},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.111.023812"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.4103\/picr.PICR_87_17"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12906\u2010018\u20102240\u20107"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2013.09.008"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1038\/265755a0"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biocel.2021.106094"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010023\u201031450\u2010w"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1042\/0264\u20106021:3570241"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i25.8082"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16020367"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12937\u2010020\u201000572\u20106"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.114.199117"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1024\/0300\u20109831\/a000602"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13020331"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu8030163"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.15972"},{"key":"e_1_2_10_58_1","unstructured":"WHO Guideline on Use of Ferritin Concentrations to assess Iron status in Individuals and Populations.2021 https:\/\/www.who.int\/publications\/i\/item\/9789240000124."},{"key":"e_1_2_10_59_1","unstructured":"NICE BNF.Iron Overload.2025 https:\/\/bnf.nice.org.uk\/treatment\u2010summaries\/iron\u2010overload\/."},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.3758\/BRM.41.4.1149"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.31645","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T10:28:40Z","timestamp":1745404120000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.31645"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,7]]},"references-count":59,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1002\/pbc.31645"],"URL":"https:\/\/doi.org\/10.1002\/pbc.31645","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,7]]},"assertion":[{"value":"2024-10-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e31645"}}