验证 AND/ASPEN 儿科营养不良诊断在马来西亚两家三级医院儿科病房住院患儿中的应用。
Validation of AND/ASPEN pediatric malnutrition diagnosis in children admitted to medical wards in two tertiary hospitals in Malaysia.
机构信息
Institute of Research Development and Innovation, International Medical University, Kuala Lumpur, Malaysia.
Division of Nutrition and Dietetics, International Medical University, Kuala Lumpur, Malaysia.
出版信息
Nutr Clin Pract. 2023 Aug;38(4):889-898. doi: 10.1002/ncp.10971. Epub 2023 Feb 22.
BACKGROUND
Identification and management of malnutrition among pediatric hospitalized patients is critical for improved clinical outcomes and recovery. This study investigated the use of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (AND/ASPEN) pediatric malnutrition diagnosis in comparison with the Subjective Global Nutritional Assessment (SGNA) tool and single anthropometric indicators (weight, height, body mass index, and mid-upper arm circumference) among hospitalized children.
METHODS
A cross-sectional study was conducted among 260 children admitted to general medical wards. SGNA and anthropometric measurements were used as references. Kappa agreement, diagnostic values, and area under the curve (AUC) were analyzed to evaluate the diagnostic ability of the AND/ASPEN malnutrition diagnosis tool. Logistic binary regression was performed to determine the predictive ability of each malnutrition diagnosis tool on the length of hospital stay.
RESULTS
The AND/ASPEN diagnosis tool detected the highest malnutrition rate (41%) among the hospitalized children in comparison with the reference methods. This tool demonstrated fair specificity of 74% and sensitivity of 70% compared with the SGNA. It obtained a weak agreement in determining the presence of malnutrition by kappa (0.06-0.42) and receiver operating characteristic curve analysis (AUC = 0.54-0.72). The use of the AND/ASPEN tool obtained an odds ratio of 0.84 (95% CI, 0.44-1.61; P = 0.59) in predicting the length of hospital stay.
CONCLUSIONS
The AND/ASPEN malnutrition tool is an acceptable nutrition assessment tool for hospitalized children in general medical wards.
背景
识别和管理儿科住院患者的营养不良对于改善临床结局和康复至关重要。本研究调查了使用营养与饮食学会和肠外与肠内营养学会（AND/ASPEN）儿科营养不良诊断与主观全面营养评估（SGNA）工具以及单一人体测量指标（体重、身高、体重指数和上臂中部周长）在住院儿童中的应用。
方法
对 260 名入住普通内科病房的儿童进行了横断面研究。将 SGNA 和人体测量测量值作为参考。分析了 Kappa 一致性、诊断值和曲线下面积（AUC），以评估 AND/ASPEN 营养不良诊断工具的诊断能力。进行逻辑二元回归分析，以确定每种营养不良诊断工具对住院时间的预测能力。
结果
与参考方法相比，AND/ASPEN 诊断工具在住院儿童中检测到最高的营养不良率（41%）。与 SGNA 相比，该工具具有 74%的良好特异性和 70%的敏感性。通过 Kappa（0.06-0.42）和受试者工作特征曲线分析（AUC=0.54-0.72），其在确定营养不良的存在方面的一致性较弱。使用 AND/ASPEN 工具预测住院时间的优势比为 0.84（95%置信区间，0.44-1.61；P=0.59）。
结论
AND/ASPEN 营养不良工具是普通内科病房住院儿童可接受的营养评估工具。
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