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Brunet-Wood K, Tul-Noor Z, Bandsma RHJ, Carter L, Fleming-Carroll B, Gramlich L, Hutchison K, Huysentruyt K, Kalnins D, Marchand V, Martinez A, Pai N, Vachon M, Hulst JM. Development of the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) using a modified Delphi technique. Appl Physiol Nutr Metab 2024; 49:700-711. [PMID: 38320255 DOI: 10.1139/apnm-2023-0180] [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] [Indexed: 02/08/2024]
Abstract
One in three hospitalized children have disease-related malnutrition (DRM) upon admission to hospital, and all children are at risk for further nutritional deterioration during hospital stay; however, systematic approaches to detect DRM in Canada are lacking. To standardise and improve hospital care, the multidisciplinary pediatric working group of the Canadian Malnutrition Taskforce aimed to develop a pediatric, inpatient nutritional care pathway based on available evidence, feasibility of resources, and expert consensus. The working group (n = 13) undertook a total of four meetings: an in-person meeting to draft the pathway based on existing literature and modelled after the Integrated Nutrition Pathway for Acute Care (INPAC) in adults, followed by three online surveys and three rounds of online Delphi consensus meetings to achieve agreement on the draft pathway. In the first Delphi survey, 32 questions were asked, whereas in the second and third rounds 27 and 8 questions were asked, respectively. Consensus was defined as any question/issue in which at least 80% agreed. The modified Delphi process allowed the development of an evidence-informed, consensus-based pathway for inpatients, the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC). It includes screening <24 h of admission, assessment with use of Subjective Global Nutritional Assessment (SGNA) <48 h of admission, as well as prevention, and treatment of DRM divided into standard, advanced, and specialized nutrition care plans. Research is necessary to explore feasibility of implementation and evaluate the effectiveness by integrating P-INPAC into clinical practice.
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Affiliation(s)
- Kim Brunet-Wood
- Canadian Malnutrition Task Force, Canadian Nutrition Society, Ottawa, ON K1C 6A8, Canada
| | - Zujaja Tul-Noor
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Robert H J Bandsma
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Laura Carter
- Nutrition Services, Alberta Health Services, Edmonton, AB, Canada
| | - Bonnie Fleming-Carroll
- SickKids Learning Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Leah Gramlich
- Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Kim Hutchison
- Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada
| | - Koen Huysentruyt
- Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Daina Kalnins
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Valerie Marchand
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Ste-Justine UHC, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Andrea Martinez
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, IWK Health Centre, University of Dalhousie, Halifax, NS B3K 6R8, Canada
| | - Nikhil Pai
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Mélanie Vachon
- Department of Clinical Nutrition, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, G1R 2J6, Canada
| | - Jessie M Hulst
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
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2
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Hulst JM, van de Vorst K, Olieman JF, Hendriks DM, Oudshoorn JH, Plötz FB, Roskam M, van der Schoor SRD, Tramper-Stranders GA, Verhoeven JJ, van Wering HM, Winder E, Joosten KFM. Prospective evaluation and follow-up of nutritional status of children hospitalized in secondary-care level hospitals: a multicentre study. Appl Physiol Nutr Metab 2024; 49:680-686. [PMID: 38359413 DOI: 10.1139/apnm-2023-0188] [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] [Indexed: 02/17/2024]
Abstract
Although disease-associated undernutrition is still an important problem in hospitalized children that is often underrecognized, follow-up studies evaluating post-discharge nutritional status of children with undernutrition are lacking. The aim of this multicentre prospective observational cohort study was to assess the rate of acute undernutrition (AU) and/or having a high nutritional risk (HR) in children on admission to seven secondary-care level Dutch hospitals and to evaluate the nutritional course of AU/HR group during admission and post-discharge. STRONGkids was used to indicate HR, and AU was based on anthropometric data (z-score < -2 for weight-for-age (WFA; <1 year) or weight-for-height (WFH; ≥1 year)). In total, 1985 patients were screened for AU/HR over a 12-month period. On admission, AU was present in 9.9% of screened children and 6.2% were classified as HR; 266 (13.4%) children comprised the AU/HR group (median age 2.4 years, median length of stay 3 days). In this group, further nutritional assessment by a dietitian during hospitalization occurred in 44% of children, whereas 38% received nutritional support. At follow-up 4-8 weeks post-discharge, 101 out of orginal 266 children in the AU/HR group (38%) had available paired anthropometric measurements to re-assess nutrition status. Significant improvement of WFA/WFH compared to admission (-2.48 vs. -1.51 SD; p < 0.001) and significant decline in AU rate from admission to outpatient follow-up (69.3% vs. 35.6%; p < 0.001) were shown. In conclusion, post-discharge nutritional status of children with undernutrition and/or high nutritional risk on admission to secondary-care level pediatric wards showed significant improvement, but about one-third remained undernourished. Findings warrant the need for a tailored post-discharge nutritional follow-up.
