一种针对慢性腹膜透析儿童的新型客观营养评分。

Edefonti Alberto, Picca Marina, Paglialonga Fabio, Loi Silvana, Grassi Maria Rosa, Ardissino Gianluigi, Marra Giuseppina, Ghio Luciana, Fossali Emilio

Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy.

Perit Dial Int. 2002 Sep-Oct;22(5):602-7.

OBJECTIVES

To establish a novel nutritional score based on a series of objective parameters capable of detecting protein-calorie malnutrition in children being treated with chronic peritoneal dialysis (CPD), to test the score in a healthy pediatric population, and to apply it to children on CPD to evaluate their nutritional status.

STUDY POPULATION

264 healthy school children (mean age 8.69 +/- 3.26 years, range 3.05-14.98 years) and 29 patients treated with CPD for 1.75 +/- 1.02 years (mean age 10.54 +/- 6.28 years, range 2.8-15.24 years).

METHODS

Nutritional status was evaluated by means of three sets of measurements: anthropometric (A1 and A2) and bioimpedance analysis (BIA) measurements. Anthropometry included two sets of measures: set A1 consisted of height (H), weight (W), and body mass index (BMI); set A2 consisted of midarm muscle circumference (MAMC), arm muscle area (AMA), and arm fat area (AFA). The BIA measurements included reactance, phase angle, and distance. All parameters are expressed as standard deviation scores (SDS).Tanner's, Rolland-Cachera's, and Frisancho's data were used as references for H, W, BMI, MAMC, AMA, and AFA; personal data obtained from 551 healthy boys and girls were used for the BIA indices. The nine anthropometry and BIA parameters were given scores of 1 to 5: 5 = > 0 SDS, 4 = < or = 0 and > -1 SDS, 3 = < or = -1 and > -2 SDS, 2 = <-2 and > -3 SDS, and 1 = < or = -3 SDS. Average scores were established for each of A1, A2, and BIA, and then summed to obtain the anthropometry-BIA nutrition (ABN) score. To establish the cutoff value between normal nutritional status and malnutrition, the method was first applied to the 264 healthy children; distribution percentiles were calculated for each area score and the ABN score. The ABN score corresponding to the 3rd percentile was considered the limit of normality and then applied three times to the 29 children on CPD, for a total of 87 nutritional assessments.

RESULTS

The score corresponding to the 3rd percentile in the population of healthy children was 10.33. Among the CPD-treated children, 41.4% of the ABN scores were higher than 10.33 (indicating a state of normal nutrition) and 58.6% were lower (indicating various degrees of malnutrition). Severe malnutrition was found in only 1.1% of the cases. The values of all nine A1, A2, and BIA parameters, as well as serum albumin levels, were significantly higher in patients with an ABN score > 10.33 than in those with a score < 10.33.

CONCLUSION

The ABN score is a simple and objective method of assessing, in clinical practice, the nutritional status of children on CPD.

目的

基于一系列客观参数建立一种新型营养评分，以检测接受慢性腹膜透析（CPD）治疗的儿童的蛋白质 - 热量营养不良，在健康儿科人群中测试该评分，并将其应用于接受CPD治疗的儿童以评估其营养状况。

研究人群

264名健康在校儿童（平均年龄8.69±3.26岁，范围3.05 - 14.98岁）和29名接受CPD治疗1.75±1.02年的患者（平均年龄10.54±6.28岁，范围2.8 - 15.24岁）。

方法

通过三组测量评估营养状况：人体测量（A1和A2）和生物电阻抗分析（BIA）测量。人体测量包括两组测量：A1组包括身高（H）、体重（W）和体重指数（BMI）；A2组包括上臂肌肉周长（MAMC）、手臂肌肉面积（AMA）和手臂脂肪面积（AFA）。BIA测量包括电抗、相位角和距离。所有参数均表示为标准差分数（SDS）。Tanner、Rolland - Cachera和Frisancho的数据用作H、W、BMI、MAMC、AMA和AFA的参考；从551名健康男孩和女孩获得的个人数据用于BIA指数。九个人体测量和BIA参数的得分从1到5：5 = > 0 SDS，4 = <或= 0且> -1 SDS，3 = <或= -1且> -2 SDS，2 = < -2且> -3 SDS，1 = <或= -3 SDS。为A1、A2和BIA分别确定平均得分，然后求和以获得人体测量 - BIA营养（ABN）评分。为了确定正常营养状况和营养不良之间的临界值，该方法首先应用于264名健康儿童；计算每个区域得分和ABN得分的分布百分位数。对应于第3百分位数的ABN得分被视为正常范围的界限，然后将其三次应用于29名接受CPD治疗的儿童，总共进行87次营养评估。

结果

健康儿童人群中对应第3百分位数的评分为10.33。在接受CPD治疗的儿童中，41.4%的ABN得分高于10.33（表明营养正常状态），58.6%的得分较低（表明不同程度的营养不良）。仅1.1%的病例发现严重营养不良。ABN得分> 10.33的患者中所有九个A1、A2和BIA参数的值以及血清白蛋白水平均显著高于得分< 10.33的患者。