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Miles C, Fox J, Davis K, Harris A, Kwa C, Little B, Thomas A, Zemrani B. Utility of mid-upper arm circumference in pediatric malnutrition: An Australasian Society of Parenteral and Enteral Nutrition consensus statement using the Delphi method. Nutr Clin Pract 2024. [PMID: 39351830 DOI: 10.1002/ncp.11205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Mid-upper arm circumference (MUAC) is a simple anthropometric tool used to screen for childhood undernutrition in humanitarian settings or low-income and middle-income countries. However, there is conflicting evidence and a lack of consensus with regard to its diagnostic use in clinical settings or population groups beyond this context. In 2023, a project officer was appointed by the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) to lead the development of a consensus review into the use of MUAC in the pediatric clinical setting. METHODS An AuSPEN appointed multidisciplinary group of informed clinicians used the Delphi method to critically appraise the evidence and develop a series of consensus statements. Delphi surveys were anonymous and distributed electronically. Members were asked to rate their level of agreement with each consensus statement using a 5-point Likert scale. A priori definition of consensus was established as ≥80% responses "agree" or "strongly agree." RESULTS Three Delphi rounds were required to reach consensus. A total of 18 consensus statements, including rationale, were developed across the topics 'assessment and diagnosis', 'screening and monitoring' and 'clinical settings'. CONCLUSION An evidence-based, region-specific consensus approach to the use of MUAC in pediatric malnutrition is a valuable tool for clinicians. MUAC is a straightforward, non-invasive and cost-effective tool, and may provide an advantage over traditional anthropometric tools in some clinical settings. There are limitations to the utility of MUAC and this consensus paper provides an empirical summary of advantages and limitations as they apply to the screening, assessment, diagnosis, and monitoring of pediatric malnutrition.
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Affiliation(s)
- Caitlin Miles
- Australasian Society of Parenteral and Enteral Nutrition, Mornington, Victoria, Australia
- Allied Health, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Julia Fox
- Australasian Society of Parenteral and Enteral Nutrition, Mornington, Victoria, Australia
- Allied Health, Queensland Children's Hospital and Health Service, Herston, Queensland, Australia
| | - Kimberly Davis
- Infectious Diseases, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Angela Harris
- Allied Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Christine Kwa
- General Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Bridget Little
- Allied Health, Starship Child Health, Auckland, New Zealand
| | - Arabella Thomas
- Allied Health, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Boutaina Zemrani
- Australasian Society of Parenteral and Enteral Nutrition, Mornington, Victoria, Australia
- Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia
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Beer SS, Wong Vega M. Malnutrition, sarcopenia, and frailty assessment in pediatric transplantation. Nutr Clin Pract 2024; 39:27-44. [PMID: 38088812 DOI: 10.1002/ncp.11105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/13/2024] Open
Abstract
Nutrition assessment can be challenging in children with end-stage organ disease and in those requiring an organ transplant. The effect of poor nutrition status can exert long-lasting effects on children with end-stage organ disease requiring transplantation. Malnutrition, sarcopenia, and frailty are conditions that require provision of optimal nutrition to prevent or support the treatment of these conditions. Unfortunately, the literature on the assessment of malnutrition, sarcopenia, and frailty in pediatric end-stage organ disease is scarce, thus leading to confusion on how to effectively identify them. Recently, the addition of a variety of validated nutrition and functional assessment techniques has assisted with appropriate assessment of these conditions. The objective of this narrative review is to provide an overview of the current literature for pediatric assessment of malnutrition, sarcopenia, and frailty in the setting of solid organ transplantation and provide practicing nutrition clinicians a solid foundation for learning how to effectively assess these conditions with the current literature available.
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Affiliation(s)
- Stacey Silver Beer
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Molly Wong Vega
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
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Thakrar T, Kumar A, Göthberg C, Grigoriadis A. Evaluation of jaw function, oral health-related quality of life, and nutritional status during oral rehabilitation procedures - a pilot study. Acta Odontol Scand 2024; 82:18-24. [PMID: 37623701 DOI: 10.1080/00016357.2023.2250423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
AIMS To evaluate limitations in jaw function, oral health-related quality of life (OHRQoL), and nutritional status during extensive oral rehabilitation procedures. MATERIAL METHODS Fourteen participants (mean age ± SD: 70 ± 3.8) undergoing major oral rehabilitation involving the restoration of a minimum of eight teeth were recruited in the study. Jaw function limitations scores (JFLS), oral health-impact profile (OHIP), and nutritional status were measured at different time points during, six months, and one year after the rehabilitation procedures. Nutritional status was evaluated by measuring the body weight and arm and calf muscle circumference. The effect of time points on the measured variables was evaluated with Friedman's test. Trends in nutritional status were evaluated with linear regression analysis. RESULTS The results of the analysis showed significant main effects of time points on the JLFS (p < .001) and OHIP scores (p = .005). However, there was no effect of time points on the body weight (p = .917) and calf muscle circumference (p = .424), but a significant effect on arm circumference (p = .038). Further, there was a decreasing trend for body weight (64.3%), arm (71.4%), and calf circumference (64.3%) in the majority of the patients. CONCLUSION The results of the preliminary study suggest that people undergoing extensive oral rehabilitation procedures show improvement in jaw function and an increase in OHRQoL after the rehabilitation procedure. Despite no major changes in the nutritional indicators, most patients showed a negative trend in their body weight, arm circumference, and calf circumference, suggesting that they may be susceptible to nutritional changes.
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Affiliation(s)
- Tina Thakrar
- Department of Prosthetic Dentistry, Folktandvården Eastman Institute, Stockholm, Sweden
| | - Abhishek Kumar
- Unit of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
| | - Catharina Göthberg
- Department of Prosthetic Dentistry, Institute for Postgraduate Dental Education, Jonkoping, Sweden
| | - Anastasios Grigoriadis
- Unit of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Vega MRW, Cerminara D, Desloovere A, Paglialonga F, Renken-Terhaerdt J, Walle JV, Shaw V, Stabouli S, Anderson CE, Haffner D, Nelms CL, Polderman N, Qizalbash L, Tuokkola J, Warady BA, Shroff R, Greenbaum LA. Nutritional management of children with acute kidney injury-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2023; 38:3559-3580. [PMID: 36939914 PMCID: PMC10514117 DOI: 10.1007/s00467-023-05884-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 03/21/2023]
Abstract
The nutritional management of children with acute kidney injury (AKI) is complex. The dynamic nature of AKI necessitates frequent nutritional assessments and adjustments in management. Dietitians providing medical nutrition therapies to this patient population must consider the interaction of medical treatments and AKI status to effectively support both the nutrition status of patients with AKI as well as limit adverse metabolic derangements associated with inappropriately prescribed nutrition support. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPR) for the nutritional management of children with AKI. We address the need for intensive collaboration between dietitians and physicians so that nutritional management is optimized in line with AKI medical treatments. We focus on key challenges faced by dietitians regarding nutrition assessment. Furthermore, we address how nutrition support should be provided to children with AKI while taking into account the effect of various medical treatment modalities of AKI on nutritional needs. Given the poor quality of evidence available, a Delphi survey was conducted to seek consensus from international experts. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs, based on the clinical judgment of the treating physician and dietitian. Research recommendations are provided. CPRs will be regularly audited and updated by the PRNT.
