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İştahsız Çocuklarda Beslenme Durumunun Değerlendirilmesinde Hematolojik-İnflamatuar İndekslerin Kullanılabilirliğinin İncelenmesi

Year 2025, Volume: 22 Issue: 3, 531 - 537, 29.09.2025
https://doi.org/10.35440/hutfd.1737459

Abstract

Amaç: İştah kaybı, çocuk sağlığı pratiğinde sık karşılaşılan bir durumdur ve uzun süreli olduğunda malnütrisyon ve büyüme geriliğine yol açabilir. Nötrofil-lenfosit oranı (NLO), trombosit-lenfosit oranı (TLO), nötrofil yüzdesi/albumin oranı (NYAO), C-reaktif protein (CRP), CRP/Albümin oranı, albümin ve lenfosit değerlerinden oluşan CALLY indeksi gibi yeni inflamatuar indeksler, çeşitli erişkin hastalıklar-da araştırılmış olsa da, çocuklarda beslenme durumunun değerlendirilmesindeki rolleri net değildir. Bu çalışmada, iştahsızlık şikayeti ile başvuran çocuklarda yeni hematolojik-inflamatuar indeksler ile beslenme durumu arasındaki ilişki değerlendirilmiştir.
Materyal ve Metod: Bu kesitsel çalışma Mayıs 2024 ile Şubat 2025 tarihleri arasında İstanbul’daki üçüncü basamak hastanede gerçekleştirildi. İştahsızlık şikayeti olan 2–16 yaş arası çocuklar çalışmaya dahil edildi.
Bulgular: İştah kaybı olan çocuklarda, kontrol grubuna kıyasla albümin ve CALLY indeksi anlamlı de-recede daha düşüktü (p < 0.001). Ayrıca nötrofil sayısı (p < 0.001), NLO (p < 0.001), TLO (p < 0.001), NYAO (p < 0.001) ve CRP/Albümin oranı (p = 0.012) anlamlı olarak daha yüksekti.
Sonuç: NYAO, CRP/Albümin oranı ve CALLY indeksi gibi yeni inflamatuar göstergeler, iştahsız çocuklarda beslenme ve inflamatuar duruma dair önemli bilgiler sunabilir. Bu indeksler, çocuk poli-kliniklerinde subklinik malnütrisyonun erken tanısında kolay erişilebilir ve maliyet etkin araçlar olabilir.

