Nutritional Risk and Malnutrition in Paediatrics: From Anthropometric Assessment to Strongkids® Screening Tool

Authors

  • Luís Vieira Gonçalves Serviço de Anestesiologia. Centro Hospitalar de Leiria. Leiria.
  • Ana Gisela Oliveira Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu.
  • Mariana Barracosa Faculdade de Ciências da Nutrição e Alimentação. Universidade do Porto. Porto.
  • Joaquina Antunes Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu.
  • Joana Pimenta Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu.

DOI:

https://doi.org/10.20344/amp.16768

Keywords:

Anthropometry, Child, Hospitalized, Malnutrition/diagnosis, Nutritional Status

Abstract

Introduction: The prevalence of malnutrition in hospitalized children is high and is associated with negative health impact. The aim of this study was to characterize the nutritional status of hospitalized children as well as comparing nutritional risk stratification using the STRONGkids® tool and anthropometric assessment.
Material and Methods: A prospective study was conducted between March and June 2019 in a paediatric unit of a district hospital. Children with ages between one month and 17 years were included. Nutritional screening (STRONGkids®) was performed, and demographic and anthropometric variables were assessed by trained doctors and nurses (z-scores for height-for-age, weight-for-age, weight-for-height and body mass index were compared to the World Health Organization reference values) and related to the underlying condition (cause of hospitalization; hospital stay; the presence of chronic disease).
Results: A total of 209 children were evaluated, 188 of whom were included. Median age was 4.6 years and median hospital length of stay was four days. Fifty-four per cent were classified with “moderate risk” and 2% with “high risk” of developing malnutrition; 25% were effectively malnourished. Of the 105 children for which it was possible to calculate the z-scores, 6% presented acute malnutrition and nearly 14% presented chronic malnutrition. The STRONGkids® score correlated positively with nutritional status on admission, disease type on admission, and presence of previous underlying disease (p < 0.05).
Conclusion: STRONGkids® is a simple, quick nutritional screening tool for hospitalized children that is related to nutritional status on admission. Given that a considerably high percentage of children were identified as being at risk for malnutrition, it is essential to identify this early and provide nutritional intervention during hospitalization.

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References

Rito A, Breda J, Carmo I. Guia de avaliação do estado nutricional infantil e juvenil. Instituto Nacional de Saúde Dr. Ricardo Jorge. 2010. [cited 2021 Mar 10]. Available from: https://www.insa.min-saude.pt/wp-content/uploads/2017/11/GuiaAvaliacaoEstadoNutricional.pdf.

Moutinho JC. Estudo de rastreio de risco nutricional: strongkids das crianças internadas no Hospital Pediátrico de Coimbra. 2014. [cited 2021 Mar 10]. Available from: https://estudogeral.uc.pt/handle/10316/31556.

Guerra AJ, Teixeira Santos N, Almeida Santos L, Carreiro E, Morais MR, Prata A. Avaliação nutricional infantil. Rev Port Pediatr. 1990;21:5-46.

Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Van den Berghe G, et al. Introductory to the ESPEN guidelines on enteral nutrition: terminology, definitions and general topics. Clin Nutr. 2006;25:180-6. DOI: https://doi.org/10.1016/j.clnu.2006.02.007

Campanozzi A, Russo M, Catucci A, Rutigliano I, Canestrino G, Giardino I, et al. Hospital-acquired malnutrition in children with mild clinical conditions. Nutrition. 2009;25:540-7. DOI: https://doi.org/10.1016/j.nut.2008.11.026

Moreno Villares JM, Varea Calderón V, Bousoño García C, Lama Moré R, Redecillas Ferreiro S, Peña Quintana L. Evaluación del estado nutricional de niños ingresados en el hospital en España: estudio DHOSPE (Desnutrición Hospitalaria en el Paciente Pediátrico en España). Nutr Hosp. 2013;28:709-18.

Costa C, Matos C, Cândido C, Gaspar E. Avaliação do risco nutricional e caracterização do estado nutricional de crianças internadas. Acta Port Nutr. 2017;10:18-22.

Pawellek I, Dokoupil K, Koletzko B. Prevalence of malnutrition in paediatric hospital patients. Clin Nutr. 2008;27:72-6. DOI: https://doi.org/10.1016/j.clnu.2007.11.001

Joosten KF, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr. 2008;20:590-6. DOI: https://doi.org/10.1097/MOP.0b013e32830c6ede

Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, Brusset MC, Mosser F, Berrier F, et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr. 2000;72:64-70.

Huysentruyt K, Alliet P, Muyshont L, Rossignol R, Devreker T, Bontems P, et al. The STRONGkids nutritional screening tool in hospitalized children: a validation study. Nutrition. 2013;29:1356-61. DOI: https://doi.org/10.1016/j.nut.2013.05.008

Portugal. Despacho n.º 6634/2018 do Gabinete do Secretário de Estado Adjunto e da Saúde. Diário da República, II Série, n.º 129 (2018/07/06). p.1-2.

Hulst JM, Zwart H, Hop WC, Joosten KF. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr. 2010;29:106-11. DOI: https://doi.org/10.1016/j.clnu.2009.07.006

Rocha GA, Rocha EJ, Martins CV. Hospitalização: efeito sobre o estado nutricional em crianças. J Pediatr. 2006;82:70-4.

Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Carney L, et al. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. J Parenter Enteral Nutr. 2013;37:460-81. DOI: https://doi.org/10.1177/0148607113479972

Joosten KF, Hulst JM. Nutritional screening tools for hospitalized children: methodological considerations. Clin Nutr. 2014;33:1-5. DOI: https://doi.org/10.1016/j.clnu.2013.08.002

Sousa I, Mendes I, Lopes J, Mendes A, Franchini B, Carvalho R. Nutritional risk screening in azorean hospitalized children: a portuguese validation study. Port J Pediatr. 2022;53:383-92.

Guarino A, Albano F, Ashkenazi S, Gendrel D, Hoekstra JH, Shamir R, et al European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/ European Society for Paediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: executive summary. J Pediatr Gastroenterol Nutr. 2008;46:619-21. DOI: https://doi.org/10.1097/MPG.0b013e31816e219e

Hartman C, Shamir R, Hecht C, Koletzko B. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metab Care. 2012;15:303-9. DOI: https://doi.org/10.1097/MCO.0b013e328352dcd4

Moeeni V, Walls T, Day AS. Assessment of nutritional status and nutritional risk in hospitalized Iranian children. Acta Paediatr. 2012;101:e446-51. DOI: https://doi.org/10.1111/j.1651-2227.2012.02789.x

Moeeni V, Walls T, Day AS. Nutritional status and nutrition risk screening in hospitalized children in New Zealand. Acta Paediatr. 2013;102:e419-23. DOI: https://doi.org/10.1111/apa.12299

Direção-Geral da Saúde. Programa Nacional para a Promoção da Alimentação Saudável. Lisboa: DGS; 2020.

Matos C, Faria A, Vasconcelos C, Asseiceira I, Tomada I, Dias MP, et al. NOP 001/2018. Versão 01 - Identificação do Risco Nutricional em Idade Pediátrica. 2018. [cited 2021 Mar 22]. Available from: https://www.ordemdosnutricionistas.pt/documentos/NOP/NOP/NOP0012018-RNIdadePediatrica01062018.pdf.

Maciel JR, Nakano EY, Carvalho KM, Dutra ES. STRONGkids validation: tool accuracy. J Pediatr. 2020;96:371-8. DOI: https://doi.org/10.1016/j.jped.2018.12.012

Barros TA, da Silva Cruvel JM, de Melo Silva B, Pires BR, Barroso MP, Coutinho MA, et al. Agreement between nutritional risk screening tools and anthropometry in hospitalized pediatric patients. Clin Nutr. 2022;47:227-32. DOI: https://doi.org/10.1016/j.clnesp.2021.12.008

World Health Organization. Length/height-for-age. 2015. [cited 2021 Apr 02]. Available from: http://www.who.int/childgrowth/standards/height_for_age/en/.

World Health Organization. Weight-for-length/height. 2015. [cited 2021 Jun 16]. Available from: http://www.who.int/childgrowth/standards/weight_for_height/en/.

World Health Organization. BMI-for-age (5-19 years). 2015. [cited 2021 May 18]. Available from: http://www.who.int/growthref/who2007_bmi_for_age/en/.

World Health Organization. Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva: World Health Organization; 1999.

Chou JH, Roumiantsev S, Singh R. PediTools electronic growth chart calculators: applications in clinical care, research, and quality improvement. J Med Internet Res. 2020;22:e16204. DOI: https://doi.org/10.2196/16204

Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:1-13. DOI: https://doi.org/10.1186/1471-2431-13-59

World Health Organization. Growth reference data for 5-19 years. 2009. [cited 2021 Mar 12]. Available from: https://www.who.int/tools/growth-referencedata-for-5to19-years/application-tools.

Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, Brusset MC, Mosser F, Berrier F, et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. AmJ Clin Nutr. 2000;72:64-70. DOI: https://doi.org/10.1093/ajcn/72.1.64

Carter LE, Shoyele G, Southon S, Farmer A, Persad R, Mazurak VC, et al. Screening for pediatric malnutrition at hospital admission: which screening tool is best? Nutr Clin Pract. 2020;35:951-8. DOI: https://doi.org/10.1002/ncp.10367

Widhalm K, Rashidian F, Emminger W, Huber WD, Bariss-Riedl M, Fritsch M, et al. Malnutrition in hospitalized children aged 3-18 years. Results by using a new score in comparison with previous described scores. J Ernährungsmedizin. 2007;9:13-7.

Hendrikse WH, Reilly JJ, Weaver LT. Malnutrition in a children’s hospital. Clin Nutr. 1997;16:13-8. DOI: https://doi.org/10.1016/S0261-5614(97)80253-1

Shaaban S, Nassar M, El-Gendy Y, El-Shaer B. Nutritional risk screening of hospitalized children aged < 3 years. Eastern Mediterr Health J. 2019;25:18-23. DOI: https://doi.org/10.26719/emhj.18.019

Rocha GA, Rocha EJ, Martins CV. Hospitalização: efeito sobre o estado nutricional em crianças. J Pediatr. 2006;82:70-4. DOI: https://doi.org/10.2223/JPED.1440

Cao J, Peng L, Li R, Chen Y, Li X, Mo B, et al. Nutritional risk screening and its clinical significance in hospitalized children. Clin Nutr. 2014;33:432-6. DOI: https://doi.org/10.1016/j.clnu.2013.06.009

Published

2023-01-18

How to Cite

1.
Vieira Gonçalves L, Oliveira AG, Barracosa M, Antunes J, Pimenta J. Nutritional Risk and Malnutrition in Paediatrics: From Anthropometric Assessment to Strongkids® Screening Tool. Acta Med Port [Internet]. 2023 Jan. 18 [cited 2024 Nov. 22];36(5):309-16. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/16768

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