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Affiliation(s)
| | | | | | - Fabio Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - José Renken-Terhaerdt
- Wilhemina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Vanessa Shaw
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University, Hippokratio Hospital, Thessaloniki, Greece
| | | | - Dieter Haffner
- Hannover Medical School, Children's Hospital, Hannover, Germany
| | | | | | | | - Jetta Tuokkola
- New Children's Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Rukshana Shroff
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Larry A Greenbaum
- Emory University, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
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Elif Öztürk M, Yabancı Ayhan N. Evaluation of malnutrition and screening tools in hospitalized children. Clin Nutr ESPEN 2023; 57:770-778. [PMID: 37739737 DOI: 10.1016/j.clnesp.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/29/2023] [Accepted: 08/25/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Detecting malnutrition and its related risk factors are crucial, in hospitalized children. Anthropometric z scores are used to assess malnutrition. Screening tools also aim to detect the presence of malnutrition and the developing risk of malnutrition in hospitalized children to determine who may benefit from nutritional support. Therefore, the aims of the study are to detect malnutrition and its related demographic and clinical risk factors in hospitalized children and determining the sensitivity of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) and Pediatric Yorkhill Malnutrition Score (PYMS) screening tools. METHODS A total of 130 hospitalized children aged between 0 and 18 years were included in to study. A survey including demographic and clinical characteristics, STAMP and PYMS were applied to parents of the children. Patients were classified into nutritional risk groups through screening tools. Anthropometric measurements (body weight, length/height, and middle upper arm circumference (MUAC) of the children were taken. Body mass index-for-age and height-for-age z scores were calculated to assess acute and chronic malnutrition prevalence. MUAC-for-age z scores were calculated as well. To detect independent risk factors for acute and chronic malnutrition multivariable logistic regression models were constructed. RESULTS A total of 14.6% of hospitalized children had acute malnutrition, 21.5% of children had chronic malnutrition and 27.7% of them had low MUAC standard deviation score (SDS) (less than -2). The independent risk factors for acute malnutrition were younger maternal age at birth and long length of stay (p < 0.05). The independent risk factors for chronic malnutrition were being female, younger maternal age at birth, longer illness duration and having urological or allergy and immunological diseases (p < 0.05). However, MUAC for age SDS groups were not related to any demographic and clinical factors, in children of all ages (p > 0.05). Regarding the screening tools, PYMS displayed 100% sensitivity against acute malnutrition. While PYMS displayed better sensitivity to identify acute malnutrition than STAMP, STAMP was more sensitive than PYMS to detect chronic malnutrition and low MUAC SDS. CONCLUSIONS Low MUAC for age SDS was not related to any demographic and clinical factors, in hospitalized children of all ages, unlike acute and chronic malnutrition, in this study. Pediatric screening tools mainly PYMS did not have high sensitivity to detect chronic malnutrition and low MUAC SDS, in hospitalized children. Therefore, the tools have to be used along with z scores of anthropometric parameters.
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Affiliation(s)
- Meryem Elif Öztürk
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Karamanoğlu Mehmetbey University, Karaman, Turkey.
| | - Nurcan Yabancı Ayhan
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara, Turkey.
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Neyer PJ, Kaboré B, Nakas CT, Hartmann B, Post A, Diallo S, Tinto H, Hammerer-Lercher A, Largiadèr CR, van der Ven AJ, Huber AR. Exploring the host factors affecting asymptomatic Plasmodium falciparum infection: insights from a rural Burkina Faso study. Malar J 2023; 22:252. [PMID: 37658365 PMCID: PMC10474782 DOI: 10.1186/s12936-023-04686-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Asymptomatic Plasmodium falciparum parasitaemia forms a reservoir for the transmission of malaria disease in West Africa. Certain haemoglobin variants are known to protect against severe malaria infection. However, data on the potential roles of haemoglobin variants and nongenetic factors in asymptomatic malaria infection is scarce and controversial. Therefore, this study investigated the associations of iron homeostasis, inflammation, nutrition, and haemoglobin mutations with parasitaemia in an asymptomatic cohort from a P. falciparum-endemic region during the high transmission season. METHODS A sub-study population of 688 asymptomatic individuals (predominantly children and adolescents under 15 years, n = 516) from rural Burkina Faso previously recruited by the NOVAC trial (NCT03176719) between June and October 2017 was analysed. Parasitaemia was quantified with conventional haemocytometry. The haemoglobin genotype was determined by reverse hybridization assays targeting a selection of 21 HBA and 22 HBB mutations. Demographics, inflammatory markers (interleukins 6 and 10, hepcidin), nutritional status (mid upper-arm circumference and body mass index), and anaemia (total haemoglobin, ferritin, soluble transferrin receptor) were assessed as potential predictors through logistic regression. RESULTS Malaria parasites were detected in 56% of subjects. Parasitaemia was associated most strongly with malnutrition. The effect size increased with malnutrition severity (OR = 6.26, CI95: 2.45-19.4, p < 0.001). Furthermore, statistically significant associations (p < 0.05) with age, cytokines, hepcidin and heterozygous haemoglobin S were observed. CONCLUSIONS According to these findings, asymptomatic parasitaemia is attenuated by haemoglobin S, but not by any of the other detected genotypes. Aside from evidence for slight iron imbalance, overall undernutrition was found to predict parasitaemia; thus, further investigations are required to elucidate causality and inform strategies for interventions.
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Affiliation(s)
- Peter J Neyer
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland.
- Graduate School for Cellular & Biomedical Sciences, University of Bern, Bern, Switzerland.
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Bérenger Kaboré
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Christos T Nakas
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Laboratory of Biometry, Department of Agriculture Crop, Production and Rural Environment, University of Thessaly, Volos, Greece
| | - Britta Hartmann
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Annelies Post
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Salou Diallo
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Halidou Tinto
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | | | - Carlo R Largiadèr
- Graduate School for Cellular & Biomedical Sciences, University of Bern, Bern, Switzerland
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andre J van der Ven
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andreas R Huber
- Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
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Motadi SA, Zuma MK, Freeland-Graves JH, Gertrude Mbhenyane X. Dietary diversity and nutritional status of children attending early childhood development centres in Vhembe District, Limpopo province, South Africa. J Nutr Sci 2023; 12:e92. [PMID: 37587972 PMCID: PMC10425762 DOI: 10.1017/jns.2023.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/13/2023] [Accepted: 07/21/2023] [Indexed: 08/18/2023] Open
Abstract
The present study assessed dietary diversity and anthropometric status of children attending early development centres in South Africa. In the Vhembe District of Limpopo province, South Africa, 273 children were conveniently chosen from 8 randomly selected early childhood development centres for a cross-sectional study. Data were gathered via a questionnaire administered by the interviewer in June 2021. Height, body weight and mid-upper arm circumference were measured to assess anthropometric status. A 24-h dietary recall was obtained to provide information on dietary diversity. The prevalence of underweight, wasting and stunting was 9, 4 and 26 %, respectively. More than half of the children had a low dietary diversity score, according to the Food and Agriculture Organization scoring system for children. Grains, roots, tubers, dairy products, other fruits and vegetables, and flesh-based foods were the highest consumed food groups. The lowest consumption was for eggs, vitamin A-rich fruits and vegetables, legumes and nuts. Height for age and weight for age were significantly associated with dietary diversity score, but not weight for height. Children who did not meet the reference value of greater than 4 for dietary diversity had a significant risk of being underweight (AOR 0⋅25, 95 % CI 0⋅08, 0⋅75) and stunted (AOR 0⋅32, 95 % CI 0⋅14, 0⋅74). The nutritional status of the children was impacted by a lack of adequate dietary diversity. Young children in rural areas need to receive a wide range of food to promote greater diversification of diets in order to diminish the risk of undernutrition.
