Concordance between pediatric nutritional screening tools in individuals with nefrotic syndrome

Paula Emília Nunes Ribeiro Bellot, Geovanna Torres de Paiva, Sancha Helena de Lima Vale, Richele Janaína de Araújo Machado

Abstract


AIMS: To evaluate the concordance between three validated nutritional screening tools for pediatrics among themselves and the correlation with the anthropometric parameters of patients hospitalized with nephrotic syndrome.
METHOD: Cross-sectional study with children and adolescents of both sexes hospitalized in the pediatric ward of a university hospital and diagnosed with nephrotic syndrome. Three nutritional screening instruments were applied: Screening of Risk for Nutritional Status and Growth (STRONGkids), Paediatric Yorkhill Malnutrition Score (PYMS) and Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP). Data on weight, height and upper arm perimeter was collected, and three nutritional screening tools were applied: The estimate of relative agreement between the instruments was evaluated with the weighted Kappa test and the correlations with anthropometric parameters were assessed with the Spearman’s Correlation Test.
RESULTS: We evaluated 11 patients, with a minimum age of 2 years and a maximum of 10 years. Screening tools detected prevalence of medium and high nutritional risk. Moderate agreement (k=0.47) was observed between PYMS and STAMP and there was no correlation between the screening tools’ result and the anthropometric data. Regarding the anthropometric parameters, 100% of the participants had adequate weight for age, 63.6% of the participants were diagnosed with normal weight by the BMI/Age index and 81.8% had adequate height for age according to the index Height/Age. After analysis of the upper arm perimeter, 27.3% were at risk of malnutrition.
CONCLUSIONS: Despite the fact that are no recommendations for use of pediatric nutritional screening tools specific to each clinical situation, two of the three screening tools analyzed in this study demonstrated moderate agreement between them. However, the tested tools did not reflect the anthropometric nutritional status of the evaluated population.


Keywords


Pediatrics; nephrotic syndrome; nutrition assessment.

References


Lage FB. Recomendação proteica para crianças com síndrome nefrótica. Rev Bras Nutr Clin. 2014;29(4):360-6.

Hussain N, Zello JA, Vasilevska-Ristovska J, Banh TM, Patel VP, Patel P, Battiston CD, Hebert D, Licht CP, Piscione TD, Parekh RS. The rationale and design of Insight into Nephrotic Syndrome: Investigating Genes, Health and Therapeutics (INSIGHT): a prospective cohort study of childhood nephrotic syndrome. BMC Nephrol. 2013;14:25. https://doi:10.1186/1471-2369-14-25

Niaudet P, Boyer O. Idiopathic nephrotic syndrome in children: clinical aspects. In: Avner E, Harmon W, Niaudet P, Yoshikawa N, Emma F, Goldstein S, editors. Pediatric nephrology. Berlin: Springer; 2016. p. 839 82. https://doi.org/10.1007/978-3-662-43596-0_24

Phan V, Blydt-Hansen T, Feber J, Alos N, Arora S, Atkinson S, Bell L, Clarson C, Couch R, Cummings EA, Filler G, Grant RM, Grimmer J, Hebert D, Lentle B, Ma J, Matzinger M, Midgley J, Pinsk M, Rodd C, Shenouda N, Stein R, Stephure D, Taback S, Williams K, Rauch F, Siminoski K, Ward LM; Canadian STOPP Consortium. Skeletal findings in the first 12 months following initiation of glucocorticoid therapy for pediatric nephrotic syndrome. Osteoporos Int. 2014;25(2):627-37. https://doi:10.1007/s00198-013-2466-7

Agrawal S, Zaritsky JJ, Fornoni A, Smoyer WE. Dyslipidaemia in nephrotic syndrome: mechanisms and treatment. Nat Rev Nephrol. 2018;14(1):57-70. https://doi:10.1038/nrneph.2017.155

El-Mashad GM, El-Hawy MA, El-Hefnawy SM, Mohamed SM. Bone mineral density in children with idiopathic nephrotic syndrome. J Pediatr. 2017;93(2):142-7. https://doi:10.1016/j.jped.2016.05.010

Fidelix MSP, organizador. Manual Orientativo: sistematização do cuidado de nutrição. São Paulo: Associação Brasileira de Nutrição; 2014.