References

  • 1. Haines J, Haycraft E, Lytle L, Nicklaus S, Kok FJ, Merdji M, et al. Nurturing Children’s Healthy Eating: Position statement. Appetite. 2019; 137: 124-33.
  • 2. Kovacic K, Rein LE, Szabo A, Kommareddy S, Bhagavatula P, Goday PS. Pediatric Feeding Disorder: A Nationwide Preva-lence Study. J Pediatr. 2021; 228:126-131.e3.
  • 3. Domnicu AE, Boia ER, Mogoi M, Manea AM, Marcovici TM, Mărginean O, et al. The Neutrophil-to-Lymphocyte Ratio (NLR) Can Predict Sepsis's Presence and Severity in Malnour-ished Infants-A Single Center Experience. Children (Basel). 2023; 10: 1616.
  • 4. Wawryk-Gawda E, Żybowska M, Ostrowicz K. The neutrophil to lymphocyte ratio in children with bronchial asthma. J Clin Med 2023; 12: 6869.
  • 5. Zhang X, Cheng G, Guo H, Fang H, Wang R. Value and clinical significance of NLR, PLR, LMR in auxiliary diagnosis of chil-dren with bronchial asthma. International Journal of Labora-tory Medicine 2019: 214-7.
  • 6. Kahramanca S, Ozgehan G, Seker D, Gökce EI, Seker G, Tunç G, et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2014; 20: 19-22.
  • 7. Ma D, Wang W, Ma J, Liu W. Differential impact of neutro-phil-to-lymphocyte ratio and time-weighted NLR on mortali-ty and survival in critically ill children: insights from a retro-spective study. Front Pediatr. 2025; 13: 1559405.
  • 8. Christian P, Mullany LC, Hurley KM, Katz J, Black RE. Nutrition and maternal, neonatal, and child health. Seminars in Peri-natology. 2015;39: 361-72.
  • 9. Müller L, Hahn F, Mähringer-Kunz A, Stoehr F, Gairing SJ, Michel M, et al. Immunonutritive scoring for patients with hepatocellular carcinoma undergoing transarterial che-moembolization: Evaluation of the CALLY index. Cancers (Ba-sel). 2021; 13: 5018.
  • 10. Sheinenzon A, Shehadeh M, Michelis R, Shaoul E, Ronen O. Serum albumin levels and inflammation. Int J Biol Macromol. 2021; 184: 857-62.
  • 11. Zamberlan P, Carlotti APCP, Viani KHC, Rodriguez IS, Simas JC, Silvério AB, et al. Increased nutrition risk at admission is associated with longer hospitalization in children and ado-lescents with COVID-19. Nutr Clin Pract. 2022; 37: 393-401.
  • 12. Zhou XL, Zhu WG, Zhu ZJ, Wang WW, Deng X, Tao WJ, et al. Lymphopenia in esophageal squamous cell carcinoma: rela-tionship to malnutrition, various disease parameters, and re-sponse to concurrent chemoradiotherapy. Oncologist. 2019; 24: 677-86.
  • 13. Yılmaz R, Esmeray H, Erkorkmaz Ü. Çocuklarda Yeme Davranışı Anketinin Türkçe uyarlama çalışması. Anatol J Psychia-try/Anadolu psikiyatri dergisi. 2011; 12: 287-94
  • 14. Ünver H, Gökçe Ceylan B, Erdoğdu Yıldırım AB, Perdahlı Fiş N. Serum peripheral markers for inflammation in adolescents with anorexia nervosa. Int J Psychiatry Clin Pract. 2024; 28: 68-72.
  • 15. Bou Khalil R, Risch N, Sleilaty G, Richa S, Seneque M, Lefebvre P, et al. Neutrophil-to-lymphocyte ratio (NLR) varia-tions in relationship with childhood maltreatment in pa-tients with anorexia nervosa: a retrospective cohort study. Eat Weight Disord. 2022; 27: 2201-12.
  • 16. Inagawa Y, Kurata K, Obi S, Onuki Y, Monden Y, Kurane K, et al. Monitoring neutrophil-to-lymphocyte ratio dynamics for personalized treatment in adolescent eating disorders: a ret-rospective cohort study. J Eat Disord. 2025; 13: 86.
  • 17. Caldiroli A, La Tegola D, Affaticati LM, Manzo F, Cella F, Scalia A, et al. Clinical and Peripheral Biomarkers in Female Pa-tients Affected by Anorexia: Does the Neutro-phil/Lymphocyte Ratio (NLR) Affect Severity?. Nutrients. 2023; 15: 1133.
  • 18. Lazarou C, Philippou E. C-Reactive Protein and Diet Quality in Children. Chapter · 2013. Publisher: Humana Press, Editors: Preedy VR, Hunter L-A, Patel VB, pp 75–86.
  • 19. Lazarou C, Panagiotakos DB, Chrysohoou C, Andronikou C, Matalas AL. C-reactive protein levels are associated with adi-posity and a high inflammatory foods index in mountainous Cypriot children. Clin Nutr. 2010; 29: 779-83.
  • 20. Chaurasiya OS, Rana S, Chhabra K, Singh M. Evaluation of the C-reactive Protein/Albumin Ratio and Fluid Overload in Criti-cally Ill Children and Adolescents Aged One Month to 18 Years. Cureus. 2024; 16: e75252.
  • 21. Sidiarthaa GL, Watib DK, Subanadac IB, Suwarba GNM. High C-Reactive Protein/Albumin Ratio Increased Risk of Acute Malnutrition During Hospitalization in Pediatric Patients. Int. J. Health Sci. 2020; 4: 32-38.
  • 22. Gao S, Yu F, Han Y. Association between Neutrophil Percent-age-to-Albumin ratio and anemia risk: a population-based study. Sci Rep. 2025; 15: 16649.
  • 23. Deng L, Wang T, Duan Y, Liu B, Jiang J, Liu D, et al. Neutro-phil percentage-to-albumin ratio is a potential marker of in-travenous immunoglobulin resistance in Kawasaki disease. Sci Rep. 2024; 14: 15232.