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Affiliation(s)
- Selekane Ananias Motadi
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
- Department of Nutrition, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Mthokozisi Kwazi Zuma
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
- Smallholder Agricultural Development Unit, Agricultural Research Council, Pretoria 0002, South Africa
| | | | - Xikombiso Gertrude Mbhenyane
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
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Khlevner J, Naranjo K, Hoyer C, Carullo AS, Kerr KW, Marriage B. Healthcare Burden Associated with Malnutrition Diagnoses in Hospitalized Children with Critical Illnesses. Nutrients 2023; 15:3011. [PMID: 37447337 DOI: 10.3390/nu15133011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Our primary study objectives were to (i) determine the proportion of children admitted to the Pediatric Intensive Care Unit (PICU) with malnutrition diagnoses, (ii) compare healthcare utilization by malnourished and non-malnourished PICU patients, and (iii) examine the impact of implementing malnutrition screening and coding practices at a major academic urban tertiary care medical center. Using patient records, we conducted a retrospective analysis of 4106 children admitted to the PICU for severe illnesses between 2011 and 2019. Patients were identified as malnourished if records showed an ICD-9 or ICD-10 code for malnutrition. We compared malnourished and non-malnourished patients by age, admitting diagnoses, number of comorbid conditions, and clinical outcomes (length of stay, hospital readmission). About 1 of every 5 PICU-admitted patients (783/4106) had a malnutrition diagnosis. Patients with malnutrition were younger (mean age 6.2 vs. 6.9 years, p < 0.01) and had more comorbid conditions (14.3 vs. 7.9, p < 0.01) than those without. Malnourished patients had longer hospital stays (26.1 vs. 10.0 days, p < 0.01) and higher 30-day readmission rates (10% vs. 7%, p = 0.03). Implementation of malnutrition screening and coding practices was associated with an increase in malnutrition diagnosis. In this study of children admitted to the PICU, malnourished patients had more comorbid diagnoses and used more healthcare resources (prolonged hospitalizations and higher 30-day readmission rates), leading to higher healthcare costs. Such findings underscore the need for policies, training, and programs emphasizing identification and treatment of malnutrition at hospitals caring for critically ill children.
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Affiliation(s)
- Julie Khlevner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Kelly Naranjo
- Department of Biology, New York University, New York, NY 10032, USA
| | - Christine Hoyer
- New York Presbyterian Morgan Stanley Children's Hospital, New York, NY 10032, USA
| | - Angela S Carullo
- New York Presbyterian Morgan Stanley Children's Hospital, New York, NY 10032, USA
| | - Kirk W Kerr
- Abbott Laboratories, Columbus, OH 43023, USA
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Patel PV, Kao E, Stekol E, Heyman MB, Vu L, Verstraete SG. Evaluating the Relationship Between Nutrition and Post-colectomy Pouchitis in Pediatric Patients with Ulcerative Colitis. Dig Dis Sci 2023; 68:2188-2195. [PMID: 36807017 PMCID: PMC11017704 DOI: 10.1007/s10620-023-07872-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Pouchitis is the most frequent complication following restorative proctocolectomy and ileal pouch anal anastomosis (RP-IPAA) in patients with Ulcerative colitis (UC). Pediatric data on nutritional status during RP-IPAA and in patients with pouchitis are limited. AIMS We aimed to delineate nutritional changes in children undergoing 2-stage and 3-stage surgeries and to evaluate the association between nutrition and the development of recurrent or chronic pouchitis. METHODS This single-center retrospective study involved 46 children with UC who underwent a RP-IPAA. Data were collected at each surgical stage and for up to 2-year post-ileostomy takedown. We used Wilcoxon matched-pairs signed-rank test to evaluate the differences in nutritional markers across surgical stages and logistic regression to identify the factors associated with recurrent or chronic pouchitis. RESULTS Twenty patients (43.5%) developed recurrent or chronic pouchitis. Children who underwent a 3-stage procedure had improvements in albumin, hematocrit, and body mass index (BMI)-for-age Z-scores (p < 0.01) between the first two stages. A positive trend in BMI-for-age Z-scores (p = 0.08) was identified in children with 2-stage procedures. All patients showed sustained nutritional improvement during the follow-up period. Among patients who underwent 3-stage surgeries, BMI worsened by 0.8 standard deviations (SDs) (p = 0.24) between the initial stages in those who developed recurrent or chronic pouchitis and improved by 1.1 SDs (p = 0.04) in those who did not. CONCLUSIONS Early improvement in BMI-for-age Z-scores following the initial stage was associated with lower rates of recurrent or chronic pouchitis. Larger prospective studies are needed to validate these findings.
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Affiliation(s)
- Perseus V Patel
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, 550 16th Street, 4th Floor, Box 0136, San Francisco, CA, 94158, USA.
| | - Emily Kao
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Emily Stekol
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, 550 16th Street, 4th Floor, Box 0136, San Francisco, CA, 94158, USA
| | - Melvin B Heyman
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, 550 16th Street, 4th Floor, Box 0136, San Francisco, CA, 94158, USA
| | - Lan Vu
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Sofia G Verstraete
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, 550 16th Street, 4th Floor, Box 0136, San Francisco, CA, 94158, USA
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Aydın K, Dalgıç B, Kansu A, Özen H, Selimoğlu MA, Tekgül H, Ünay B, Yüce A. The significance of MUAC z-scores in diagnosing pediatric malnutrition: A scoping review with special emphasis on neurologically disabled children. Front Pediatr 2023; 11:1081139. [PMID: 36950173 PMCID: PMC10025394 DOI: 10.3389/fped.2023.1081139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/16/2023] [Indexed: 03/24/2023] Open
Abstract
This review by a panel of pediatric gastroenterology-hepatology-nutrition and pediatric neurology experts aimed to address the significance of mid-upper arm circumference (MUAC) assessment in diagnosis of pediatric malnutrition. Specifically, the potential utility of recently developed MUAC z-score tape in clinical practice for larger patient populations was addressed including the neurologically disabled children. In accordance with the evidence-based data, four statements were identified by the participating experts on the utility of MUAC z-score tape, including (1) MUAC z-scores correlate with body mass index (BMI) and weight for height/length (WFH/l) z-scores in diagnosing malnutrition; (2) MUAC z-score tape offers a higher sensitivity to diagnose the mild and moderate malnutrition and better ability to track the changes in nutritional status over time than the other single datapoint measurements; (3) Using single-step MUAC z-score tape in children with cerebral palsy (CP) seems to provide more reliable data on anthropometry; and (4) The clinical value of the tool in classifying secondary malnutrition in CP should be investigated in large-scale populations. In conclusion, enabling single-step estimation of nutritional status in a large-scale pediatric population regardless of age and within a wide range of weight, without formal training or the need for ancillary reference charts and calculators, MUAC z-tape offers a favorable tool for easier and earlier diagnosis of pediatric malnutrition. Nonetheless, further implementation of MUAC z-score screening in larger-scale and/or special populations is necessary to justify its utility in relation to other primary anthropometric indicators in diagnosis of malnutrition as well as in treatment monitoring in the community and hospital setting.
