Hospital-acquired undernutrition and associated factors in children and adolescents admitted to a tertiary care hospital.

BACKGROUND: The present study aimed to verify the proportion and factors associated with hospital-acquired malnutrition in the paediatric unit of a tertiary care hospital. METHODS: A retrospective study was carried out in a tertiary care hospital in the state of Maranhão, Brazil. Demographic and clinical data on children and adolescents were collected from medical records and the data regarding weight, height and z-scores of anthropometric indicators were obtained from the World Health Organization (WHO) Anthro® and WHO Anthro Plus® applications. Those with weight-for-height z-score (< 5 years) and a body mass index (BMI)/age z-score (≥ 5 years) < -2 SD at admission were considered to be malnourished. Patients who presented a decrease of > 0.25 SD between the z-score of BMI-for-age (BMIZ) at admission and at discharge were classified as having hospital-acquired malnutrition. Weight loss was also evaluated and was considered significant when it was > 2% between the weight measured at admission and the one before discharge. Logistic regression analysis was performed to verify the factors associated with hospital-acquired malnutrition. RESULTS: The median age was 4.7 years and the length of stay was 21 days; 26.8% of patients had significant weight loss during hospitalisation and a greater proportion had hospital-acquired malnutrition (34.9%). Gastroenteropathies, neuropathies and malnutrition on admission were significantly associated with hospital-acquired malnutrition. CONCLUSIONS: The occurrence of hospital-acquired malnutrition is still a problem in paediatric patients. Thus, providing adequate nutritional support from admission is essential when aiming to avoid deterioration of the nutritional status of paediatric patients during hospitalisation.

Agreement between nutritional risk screening tools and anthropometry in hospitalized pediatric patients.

BACKGROUND/OBJECTIVES: The use of malnutrition screening tools has been recommended to identify the risk of malnutrition among hospitalized children. The aim of this study was to evaluate the association between the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and anthropometric nutritional parameters to identify malnutrition in hospitalized children. SUBJECTS/METHODS: Data recorded in the nutrition sector for 672 pediatric patients hospitalized between 2019 and 2020 were used to complete the STRONGkids and STAMP tools. To test for associations, the chi-square test or Fisher-Freeman-Halton Exact Test were employed, accepting a p-value <0.05 as the threshold for significance. To determine agreement, the Kappa coefficient was applied. RESULTS: Patients with a mean age of 5 years and 7 months were classified as at high nutritional risk by STRONGkids and STAMP in 10.1% (n = 68) and 24.3% (n = 163) of cases, respectively. A significant association (p < 0.05) was identified between all parameters studied for both tools. For STRONGkids, the chi-square test were as follows: BMI/Age, 69.707; Height/Age, 37.730; Weight/Age, 72.202; and Weight/Height, 60.595, whereas for STAMP, they were BMI/Age, 79.620; Height/Age, 75.246; Weight/Age, 91.034; and Weight/Height, 57.227. When compared, the two tools showed significant moderate agreement (κ = 0.448; p < 0.001). CONCLUSIONS: STAMP classified a higher percentage of patients as being at high nutritional risk when compared with STRONGkids, and both tools had a significant association when compared with anthropometric parameters. Screening tools are easy to apply and can be used to identify the risk of malnutrition in this population.

Prognostic nutritional index and mortality in children and adolescents underwent cardiac surgery / Índice nutricional prognóstico e mortalidade entre crianças e adolescentes submetidos à cirurgia cardíaca

Abstract Objectives: to analyze the prognostic nutritional index and factors associated with mortality in children and adolescents with heart disease who underwent cardiac surgery. Methods: this is a longitudinal, retrospective study that included 98 children and adolescents with heart disease from 0 to 14 years old, and assessed the prognostic nutritional index and nutritional status, through the body mass index for age, weight for height, weight for age and height for age. Multiple logistic regression analysis was performed. Results: malnutrition was present in 27 patients, 68 were categorized as having a low prognostic nutritional index and 16 died. In the adjusted analysis, malnutrition (OR=4.11; CI95%=1.26-13.40; p=0.019), the low body mass index for age (OR=4.14; CI95%=1.26-13.61; p=0.019), low weight for height (OR=4.15; CI95%=1.29-13.35; p=0.017) and low weight for age (OR=5.20; CI95%=1.39-19.43; p=0.014) were associated with mortality. Conclusions: malnutrition, low body mass index for age, weight for height and weight for age had shown a significant association with mortality. Despite being an easily applicable indicator of nutritional status, the findings suggest no association between the prognostic nutritional index and mortality in patients with congenital heart disease after cardiac surgery.

Resumo Objetivos: analisar o índice nutricional prognóstico e os fatores associados a mortalidade em crianças e adolescentescardiopatas submetidas à cirurgia cardíaca. Métodos: estudo longitudinal, retrospectivo, que incluiu 98 crianças e adolescentes cardiopatas entre zero a 14 anos e avaliou o índice nutricional prognóstico e o estado nutricional, através dos indicadores índice de massa corporal para idade, peso para estatura, peso para idade e estatura para idade. Foi realizada análise de regressão logística múltipla. Resultados: a desnutrição esteve presente em 27 pacientes, 68 foram categorizados como baixo índice nutricional prognóstico e 16 foram a óbito. Na análise ajustada, a desnutrição (OR=4,11; IC95%=1,26-13,40; p=0,019), o baixo índice de massa corporal para idade (OR=4,14; IC95%=1,26-13,61; p=0,019), o baixo peso para estatura (OR=4,15; IC95%=1,29-13,35; p=0,017) e baixo peso para idade (OR=5,20; IC95%=1,39-19,43; p=0,014) apresentaram associação com a mortalidade. Conclusão: desnutrição, baixo índice de massa corporal para idade, peso para estatura e peso para idade mostraram associação significativa com a mortalidade. Apesar de ser um indicador do estado nutricional de fácil aplicação não foi observada associação do índice nutricional prognóstico com a mortalidade em pacientes com cardiopatias congênitas após cirurgia cardíaca.