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Affiliation(s)
- Jessie M Hulst
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Kelly van de Vorst
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joanne F Olieman
- Department of Dietetics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Daniëlle M Hendriks
- Department of Paediatrics, HAGA Hospital-Juliana Children's Hospital, The Hague, the Netherlands
| | | | - Frans B Plötz
- Department of Paediatrics, Tergooi Hospital, Blaricum, the Netherlands
| | - Mariëlle Roskam
- Department of Paediatrics, Sint Lucas Andreas Hospital, Amsterdam, the Netherlands
| | | | | | | | | | - Eefje Winder
- Department of Dietetics, MC Alkmaar, Alkmaar, the Netherlands
| | - Koen F M Joosten
- Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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3
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Pepe A, Mandato C, Di Leo T, Boccia G, Lucaroni G, Franci G, Mauro C, Di Cara G, Valitutti F. Celiac Disease on the Bed-Side: Embedding Case Finding and Screening in Hospitalized Children. Nutrients 2023; 15:4899. [PMID: 38068757 PMCID: PMC10708066 DOI: 10.3390/nu15234899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Strategies for diagnosing celiac disease (CD) include case-finding and population-screening programs. Case finding consists of testing individuals at increased risk for the disease due to symptoms or associated conditions. Screening programs are widespread campaigns, which definitely perform better in terms of unveiling CD diagnoses but nowadays are still debatable. The global prevalence of CD is around 1% but it almost doubles when considering screening programs among school children. Within this framework, we aimed to estimate the prevalence of CD among hospitalized children in the Pediatric Department of a Southern Italy University Hospital in the period from January 2018 through December 2021. In addition, we attempted to explore, at the time of diagnosis, the prevalence of leading clinical alerts due to malabsorption/malnutrition such as anemia or failure to thrive or due to systemic inflammation/immune dysfunction as hypertransaminasemia and thyroid dysfunction. METHODS Data records of pediatric patients admitted as inpatients and tested by anti-transglutaminase IgA antibodies (TGA-IgA) were retrospectively analyzed. CD was diagnosed according to either 2012 or 2020 ESPGHAN guidelines, depending on the year of diagnosis. CD autoimmunity (CDA) was a wider group defined within our protocol if patients had elevated TGA-IgA on at least one occasion, regardless of anti-endomysial antibodies (EMA-IgA) and without biopsy confirmation. RESULTS During the observation period, 3608 pediatric patients were admitted and 1320 were screened for CD (median age 5 years, IQR 2-9 years; CD test rate: 36.6% out of all admissions). The available prevalence of newly diagnosed CD was 1.59% (21 patients diagnosed) and the available prevalence of CDA was 3.86% (51 subjects). Among CD patients, underweight/malnourished children accounted for 28.6% (6 out of 21). CONCLUSIONS The estimated prevalence of CD diagnoses within our setting was comparable to the most recent population-screening programs. The estimated prevalence of CDA was even higher. A hospital-admission CD testing during routine blood draws might be a non-invasive, cost-effective and valuable approach to reduce discrepancy of prevalence between case-finding and population-screening programs.
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Affiliation(s)
- Angela Pepe
- Pediatrics Section, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (A.P.); (C.M.); (G.L.)
| | - Claudia Mandato
- Pediatrics Section, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (A.P.); (C.M.); (G.L.)
| | - Tiziana Di Leo
- Clinical Pathology and Biochemistry Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy;
| | - Giovanni Boccia
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (G.B.); (G.F.)
| | - Giulia Lucaroni
- Pediatrics Section, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (A.P.); (C.M.); (G.L.)
| | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (G.B.); (G.F.)