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Affiliation(s)
- Kürşad Aydın
- Department of Pediatric Neurology, Medipol University Faculty of Medicine, Istanbul, Türkiye
| | - Buket Dalgıç
- Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Aydan Kansu
- Department of Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Hasan Özen
- Department of Pediatric Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
- Correspondence: Hasan Özen
| | - Mukadder Ayşe Selimoğlu
- Department of Pediatric Gastroenterology, Memorial Atasehir and Bahcelievler Hospitals, Istanbul, Türkiye
| | - Hasan Tekgül
- Department of Pediatric Neurology, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Bülent Ünay
- Department of Pediatric Neurology, Gulhane Faculty of Medicine, Ankara, Türkiye
| | - Aysel Yüce
- Department of Pediatric Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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Aryafar M, Mahdavi M, Shahzadi H, Nasrollahzadeh J. Effect of feeding with standard or higher-density formulas on anthropometric measures in children with congenital heart defects after corrective surgery: a randomized clinical trial. Eur J Clin Nutr 2022; 76:1713-1718. [PMID: 35906331 DOI: 10.1038/s41430-022-01186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of the present study was to assess the efficacy of feeding a higher-density formula (HDF) in infant with congenital heart disease (CHD). METHODS In a parallel randomized trial, infants (6 to 12 months) who underwent CHD corrective surgery received either a standard-density formula (SDF, 67 kcal /100 ml) or an HDF (90 kcal/100 ml) after discharge from the intensive care unit for 8 weeks. In addition to the formula, infants could receive breast milk or complementary food. Anthropometry, biochemistry, and formula intake were collected. RESULT Sixty-four infants completed the study (n = 32 in each group). All infants gained weight. The mean ± standard deviation (SD) of weight z score at baseline and week-8 were -2.38 ± 10.04 to -1.38 + 0.97 in the SDF group and -2.69 ± 1.19 to -0.89 ± 0.90 in the HDF group (between-group p = 0.0001). Both groups gained length, but showed a decline in length z-score which was significant in the SDF group but not significant in the HDF group. Mid-upper arm circumference and its z score improved in both groups, with more improvement in the HDF group. Serum albumin level was higher in the HDF than the SDF group at week-8, but no significant between-group differences were observed in hemoglobin, serum ferritin, or iron. Symptoms of gastrointestinal intolerance were not reported, but parents of 4 infants in the HDF group complained of their infants' constipation. CONCLUSION Feeding infants using a concentrated formula could increase infants' weight gain and growth, and improve the nutritional status after CHD surgery.
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Affiliation(s)
- Maryam Aryafar
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdavi
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Shahzadi
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Nasrollahzadeh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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12
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Haque MA, Choudhury N, Ahmed SMT, Farzana FD, Ali M, Naz F, Raihan MJ, Rahman SS, Siddiqua TJ, Faruque ASG, Ahmed T. Does a child's mid-upper arm circumference-for-age z-score represent another nutritional indicator of childhood malnutrition status? MATERNAL & CHILD NUTRITION 2022; 18:e13404. [PMID: 35821653 PMCID: PMC9480943 DOI: 10.1111/mcn.13404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/26/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
Abstract
Child wasting is defined as a weight-for-height/length z-score (WLZ/WHZ) < -2, and this indicator of nutritional status is used worldwide. However, a precise measurement is required for the assessment of a child's nutritional status, which may not always be possible due to expensive instruments, especially in poor resource settings. In some instances, mid-upper arm circumference-for-age z-score (MUACZ) is also being used for screening purposes, which is a simple and useful nutritional indicator. The objective of this paper is to identify the optimal cut-off point for the MUACZ to identify wasted children, and also to determine if the same factors are associated with MUACZ and wasting. Data were derived from the Suchana evaluation data. The optimal cut-off value was estimated via receiver operating characteristic (ROC) curve analysis using acute malnutrition as a gold standard with maximum sensitivity and specificity. Multiple logistic regression was used to assess the associated factors with the MUACZ. Using the gold standard indicator of nonwasting (WLZ ≥ -2), a positive outcome, the optimal cut-off point for the MUACZ was -1.27. The area under the ROC curve was 0.88, indicating that the model had a power of 88% to differentiate between the positive and negative classes. It implies that a child's MUACZ was correlated with WLZ, and a MUACZ below -1.27 appeared to accurately identify wasting among children aged 3-23 months. MUACZ < -1.27 might be another useful indicator of childhood wasting than a WLZ < -2.
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Affiliation(s)
| | - Nuzhat Choudhury
- Nutrition and Clinical Services Division, icddr,bDhakaBangladesh
| | | | | | - Mohammad Ali
- Nutrition and Clinical Services Division, icddr,bDhakaBangladesh
| | - Farina Naz
- Nutrition and Clinical Services Division, icddr,bDhakaBangladesh
| | | | | | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,bDhakaBangladesh
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13
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Pre-operative nutritional status and its association with short-term post-operative outcomes in Iranian children with CHD. Cardiol Young 2022; 33:579-589. [PMID: 35695155 DOI: 10.1017/s1047951122001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Nutritional assessment appears to be an essential component of the evaluation of children with CHD undergoing surgery because nutritional status may impact corrective surgery-associated morbidity. METHODS A prospective single-centre cohort study with children between 6 and 24 months of age. Patients who had genetic syndromes or those who were premature or low birthweight at birth were excluded. Pre-operative nutritional parameters included anthropometric measurements and serum concentrations of total protein, vitamin D, iron, and ferritin. Outcome measures included ICU length of stay, mechanical ventilation, vasoactive-inotropic score, and duration of inotropes. Linear regression analysis was performed to determine whether pre-operative variables were associated with outcomes. RESULTS Analysis was performed on 120 patients (median age of 8 months), of whom 67 were male. Prior to surgery, 50.8% of patients had reduced (z ≤ -2.0) weight-for-age z score, 23.3% had reduced length-for-age z score, and 59.2% had reduced mid-upper arm circumference z score. Pre-operative serum total protein levels were 59.36 ± 9.16 g/L. Multiple regression analysis showed that low serum protein was associated with longer ICU length of stay and length of mechanical ventilation, while mid-upper arm circumference z score ≤ -2 was associated with longer ICU length of stay and mechanical ventilation and inotropes duration. CONCLUSIONS Pre-operative assessment of nutritional status by performing anthropometric and biochemical measurements including mid-upper arm circumference z score and serum protein concentrations in children undergoing CHD surgery appears to be predictors of some post-operative short-term outcomes and could be used as a guide to highlight patients needing appropriate perioperative nutritional interventions.
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14
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Irving SY, Ravishankar C, Miller M, Chittams J, Stallings V, Medoff-Cooper B. Anthropometry Based Growth and Body Composition in Infants with Complex Congenital Heart Disease. Clin Nurs Res 2022; 31:931-940. [PMID: 35135359 DOI: 10.1177/10547738221075720] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Infants with congenital heart disease (CHD) often have poor growth and altered body composition (fat and muscle accretion). AIM Describe growth patterns in infants with CHD using interval weight, length, head circumference (HC), triceps (TSF), subscapular skinfolds (SSSF), and mid-upper arm circumference (MUAC) measurements. SUBJECTS AND METHODS A total of 120 infants enrolled: 48% healthy and 58% with CHD (45% single ventricle [SV]; 55% two ventricle [2V] physiology). Weight, length, HC, TSF, SSSF, and MUAC measured at 3-, 6-, 9-, and 12-months of age. RESULTS CHD infants had lower weight, length, and HC z-scores at 3-, 6-, and 9-months. At 9-months, infants with SV physiology had larger TSF and SSSF z-scores over 2V and healthy infants. Overall MUAC z-scores were smaller at 3- and 6-months in infants with CHD. CONCLUSISON Infants with CHD have a complex pattern of growth. Longitudinal growth and body composition measurements provide information to better understand this pattern.
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Affiliation(s)
- Sharon Y Irving
- University of Pennsylvania School of Nursing, Philadelphia, USA.,Children's Hospital of Philadelphia, PA, USA
| | - Chitra Ravishankar
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Mary Miller
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Jesse Chittams
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Virginia Stallings
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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15
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Becker PJ, Brunet-Wood MK. Pediatric malnutrition screening and assessment tools: Analyzing the gaps. Nutr Clin Pract 2021; 37:1088-1104. [PMID: 34664733 DOI: 10.1002/ncp.10793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Pediatric healthcare professionals know that children who are malnourished have worse clinical outcomes than do their well-nourished peers. The body of evidence in the literature on the topic of pediatric malnutrition (PMN) is growing and supports this conclusion. The goal of this article is to present the current state of practice related to PMN screening, the use of malnutrition risk screening (MNRS) tools, malnutrition assessment, and the use of malnutrition assessment tools. The purpose is also to discuss best practice for MNRS and assessment and to consider the gaps in practice where additional work is needed.
