Bouma Sandra
University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA.
Nutr Clin Pract. 2017 Feb;32(1):52-67. doi: 10.1177/0884533616671861.
The publication of the landmark paper "Defining Pediatric Malnutrition: A Paradigm Shift Toward Etiology-Related Definitions" launched a new era in diagnosing pediatric malnutrition. This work introduced the paradigm shift of etiology-related definitions-nonillness and illness related-and the use of anthropometric z scores to help identify and describe children with malnutrition (undernutrition) in the developed world. Putting the new definition into practice resulted in some interesting observations: (1) Etiology-related definitions result in etiology-related interventions. (2) Illness-related malnutrition cannot always be immediately "fixed." (3) Using z scores in clinical practice often puts the burden of proof on the clinician to show that a child is not malnourished, rather than the other way around. (4) Children with growth failure severe enough to be admitted with "failure to thrive" should always be assessed for malnutrition, and when they meet the criteria, malnutrition should be documented and coded. The publication of the consensus statement came next, announcing the evidence-informed, consensus-derived pediatric malnutrition indicators. Since the indicators are a work in progress, clinicians are encouraged to use them and give feedback through an iterative process. This review attempts to respond to the consensus statement's call to action by thoughtfully appraising the indicators and making recommendations for future review. Coming together as a healthcare community to identify pediatric malnutrition will ensure that this vulnerable population is not overlooked. Outcomes research will validate the indicators and result in new discoveries of effective ways to prevent and treat pediatric malnutrition.
具有里程碑意义的论文《定义儿童营养不良：向病因相关定义的范式转变》的发表开启了儿童营养不良诊断的新时代。这项工作引入了病因相关定义的范式转变——非疾病相关和疾病相关——以及使用人体测量Z评分来帮助识别和描述发达国家中患有营养不良（营养不足）的儿童。将新定义付诸实践产生了一些有趣的观察结果：（1）病因相关定义导致病因相关干预措施。（2）与疾病相关的营养不良并非总能立即“治愈”。（3）在临床实践中使用Z评分往往将举证责任置于临床医生身上，要求其证明儿童没有营养不良，而不是相反。（4）对于因“发育迟缓”而住院的严重生长发育不良儿童，应始终评估其是否存在营养不良，若符合标准，应记录并编码营养不良情况。接下来发表了共识声明，公布了基于证据、经共识得出的儿童营养不良指标。由于这些指标仍在完善中，鼓励临床医生使用它们，并通过迭代过程提供反馈。本综述试图通过认真评估这些指标并为未来的审查提出建议，回应共识声明的行动呼吁。作为一个医疗保健社区共同努力识别儿童营养不良情况，将确保这一弱势群体不被忽视。结果研究将验证这些指标，并带来预防和治疗儿童营养不良有效方法的新发现。