Evaluating the Utility of Hematologic-Inflammatory Indices in Assessing Nutritional Status in Children with Appetite Loss

Year 2025, Volume: 22 Issue: 3, 531 - 537, 29.09.2025
https://doi.org/10.35440/hutfd.1737459

Abstract

Background: Appetite loss is a common concern in pediatric practice and may lead to malnutrition and delayed growth if persistent. While novel inflammatory indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil percentage-to-albumin ratio (NPAR), CRP/Albumin, and the CRP, albu-min, and lymphocyte (CALLY) index have been investigated in various adult diseases, their role in pediatric nutritional assessment remains unclear. This study aimed to evaluate the relationship between novel hema-tologic-inflammatory indices and nutritional status in children presenting with loss of appetite.
Materials and Methods: A cross-sectional study was conducted between May 2024 and February 2025 in ter-tiary hospitals in Istanbul. Pediatric patients aged 2–16 years with appetite loss were included.
Results: Children with loss of appetite had significantly lower albumin and CALLY index levels (p < 0.001) com-pared to controls. Additionally, they exhibited significantly higher neutrophil counts (p < 0.001), NLR (p < 0.001), PLR (p < 0.001), NPAR (p < 0.001), and CRP/albumin ratio (p = 0.012).
Conclusion: Novel inflammatory markers such as NPAR, CRP/Albumin, and the CALLY index may offer valuable insight into the nutritional and inflammatory status of children with poor appetite. These indices could serve as accessible and cost-effective tools in the early identification of subclinical malnutrition in pediatric outpati-ent settings.