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Affiliation(s)
| | - M Kim Brunet-Wood
- Pediatric Working Group, Canadian Malnutrition Task Force, St Albert, Alberta, Canada
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16
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Zorrilla-Revilla G, Rodrigues D, Machado-Rodrigues AM, Mateos A, Rodríguez J, Padez C. Sex-specific differences in somatic investment and strategies of physical activity among Portuguese schoolchildren. Am J Hum Biol 2021; 34:e23626. [PMID: 34076323 DOI: 10.1002/ajhb.23626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Physical activity (PA) is required for healthy growth, development, and maturation and plays an important role in the prevention of overweight and obesity in childhood and adolescence. Sex-differences in PA levels are well documented, with boys spending more time in PA, especially in moderate-to-vigorous activities. Following the Life History Theory, our aim is to study if PA affects the fat tissues increases during childhood and juvenile phases in both sexes. METHODS Time spent in sedentary, light, and moderate-to-vigorous PA levels were measured in a sample of 415 Portuguese children and juveniles (207 females/208 males; aged 6-11 years), using an accelerometer for 7 days. Skinfolds related with body fat were objectively collected and socioeconomic status factors were reported using a parental questionnaire. RESULTS The outcomes show that girls' and boys' fat variables increased during the end of the childhood and the juvenile phase. However, these variables were differently affected by PA. Girls increased fat variables with the sedentary activity while boys decreased fat variables with moderate-to-vigorous PA. Alike, active boys but not girls reduced the fat increase tendency with age. CONCLUSIONS Although both sexes displayed a general fat increment with age, moderate-to-vigorous PA dampens the increase only in boys. In fact, active girls increased body fat in the same manner as non-active girls. From an evolutionary perspective, it could explain sex-specific somatic strategies related to future reproduction or, with future mating and intrasexual competition.
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Affiliation(s)
| | - Daniela Rodrigues
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Aristides M Machado-Rodrigues
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Coimbra, Portugal.,High School of Education, Polytechnic Institute of Viseu, Viseu, Portugal
| | - Ana Mateos
- National Research Center on Human Evolution, CENIEH, Burgos, Spain
| | - Jesús Rodríguez
- National Research Center on Human Evolution, CENIEH, Burgos, Spain
| | - Cristina Padez
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Coimbra, Portugal.,Department of Life Sciences, University of Coimbra, Coimbra, Portugal
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17
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Mazzoni BP, Lessa BV, Zamberlan P. METABOLIC AND NUTRITIONAL REPERCUSSIONS OF LIVER DISEASE ON CHILDREN: HOW TO MINIMIZE THEM? ACTA ACUST UNITED AC 2021; 40:e2020149. [PMID: 34076201 PMCID: PMC8240628 DOI: 10.1590/1984-0462/2022/40/2020149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022]
Abstract
Objective: To describe the metabolic and nutritional repercussions of chronic liver disease (CLD), proposing strategies that optimize nutritional therapy in the pre- and post-liver transplantation (LT) period, in order to promote favorable clinical outcomes and adequate growth and development, respectively. Data sources: Bibliographic search in the PubMed, Lilacs and SciELO databases of the last 12 years, in English and Portuguese; target population: children from early childhood to adolescence; keywords in Portuguese and their correlates in English: “Liver Transplant,” “Biliary Atresia,” “Nutrition Therapy,” “Nutritional Status,” and “Child”; in addition to Boolean logics “and” and “or,” and the manual search of articles. Data synthesis: Malnutrition in children with CLD is a very common condition and an important risk factor for morbidity and mortality. There is an increase in energy and protein demand, as well as difficulties in the absorption of carbohydrates, lipids and micronutrients such as fat-soluble vitamins and some minerals. An increase in the supply of energy, carbohydrates and proteins and micronutrients, especially fat-soluble vitamins, iron, zinc and calcium, is suggested, except in cases of hepatic encephalopathy (this restriction is indicated for a short period). Conclusions: Based on metabolic changes and anthropometric and body composition monitoring, a treatment plan should be developed, following the nutritional recommendations available, in order to minimize the negative impact of malnutrition on clinical outcomes during and after LT.
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Toh S, Ong C, Sultana R, Kirk AHP, Koh JC, Lee JH. Association between admission body mass index and outcomes in critically ill children: A systematic review and meta-analysis. Clin Nutr 2021; 40:2772-2783. [PMID: 33933743 DOI: 10.1016/j.clnu.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/23/2021] [Accepted: 04/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS The association between nutritional status at pediatric intensive care unit (PICU) admission with clinical outcomes remains unclear. We conducted this systematic review to summarize the overall impact of PICU admission body mass index (BMI) on clinical outcomes. METHODS We searched the following medical databases from inception through May 2020: PubMed, Excerpta Medica database (Embase), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Web of Science. We included studies on patients ≤18 years old admitted to a PICU that investigated the effect of BMI on mortality, PICU or hospital length of stay (LOS), or duration of mechanical ventilation (MV). Classification of underweight, overweight, and obese were based on each study's criteria. RESULTS There was a total of 21,558 patients from 20 included studies. 12,936 (60.0%), 2965 (13.8%), 2182 (10.1%), 3348 (15.5%) were normal weight, underweight, overweight, and obese patients, respectively. Relative to normal weight patients, underweight (OR 1.32, 95% CI 0.89-1.98; p = 0.171) and overweight/obese patients (OR 1.10, 95% CI 0.86-1.42; p = 0.446) did not have an increase risk in mortality. There was also no difference in duration of MV, PICU and hospital LOS between all three weight categories. Included studies were heterogeneous and lacked standardized nutritional categorization. Sensitivity analysis including only studies that used BMI z-scores as nutritional classification (n = 5) revealed that underweight patients had higher odds of mortality compared to patients with normal weight (OR 1.61, 95% CI 1.35-1.92; p < 0.001); studies that used percentiles as classification did not reveal any differences in mortality. Sensitivity analysis including only studies containing mixed PICU cohorts (i.e., excluding specialized cohorts e.g., congenital heart surgeries, burns) revealed higher mortality odds in underweight patients (OR 1.53, 95% CI 1.25-1.87; p < 0.001) and overweight/obese patients (OR 1.51, 95% CI 1.14-2.01; p = 0.004) relative to normal weight patients. CONCLUSIONS Our systematic review did not reveal any association between PICU admission BMI status and outcomes in critically ill children. Further investigation with standardized nutrition status classification on admission, stratified by patient subgroups, is needed to clarify the association between nutritional status and clinical outcomes of PICU patients.
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Affiliation(s)
- Samantha Toh
- Duke-NUS Medical School, 8 College Rd, 169857, Singapore
| | - Chengsi Ong
- Department of Nutrition and Dietetics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore
| | - Rehena Sultana
- Duke-NUS Medical School, 8 College Rd, 169857, Singapore
| | - Angela Hui Ping Kirk
- Children's Intensive Care Unit, Division of Nursing, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore
| | - Janine Cynthia Koh
- Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore
| | - Jan Hau Lee
- Duke-NUS Medical School, 8 College Rd, 169857, Singapore; Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore.