| | - Carolina Mauro
- Pediatric Unit, Department of Maternal and Child Health, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy;
| | - Giuseppe Di Cara
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, 06123 Perugia, Italy;
| | - Francesco Valitutti
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, 06123 Perugia, Italy;
- European Biomedical Research Institute of Salerno (EBRIS), Via De Renzi 50, 84125 Salerno, Italy
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4
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Pradelli L, Zaniolo O, Sanfilippo A, Lezo A, Riso S, Zanetti M. Prevalence and economic cost of malnutrition in Italy: A systematic review and metanalysis from the Italian Society of Artificial Nutrition and Metabolism (SINPE). Nutrition 2023; 108:111943. [PMID: 36669368 DOI: 10.1016/j.nut.2022.111943] [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: 05/25/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Disease-related malnutrition (DRM) is a major public health issue with dramatic consequences on outcomes. However, in Italy a comprehensive and updated overview on national prevalence, in both the adult and pediatric populations, and its burden on the health care environment, is missing. The aim of this systematic literature review and meta-analysis was to identify and summarize the available evidence regarding the prevalence of DRM in Italy from pediatric to adult and older ages, and to project its global costs on the health care system. METHODS We performed a systematic literature search for articles on epidemiology of DRM in Italy published up to June 2021. Studies reporting data on the prevalence of DRM in community-dwelling individuals with chronic diseases, nursing home patients, and hospitalized patients (medical, surgery, and oncology patients), were selected for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria. An epidemiologic meta-analysis to obtain an aggregate estimate of prevalence of DRM was performed and a model for estimating the cost of illness, based on the application of epidemiologic results to official national hospitalization data, and attribution of relevant unit costs in the national context was constructed. RESULTS Sixty-seven studies reporting on the prevalence of DRM in Italian populations were included in the final selection; meta-analytical pooling yields mean prevalence estimates of about 50% and 30% in adult and pediatric hospitalized populations, respectively, with even higher findings for residents of long-term care facilities. Modeled projections of DRM-attributable yearly economic effects on the Italian health care system exceed 10 billion € in base case analysis, with the most optimistic estimate still exceeding 2.5 billion €. CONCLUSION Although comparable in magnitude to data from previous studies in analogous international settings, the diffusion and effects of DRM in the Italian setting is impressive. Increased awareness of these data and proactive fostering of clinical nutrition services are warranted, as prompt identification and treatment of malnutrition have been shown to effectively improve clinical and economic results.
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Affiliation(s)
| | | | | | - Antonella Lezo
- Clinical Nutrition Unit, Children's Hospital "Regina Margherita," AOU Città della Salute e della Scienza, Turin, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetic Unit - "Maggiore della Carità" University Hospital, Novara, Italy
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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5
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Iacopelli M, Cereda E, Caccialanza R, Borgatti R, Mensi MM. Delayed appearance of refeeding syndrome in a patient with anorexia nervosa: a case report. Nutrition 2022; 103-104:111788. [DOI: 10.1016/j.nut.2022.111788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/09/2022] [Accepted: 06/25/2022] [Indexed: 10/31/2022]
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Hulst JM, Huysentruyt K, Gerasimidis K, Shamir R, Koletzko B, Chourdakis M, Fewtrell M, Joosten KF. A Practical Approach to Identifying Pediatric Disease-Associated Undernutrition: A Position Statement from the ESPGHAN Special Interest Group on Clinical Malnutrition. J Pediatr Gastroenterol Nutr 2022; 74:693-705. [PMID: 35258497 DOI: 10.1097/mpg.0000000000003437] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
ABSTRACT Disease-associated undernutrition (DAU) is still common in hospitalized children and is generally accepted to be associated with adverse effects on disease outcomes; hence making proper identification and assessment essential in the management of the sick child. There are however several barriers to routine screening, assessment, and treatment of sick children with poor nutritional status or DAU, including limited resources, lack of nutritional awareness, and lack of agreed nutrition policies. We recommend all pediatric facilities to 1) implement procedures for identification of children with (risk of) DAU, including nutritional screening, criteria for further assessment to establish diagnosis of DAU, and follow-up, 2) assess weight and height in all children asa minimum, and 3) have the opportunity for children at risk to be assessed by a hospital dietitian. An updated descriptive definition of pediatric DAU is proposed as "Undernutrition is a condition resulting from imbalanced nutrition or abnormal utilization of nutrients which causes clinically meaningful adverse effects on tissue function and/or body size/composition with subsequent impact on health outcomes." To facilitate comparison of undernutrition data, it is advised that in addition to commonly used criteria for undernutrition such as z score < -2 for weight-for-age, weight-for-length, or body mass index <-2, an unintentional decline of >1inthese z scores over time should be considered as an indicator requiring further assessment to establish DAU diagnosis. Since the etiology of DAU is multifactorial, clinical evaluation and anthropometry should ideally be complemented by measurements of body composition, assessment of nutritional intake, requirements, and losses, and considering disease specific factors.
