Nutritional risk assessment in hospitalized children: a comparison of pediatric subjective global assessment and STRONGkids screening tool with anthropometric indicators

  • Luciana da S. Klein Campos Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)
  • Laura Dresch Neumann Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)
  • Estela Iraci Rabito Universidade Federal do Paraná (UFPR)
  • Elza Daniel de Mello Universidade Federal do Rio Grande do Sul (UFRGS)
  • Juliana Paludo Vallandro Universidade Federal do Rio Grande do Sul (UFRGS)
Keywords: nutrition assessment, child, hospitalized, malnutrition.

Abstract

Aims: To compare the Subjective Global Nutritional Assessment (SGNA) and the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) protocols with anthropometric measurements at admission, and associate them to length of stay in hospitalized children.

Methods: Cross-sectional study with patients from four to 8.9 years admitted to a pediatric hospital in Porto Alegre, Rio Grande do Sul, Brazil. The sample was selected by convenience, and data collection occurred between June and October 2014. Patients in the Intensive Care Unit and those unable to feed orally were not included. We collected general and socioeconomic information and applied STRONGkids and SGNA protocols at admission. Clinical and anthropometric data were retrieved from electronic medical records.

Results: We evaluated 317 patients with a mean age of 76.1±17.5 months, most of them admitted for surgery (21.5%). According to anthropometric measurements, 5% of patients were malnourished, 74.1% had normal weight and 20.8% were overweight. There was a statistically significant association between malnutrition classified by anthropometric measurements and moderate and severe malnutrition defined by SGNA (p<0.001). There was also a significant association between overweight, normal weight and malnutrition classified by anthropometric measurements and low, medium and high nutritional risk, respectively (p<0.001). There was a statistically significant agreement, although very weak, between STRONGkids and anthropometric measurements (kappa=0.148; p=0.001).

Conclusions: All protocols were associated (though in low intensity) to length of hospital stay. In addition, STRONGkids showed greater agreement, although still weak, with anthropometric measurements when compared to the SGNA. Further studies are needed to verify the agreement of these protocols with other objective methods of nutritional assessment.

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Author Biographies

Luciana da S. Klein Campos, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)
Nutricionista. Pós graduada em Atenção em Terapia Intensiva pelo Programa de Residência Multiprofissional Integrada em Saúde da UFCSPA.
Laura Dresch Neumann, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)
Aluna do curso de graduação em Nutrição da UFCSPA.
Estela Iraci Rabito, Universidade Federal do Paraná (UFPR)
Professora doutora do Departamento de Nutrição da UFPR.
Elza Daniel de Mello, Universidade Federal do Rio Grande do Sul (UFRGS)
Professora Doutora do Programa de Pós Graduação em Saúde da Criança e do Adolescente da UFRGS.
Juliana Paludo Vallandro, Universidade Federal do Rio Grande do Sul (UFRGS)
Nutricionista. Mestre e doutoranda em Saúde da Criança e do Adolescente pela UFRGS.

References

Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Schneider S, van den Berghe G, Pichard C. Introductory to the ESPEN Guidelines on enteral nutrition: terminology, definitions and general topics. Clin Nutr. 2006;25:180-6. http://dx.doi.org/10.1016/j.clnu.2006.02.007

Joosten KFM, Hulst JM. Malnutrition in pediatric hospital patients: Current issues. Nutrition. 2011;27:133-7. http://dx.doi.org/10.1016/j.nut.2010.06.001

Bejon P, Mohammed S, Mwangi I, Atkinson SH, Osier F, Peshu N, Newton CR, Maitland K, Berkley JA. Fraction of all hospital admissions and deaths attributable to malnutrition among children in rural Kenya. Am J Clin Nutr. 2008;88:1626-31. http://dx.doi.org/10.3945/ajcn.2008.26510

Hartman C, Raanan S, Hecht C, Koletzko B. Malnutrition screening tools for hospitalized children. Curr Opin Clin Nutr Metab Care. 2012;15:303-9. http://dx.doi.org/10.1097/MCO.0b013e328352dcd4

Dal Bosco S. Terapia nutricional pediátrica. 1ª ed. São Paulo: Atheneu, 2010.

Mahdavi AM, Safaiyan A, Ostadrahimi A. Subjective vs. objective nutritional assessment study in children: a cross-sectional study in the northwest of Iran. Nutr Res. 2009;29:269-74. http://dx.doi.org/10.1016/j.nutres.2009.03.009

Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, Brusset MC, Mosser F, Berrier F, Ricour C. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr. 2000;72:64-70.

