Undernourishment Risk in Hospitalized Children: Development of a Risk Assessment Tool

Ericka Montijo-Barrios¹, Martha Guevara-Cruz², Beatriz Adriana Pinzón-Navarro¹, Judith Ileana Gris-Calvo¹, Miriam G. Bautista-Silva¹, Monserrat Cazares-Mendez¹, Roberto Cervantes-Bustamante¹, Jaime A. Ramírez-Mayans¹ and Isabel Medina-Vera^3,

¹Servicio de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, CDMX, México

²Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, CDMX, México

³Departamento de Metodología de la Investigación, Instituto Nacional de Pediatría, CDMX, México

Cite this paper:
Ericka Montijo-Barrios, Martha Guevara-Cruz, Beatriz Adriana Pinzón-Navarro, Judith Ileana Gris-Calvo, Miriam G. Bautista-Silva, Monserrat Cazares-Mendez, Roberto Cervantes-Bustamante, Jaime A. Ramírez-Mayans and Isabel Medina-Vera. Undernourishment Risk in Hospitalized Children: Development of a Risk Assessment Tool. Journal of Food and Nutrition Research. 2020; 8(1):15-20. doi: 10.12691/jfnr-8-1-2

Abstract

Aim: To develop a new screening tool that can quickly assess the risk of undernourishment and evaluate its correlation with frequently used anthropometric indicators. Methods: A new, easy-to-access screening tool was developed for clinical practice with 5 items. A total of 650 children were evaluated, with an average age of 54 months. Their global nutritional status was assessed, as well as the proposed new screening tool. Results: We found that the presence of the item "The patient is in serious condition" was associated with longer days of hospital stay (18.8 ± 4.5, p=0.002), as was the presence of the item "There are factors that increase metabolic and energy demand (20%)" (14.4 ± 1.9, p=0.007). Similarly, we observed a greater risk with the presence of undernourishment [OR=2.8 (95% CI=2 – 3.9)] and the item “There is functional limitation for feeding” [OR=2.3 (95% CI=1.4 – 3.5)]. The score of the new tool differed between those who children who exhibited undernourishment versus those who did not [2.1 ± 1.08 vs 1.6 ± 0.99 (p=0.0001)]. Conclusions: The identification of at least 2 items of the new screening tool could help to detect undernourishment, especially in paediatric populations where, due to the large amount of admissions.

Keywords:
undernourishment nutrition screening tool paediatrics

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Joosten KF., Zwart H., Hop WC., Hulst JM. National malnutrition screening days in hospitalised children in The Netherlands. Arch Dis Child. 2010; 95: 141-145.
[2]	Barker LA., Gout BS., Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011; 8: 514-527.
[3]	Cao J., Peng L., Li R., Chen Y., LiX, Mo B., Li X. Nutritional risk screening and its clinical significance in hospitalized children. Clin Nutr 33:432-436, 2014.
[4]	Mehta NM., Corkins MR., Lyman B., Malone A., Goday PS., Carney LN., et al. American Society for Parenteral and Enteral Nutrition Board of Directors. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr. 2013; 37: 460-481.
[5]	Corkins KG., Teague EE. Pediatric nutrition assessment. Nutr Clin Pract. 2017, 32: 40-51.
[6]	Goossens S., Bekele Y., Yun O., Harczi G., Ouannes M., Shepherd S. Mid-upper arm circumference based nutrition programming: evidence for a new approach in regions with high burden of acute malnutrition. PLoS One. 2012; 7 (11):e49320.
[7]	Corkins KG., Teague EE. Pediatric nutrition assessment: anthropometrics to zinc. Nutr Clin Pract. 2017; 32:40-51.
[8]	Kondrup J., Allison SP., Elia M., Vellas B., Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003; 22: 415-421.
[9]	Agostoni C., Axelson I., Colomb V., Goulet O., Koletzko B., Michaelsen KF., et al. ESPGHAN Committee on Nutrition, European Society for Paediatric Gastroenterology. 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.
[10]	Wong Vega VM., 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. 2019; 34 (3): 406-413.
[11]	Wonoputri N., Djais JT., Rosalina I. Validity of nutritional screening tools for hospitalized children. J Nutr Metab. 2014; 143649.
[12]	Durakbasa CU., Fettahoglu S., Bayar A., Mutus M., Okur H. The prevalence of malnutrition and effectiveness of STRONGkids tool in the identification of malnutrition risks among pediatric surgical patients. Balkan Med J. 2014; 31: 313-321.
[13]	Marginean O., Pitea AM., Voidazan S., Marginean C. Prevalence and assessment of malnutrition risk among hospitalized children in Romania. J Health Popul Nutr. 2014; 32: 97-102.
[14]	Velasco C., Garcia E., Rodriguez V., Frias L., Garriga R., Alvarez J, et al. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr. 2011; 65: 269-274.
[15]	Hartman C., Shamir R., Hecht C., Koletzko B. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metab Care. 2012; 15: 303-309.
[16]	Huysentruyt K., Devreker T., Dejonckheere J., De Schepper J., Vandeplas Y., Cools F. Accuracy of nutritional screening tools in assessing the risk of undernutrition in hospitalized children. J Pediatr Gastroenterol Nutr. 2015; 61:159-166.
[17]	Lohmann TG., Roche AF., Martorell R. Anthropometric Standardization Reference Manual. Champaign: Human Kinetics Books; 1988.
[18]	Dairo MD., Fatokun ME., Kuti M. Reliability of the mid upper arm circumference for the assessment of wasting among children aged 12-59 months in urban ibadan, Nigeria. Int J Biomed Sci. 2012; 8:140-143.
[19]	Carvalho-Salemi J., Salemi JL., Wong-Vega MR., Spooner KK., Juarez MD., Beer SS., Canada NL. Malnutrition among hospitalized children in the United States: changing prevalence, clinical correlates, and practice patterns between 2002 and 2011. J Acad Nutr Diet. 2018; 118:40-51.
[20]	Lutter CK., Daelmans BM., de Onis M., Kothari Mt., Ruel MT., Arimond M., et al. Undernutrition, poor feeding practices, and low coverage of key nutrition interventions. Pediatrics. 2011; 128: e1418-1427.
[21]	Wiskin AE., Davies JH., Wootton SA., Beattie RM. Energy expenditure, nutrition and growth. Arch Dis Child. 2011; 96: 567-572.
[22]	Wiskin AE., Wootton SA., Culliford DJ., Afzal NA., Jackson AA., Beattie RM. Impact of disease activity on resting energy expenditure in children with inflammatory bowel disease. Clin Nutr. 2009; 28:652-656.
[23]	Shetty PS. Adaptation to low energy intakes: the responses and limits to low intakes in infants, children and adults. Eur J Clin Nutr. 1999; 53 Suppl 1:S14-S3.
[24]	Chaput JP., Katzmarzyk PT., Barnes JD., Fogelholm M., Hu G., Kuriyan R., et al. ISCOLE Research Group. Mid-upper arm circumference as a screening tool for identifying children with obesity: a 12-country study. Pediatr Obes. 2017; 12: 439-445.
[25]	Bejon P., Mohammed S., Mwangi I., Atkinson SH., Osier F., Peshu N., et al. Fraction of all hospital admissions and deaths attributable to malnutrition among children in rural Kenya. Am J Clin Nutr. 2008; 88: 1626-1631.
[26]	Mwangome MK., Fegan G., Mbunya R., Prentice AM., Berkley JA. Reliability and accuracy of anthropometry performed by community health workers among infants under 6 months in rural Kenya. Trop Med Int Health. 2012; 17: 622-629.