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Affiliation(s)
- Jessie M Hulst
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario
- the Department of Pediatrics & Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Koen Huysentruyt
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario
- the Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Konstantinos Gerasimidis
- the Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK
| | - Raanan Shamir
- the Institute of Gastroenterology, Nutrition and Liver diseases, Schneider Children's Medical Center, Petah Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Berthold Koletzko
- the LMU - Ludwig-Maximilians-Universitat Munich, Div. Metabolic and Nutritional Medicine, Department Paediatrics, Dr von Hauner Children's Hospital, LMU University Hospitals, Munich, Germany
| | - Michail Chourdakis
- the School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mary Fewtrell
- the UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Koen F Joosten
- the Department of Pediatrics and Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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7
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Verduci E, D'Auria E, Bosetti A, DI Profio E, Vizzuso S, Milanta C, Pendezza E, Borsani B, Zuccotti GV. Immunomodulatory diet in pediatric age. Minerva Pediatr (Torino) 2021; 73:128-149. [PMID: 33880904 DOI: 10.23736/s2724-5276.21.06214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In the last few decades, the importance of a functioning immune system and health status has become more evident. Multiple factors are able to influence the development of chronic diseases and diet is one of the most important environmental factors. Evidence demonstrates that dietary patterns high in fat and low in fiber are associated with the development of non-communicable diseases. Moreover, optimal nutritional status can modulate immune maturation and response to inflammation. During inflammatory conditions, nutritional deficiencies may occur, establishing a vicious circle, consequently a balanced nutritional status is essential to prevent and counteract infections. Dietary diversity can prevent allergic diseases and nutrients such as DHA, arginine, vitamins and trace elements have an impact on physical barriers (such as gut mucosal barrier and skin), on the immune system response and on microbiome modulation. Protein deficiencies can compromise innate and adaptive immune functions; arginine availability can affect the immune response in injured states and other disease processes; EPA and DHA can modulate both innate and adaptive immunity; prebiotics have a beneficial effect on the functioning of the immune system. Zinc, copper, selenium and iron are involved in the correct development and function of the immune system. Vitamins D, E, A, B and C have a role on immune system through different mechanisms of action. Since a complex interplay exists between diet, microbiome and epigenetic factors which determine nutrient-induced changes on the immune function, the effect of each single nutrient may be difficult to study. Well-designed intervention studies, investigating the effects of whole dietary pattern, should be performed to clarify impact of foods on the immune function and disease risk.
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Affiliation(s)
- Elvira Verduci
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy - .,Department of Health Science, University of Milan, Milan, Italy -
| | - Enza D'Auria
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy.,Department of Health Science, University of Milan, Milan, Italy
| | | | | | - Sara Vizzuso
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
| | - Chiara Milanta
- Department of Health Science, University of Milan, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
| | - Barbara Borsani
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
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8
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Maria Monteleone A, Mereu A, Cascino G, Ruzzi V, Castiglioni MC, Patriciello G, Criscuolo M, Pellegrino F, Vicari S, Zanna V. The validity of the fifth and the 10th Body Mass Index percentile as weight cut-offs for anorexia nervosa in adolescence: No evidence from quantitative and network investigation of psychopathology. EUROPEAN EATING DISORDERS REVIEW 2020; 29:232-244. [PMID: 33314419 DOI: 10.1002/erv.2814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Although the fifth Body Mass Index (BMI) percentile is the Diagnostic and Statistic Manual of Mental Disorders -5 weight cut-off criterion to diagnose anorexia nervosa (AN) in children and adolescents, its validity has not been proved, and the 10th percentile value is often applied. We aimed to investigate the diagnostic validity of these weight cut-offs. METHOD We compared general and eating-disorder (ED) specific psychopathology in 380 adolescents with AN or atypical AN. They were grouped first with respect to the fifth BMI percentile and then with respect to the 10th BMI percentile and differences between groups were analysed. Network analyses on psychopathological symptoms were also conducted. RESULTS Adolescents with BMI above the fifth and the 10th percentile reported more severe ED specific symptomatology compared to those with BMI below these cut-offs. No significant differences emerged between groups neither in general psychopathology nor in the network structure of psychopathology. CONCLUSIONS The fifth BMI percentile does not discriminate psychopathology severity in adolescents with AN. From the psychopathology perspective, our findings suggest that adolescents with atypical AN deserve the same clinical and research attention as those with full AN. Future studies are needed to identify a more accurate definition of underweight in adolescents.
