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Becker P, Abdel-Rahman S, Nemet D, Marino LV, Noritz G, Fisberg M, Beretich K. Measurement of mid-upper arm circumference to screen for childhood malnutrition: General applicability and use in special populations. Nutr Clin Pract 2024. [PMID: 39292197 DOI: 10.1002/ncp.11208] [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: 01/10/2024] [Revised: 07/19/2024] [Accepted: 08/16/2024] [Indexed: 09/19/2024] Open
Abstract
Since the development of consensus-recommended indicators for pediatric malnutrition in 2014, screening and diagnosis of pediatric malnutrition have improved, but the indicators are not always used; malnutrition continues to be underdiagnosed in some community and healthcare settings. In particular, mid-upper arm circumference (MUAC) is underused as a screening indicator for pediatric malnutrition, despite its unique advantages and usefulness in several clinical situations. In December 2022, a scientific roundtable was held to bring together several experts in pediatric malnutrition. One of the goals of the scientific roundtable was to discuss the clinical use of anthropometric measures as screening tools for pediatric malnutrition status, with a focus on the use of MUAC. This article arose from that event and is intended as an educational tool to aid clinicians in implementing MUAC measurements. In addition to describing the use of MUAC as a screening tool, the article discusses several clinical situations in which MUAC is especially useful. Additionally, the article reviews practical aspects of measuring and interpreting MUAC values, provides links to additional educational resources, and briefly reviews areas in which further research is needed regarding the use of MUAC for screening of nutrition status in children.
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Affiliation(s)
- Patricia Becker
- Neonatal Intensive Care Unit/Nutrition Clinic, Dayton's Children's Hospital, Dayton, Ohio, USA
| | | | - Dan Nemet
- Meir Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Luise V Marino
- University Hospital Southampton, NHS Foundation Trust, and Faculty of Medicine and Health Sciences, University of Southampton, Southampton, UK
| | - Garey Noritz
- Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Mauro Fisberg
- CENDA-Instituto PENSI-Sabará Children's Hospital Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kaitlan Beretich
- Medical Affairs & Research, Abbott Nutrition, Dallas-Fort Worth, Texas, USA
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Létourneau J, Bélanger V, Marchand V, Boctor DL, Rashid M, Avinashi V, Groleau V, Spahis S, Levy E, Marcil V. Post-discharge complications and hospital readmissions are associated with nutritional risk and malnutrition status in a cohort of Canadian pediatric patients. BMC Pediatr 2024; 24:469. [PMID: 39044205 PMCID: PMC11265476 DOI: 10.1186/s12887-024-04941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND This study constitutes a secondary analysis of a prospective cohort aiming to evaluate the potential correlation between nutritional risk and status at admission with the occurrence of post-discharge complications and hospital readmissions in children receiving care at high resource Centres. METHODS Data was collected from 5 Canadian tertiary pediatric Centers between 2012 and 2016. Nutritional risk and status were evaluated at hospital admission with validated tools (STRONGkids and Subjective Global Nutrition Assessment [SGNA]) and anthropometric measurements. Thirty days after discharge, occurrence of post-discharge complications and hospital readmission were documented. RESULTS A total of 360 participants were included in the study (median age, 6.1 years; median length of stay, 5 days). Following discharge, 24.1% experienced complications and 19.5% were readmitted to the hospital. The odds of experiencing complications were nearly tripled for participants with a high nutritional risk compared to a low risk (OR = 2.85; 95% CI [1.08-7.54]; P = 0.035) and those whose caregivers reported having a poor compared to a good appetite (OR = 2.96; 95% CI [1.59-5.50]; P < 0.001). According to SGNA, patients identified as malnourished had significantly higher odds of complications (OR, 1.92; 95% CI, 1.15-3.20; P = 0.013) and hospital readmission (OR, 1.95; 95% CI, 1.12-3.39; P = 0.017) than to those well-nourished. CONCLUSIONS This study showed that complications and readmission post-discharge are common, and these are more likely to occur in malnourished children compared to their well-nourished counterparts. Enhancing nutritional care during admission, at discharge and in the community may be an area for future outcome optimization.
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Affiliation(s)
- Joëlle Létourneau
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Véronique Bélanger
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Valérie Marchand
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC, Canada
| | - Dana L Boctor
- Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Mohsin Rashid
- IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - Vishal Avinashi
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Véronique Groleau
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC, Canada
| | - Schohraya Spahis
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Emile Levy
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Valérie Marcil
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada.