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19
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Bellini SG, Chapman P, Szendre K, McDonald C, Williams N, Hopkin L, Eggett D, Dean A. Changes in handgrip strength in children with cystic fibrosis compared to children without cystic fibrosis. Clin Nutr ESPEN 2021; 42:206-211. [PMID: 33745579 DOI: 10.1016/j.clnesp.2021.01.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Cystic Fibrosis (CF) may impact nutritional status. Handgrip strength (HGS) may be used for nutrition assessment. The objective of the study was to evaluate changes in HGS over time in children with CF compared to children without CF. A secondary purpose was to analyze the relationship of clinical characteristics of CF with HGS. METHODS A prospective, longitudinal study was conducted. The non-CF group (n = 76) was recruited from a school and the CF group (n = 75) from an accredited CF center. Height, weight, mid-upper arm circumference, triceps skinfold, and HGS were measured at baseline and approximately three and six months in both groups. Data for pulmonary function, nutrition risk, enteral supplementation, CF transmembrane conductance regulator modulator, steroids, antibiotics, vitamin levels, CF related diabetes (CFRD), and recent hospitalization were collected for the CF group. A mixed model determined the difference in the change in HGS between the CF group and the non-CF group. For all analyses, p=<0.05 was significant. RESULTS The rate of change in HGS z-score in the CF-group (0.18 ± 0.05) versus the non-CF group (0.06 ± 0.06) was not significant (p = 0.15). Initial mean dominant HGS z-score was significantly lower (p = 0.02) in those with vitamin D deficiency (-1.35 ± 0.09) versus those without (-1.02 ± 0.11). HGS z-score significantly (p = 0.02) decreased over time in children with CFRD (-0.19 ± 0.22) versus children without CFRD (0.32 ± 0.14), p = 0.02. CONCLUSION Serial measurements of HGS may help detect changes in muscle function related to CFRD and vitamin D deficiency. Further investigation is warranted to elucidate HGS's role in nutrition assessment of children with CF.
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Affiliation(s)
- Sarah Gunnell Bellini
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, Provo, UT 84602, USA.
| | - Perry Chapman
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, Provo, UT 84602, USA.
| | - Kayla Szendre
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, Provo, UT 84602, USA.
| | - Catherine McDonald
- Primary Children's Hospital Cystic Fibrosis Center, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA.
| | - Nicole Williams
- Primary Children's Hospital Cystic Fibrosis Center, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA.
| | - Lauren Hopkin
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, Provo, UT 84602, USA.
| | - Dennis Eggett
- Statistics Department, Brigham Young University, Provo, UT 84602, USA.
| | - April Dean
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, Provo, UT 84602, USA; Freedom Prep Academy, 1190 W 900 N, Provo, UT 84604, USA.
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20
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Ouyang N, Lu X, Cai R, Liu M, Liu K. Nutritional Screening and Assessment, and Quality of Life in Children with Cancer: A Cross-Sectional Study in Mainland China. J Pediatr Nurs 2021; 57:99-105. [PMID: 32962884 DOI: 10.1016/j.pedn.2020.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To apply Screening Tool for Risk on Nutritional status and Growth (STRONGkids) and the subjective global nutritional assessment (SGNA) for evaluating nutritional status, to identify the disease-related and demographic-related factors of malnutrition, and to examine the relationship between nutritional status and quality of life (QOL) in children with cancer during chemotherapy in mainland China. DESIGN AND METHODS Children, ages 2-18, with a leukemia, lymphoma, or solid tumor diagnosis were recruited from a top cancer center in Guangzhou, China. Socio-demographic information, clinical information were collected, while nutritional status using SGNA, malnutrition risk using STRONGkids, and QOL of these children were measured. Descriptive analyses, Chi2-tests, ANOVA and logistic regression analysis were used to analyze data. RESULTS Among included participants, 55.8% of them were malnourished, and 74.2% of them had moderate to high risk of malnutrition. The overall QOL and subscales were associated with nutritional status. In the logistic-regression model, high malnutrition risk, patients' mother having primary school education or less, worse physical functioning quality of life, and lower BMI level were strongly associated with malnutrition. CONCLUSIONS The prevalence of malnutrition in children with cancer is high, which related to worse QOL. Patients' BMI, physical functioning QOL and mothers' educational level could help to predict their nutritional status. PRACTICE IMPLICATIONS STRONGkids and SGNA could be widely used in mainland China. Health professionals should pay attention to patients with lower BMI and physical functioning scores, and patients' mother having primary school education or less.
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Affiliation(s)
- Na Ouyang
- School of Nursing, Sun Yat-sen University, Guangdong, China
| | - Xia Lu
- School of Nursing, Sun Yat-sen University, Guangdong, China
| | - Ruiqing Cai
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangdong, China
| | - Meiling Liu
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangdong, China
| | - Ke Liu
- School of Nursing, Sun Yat-sen University, Guangdong, China.
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21
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Phong RY, Taylor SL, Robinson BA, Jhawar S, Nandalike K. Utility of Mid-Upper Arm Circumference in Diagnosing Malnutrition in Children With Cystic Fibrosis. Nutr Clin Pract 2020; 35:1094-1100. [PMID: 33078441 DOI: 10.1002/ncp.10593] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Standardized diagnostic indicators for malnutrition using growth percentile z-scores (weight for length or body mass index [BMI]) and mid-upper arm circumference (MUAC) z-scores are being used in clinical practice; however, their application to the pediatric cystic fibrosis (CF) population is not well described. In this study, we aim to compare growth percentile z-scores and MUAC z-scores in diagnosing and classifying malnutrition in children with CF and assess the relationship between their degree of malnourishment and corresponding pulmonary function tests (PFTs). METHODS In this retrospective observational outpatient study of 49 pediatric CF patients, data were collected on baseline characteristics, anthropometrics, and PFTs over 12 months. Agreement in malnutrition diagnoses was quantified by Cohen κ statistics. Pearson test assessed the correlation between MUAC and BMI z-scores as well as PFTs and anthropometrics. Serial anthropometrics and PFTs were obtained and compared for a subset of patients (n = 28). RESULTS Growth percentile and MUAC z-scores were positively correlated in diagnosing malnutrition (Pearson correlation r = 0.87), but MUAC z-scores identified more patients as malnourished compared with growth percentile z-scores (49% vs 12%, Cohen κ of 0.22 [95% CI, 0.04-0.40]). There was no significant relationship between anthropometrics and PFTs. MUAC z-scores increased significantly over time, but BMI z-scores did not show this trend. CONCLUSIONS Our small-scale data suggest a promising role for MUAC z-scores in classifying malnutrition and in measuring changes in nutrition status over time in pediatric CF.