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Affiliation(s)
| | - Alberta Mereu
- Child and Adolescent Psychiatry, Center of Excellence in Neuroscience, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Valeria Ruzzi
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Maria Chiara Castiglioni
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | | | - Michela Criscuolo
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Francesca Pellegrino
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Stefano Vicari
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Valeria Zanna
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
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9
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Lezo A, Povero M, Pradelli L, Nigro E, Plazzotta C, Lagazio C. Assessing the Effect of Nutrition Therapy on Rehospitalization Rate in Malnourished Pediatric Patients With Chronic Diseases. JPEN J Parenter Enteral Nutr 2020; 45:1400-1407. [PMID: 33188574 DOI: 10.1002/jpen.2046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Malnutrition is common among hospitalized children with chronic diseases and increases hospital care needs. The aim of this study is to estimate the clinical consequences of nutrition therapy (NT) after discharge. METHODS A retrospective analysis of all pediatric inpatients with diagnosis of malnutrition hospitalized at our center from January 2017 to February 2018 was conducted. Malnutrition was assessed according to body mass index (BMI) z-score, routinely recorded in patient's files. The treatment group consists of all patients referred to nutrition assessment and treated by the clinical nutrition team; all the other patients not receiving NT are selected as the control group. The effect of NT on rehospitalization rates, length of stay (LOS), and emergency room (ER) visits was estimated for the total cohort and in a propensity score (PS) matched sample. RESULTS 277 malnourished pediatric inpatients were enrolled and analyzed. NT was prescribed in 111 patients (40%). Rehospitalization rate was lower in the treated group (rate ratio [RR] = 0.797; 95% CI, 0.630-1.009); particularly, nonelective hospital admissions are considerably lower (RR = 0.556; 95% CI, 0.325-0.952). The strength of this association increased in the PS-matched sample. There is no clear evidence of NT's effect on ER visits (RR = 0.892; 95% CI, 0.580-1.373) or LOS per episode (Δ = 1.46 days; 95% CI, -3.39 to 6.31). CONCLUSIONS Detecting and treating malnutrition seems to promptly improve the patients' clinical course after discharge, reducing the number of subsequent hospitalizations, particularly nonelective ones, probably caused by unresolved, ongoing malnutrition.
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Affiliation(s)
- Antonella Lezo
- Dietetics and Clinical Nutrition Unit, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | | | - Emanuela Nigro
- Dietetics and Clinical Nutrition Unit, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
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10
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Lezo A, Baldini L, Asteggiano M. Failure to Thrive in the Outpatient Clinic: A New Insight. Nutrients 2020; 12:E2202. [PMID: 32722001 PMCID: PMC7468984 DOI: 10.3390/nu12082202] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022] Open
Abstract
Failure to thrive (FTT) is an abnormal growth pattern determined by inadequate nutrition. It is a common problem in children, representing 5% to 10% of patients seen in an outpatient setting. Many definitions have been proposed based on anthropometric deterioration; however, they show poor concordance. No single definition is sufficiently sensitive in identifying faltering growth whilst a combination of multiple criteria seems more accurate. In light of the recent redefinition of pediatric malnutrition as a disequilibrium between requirements and intakes of energy, and macro- and micronutrients, a wider conception of FTT as an unsatisfactory nutritional status related to poor growth and health is useful. Although the most severe problems of micronutrient malnutrition are found in developing countries, people of all regions of the world can be affected by micronutrient deficiencies (MNDs), a form of undernutrition with relevant effects on growth and health. Changes in diets and lifestyle, elimination diets, food insecurity, and food intake disorders create the conditions at risk of faltering growth and MNDs. This new insight integrates the "classical" anthropometric criteria for definition and treatment, in the aim of warranting both a regular increase in size and an overall adequate development and health status.
