Use of standardized body composition measurements and malnutrition screening tools to detect malnutrition risk and predict clinical outcomes in children with chronic conditions.
Am J Clin Nutr
; 112(6): 1456-1467, 2020 12 10.
Article
in En
| MEDLINE
| ID: mdl-32520318
ABSTRACT
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Body Composition
/
Child Nutrition Disorders
/
Child Development
Type of study:
Diagnostic_studies
/
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limits:
Adolescent
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Child
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Child, preschool
/
Female
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Humans
/
Male
Language:
En
Journal:
Am J Clin Nutr
Year:
2020
Document type:
Article
Affiliation country: