The Prevalence of Malnutrition and Effectiveness of STRONGkids Tool in the Identification of Malnutrition Risks among Pediatric Surgical Patients

Öz

Abstract

Background: High prevalence of malnutrition along with the risk for the development of malnutrition in hospitalised children has been reported. However, this problem remains largely unrecognised by healthcare workers. Aims: To determine the prevalence of malnutrition and effectiveness of STRONGkids nutritional risk screening (NRS) tool in the identification of malnutrition risk among pediatric surgical patients. Study Design: Cross-sectional study. Methods: A total of 494 pediatric surgical patients (median age 59 months, 75.8% males) were included in this prospective study conducted over 3 months. SD-scores <-2 for Body Mass Index (BMI) for age or weight-for-height (WFH) and height-for-age (HFA) were considered to indicate acute and chronic malnutrition, respectively. The STRONGkids NRS tool was used to determine risk for malnutrition. Results: Malnutrition was detected in 13.4% in this group of pediatric surgical patients. Acute malnutrition was identified in 10.1% of patients and more commonly in patients aged ≤60 months than aged >60 months (13.4 vs. 6.6%, p=0.012). Chronic malnutrition was identified in 23 (4.6%) of patients with no significant difference between age groups. There were 7 (1.4%) children with coexistent acute and chronic malnutrition. The STRONGkids tool revealed that 35.7% of patients were either in the moderate or high risk group for malnutrBackground: High prevalence of malnutrition along with the risk for the development of malnutrition in hospitalised children has been reported. However, this problem remains largely unrecognised by healthcare workers. Aims: To determine the prevalence of malnutrition and effectiveness of STRONGkids nutritional risk screening (NRS) tool in the identification of malnutrition risk among pediatric surgical patients. Study Design: Cross-sectional study. Methods: A total of 494 pediatric surgical patients (median age 59 months, 75.8% males) were included in this prospective study conducted over 3 months. SD-scores <-2 for Body Mass Index (BMI) for age or weight-for-height (WFH) and height-for-age (HFA) were considered to indicate acute and chronic malnutrition, respectively. The STRONGkids NRS tool was used to determine risk for malnutrition. Results: Malnutrition was detected in 13.4% in this group of pediatric surgical patients. Acute malnutrition was identified in 10.1% of patients and more commonly in patients aged ≤60 months than aged >60 months (13.4 vs. 6.6%, p=0.012). Chronic malnutrition was identified in 23 (4.6%) of patients with no significant difference between age groups. There were 7 (1.4%) children with coexistent acute and chronic malnutrition. The STRONGkids tool revealed that 35.7% of patients were either in the moderate or high risk group for malnutr

Keywords

• Hospitalisation, malnutrition, nutritional status, outpatients, pediatric surgery, risk assessment, STRONGkids

Kaynakça

1. 1. Widhalm K, Rashidian F, Emminger W Huber WD, Bariss-Riedl M. Fritsch M, et al. Malnutrition in hospitalized children aged 3-18 years. Results by using a new score in comparison with previous described scores. J Ernährungsmedizin 2007;9:13-7.
2. 2. Joosten KF, Hulst JM. Malnutrition in pediatric hospital patients: Current issues. Nutrition 2011;27:133-7. [CrossRef]
3. 3. Huysentruyt K, Alliet P, Muyshont L, Rossignol R, Devreker T, Bontems P, Dejonckheere J, Vandenplas Y, De Schepper J. The STRONGkids nutritional screening tool in hospitalized children: A validation study. Nutrition 2013;29:1356-61. [CrossRef]
4. 4. Joosten KFM, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr 2008;2:590-6. [CrossRef]
5. 5. Wiskin AE, Owens DR, Cornelius VR, Wooton SA, Beattie RM. Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. J Hum Nutr Diet 2012;25:319-22. [CrossRef]
6. 6. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22:415-21.[CrossRef]
7. 7. Hulst JM, Zwart H, Hop WC, Joosten KF. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr 2010;29:106-11.[CrossRef]
8. 8. WHO. Child growth standards. Available from: http://www.who.int/ childgrowth/software/en/