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Hulst JM, de Lange A, DaSilva K, Owens J, Bannister L, Beaulieu J, Chowdhury F, Fleming-Carroll B, Haliburton B, Kalnins D, Mahant S, McEwan S, Morra A, Talone L, Pai N. Malnutrition care in hospitalized pediatric inpatients: comparison of perceptions and experiences across two pediatric academic health sciences centres. Appl Physiol Nutr Metab 2024; 49:712-717. [PMID: 38290115 DOI: 10.1139/apnm-2023-0189] [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: 02/01/2024]
Abstract
Malnutrition affects up to one in three Canadian children admitted to hospital. Awareness among pediatric healthcare providers (HCPs) of the prevalence and impacts of hospitalized malnutrition is critical for optimal management. The purpose of this study was to determine perceptions of malnutrition among pediatric HCP across two major academic health sciences centres, and to determine how the use of a standardized pediatric nutritional screening tool at one institution affects responses. Between 2020 and 2022, 192 HCPs representing nursing, dietetics, medicine, and other allied health were surveyed across McMaster Children's Hospital and The Hospital for Sick Children. 38% of respondents from both centres perceived rates of malnutrition between approximately one in three patients. Perceptions of the need for nutritional screening, assessment, and management were similar between centres. All respondents identified the need for better communication of hospitalized malnutrition status to community providers at discharge, and resource limitations affecting nutritional management of pediatric inpatients. This study represents the largest and most diverse survey of inpatient pediatric HCPs to date. We demonstrate high rates of baseline knowledge of hospital malnutrition, ongoing resource challenges, and the need for a systematic approach to pediatric nutritional management.
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Affiliation(s)
- Jessie M Hulst
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Anna de Lange
- McMaster Children's Hospital, Hamilton, ON, Canada
- School of Food and Nutritional Sciences, Brescia University College, Western University, London, ON, Canada
| | - Kristen DaSilva
- School of Food and Nutritional Sciences, Brescia University College, Western University, London, ON, Canada
| | | | - Louise Bannister
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jordan Beaulieu
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fariha Chowdhury
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, McMaster Children's Hospital, Hamilton, ON, Canada
| | | | - Beth Haliburton
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daina Kalnins
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sanjay Mahant
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sarah McEwan
- Division of Pediatric Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Adelina Morra
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lisa Talone
- McMaster Children's Hospital, Hamilton, ON, Canada
| | - Nikhil Pai
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, McMaster Children's Hospital, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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Gramlich L, Cardenas D, Correia MITD, Keller H, Basualdo-Hammond C, Bauer J, Jensen G, Nasser R, Tarasuk V, Reynolds J. Canadian Nutrition Society Dialogue on disease-related malnutrition: a commentary from the 2022 Food For Health Workshop. Appl Physiol Nutr Metab 2023; 48:710-717. [PMID: 37229778 DOI: 10.1139/apnm-2022-0417] [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: 05/27/2023]
Abstract
This commentary represents a dialogue on key aspects of disease-related malnutrition (DRM) from leaders and experts from academia, health across disciplines, and several countries across the world. The dialogue illuminates the problem of DRM, what impact it has on outcomes, nutrition care as a human right, and practice, implementation, and policy approaches to address DRM. The dialogue allowed the germination of an idea to register a commitment through the Canadian Nutrition Society and the Canadian Malnutrition Task Force in the UN/WHO Decade of Action on Nutrition to advance policy-based approaches for DRM. This commitment was successfully registered in October 2022 and is entitled CAN DReaM (Creating Alliances Nationally for Policy in Disease-Related Malnutrition). This commitment details five goals that will be pursued in the Decade of Action on Nutrition. The intent of this commentary is to record the proceedings of the workshop as a stepping stone to establishing a policy-based approach to DRM that is relevant in Canada and abroad.
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Affiliation(s)
| | | | | | - Heather Keller
- Division of Nutrition & Aging, Schlegel-UW Research Institute for Aging, Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Carlota Basualdo-Hammond
- Nutrition Services Provincial Strategy, Standards and Practice, Alberta Health Services, CMTF, Canada
| | - Judy Bauer
- Dietetics and Food Department of Nutrition, Monash University, Clayton, Australia
| | - Gordon Jensen
- Department of Medicine and Nutrition, The Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
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Koletzko B, Shamir R. Editorial: Disease-associated malnutrition in paediatric patients must be diagnosed and treated. Curr Opin Clin Nutr Metab Care 2022; 25:186-187. [PMID: 35762172 DOI: 10.1097/mco.0000000000000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Berthold Koletzko
- LMU - Ludwig-Maximilians-Universität Munich, Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr von Hauner Children's Hospital, LMU University Hospitals, Munich, Germany
| | - Raanan Shamir
- Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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