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Affiliation(s)
- Rachel Y Phong
- Department of Food and Nutrition Services, University of California Davis Health, Sacramento, California, USA
| | - Sandra L Taylor
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Sacramento, California, USA
| | - Brandt A Robinson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California Davis Health, Sacramento, California, USA
| | - Sanjay Jhawar
- Division of Pulmonary Medicine, Department of Pediatrics, University of California Davis Health, Sacramento, California, USA
| | - Kiran Nandalike
- Division of Pulmonary Medicine, Department of Pediatrics, University of California Davis Health, Sacramento, California, USA
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22
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Bellini SG, Becker PJ, Carney LN, Green Corkins K, Medico T, Van Poots HA. Current Practices Using Pediatric Malnutrition Indicators: A Survey of Dietitians Working in Pediatrics. Nutr Clin Pract 2020; 35:1080-1086. [DOI: 10.1002/ncp.10495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sarah Gunnell Bellini
- Nutrition, Dietetics, and Food Science Department Brigham Young University Provo Utah USA
| | - Patricia J. Becker
- Dayton Children's Hospital Medical Center Dayton Ohio USA
- Owner KidsRD.com/PediatricMalnutrition.com Dayton Ohio USA
| | | | - Kelly Green Corkins
- Le Bonheur Children's Hospital Department of Nutrition Therapy Memphis Tennessee USA
| | - Tegan Medico
- Morrison Healthcare/University of Virginia Health System Charlottesville Virginia USA
- University of Virginia–School of Continuing and Professional Studies Charlottesville Virginia USA
- Piedmont Valley Community College–Division of Business, Mathematics & Technologies Charlottesville Virginia USA
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23
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Utilization of Current Diagnostic Indicators to Characterize Pediatric Undernutrition among US Children. Nutrients 2020; 12:nu12051409. [PMID: 32422888 PMCID: PMC7285203 DOI: 10.3390/nu12051409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to estimate the prevalence of pediatric undernutrition in the US general population using the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition consensus statement on identification of pediatric malnutrition (undernutrition). National Health and Nutrition Examination Survey (NHANES) data for years 2005–2014 was analyzed for children ages 1–13 years (n = 13,950) with valid anthropometric data. The prevalence of undernutrition was assessed through z-scores for weight-for-height, body mass index (BMI)-for-age, height-for-age, and mid-upper-arm circumference-for-age generated from the 2000 Centers for Disease Control and Prevention growth charts. Children were stratified into: no undernutrition, mild undernutrition, and moderate or severe undernutrition. Descriptive statistics were used to identify the prevalence of undernutrition. Differences in Z-scores across growth chart metrics were compared across undernutrition categories using analysis of variance. The total prevalence of pediatric undernutrition in this sample was 0.4% (severe undernutrition), 2.0% (moderate undernutrition), and 10.9% (mild undernutrition) for all ages. Z-scores differed significantly across all levels of undernutrition for all anthropometrics, showing poorer mean growth metrics in those with undernutrition. Pediatric undernutrition is a prevalent condition that transcends the prior focus on <5th percentile of growth curves and impacts children across different demographic categories.
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Feng S, Cheng L, Lu H, Shen N. Nutritional Status and Clinical Outcomes in Children with Cancer on Admission to Intensive Care Units. Nutr Cancer 2020; 73:83-88. [PMID: 32188289 DOI: 10.1080/01635581.2020.1742361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Malnutrition is prevalent among pediatric oncology patients admitted to the pediatric intensive care unit (PICU), which leads to unfavorable clinical outcomes. This was a secondary data analysis of the nutrition data of 160 pediatric oncology patients admitted to the PICU. Cox's regression (adjusted for sex, age, and pediatric critical illness score) and Chi-square were used to examine the association between nutritional status and outcomes. Most of the patients were diagnosed with leukemia and admitted to PICU for medical reasons. The prevalence of malnutrition was 11.3% according to weight-for-age z-score, 16.3% according to height-for-age z-score, 21.3% according to body mass index-for-age z-score, 14.4% according to weight-for-height z-score, 34.4% according to mid-upper arm circumference-for-age z-score. Anthropometrical parameters that predicted the duration of mechanical ventilation were weight-for-age (hazard ratio [HR], 2.727; 95% confidence interval [CI], 1.729-4.302); height-for-age (HR, 1.969; 95% CI, 1.440-2.693); weight-for-height (HR, 2.645; 95% CI, 1.575-4.441); and upper arm muscle area-for-age (HR, 2.098; 95% CI, 1.430-3.077). Length of PICU stay was predicted by weight-for-age (HR, 1.207; 95% CI, 1.014-1.436). Malnutrition is prevalent among pediatric oncology patients admitted to the PICU, which lead to unfavorable clinical outcomes. Comprehensive nutritional status assessment should be performed for these children.
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Affiliation(s)
- Sheng Feng
- Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Cheng
- School of Nursing, Fudan University, Shanghai, China
| | - Hua Lu
- Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Nanping Shen
- Hemotology & Oncology, Nursing Department, Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Miller MA, Mallory K, Escobedo M, Tarot AC, Abdel-Rahman S. Assessing effectiveness of a novel mid-upper arm circumference Z-score tape in a community setting in Guatemala. ACTA ACUST UNITED AC 2019; 77:44. [PMID: 31592316 PMCID: PMC6777036 DOI: 10.1186/s13690-019-0370-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022]
Abstract
Background Mid-Upper Arm Circumference (MUAC) is an independent anthropometric measurement used to identify malnutrition in children. While much research has been dedicated to applying fixed estimates of MUAC to identify cases of malnutrition in children under 5 years of age, far less has been done with age-specific MUAC Z-score values across the continuum of age from birth through adolescence. Methods The present study examined the effectiveness of a novel MUAC Z-score tape, in the hands of community health volunteers, to identify children over the age of 5 who would benefit from nutritional rehabilitation. In January of 2019, 112 community health volunteers working within Children International in Guatemala were trained to use the MUAC Z-score tape and asked to collect measurements on children or youth in their communities. Results Of the 818 MUAC Z-score tape measurements obtained by volunteers, 88.26% (722/818) were concordant with nutritional risk status as predicted by BMI Z-score, and 90.95% (744/818) were concordant with MUAC Z-score tape measurements made by field medical staff. MUAC Z-scores identified 87.10% (27/31) of the severely or moderately undernourished children as determined by the BMI Z-score who would be candidates for the nutrition rehabilitation program (Z-score ≤ − 2) along with an additional six children that would not have been classified as such with BMI Z-score. A qualitative survey distributed to the volunteers showed moderate rates of understanding of nutritional risk using the tape, and 62.50% reported the tape was easy to use. Conclusions These quantitative and qualitative findings suggest that with more in-depth training and education the MUAC Z-score tape is a viable, low-cost, low-burden alternative for community-level nutritional status assessment among the population served by Children International in Guatemala. Supplementary information Supplementary information accompanies this paper at (10.1186/s13690-019-0370-0).
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Nutrition Support of Children With Chronic Liver Diseases: A Joint Position Paper of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2019; 69:498-511. [PMID: 31436707 DOI: 10.1097/mpg.0000000000002443] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic liver disease places patients at increased risk of malnutrition that can be challenging to identify clinically and treat. Nutrition support is a key aspect of the management of these patients as it has an impact on their quality of life, morbidity, and mortality. There are significant gaps in the literature regarding the optimal nutrition support for patients with different types of liver diseases and the impact of these interventions on long-term outcomes. This Position Paper summarizes the available literature on the nutritional aspects of the care of patients with chronic liver diseases. Specifically, the challenges associated with the nutritional assessment of these subjects are discussed, and recently investigated approaches to determining the patients' nutritional status are reviewed. Furthermore, the pathophysiology of the malnutrition seen in the context of chronic liver disease is summarized and monitoring, as well as treatment, recommendations are provided. Lastly, suggestions for future research studies are described.
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Thaete K, Rowzer K, Stephens K, Abdel-Rahman SM. User-Informed Medical Device Development: A Case Study for Pediatric Malnutrition Assessment. Glob Pediatr Health 2019; 6:2333794X19861575. [PMID: 31360739 PMCID: PMC6636220 DOI: 10.1177/2333794x19861575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/16/2022] Open
Abstract
Background. Mid-upper arm circumference (MUAC) has been
extensively used to classify pediatric malnutrition. Recently, MUAC
z score was recommended; however, the logistics of
implementation were not addressed. This study examines the usability of a device
that provides MUAC and corresponding z score range in a single
device. Methods. This was a single-center study of nutrition
services providers. The device was applied to children aged 2 months to 18 years
admitted as inpatients or seen as outpatients. Surveys incorporated benchmarking
questions, assessed the ease with which respondents could perform 6 critical
tasks, and provided an open-ended question to elicit feedback. Users were
surveyed monthly until saturation was reached. Survey data were analyzed in
aggregate and cross-tabulated by the respondents’ experience with the device.
