Department of Nutrition and Dietetics, Faculty of Health Sciences, Karamanoğlu Mehmetbey University, Karaman, Turkey.
Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara, Turkey.
Clin Nutr ESPEN. 2023 Oct;57:770-778. doi: 10.1016/j.clnesp.2023.08.031. Epub 2023 Sep 9.
BACKGROUND & AIMS: Detecting malnutrition and its related risk factors are crucial, in hospitalized children. Anthropometric z scores are used to assess malnutrition. Screening tools also aim to detect the presence of malnutrition and the developing risk of malnutrition in hospitalized children to determine who may benefit from nutritional support. Therefore, the aims of the study are to detect malnutrition and its related demographic and clinical risk factors in hospitalized children and determining the sensitivity of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) and Pediatric Yorkhill Malnutrition Score (PYMS) screening tools.
A total of 130 hospitalized children aged between 0 and 18 years were included in to study. A survey including demographic and clinical characteristics, STAMP and PYMS were applied to parents of the children. Patients were classified into nutritional risk groups through screening tools. Anthropometric measurements (body weight, length/height, and middle upper arm circumference (MUAC) of the children were taken. Body mass index-for-age and height-for-age z scores were calculated to assess acute and chronic malnutrition prevalence. MUAC-for-age z scores were calculated as well. To detect independent risk factors for acute and chronic malnutrition multivariable logistic regression models were constructed.
A total of 14.6% of hospitalized children had acute malnutrition, 21.5% of children had chronic malnutrition and 27.7% of them had low MUAC standard deviation score (SDS) (less than -2). The independent risk factors for acute malnutrition were younger maternal age at birth and long length of stay (p < 0.05). The independent risk factors for chronic malnutrition were being female, younger maternal age at birth, longer illness duration and having urological or allergy and immunological diseases (p < 0.05). However, MUAC for age SDS groups were not related to any demographic and clinical factors, in children of all ages (p > 0.05). Regarding the screening tools, PYMS displayed 100% sensitivity against acute malnutrition. While PYMS displayed better sensitivity to identify acute malnutrition than STAMP, STAMP was more sensitive than PYMS to detect chronic malnutrition and low MUAC SDS.
Low MUAC for age SDS was not related to any demographic and clinical factors, in hospitalized children of all ages, unlike acute and chronic malnutrition, in this study. Pediatric screening tools mainly PYMS did not have high sensitivity to detect chronic malnutrition and low MUAC SDS, in hospitalized children. Therefore, the tools have to be used along with z scores of anthropometric parameters.
在住院儿童中，检测营养不良及其相关危险因素至关重要。人体测量学 z 分数用于评估营养不良。筛查工具也旨在检测住院儿童中营养不良的存在及其发生营养不良的风险，以确定谁可能受益于营养支持。因此，本研究的目的是检测住院儿童的营养不良及其相关人口统计学和临床危险因素，并确定 Screening Tool for the Assessment of Malnutrition in Pediatrics（STAMP）和 Pediatric Yorkhill Malnutrition Score（PYMS）筛查工具的敏感性。
本研究纳入了 130 名年龄在 0 至 18 岁之间的住院儿童。向儿童的家长发放包括人口统计学和临床特征、STAMP 和 PYMS 的调查问卷。通过筛查工具将患者分为营养风险组。测量儿童的人体测量学指标（体重、身高/长度和中上臂围（MUAC）。计算体重指数年龄和身高年龄 z 分数以评估急性和慢性营养不良的患病率。还计算 MUAC 年龄 z 分数。构建多变量逻辑回归模型以检测急性和慢性营养不良的独立危险因素。
共有 14.6%的住院儿童存在急性营养不良，21.5%的儿童存在慢性营养不良，27.7%的儿童 MUAC 标准差评分（SDS）较低（低于-2）。急性营养不良的独立危险因素是母亲分娩时年龄较小和住院时间较长（p<0.05）。慢性营养不良的独立危险因素是女性、母亲分娩时年龄较小、疾病持续时间较长以及患有泌尿系统或过敏和免疫性疾病（p<0.05）。然而，MUAC 年龄 SDS 组与所有年龄段儿童的任何人口统计学和临床因素均无关（p>0.05）。关于筛查工具，PYMS 对急性营养不良的敏感性为 100%。虽然 PYMS 对识别急性营养不良的敏感性优于 STAMP，但 STAMP 对慢性营养不良和低 MUAC SDS 的敏感性高于 PYMS。
与本研究中的急性和慢性营养不良不同，低 MUAC 年龄 SDS 与所有年龄段住院儿童的任何人口统计学和临床因素均无关。儿科筛查工具主要是 PYMS 对检测住院儿童的慢性营养不良和低 MUAC SDS 的敏感性不高。因此，这些工具必须与人体测量学参数的 z 分数一起使用。