Fortes Almeida A, Lima Gusmao-Sena MH, Gonzaga Oliveira LC, Santana Gomes T, Neves do Nascimento TV, Nunes Gobatto AL, Ramos Sampaio L, Barreto-Medeiros JM. Inflammatory, nutritional and clinical parameters of individuals with chronic kidney disease undergoing conservative treatment. Nutr Hosp. 2015;32(3):1376-81. https://doi:10.3305/nh.2015.32.3.9125

Hulst JM, Zwart H, Hop WC, Joosten KF. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr. 2010;29(1):106-11. https://doi:10.1016/j.clnu.2009.07.006

Gerasimidis K, Keane O, Macleod I, Flynn DM, Wright CM. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr. 2010;104(5):751-6. https://doi:10.1017/S0007114510001121

McCarthy H, Dixon M, Crabtree I, Eaton-Evans MJ, McNulty H. The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) for use by healthcare staff. J Hum Nutr Diet. 2012;25(4):311-8. https://doi:10.1111/j.1365-277X.2012.01234.x

Raslan M, Gonzalez MC, Dias MCG, Paes-Barbosa FC, Cecconello I, Waitzberg DL. Aplicabilidade dos métodos de triagem nutricional no paciente hospitalizado. Rev Nutr. 2008;21(5): 553-61. https://doi:10.1590/S1415-52732008000500008

Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Especializada e Temática. Manual de Terapia Nutricional na Atenção Especializada Hospitalar no âmbito do Sistema Único de Saúde – SUS. Brasília: Ministério da Saúde; 2016. https://doi.org/10.5123/s1679-49742019000100016

Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Orientações para a coleta e análise de dados antropométricos em serviços de saúde: norma técnica do sistema de vigilância alimentar e nutricional – SISVAN. Brasília: Ministério da Saúde; 2011. https://doi.org/10.5123/s1679-49742019000200006

de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):0660-7. https://doi:10.2471/BLT.07.043497

WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450:76-85. https://doi:10.1080/08035320500495548

Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status. Clin Nutrition. 1991;10(2):131-2. https://doi:10.1016/0261-5614(91)90103-J

Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet. 2003;362(9384):629-39. https://doi:10.1016/S0140-6736(03)14184-0

León DC, Agudelo AM, Ramos J, Ibarra MD. Caracterización clínica del síndrome nefrótico en infantes de Neiva. RFS Revista Facultad de Salud. 2015;7(1):9-16. https://doi:10.25054/rfs.v7i1.174

Peres LAB, Bertol MFR. Doenças renais na infância. Rev Med Res. 2012;14(3):186-92.

Moreno MPR, García GP. Characteristics of idiopathic nephrotic syndrome at an unusual age in a tertiary-level pediatric hospital in Guadalajara, Jalisco, México. Bol Med Hosp Infant Mex. 2011;68(4):271-7.

Park SJ, Shin J Il. Complications of nephrotic syndrome. Korean J Pediatr. 2011;54(8):322-8. https://doi:10.3345/kjp.2011.54.8.322

Wonoputri N, Djais JTB, Rosalina I. Validity of nutritional screening tools for hospitalized children. J Nutr Metabol. 2014;2014:ID 143649. https://doi:10.1155/2014/143649

Ling RE, Hedges V, Sullivan PB. Nutritional risk in hospitalised children: an assessment of two instruments. Clin Nutr ESPEN. 2011;6(3):e153-7. https://doi:10.1016/j.eclnm.2011.01.007

Bousquet LA, Stringhini MLF, Mortoza AS. Avaliação nutricional subjetiva global: Instrumentos para triagem em crianças hospitalizadas. Rev Atenção Saúde. 2016;14(47):67-74. https://doi:10.13037/rbcs.vol14n47.3487

Aponte Borda AD, Pinzón Espitia OL, Aguilera Otalvaro PA. Tamizaje nutricional en paciente pediátrico hospitalizado: revisión sistemática. Nutrición Hospitalaria. 2018;35(5):1221-8. https://doi:10.20960/nh.1658

Mramba L, Ngari M, Mwangome M, Muchai L, Bauni E, Walker AS, Gibb DM, Fegan G, Berkley JA. A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study. BMJ. 2017;358(8117):j3423. https://doi:10.1136/bmj.j3423

Solarin AU, Adekunle MO, Olutekunbi OA, Lamina OM, Aremu OE, Animasahun AB, Njokanma FO. Nutritional Assessment of Children with Nephrotic Syndrome Attending a Tertiary Health Facility: a case control study. Tropical Journal of Nephrology. 2018;13(2):97-104.

Oliveira IC, Belangero VMS. Crescimento e composição corporal em crianças e adolescentes com síndrome nefrótica córtico-dependente. J Bras Nefrol. 2009;31(4):252-57. https://doi:10.1590/S0101-28002009000400003




DOI: http://dx.doi.org/10.15448/1980-6108.2019.4.33642

e-ISSN: 1980-6108 | ISSN-L: 1806-5562


Except where otherwise specified, material published in this journal is licensed under a Creative Commons Attribution 4.0 International license, which allows unrestricted use, distribution and reproduction in any medium, provided the original publication is correctly cited.