Obesidade abdominal e fatores associados em adultos atendidos em uma clínica escola / Abdominal obesity and associated factors among adults attending a university health center / Obesidad abdominal y factores asociados en adultos asistidos en una clínica escuela

Objetivo: Determinar a prevalência de obesidade abdominal e identificar associação entre fatores socioeconômicos e estilo de vida em adultos atendidos numa clínica escola em São Luís, Brasil. Métodos: Estudo retrospectivo e transversal, realizado entre março e abril de 2015, com 1.022 prontuários de adultos de ambos os sexos, atendidos numa clínica escola, nos últimos cinco anos. Foram coletadas informações sobre dados socioeconômicos (sexo, idade, estado civil, renda familiar e escolaridade), antropométricos (peso atual, altura, IMC e CC) e estilo de vida (tabagismo, ingestão de álcool e atividade física). A variável dependente foi a obesidade abdominal, definida pela razão cintura/estatura (RCest). Realizou-se análise multivariada pelo método regressão logística. Resultados: A prevalência de obesidade abdominal foi de 79,8%, de acordo com a RCest e, segundo IMC, o excesso de peso correspondeu a 77,1%. Verificou-se que as idades de 30 a 59 anos foram fator de risco para obesidade abdominal para ambos os sexos e, quando estratificada, para o sexo feminino. Porém, com relação ao sexo masculino, somente a faixa etária de 50 a 59 anos foi fator de risco (OR=5,76; IC=1,13-29,35; p=0,035). Viver com companheiro (OR=1,53; IC=1,07-2,18; p=0,017) e consumir álcool (OR=1,62; IC=1,09-2,40; p=0,015) apresentaram risco para ambos os sexos, sendo este também fator de risco para o sexo masculino (OR=2,46; IC=1,02-5,95; p=0,045). Conclusão: Observou-se alta prevalência de obesidade abdominal, que se mostrou associada à faixa etária de 30 a 59 para mulheres e 50 a 59 anos para homens, à convivência com o companheiro e ao consumo de álcool para ambos os sexos.

Objective: To determine the prevalence of abdominal obesity and identify the association between socioeconomic factors and lifestyle among adults attending a university health center. Methods: Retrospective and cross-sectional study conducted between March and April 2015 with 1,022 medical records of adults of both genders attending a university health center in the last five years. We collected sociodemographic data (gender, age, marital status, household income and education), anthropometric data (current weight, height, BMI and WC) and information on lifestyle (smoking, drinking and physical activity). The dependent variable was abdominal obesity, defined by the waist-height ratio (WHtR). Multivariate analysis was performed using the logistic regression method. Results: The prevalence of abdominal obesity was 79.8% according to WHtR and, according to BMI, excessive weight accounted for 77.1%. It was found that the ages 30-59 years were a risk factor for abdominal obesity for both genders, and for women when stratified. However, with regard to men, only the age group 50-59 years constituted a risk factor (OR=5.76; CI=1.13-29.35; p=0.035). Living with a partner (OR=1.53; CI=1.07-2.18; p=0.017) and drinking (OR=1.62; CI=1.09-2.40; p=0.015) constituted risk factors for both genders and also for men (OR=2.46; CI=1.02- 5.95; p=0.045). Conclusion: There was a high prevalence of abdominal obesity and it was associated with the age groups 30-59 years for women and 50-59 years for men, and living with a partner and drinking for both genders.

Objetivo: Determinar la prevalencia de obesidad abdominal e identificar su asociación con los factores socioeconômicos y estilo de vida de adultos asistidos en una clínica escuela de São Luís, Brasil. Métodos: Estudio retrospectivo y transversal realizado entre marzo y abril de 2015 en 1.022 historiales clínicos de adultos de ambos los sexos, asistidos en una clínica escuela em los últimos cinco años. Se recogieron informaciones de datos socioeconómicos (el sexo, la edad, el estado civil, la renta familiar y la escolaridad), antropométricos (el peso actual, la altura, el IMC y la CC) y estilo de vida (el tabaquismo, la ingesta de alcohol y la actividad física). La variable dependiente fue la obesidad abdominal que fue definida por la razón cintura/estatura (RCest). Se realizó un análisis multivariado por el método de regresión logística. Resultados: La prevalencia de la obesidad abdominal fue del 79,8%, según la RCest y según el IMC, el exceso de peso correspondió al 77,1%. Se verificó que las edades entre 30 y 59 años fueron factor de riesgo para la obesidad abdominal para ambos los sexos y, al estratificar, para el sexo femenino. Sin embargo, respecto al sexo masculino solamente la franja de edad entre 50 y 59 años fue factor de riesgo (OR=5,76; IC=1,13-29,35; p=0,035). Vivir con un compañero (OR=1,53; IC=1,07-2,18;p=0,017) y consumir alcohol (OR=1,62; IC=1,09-2,40; p=0,015) fueron identificados como riesgo para ambos los sexos y este último ha sido también un factor de riesgo para el sexo masculino (OR=2,46; IC=1,02-5,95; p=0,045). Conclusión: Se observo alta prevalencia de obesidad abdominal que estuvo asociada a la franja de edad entre 30 y 50 años para las mujeres y 50 y 59 años para los hombres, a la convivencia con el compañero y al consumo de alcohol para ambos los sexos.