Thematic analysis of the open-ended responses followed a structured approach.
Results. Sixty device users responded to the survey 280
times. Respondents were female (100%) with a mean age of 45.2 ± 13.2 years and
9.6 ± 8.0 years in practice. Increasing device use was accompanied by
significantly shortened measuring times (P < .001) and
shifts in ease of performance for 5 of 6 critical tasks (P <
.05). Open-ended response themes related largely to design and materials. These
were used to iteratively refine the device. Conclusions. The
active engagement of end users in the real-world testing of our nutritional
assessment device allowed us to refine the innovation with special attention
paid to the needs of dietitians. The result is a device the majority of
dietitians found easy to use, efficient, convenient, and preferable to
alternative measurement options.
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Affiliation(s)
- Kristi Thaete
- Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Kasey Rowzer
- Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Karen Stephens
- Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Susan M Abdel-Rahman
- Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri-Kansas City, MO, USA
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Stephens K, Orlick M, Beattie S, Snell A, Munsterman K, Oladitan L, Abdel-Rahman S. Examining Mid-Upper Arm Circumference Malnutrition z-Score Thresholds. Nutr Clin Pract 2019; 35:344-352. [PMID: 31175704 DOI: 10.1002/ncp.10324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Anthropometric z-scores used commonly for diagnosis and determining degree of malnutrition, specifically body mass index (BMIz), weight-for-length (WLz), and mid-upper arm circumference (MUACz), are not wholly concordant, yet the proposed thresholds for classification are identical. This study was designed to critically examine MUACz thresholds and their ability to correctly classify nutrition status. METHODS This was a 2-year, prospective single-center study of children ≤18 years seen by registered dietitians within a large pediatric institution. The sensitivity, specificity, and predictive performance of the malnutrition classification thresholds were estimated against clinician-based classification. RESULTS Sixty-one dietitians enrolled 10,401 patients with distributions of z-scores for weight (-0.5 ± 1.9), length (-0.8 ± 1.6), BMI or WL (-0.1 ± 1.8), and MUAC (-0.4 ± 1.5), suggesting participants were smaller and shorter than the reference U.S. POPULATION Distributions of MUACz were broad and overlapped between nutrition classification groups, an observation that extended to BMIz and WLz as well. Consequently, existing thresholds do not accurately classify 100% of children. Misclassification rates increase, with increasing severity ranging from 8% in children with no malnutrition to 71% in children with severe malnutrition. Algorithm- and manually-based refinement of thresholds result in mixed improvements and can be explored by the reader with the associated supplement. CONCLUSION The sensitivity of proposed MUACz thresholds systematically decreases with increasing severity of malnutrition and will require optimization if we aim to limit the number of children at risk of misclassification. Indicators for overnutrition remain to be addressed but are explored herein.
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Affiliation(s)
- Karen Stephens
- Nutrition Services, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Meike Orlick
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | - Audrey Snell
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | - Leah Oladitan
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Susan Abdel-Rahman
- UMKC School of Medicine, Kansas City, Missouri, USA.,Innovation in Health Care Delivery, Children's Research Institute, Kansas City, Missouri, USA.,Section of Therapeutic Innovation, Children's Mercy Hospital, Kansas City, Missouri, USA
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Mogensen KM, Malone A, Becker P, Cutrell S, Frank L, Gonzales K, Hudson L, Miller S, Guenter P. Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Usability and Association With Outcomes. Nutr Clin Pract 2019; 34:657-665. [PMID: 31074906 DOI: 10.1002/ncp.10310] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Malnutrition has been documented in approximately one-third of patients in developed countries on hospital admission and is associated with negative clinical outcomes. The need to identify and intervene in at-risk patients is critical to minimize these negative outcomes. A consensus approach for diagnosing and documenting malnutrition in hospitalized adult and pediatric patients was published jointly by the Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (ASPEN) in 2012 and 2014, respectively. The purpose of this paper is to review the available literature on the usability, feasibility, validity, and reliability of both the adult and pediatric consensus malnutrition diagnostic approaches, as well as to evaluate their use in studying clinical outcomes. In adults, abstracts and published studies have shown the diagnostic tool is a usable, feasible, and reliable method for the identification of severe and non-severe or moderate malnutrition. In pediatrics, only 1 published study to date used the pediatric malnutrition indicators, indicating the need to demonstrate that the tool is feasible, valid, and reliable. Both the adult and pediatric tools have shown significant correlation with negative clinical outcomes in malnourished patients, including increased mortality, increased hospital length of stay (adults), increased complications (pediatrics), and increased hospital readmissions. Further large-scale studies are needed to evaluate the feasibility, usability, validity, and reliability of both the adult and pediatric malnutrition diagnostic approaches.
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Affiliation(s)
- Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ainsley Malone
- Nutrition Support Team, Mt. Carmel West Hospital, Columbus, Ohio, USA.,American Society for Parenteral and Enteral Nutrition Silver Spring, Silver Spring, Maryland, USA
| | | | - Stephanie Cutrell
- Pharmacy Department, Vidant Medical Center, Greenville, North Carolina, USA
| | - Laura Frank
- MultiCare Health System, Tacoma, Washington, USA
| | | | - Lauren Hudson
- Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah Miller
- Skaggs School of Pharmacy, University of Montana, Missoula, Montana, USA
| | - Peggi Guenter
- Clinical Practice, Quality, and Advocacy, American Society for Parenteral and Enteral Nutrition Silver Spring, Silver Spring, Maryland, USA
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Wong Vega M, Beer S, Juarez M, Srivaths PR. Malnutrition Risk in Hospitalized Children: A Descriptive Study of Malnutrition-Related Characteristics and Development of a Pilot Pediatric Risk-Assessment Tool. Nutr Clin Pract 2018; 34:406-413. [PMID: 30294809 DOI: 10.1002/ncp.10200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Underrecognition of pediatric malnutrition may affect nutrition interventions and outcomes. Pediatric malnutrition uses more specific etiology-based criteria but lacks clarity in implementation guidelines. Study goals were to identify malnutrition and risk among hospitalized patients, characterize malnutrition risk factors, and assess reliability of criteria against outcome measures. MATERIALS AND METHODS All children 44 weeks postmenstrual age-18 years, admitted for 48 hours during a 16-day period, were included (n = 528). Trained dietitians assessed patients in physical assessments (PA), growth, energy intake, increased nutrient losses (IL), altered absorption of nutrients (AA), hypermetabolism and inflammation, laboratory information, micronutrient deficiency, and functional status. Outcome data assessed were length of stay (LOS), intensive care unit (ICU) LOS, ventilation days, nutrition support, and dietitian intervention. RESULTS Malnutrition prevalence upon admission was 19.7%. Weight/length or BMI/age z-score (ZS) had no effect on LOS. AA and IL upon admission were independently associated with malnutrition (both, P<.01). Wasting and hypermetabolism were independently associated with longer LOS (P<.01). Other factors associated with longer LOS included IL and inflammation (P < .05). Those with hypermetabolism had significant ZS improvements if followed by a dietitian (P < .05). Wasting via PA was the only factor associated with longer ICU LOS (P < .05). CONCLUSIONS Identification of risk factors (wasting, hypermetabolism, AA, IL) beyond anthropometrics to define malnutrition and risk is important in prioritizing care in a tertiary pediatric facility. Of great significance is the ability of dietitian-based PA to predict LOS and need for intervention.
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Affiliation(s)
- Molly Wong Vega
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Stacey Beer
- Gastroenterology, Hepatology and Nutrition Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Marisa Juarez
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Poyyapakkam R Srivaths
- Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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