Measuring body composition in pediatric patients with complex diagnoses: Acceptability, practicality, and validation of different techniques.

BACKGROUND: Body composition could help identify malnutrition in pediatric patients, but there is uncertainty over which techniques are most suitable and prevailing opinion that measurements are difficult to obtain in practice. This study examined the acceptability, practicality, reliability, and validity of different anthropometric and body composition measurements in patients with complex diagnoses in a tertiary pediatric hospital. METHODS: A total of 152 children aged 5-18 years had weight, height, body mass index (BMI), mid-upper arm circumference (MUAC), 4-site skinfold thicknesses (SFT), bioelectrical impedance analysis (BIA), and dual-energy x-ray absorptiometry (DXA) assessed on admission and discharge. Acceptability was assessed in a continuous scale, practicality with number/percentage of successful measurements, reliability with intraclass correlation coefficients and coefficients of repeatability, and validity between "simpler" techniques and DXA with Bland-Altman analysis of agreement and Cohen kappa. RESULTS: Techniques were overall acceptable. Measurements were successful in >50%, with patient refusal uncommon. Coefficients of repeatability were good (0.3 cm MUAC and height, 0.2 kg weight, and 1.0 mm SFTs). All techniques significantly overestimated DXA fat mass, but BMI and triceps SFT better identified abnormal fat mass (κ = 0.46 and 0.49). BIA fat-free mass was not significantly different from DXA, with substantial agreement between techniques (κ = 0.65). CONCLUSION: Body composition by a range of techniques is acceptable, practical, and reliable in a diverse group of children with complex diagnoses. BIA seems a good alternative to DXA for assessing fat-free mass, triceps SFT, and BMI for fat mass but should be used with care as it could overestimate total fat mass in individuals.

Public involvement in research: exploring periodontal and peri-implant health and disease in partnership with Perio@RLH patient forum members.

Patients, carers and the public form an important partnership with the research community. By working alongside researchers, patients make a valuable contribution to all parts of the research cycle. This paper provides an opinion regarding public involvement in periodontal and peri-implant research and summarises the key points derived from a focus group that explored the topic of research in the conditions of periodontal and peri-implant health and disease. The partnership comprised forum members from the Royal London Hospital periodontics patient group (Perio@RLH) and a multidisciplinary team of researchers and clinicians.

Sobrecarga en cuidadores primarios informales de pacientes en cuidados paliativos: un estudio transversal / Overload in informal primary caregivers of palliative care patients: a cross-sectional study

Introducción: La sobrecarga puede perjudicar distintas áreas de la vida de los cuidadores primarios de pacientes con enfermedad avanzada. Conocer su frecuencia y los factores asociados puede ayudar a desarrollar estrategias para mitigarla. Objetivo: Evaluar el nivel de sobrecarga y los factores asociados a la misma en cuidadores primarios informales (CPI) de pacientes adultos pertenecientes a la unidad de cuidados paliativos (CP) de un hospital público de México. Método: Estudio transversal descriptivo con muestreo no probabilístico consecutivo, desarrollado entre enero y abril de 2019. Participaron CPI de pacientes adultos en CP. Fueron excluidos quienes tenían prisa o no desearon participar. La sobrecarga (variable de desenlace primaria) fue evaluada mediante la escala Zarit, adicionalmente se aplicó un cuestionario de datos sociodemográficos y otras variables de interés del CPI y características del cuidado. Se realizó un análisis descriptivo de las variables y un análisis de las asociaciones con sobrecarga. Resultados: Participaron 141 CPI, de los cuales 24,11 % presentaron sobrecarga. Las variables que se asociaron de forma significativa (p < 0,05) con una mayor probabilidad de sobrecarga fueron la percepción de gravedad del paciente y afectaciones en diferentes áreas de su vida (familia, pareja y economía), mientras que las que se asociaron con una menor probabilidad fueron haber adquirido el rol de cuidador por afecto, realizar actividades de agrado, buen autocuidado (actividad física, alimentación, higiene y salud) y buena relación con el paciente. Las variables “afectaciones en el área familiar”, “relación con el paciente” y “autocuidado en actividad física” mostraron la mejor asociación con el riesgo de sobrecarga en conjunto. (AU)