Secker DJ, Jeejeebhoy KN. Subjective global nutritional assessment for children. Am J Clin Nutr. 2007;85:1083-9.

McCarthy H, McNulty H, Dixon M, Eaton-Evans MJ. Screening for nutrition risk in children: the validation of a new tool. J Hum Nutr Diet. 2008;21:395-6. http://dx.doi.org/10.1111/j.1365-277X.2008.00881_31.x

Hulst JM, Zwart H, Hop WC, Joosten KFM. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clinical Nutrition. 2010;29:106-11. http://dx.doi.org/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;104:751-6. http://dx.doi.org/10.1017/S0007114510001121

ABEP - Associação Brasileira de Empresas de Pesquisa [Internet]. Critério de Classificação Econômica Brasil. 2012 [cited 2014 out 27]. Available from: http://www.abep.org/codigosCondutas.aspx

WHO Multicentre Growth Reference Study Group. WHO child growth standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450:76-85.

Software for assessing growth and development of the world's children. WHO Anthro for personal computers [programa de computador]. Versão 2011. Geneva: World Health Organization; 2010. [cited 2014 out 27]. Available from: http://www.who.int/childgrowth/software/en/

Software for assessing growth of the world's children and adolescents. WHO AnthroPlus for personal computers [programa de computador]. Versão 2009. Geneva: World Health Organization, 2009. [cited 2014 out 27]. Available from: http://www.who.int/growthref/tools/en/

Brooks J, Day S, Shavelle R, Strauss D. Low weight, morbidity, and mortality in children with cerebral palsy: new clinical growth charts. Pediatrics. 2011;128:e299-e307. http://dx.doi.org/10.1542/peds.2010-2801

Cronk C, Crocker AC, Pueschel SM, Shea AM, Zackai E, Pickens G, Reed RB. Growth charts for children with Down syndrome: 1 month to 18 years of age. Pediatrics. 1988;81:102-10.

Cao J, Peng L, Li R, Chen Y, Li X, Mo B, Li X. Nutritional risk screening and its clinical significance in hospitalized children. Clinical Nutrition. 2014;33:432-36. http://dx.doi.org/10.1016/j.clnu.2013.06.009

Wonoputri N, Djais JTB, Rosalina I. Validity of nutritional screening tools for hospitalized children. J Nutr Metab. 2014;2014:143649. http://dx.doi.org/10.1155/2014/143649

Vermilyea S, Slicker J, El-Chammas K, Sultan M, Dasgupta M, Hoffmann RG, Wakeham M, Goday PS. Subjective global nutritional assessment in critically ill children. JPEN J Parenter Enteral Nutr. 2013;37:659-66. http://dx.doi.org/10.1177/0148607112452000

Mărginean O, Pitea AM, Voidăzan S, Mărginean C. Prevalence and assessment of malnutrition risk among hospitalized children in Romania. J Health Popul Nutr. 2014;32:97-102.

Wiskin AE, Owens DR, Cornelius VR, Wootton SA, Beattie RM. Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. J Hum Nutr Diet. 2012;25:319-22. http://dx.doi.org/10.1111/j.1365-277X.2012.01254.x

Spagnuolo MI, Liguoro I, Chiatto F, Mambretti D, Guarino A. Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting. Ital J Pediatr. 2013;39:81. http://dx.doi.org/10.1186/1824-7288-39-81

Joosten KF, Zwart H, Hop WC, Hulst JM. National malnutrition screening days in hospitalized children in The Netherlands. Arch Dis Child. 2010;95:141-45. http://dx.doi.org/10.1136/adc.2008.157255

Tanner JM. Growth at adolescence: with a general consideration of the effects of hereditary and environmental factors upon growth and maturation from birth to maturity. 2nd edition. Oxford: Blackwell Scientific Publications; 1962.

Published
2016-01-26
How to Cite
Campos, L. da S. K., Neumann, L. D., Rabito, E. I., de Mello, E. D., & Vallandro, J. P. (2016). Nutritional risk assessment in hospitalized children: a comparison of pediatric subjective global assessment and STRONGkids screening tool with anthropometric indicators. Scientia Medica, 25(3), ID21948. https://doi.org/10.15448/1980-6108.2015.3.21948
Section
Original Articles