9. 9. WHO. Growth reference 5-19 years. Available from: http://www.who. int/growthref/tools/en/
10. 10. Joosten KF, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr 2008;20:590-6.[CrossRef]
11. 11. Moeeni V, Walls T, Day AS. Assessment of nutritional status and nutritional risk in hospitalized Iranian children. Acta Paediatr 2012;101: e446-51.[CrossRef]
12. 12. Turkey Demographic and Health Suvey 2008. Hacettepe University Institute of Population Studies, Ankara, Turkey, 2009. Available from: http://www.hips.hacettepe.edu.tr/eng/dokumanlar/TDHS-2008_Main_ Report.pdf
13. 13. Gür E, Gunay C, Akkus S, Ercan G, Arvas A, Güzelöz S, Cifçili S. Is undernutrition a problem among Turkish School Children? Which factors have an influence on it? J Trop Pediatr 2006;52;421-6.[CrossRef]
14. 14. Pawellek I, Dokoupil K, Koletzko B. Prevalence of malnutrition in paediatric hospital patients. Clin Nutr 2008;27:72-6.[CrossRef]
15. 15. Özer N, Urganci N, Usta A, Kayaalp N. Determination of malnutrition in hospitalized children. T Klin J Pediatr 2001;10:133-8.
16. 16. Doğan Y, Erkan T, Yalvaç S, Altay S, Cokuğraş FC, Aydin A, Kutlu T. Nutritional status of patients hospitalized in pediatric clinic. Turk J Gastroenterol 2005;16:212-6.
17. 17. Hendricks KM, Duggan C, Gallagher L, CarlinAC, Richardson DS, Collier SB, Simpson W, Lo C. Malnutrition in hospitalized pediatric patients. Current prevalence. Arch Pediatr Adolesc Med 1995;149:1118-22. [CrossRef]
18. 18. Mueller C, Compher C, Ellen DM. A.S.P.E.N. clinical guidelines: nutrition screening, assessment, and intervention in adults. J Parenter Enteral Nutr 2011;35:16-24.[CrossRef]
19. 19. Aurangzeb B, Whitten KE, Harrison B, Mitchell M, Kepreotes H, Sidler M, et al. Prevalence of malnutrition and risk of under-nutrition in hospitalized children. Clin Nutr 2012;31:35-40. [CrossRef]
20. 20. Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, Brusset MC, Mosser F, Berrier F, et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr 2000;72:64-70.
21. 21. McCarthy HMH, Dixon M, Eaton-Evans MJ. Nutrition screening in children - the validation of a new tool. J Hum Nutr Diet 2008;21:395-6. [CrossRef]
22. 22. GerasimidisK, Keane O, Macleod I, Flynn DM, Wright CM.Afour-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr 2010;104:751-6. [CrossRef]
23. 23. Wiskin AE, Owens DR, Cornelius VR, Wootton SA, Beatie RM. Pediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. J Hum Nutr Diet 2012;25:319-22.[CrossRef]
24. 24. Alliet PL, Verspeek L, Devolder H, Aerssens P, Achten W. Undernutrition in ambulatory children with cerebral palsy: anthropometrics vs STRONGkids Nutritional Screening Tool [abstract]. In: Szajewska H, Heyman MB, editors. Abstracts from the 47th Annual Meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition; 2014 June 9-12; Jerusalem, Israel. J Pediatr Gastroenterol Nutr 2014;58(Suppl 1): S519.
25. 25. Cao J, Peng L, Li R, Chen Y, Li X, Mo B, Li X. Nutritional risk screening and its clinical significance in hospitalized children. Clin Nutr 2014;33:432-6. [CrossRef]
26. 26. Agostoni C, Axelson I, Colomb V, Goulte O, Koletzko B, Michaelsen KF, Puntis JW, Rigo J, Shamir R, Szajewska H, Turck D. The need for nutrition support teams in pediatric units: A commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2005;41:8-11.[CrossRef]
27. 27. de Souza Menezes F, Leite HP, Koch Nogueira PC. Malnutrition as an independent predictor of clinical outcome in critically ill children. Nutrition 2012;28:267-70.[CrossRef]
28. 28. Oztürk Y, Büyükgebiz B, Arslan N, Ellidokuz H. Effects of hospital stay on nutritional anthropometric data in Turkish children. J Trop Pediatr 2003;49:189-90.[CrossRef