Pawaria Arti, Khanna Rajeev, Sood Vikrant, Siloliya Manish, Benjamin Jaya J, Kumar Guresh, Alam Seema
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Clinical Nutrition, Institute of Liver and Biliary Sciences, New Delhi, India.
Br J Nutr. 2022 Mar 28;127(6):904-913. doi: 10.1017/S0007114521001604. Epub 2021 May 14.
Objective of the study was to assess subjective global nutritional assessment (SGNA) in children with chronic liver diseases (CLD). Children aged 3 months to 18 years with CLD were prospectively enrolled (January 2016 to October 2018). SGNA was performed as per validated pro forma for children. Nutritional categories were categorised into three groups: A (well-nourished), B (moderately malnourished) and C (severely malnourished). Agreement between SGNA and anthropometric measures, prediction of morbidity and death or liver transplantation (LT) at 1-year post-enrolment by SGNA and inter-observer reliability of SGNA were assessed. Ninety-two subjects were enrolled, median age 23·5 (3-216) months. SGNA classified 47 patients (51·1 %) in group A, 26 (28·3 %) in group B and 19 (20·6 %) in group C. Kendall coefficients disclosed significant association of SGNA with all anthropometric measurements, greatest with weight for age (r = -0·637), height for age (r = -0·581) and mid-arm fat area (r = -0·449). At 12 months follow-up, twenty children died and four received LT. A significantly higher number of children with malnutrition (groups B and C) had poor outcome (OR 6·74 (95 % CI 2·21, 20·55), P = 0·001), increased risk of hospital readmission (OR 12·2 (95 % CI 4·60, 35·88), P = 0·001), higher rate of infectious complications (OR 22·68 (95 % CI 7·29, 70·53), P < 0·0001) and lower median survival with native liver (Log Rank < 0·001) as compared with group A. Inter-observer agreement in assessment of SGNA was good (90·2 %). SGNA, in contrast to anthropometric measures, is a better nutritional assessment tool. It is reliable, comprehensive and predicts poor outcome in childhood CLD.
本研究的目的是评估慢性肝病（CLD）患儿的主观全面营养评估（SGNA）。前瞻性纳入了年龄在3个月至18岁的CLD患儿（2016年1月至2018年10月）。按照针对儿童的有效格式进行SGNA。营养类别分为三组：A组（营养良好）、B组（中度营养不良）和C组（重度营养不良）。评估了SGNA与人体测量指标之间的一致性、SGNA对入组后1年发病率、死亡率或肝移植（LT）的预测以及SGNA的观察者间可靠性。共纳入92名受试者，中位年龄23.5（3 - 216）个月。SGNA将47例患者（51.1%）归为A组，26例（28.3%）归为B组，19例（20.6%）归为C组。肯德尔系数显示SGNA与所有人体测量指标均存在显著关联，与年龄别体重（r = -0.637）、年龄别身高（r = -0.581）和上臂脂肪面积（r = -0.449）的关联最为显著。在12个月的随访中，20名儿童死亡，4名接受了LT。与A组相比，营养不良儿童（B组和C组）的不良结局发生率显著更高（比值比6.74（95%置信区间2.21，20.55），P = 0.001），再次入院风险增加（比值比12.2（95%置信区间4.60，35.88），P = 0.001），感染并发症发生率更高（比值比22.68（95%置信区间7.29，70.53），P < 0.0001），且肝脏原位的中位生存期更低（对数秩<0.001）。SGNA评估中的观察者间一致性良好（90.2%）。与人体测量指标相比，SGNA是一种更好的营养评估工具。它可靠、全面，并且能预测儿童CLD的不良结局。