References

  • 1. Haines J, Haycraft E, Lytle L, Nicklaus S, Kok FJ, Merdji M, et al. Nurturing Children’s Healthy Eating: Position statement. Appetite. 2019; 137: 124-33.
  • 2. Kovacic K, Rein LE, Szabo A, Kommareddy S, Bhagavatula P, Goday PS. Pediatric Feeding Disorder: A Nationwide Preva-lence Study. J Pediatr. 2021; 228:126-131.e3.
  • 3. Domnicu AE, Boia ER, Mogoi M, Manea AM, Marcovici TM, Mărginean O, et al. The Neutrophil-to-Lymphocyte Ratio (NLR) Can Predict Sepsis's Presence and Severity in Malnour-ished Infants-A Single Center Experience. Children (Basel). 2023; 10: 1616.
  • 4. Wawryk-Gawda E, Żybowska M, Ostrowicz K. The neutrophil to lymphocyte ratio in children with bronchial asthma. J Clin Med 2023; 12: 6869.
  • 5. Zhang X, Cheng G, Guo H, Fang H, Wang R. Value and clinical significance of NLR, PLR, LMR in auxiliary diagnosis of chil-dren with bronchial asthma. International Journal of Labora-tory Medicine 2019: 214-7.
  • 6. Kahramanca S, Ozgehan G, Seker D, Gökce EI, Seker G, Tunç G, et al. Neutrophil-to-lymphocyte ratio as a predictor of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2014; 20: 19-22.
  • 7. Ma D, Wang W, Ma J, Liu W. Differential impact of neutro-phil-to-lymphocyte ratio and time-weighted NLR on mortali-ty and survival in critically ill children: insights from a retro-spective study. Front Pediatr. 2025; 13: 1559405.
  • 8. Christian P, Mullany LC, Hurley KM, Katz J, Black RE. Nutrition and maternal, neonatal, and child health. Seminars in Peri-natology. 2015;39: 361-72.
  • 9. Müller L, Hahn F, Mähringer-Kunz A, Stoehr F, Gairing SJ, Michel M, et al. Immunonutritive scoring for patients with hepatocellular carcinoma undergoing transarterial che-moembolization: Evaluation of the CALLY index. Cancers (Ba-sel). 2021; 13: 5018.
  • 10. Sheinenzon A, Shehadeh M, Michelis R, Shaoul E, Ronen O. Serum albumin levels and inflammation. Int J Biol Macromol. 2021; 184: 857-62.
  • 11. Zamberlan P, Carlotti APCP, Viani KHC, Rodriguez IS, Simas JC, Silvério AB, et al. Increased nutrition risk at admission is associated with longer hospitalization in children and ado-lescents with COVID-19. Nutr Clin Pract. 2022; 37: 393-401.
  • 12. Zhou XL, Zhu WG, Zhu ZJ, Wang WW, Deng X, Tao WJ, et al. Lymphopenia in esophageal squamous cell carcinoma: rela-tionship to malnutrition, various disease parameters, and re-sponse to concurrent chemoradiotherapy. Oncologist. 2019; 24: 677-86.
  • 13. Yılmaz R, Esmeray H, Erkorkmaz Ü. Çocuklarda Yeme Davranışı Anketinin Türkçe uyarlama çalışması. Anatol J Psychia-try/Anadolu psikiyatri dergisi. 2011; 12: 287-94
  • 14. Ünver H, Gökçe Ceylan B, Erdoğdu Yıldırım AB, Perdahlı Fiş N. Serum peripheral markers for inflammation in adolescents with anorexia nervosa. Int J Psychiatry Clin Pract. 2024; 28: 68-72.
  • 15. Bou Khalil R, Risch N, Sleilaty G, Richa S, Seneque M, Lefebvre P, et al. Neutrophil-to-lymphocyte ratio (NLR) varia-tions in relationship with childhood maltreatment in pa-tients with anorexia nervosa: a retrospective cohort study. Eat Weight Disord. 2022; 27: 2201-12.
  • 16. Inagawa Y, Kurata K, Obi S, Onuki Y, Monden Y, Kurane K, et al. Monitoring neutrophil-to-lymphocyte ratio dynamics for personalized treatment in adolescent eating disorders: a ret-rospective cohort study. J Eat Disord. 2025; 13: 86.
  • 17. Caldiroli A, La Tegola D, Affaticati LM, Manzo F, Cella F, Scalia A, et al. Clinical and Peripheral Biomarkers in Female Pa-tients Affected by Anorexia: Does the Neutro-phil/Lymphocyte Ratio (NLR) Affect Severity?. Nutrients. 2023; 15: 1133.
  • 18. Lazarou C, Philippou E. C-Reactive Protein and Diet Quality in Children. Chapter · 2013. Publisher: Humana Press, Editors: Preedy VR, Hunter L-A, Patel VB, pp 75–86.
  • 19. Lazarou C, Panagiotakos DB, Chrysohoou C, Andronikou C, Matalas AL. C-reactive protein levels are associated with adi-posity and a high inflammatory foods index in mountainous Cypriot children. Clin Nutr. 2010; 29: 779-83.
  • 20. Chaurasiya OS, Rana S, Chhabra K, Singh M. Evaluation of the C-reactive Protein/Albumin Ratio and Fluid Overload in Criti-cally Ill Children and Adolescents Aged One Month to 18 Years. Cureus. 2024; 16: e75252.
  • 21. Sidiarthaa GL, Watib DK, Subanadac IB, Suwarba GNM. High C-Reactive Protein/Albumin Ratio Increased Risk of Acute Malnutrition During Hospitalization in Pediatric Patients. Int. J. Health Sci. 2020; 4: 32-38.
  • 22. Gao S, Yu F, Han Y. Association between Neutrophil Percent-age-to-Albumin ratio and anemia risk: a population-based study. Sci Rep. 2025; 15: 16649.
  • 23. Deng L, Wang T, Duan Y, Liu B, Jiang J, Liu D, et al. Neutro-phil percentage-to-albumin ratio is a potential marker of in-travenous immunoglobulin resistance in Kawasaki disease. Sci Rep. 2024; 14: 15232.
There are 23 citations in total.

Details

Primary Language English
Subjects Pediatric Endocrinology, Paediatrics (Other)
Journal Section Research Article
Authors

Ömer Okuyan 0000-0002-1614-6149

Sinem Durmuş 0000-0002-9272-9098

Şeyma Dümür 0000-0001-8893-2926

Yusuf Elgörmüş 0000-0002-6382-204X

Hafize Uzun 0000-0002-1347-8498

Early Pub Date September 10, 2025
Publication Date September 29, 2025
Submission Date July 8, 2025
Acceptance Date September 5, 2025
Published in Issue Year 2025 Volume: 22 Issue: 3

Cite

Vancouver Okuyan Ö, Durmuş S, Dümür Ş, Elgörmüş Y, Uzun H. Evaluating the Utility of Hematologic-Inflammatory Indices in Assessing Nutritional Status in Children with Appetite Loss. Harran Üniversitesi Tıp Fakültesi Dergisi. 2025;22(3):531-7.