Introduction: Overload can impact multiple aspects in the life of primary caregivers of patients with advanced disease. Characterizing its frequency and associated factors could help develop strategies to mitigate it. Objective: To assess overload levels and associated factors in informal primary caregivers of adult patients in the palliative care unit of a public hospital in Mexico. Method: A descriptive cross-sectional study with consecutive sampling was carried out between January and April 2019. Informal primary caregivers of adult patients in palliative care participated. Those who were in a hurry or did not want to participate were excluded. Overload (primary outcome variable) was evaluated using the Zarit Burden Interview; additionally, a questionnaire of sociodemographic data and other variables related to caregiver interests and the characteristics of the care provided was completed by the participants. A descriptive analysis of the variables and their associations with the presence of overload was conducted. Results: The study enrolled 141 caregivers, 24.11% of which were diagnosed with overload. The variables that showed a significant association with overload (p < 0.05), increasing the probability of occurrence, were perception of the severity of the patient’s condition, and negative impact on different areas of the caregiver’s life (family, partner, economy). Caregivers with a lower potential for overload included those who took on the role of caregiver for affective reasons, who indulged in pleasant activities, who were good at self-care (physical activity, food, hygiene, and health), and who had a good relation with the patient. The variables of a “negative impact on the family”, “relationship with the patient” and “self-care in physical activity” combined showed the greatest association with the risk of overload. (AU)

Use of standardized body composition measurements and malnutrition screening tools to detect malnutrition risk and predict clinical outcomes in children with chronic conditions.

BACKGROUND: Better tools are needed to diagnose and identify children at risk of clinical malnutrition. OBJECTIVES: We aimed to compare body composition (BC) and malnutrition screening tools (MSTs) for detecting malnutrition on admission; and examine their ability to predict adverse clinical outcomes [increased length of stay (LOS) and complications] in complex pediatric patients. METHODS: This was a prospective study in children 5-18 y old admitted to a tertiary pediatric hospital (n = 152). MSTs [Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids)] were completed on admission. Weight, height, and BC [fat mass (FM) and lean mass (LM) by DXA] were measured (n = 118). Anthropometry/BC and MSTs were compared with each other and with clinical outcomes. RESULTS: Subjects were significantly shorter with low LM compared to reference data. Depending on the diagnostic criteria used, 3%-17% were classified as malnourished. Agreement between BC/anthropometric parameters and MSTs was poor. STAMP and STRONGkids identified children with low weight, LM, and height. PYMS, and to a lesser degree STRONGkids, identified children with increased LOS, as did LM compared with weight or height. Patients with complications had lower mean ± SD LM SD scores (-1.38 ± 1.03 compared with -0.74 ± 1.40, P < 0.05). In multivariable models, PYMS high risk and low LM were independent predictors of increased LOS (OR: 3.76; 95% CI: 1.36, 10.35 and OR: 3.69; 95% CI: 1.24, 10.98, respectively). BMI did not predict increased LOS or complications. CONCLUSIONS: LM appears better than weight and height for predicting adverse clinical outcomes in this population. BMI was a poor diagnostic parameter. MSTs performed differently in associations to BC/anthropometry and clinical outcomes. PYMS and LM provided complementary information regarding LOS. Studies on specific patient populations may further clarify the use of these tools and measurements.

Validation and Adaptation of the Spanish Version of the STRONGkids Nutrition Screening Tool.

BACKGROUND: The use of malnutrition screening tools (MSTs) among hospitalized pediatric patients is a simple practice that may allow the identification of patients at nutrition risk. There are different tools developed in the English language, but there are limited data available on their validity when translated into other languages. The aim of this study was to construct a Spanish version (SV) of the STRONGkids MST and determine its validity and reliability in a pediatric population. METHODS: The translation and cross-cultural adaptation of the tool was performed, followed by the reliability, feasibility, and validity of the SV of the STRONGkids MST. Anthropometric assessment was used as the reference standard to evaluate the criterion validity of the MST. The length of hospital stay was used to determine predictive validity. RESULTS: A total 400 children were included in the study, 90 of whom took part in the reliability phase. The interrater agreement between dietitians and nursing staff was kappa (κ) = 0.67, while the intrarater agreement among dietitians was κ = 0.82. The feasibility of the MST was adequate for clinical use. The results for criterion validity between STRONGkids and anthropometric assessment was κ = 0.56, and the criterion validity between STRONGkids and length of hospital stay was κ = 0.20. The sensitivity of the MST was 86% and the specificity was 72%. CONCLUSIONS: The SV of the MST showed good reliability and feasibility. The validity is moderate, and the MST could be considered a useful resource for early detection of malnutrition risk.