ReviewMalnutrition in pediatric hospital patients: Current issues
Introduction
From the early 1980s it has been known that the prevalence of acute and chronic malnutrition of children admitted to the hospital is high depending on the criteria used [1]. The prevalence of malnutrition is also dependent on the used reference growth curves and the use of specific growth curves for specific conditions and premature infants. Most commonly, for wasting or acute malnutrition, weight-for-height (WFH) standard deviation (SD) scores are used, and for chronic malnutrition, height-for-age (HFA) SD scores are used, but the body mass index (BMI) is also used to describe malnutrition. Although actual nutritional status can be expressed in SD scores, there is still discussion about the definition of faltering growth or failure to thrive. Furthermore, there is a need for screening for the risk of malnutrition in hospitalized children and several tools have been developed. In this review, current issues about these topics are described.
Section snippets
Definition of malnutrition
Malnutrition can be defined as a state of nutrition in which a deficiency or an excess of energy, protein, and other nutrients causes measurable adverse effects on tissue and body form and function and on clinical outcome.
Growth is the best indicator of nutritional status and using growth curves remains the simplest way for assessing nutritional status in children. Assessment of growth involves accurate measurements of weight and height.
The reported prevalence of acute malnutrition over the
BMI to describe malnutrition
Various definitions are used to describe the prevalence of malnutrition. To compare prevalence data appropriately, using equivalent criteria for defining malnutrition has been proposed [1]. Most commonly, for wasting or acute malnutrition, WFH SD scores are used, and for chronic malnutrition, HFA SD scores are used. The likelihood of malnutrition is defined using a cutoff point of −2 SD. One criterion that is currently used more frequently is the BMI. The BMI is a simple and reproducible index
Failure to thrive
Failure to thrive (FTT) describes the problem of inadequate growth in early childhood [9]. These children do not achieve a normal or expected rate of growth. This may result in delayed physical and intellectual development. However, it is not clear whether there is a threshold for the association between poor growth and intellectual impairment. For many years, there has been ambiguity and inconsistency in the precise definition and use of FTT [10].
In 2007, Olsen et al. [11] compared seven
Use of WHO growth charts
The most established way to describe malnutrition is the use of SD scores, with the reference population defined as according to reference charts from a specific country. In 2006 the new WHO child-growth charts were established on the basis of a longitudinal study conducted in children living in different countries and different continents [16]. These WHO growth charts are based on data from the Multicenter Growth reference study (1997–2003) involving 8500 children from Brazil, Ghana, India,
Use of target height
Stunting or chronic malnutrition is defined if a SD score is lower than −2. In a general population, this means that 2.3% of healthy children have a short stature. Therefore, determination of genetic height potential, based on parental heights, might be helpful in the evaluation of growth in children. Various mathematical formulas have been proposed for target height, expressed in centimeters or SD score units [19]. In some formulas the target height is modified assuming a secular trend across
Malnutrition in preterm neonates and use of specific growth charts
Preterm infants are sensitive to changes in nutritional status, and growth failure during a hospital stay is common. For many years, to determine the growth of prematurely born infants, the intrauterine growth curves of Usher and McLean [22] were used for calculation of SD scores for weight and length up to a postconceptual age of 41 wk. These reference data were derived from preterm infants born from 1959 to 1963 in Canada and were revised regularly in different countries (USA, Sweden, Norway,
Use of growth charts for specific groups
Malnutrition has been reported to be highly prevalent in children with an underlying disease. Compared with data from 20 to 30 y ago, the prevalence rate of malnutrition has been reported to be lower, especially in children with CF and malignancies, but in children with chronic inflammatory diseases such as chronic kidney disease, acute and chronic malnutrition remain very prevalent [1]. Furthermore, in children with neurologic disorders, attention should be focused on appropriate methods of
Screening tools to identify children at risk of malnutrition
Currently, there is no consensus on the ideal method to determine which children on admission are at risk to develop malnutrition during a hospital stay. Such a screening tool is basically different from measuring actual nutritional status with weight and height. There are four screening tools available in the literature. Secker and Jeejeebhoy (2007) [30] and Sermet-Gaudelus et al. (2000) [31] developed the Pediatric Nutritional Risk Score and the Subjective Global Nutritional Assessment,
Conclusion
Because of the diversity of medical conditions and syndromes in hospitalized children, assessment of nutritional status and interpretation of anthropometric data need a tailored approach. Table 3 presents a summary of issues that have to be taken into account for the interpretation of prevalence data of malnutrition.
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