Validation of AND/ASPEN pediatric malnutrition diagnosis in children admitted to medical wards in two tertiary hospitals in Malaysia.

BACKGROUND: Identification and management of malnutrition among pediatric hospitalized patients is critical for improved clinical outcomes and recovery. This study investigated the use of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (AND/ASPEN) pediatric malnutrition diagnosis in comparison with the Subjective Global Nutritional Assessment (SGNA) tool and single anthropometric indicators (weight, height, body mass index, and mid-upper arm circumference) among hospitalized children. METHODS: A cross-sectional study was conducted among 260 children admitted to general medical wards. SGNA and anthropometric measurements were used as references. Kappa agreement, diagnostic values, and area under the curve (AUC) were analyzed to evaluate the diagnostic ability of the AND/ASPEN malnutrition diagnosis tool. Logistic binary regression was performed to determine the predictive ability of each malnutrition diagnosis tool on the length of hospital stay. RESULTS: The AND/ASPEN diagnosis tool detected the highest malnutrition rate (41%) among the hospitalized children in comparison with the reference methods. This tool demonstrated fair specificity of 74% and sensitivity of 70% compared with the SGNA. It obtained a weak agreement in determining the presence of malnutrition by kappa (0.06-0.42) and receiver operating characteristic curve analysis (AUC = 0.54-0.72). The use of the AND/ASPEN tool obtained an odds ratio of 0.84 (95% CI, 0.44-1.61; P = 0.59) in predicting the length of hospital stay. CONCLUSIONS: The AND/ASPEN malnutrition tool is an acceptable nutrition assessment tool for hospitalized children in general medical wards.

Effects of Perioperative Oral Nutrition Supplementation in Malaysian Patients Undergoing Elective Surgery for Breast and Colorectal Cancers-A Randomised Controlled Trial.

This study aimed to investigate the effectiveness of preoperative and an extended 90-days postoperative use of ONS among patients undergoing elective surgery for breast and colorectal cancers. Ninety-one patients were randomised into (i) Group SS received ONS up to 14 days preoperatively and postoperatively up to discharge, (ii) Group SS-E received ONS up to 14 days preoperatively, postoperatively up to discharge and for an extended 90-days after discharge and (iii) Group DS received ONS postoperatively up to discharge. Preoperatively, SS had significantly higher body weight (66.1 ± 15.3 kg vs. 62.5 ± 12.0 kg, p = 0.010) and BMI (26.8 ± 6.8 kg/m2 vs. 26.1 ± 6.7 kg/m2, p = 0.022) than DS when adjusted for baseline values. Postoperatively, SS-E had significantly higher handgrip strength (26 ± 9 kgF vs. 24 ± 6 kgF, p = 0.044) than DS at 90-days post-discharge after adjusted for preoperative values. At 90-days post-discharge, the proportions of patients in SS with albumin < 35 g/d, CAR ≥ 0.1, mPINI ≥ 0.4, mGPS score 1 or 2 were significantly reduced while in SS-E, the reduction in proportions of patients with high hsCRP and mPINI ≥ 0.4 was significant compared to upon discharge. Preoperative ONS had modest benefits in attenuating weight loss whilst postoperative supplementation up to 90-days post-discharge improved handgrip strength and inflammatory prognostic markers.

Diagnosis of Malnutrition in Children and Adolescents with Identified Developmental Disabilities (IDD) Using Subjective Global Nutrition Assessment (SGNA).

BACKGROUND: Children with identified developmental disabilities (IDD) experience a higher risk of growth retardation. Anthropometric indicator is one common objective measurement used to determine malnutrition in those children. A comprehensive nutritional assessment tool should be introduced to offer a more robust approach in understanding their nutritional problems. OBJECTIVE: To determine the use of Subjective Global Nutrition Assessment (SGNA) as a nutrition assessment tool for children with IDD in comparison to the anthropometric indicators. METHODS: This cross-sectional study was conducted in local community settings. IDD included in this study were autism spectrum disorder (ASD), Down syndrome (DS) and cerebral palsy (CP). SGNA and anthropometry measurements including weight, height, mid-upper arm circumference and triceps skinfolds were performed on 93 children with IDD (40 ASD, 26 DS and 27 CP) aged 5-18 years. Cohen's Kappa, sensitivity, specificity and its 95% confidence interval were calculated between SGNA and anthropometric indicators for the agreement in determining malnutrition status of the children. RESULTS: SGNA identified a lower prevalence of malnutrition in children with IDD in comparison to the use of anthropometric indicators. SGNA obtained a moderate-to-fair agreement (above 80% agreement, except height-for-age parameter) and sensitivity (25.71-59.09%) against the use of a single anthropometric indicator in identifying the malnutrition status of the children. CONCLUSIONS: The use of SGNA as an adjunct to body mass index-for-age as an anthropometric measurement for diagnosing malnutrition in children and adolescents with IDD is recommended.

Validation of Paediatric Nutrition Screening Tool (PNST) among Hospitalized Malaysian Children.

BACKGROUND: It is recommended to screen hospitalized children to identify those at risk of malnutrition. Constricted schedule in tertiary care settings calls for the needs of a less burdensome yet effective nutrition screening tool. This study aimed to validate the use of Paediatric Nutrition Screening Tool (PNST) among hospitalized children in a Malaysian tertiary hospital. METHODS: This cross-sectional study recruited children below 18 years old admitting into general paediatric ward in a public hospital. The PNST and Subjective Global Nutritional Assessment (SGNA) were performed on 100 children (64 boys and 36 girls). The objective measurements include anthropometry (z-scores for weight, height and body mass index), dietary history and biochemical markers were measured. These were used to classify malnutrition as per Academy of Nutrition and Dietetics/American Society of Parental and Enteral Nutrition (AND/ASPEN) Consensus Statement for identification of paediatric malnutrition and WHO growth standards for children. Cohen's kappa was computed to report the level of agreement. RESULTS: The PNST identified 57% of hospitalized children as being at risk of malnutrition. In this study, there was a stronger agreement between PNST with AND/ASPEN malnutrition classification (k = 0.602) as when PNST was compared with WHO (k = 0.225) and SGNA (k = 0.431). The PNST shows higher specificity (85.29%) and sensitivity (78.79%) when compared with AND/ASPEN than with WHO malnutrition criteria (55.81% specificity and 66.67% sensitivity). CONCLUSION: This study showed the usefulness of routine use of PNST for screening the malnutrition risk of hospitalized children in Malaysian tertiary hospital settings.