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Affiliation(s)
- Antonella Lezo
- Dietetic and Clinical Nutrition Unit, Children’s Hospital Regina Margherita, AOU Città della Salute e della Scienza, 10126 Turin, Italy;
| | - Letizia Baldini
- Department of Public Health and Pediatrics, School of Pediatrics, University of Turin, 10126 Turin, Italy;
| | - Monica Asteggiano
- Department of Public Health and Pediatrics, School of Pediatrics, University of Turin, 10126 Turin, Italy;
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McCarthy A, Delvin E, Marcil V, Belanger V, Marchand V, Boctor D, Rashid M, Noble A, Davidson B, Groleau V, Spahis S, Roy C, Levy E. Prevalence of Malnutrition in Pediatric Hospitals in Developed and In-Transition Countries: The Impact of Hospital Practices. Nutrients 2019; 11:nu11020236. [PMID: 30678232 PMCID: PMC6412458 DOI: 10.3390/nu11020236] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/02/2019] [Accepted: 01/13/2019] [Indexed: 01/04/2023] Open
Abstract
Presently, undernutrition still goes undetected in pediatric hospitals despite its association with poor clinical outcomes and increased annual hospital costs, thus affecting both the patient and the health care system. The reported prevalence of undernutrition in pediatric patients seeking care or hospitalized varies considerably, ranging from 2.5 to 51%. This disparity is mostly due to the diversity of the origin of populations studied, methods used to detect and assess nutritional status, as well as the lack of consensus for defining pediatric undernutrition. The prevalence among inpatients is likely to be higher than that observed for the community at large, since malnourished children are likely to have a pre-existent disease or to develop medical complications. Meanwhile, growing evidence indicates that the nutritional status of sick children deteriorates during the course of hospitalization. Moreover, the absence of systematic nutritional screening in this environment may lead to an underestimation of this condition. The present review aims to critically discuss studies documenting the prevalence of malnutrition in pediatric hospitals in developed and in-transition countries and identifying hospital practices that may jeopardize the nutritional status of hospitalized children.
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Affiliation(s)
- Andrea McCarthy
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Edgard Delvin
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Biochemistry, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Valerie Marcil
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Veronique Belanger
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Valerie Marchand
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Pediatrics, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Dana Boctor
- Pediatric Gastroenterology, Alberta Children's Hospital, University of Calgary, Calgary, AL T2N 1N4, Canada.
| | - Mohsin Rashid
- Dalhousie University and IWK Health Center, Halifax, NS B3H 1S6, Canada.
| | - Angela Noble
- Dalhousie University and IWK Health Center, Halifax, NS B3H 1S6, Canada.
| | | | - Veronique Groleau
- Departments of Pediatrics, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Schohraya Spahis
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Claude Roy
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Pediatrics, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Emile Levy
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
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Diamanti A, Cereda E, Capriati T, Giorgio D, Brusco C, Liguori A, Raponi M. Prevalence and outcome of malnutrition in pediatric patients with chronic diseases: Focus on the settings of care. Clin Nutr 2018; 38:1877-1882. [PMID: 30097363 DOI: 10.1016/j.clnu.2018.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/22/2018] [Accepted: 07/07/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Information on disease-related malnutrition and related outcomes in pediatric patients with chronic diseases in different settings of care is not available. METHODS Consecutive eligible patients attending the out-patient clinic (n = 177) or admitted to the day-hospital clinic (n = 163) or to hospital (n = 201) were screened for the presence of malnutrition (BMI and/or height/length for age z-scores < -2). We recorded data on emergency care admissions to hospital that occurred during the 3 years before screening and related total days of stay, as well as data on emergency care admissions to hospital occurring within 6 months after screening. RESULTS Prevalence of malnutrition was 2-fold higher (P < 0.001) in in-patients (56.7% [95% CI, 49.6-63.7]) than in patients assessed at the out-patient (33.3% [95% CI, 26.4-40.8]) and day-hospital (28.3% [95% CI, 21.5-35.8]) clinics. Estimates were heterogeneous across diagnostic groups with higher rates in patients with neurologic (61%) and cardiac (56%) diseases. Stunting was more frequent among in-patients, who also had more evident nutritional derangements. Multivariate logistic regression (covariates: age, gender, healthcare setting and disease group), showed that malnutrition (OR = 1.86 [95% CI, 1.21-2.88]; P = 0.005) was significantly associated with prolonged hospitalization (≥15 days) in the 3 years before screening. In-patients were also more likely to have been hospitalized ≥15 days (using out-patients as reference category, OR = 2.24 [95% CI, 1.39-3.63], P = 0.001), but we did not find any modifying effect (interaction) of the setting of care on the association between malnutrition and prolonged hospitalization. DISCUSSION The rates of malnutrition in children with chronic diseases are very high and increase hospital care needs, especially when they are admitted to hospital. Nutritional care in this patient population is recommended.
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Affiliation(s)
- Antonella Diamanti
- Artificial Nutrition Unit, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy.
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Teresa Capriati
- Artificial Nutrition Unit, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
| | - Daniela Giorgio
- Medical Direction, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
| | - Carla Brusco
- Medical Direction, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
| | - Alessandra Liguori
- Artificial Nutrition Unit, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
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