Evaluando la desnutrición en pediatría, un reto vigente <span class="so-article-trans-title" dir="auto"> Translated title: Evaluating malnutrition in pediatrics, a current challenge </span>

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Abstract

Resumen La desnutrición en el paciente pediátrico condiciona su salud/enfermedad. La desnutrición en el niño enfermo agrava aun más, si cabe, su situación de base y condiciona su evolución y pronóstico. A pesar de su relevancia, no se evalúa en muchos casos ni se tiene una única definición que facilite su diagnóstico. El objetivo de este artículo es establecer los aspectos prioritarios a la hora de evaluar la desnutrición y resaltar la importancia de hacerlo de forma rutinaria.

Translated abstract

Abstract Malnutrition in pediatric patients conditions their health/illness. Malnutrition in sick children further aggravates their baseline situation, and conditions their evolution and prognosis. Despite its relevance, it is not evaluated in many cases, nor is there a single definition that facilitates its diagnosis. The objective of this article is to establish the principal aspects to consider when evaluating malnutrition, and to highlight the importance of routine evaluation.

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Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions.

Nilesh Mehta, Mark Corkins, Beth Lyman … (2013)

Lack of a uniform definition is responsible for underrecognition of the prevalence of malnutrition and its impact on outcomes in children. A pediatric malnutrition definitions workgroup reviewed existing pediatric age group English-language literature from 1955 to 2011, for relevant references related to 5 domains of the definition of malnutrition that were a priori identified: anthropometric parameters, growth, chronicity of malnutrition, etiology and pathogenesis, and developmental/ functional outcomes. Based on available evidence and an iterative process to arrive at multidisciplinary consensus in the group, these domains were included in the overall construct of a new definition. Pediatric malnutrition (undernutrition) is defined as an imbalance between nutrient requirements and intake that results in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. A summary of the literature is presented and a new classification scheme is proposed that incorporates chronicity, etiology, mechanisms of nutrient imbalance, severity of malnutrition, and its impact on outcomes. Based on its etiology, malnutrition is either illness related (secondary to 1 or more diseases/injury) or non-illness related, (caused by environmental/behavioral factors), or both. Future research must focus on the relationship between inflammation and illness-related malnutrition. We anticipate that the definition of malnutrition will continue to evolve with improved understanding of the processes that lead to and complicate the treatment of this condition. A uniform definition should permit future research to focus on the impact of pediatric malnutrition on functional outcomes and help solidify the scientific basis for evidence-based nutrition practices.

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Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children.

Jessie M. Hulst, Henrike Zwart, Wim Hop … (2010)

Children admitted to the hospital are at risk of developing malnutrition. The aim of the present study was to investigate the feasibility and value of a new nutritional risk screening tool, called STRONG(kids), in a nationwide study. A Prospective observational multi-centre study was performed in 44 Dutch hospitals (7 academic and 37 general), over three consecutive days during the month of November 2007. The STRONG(kids) screening tool consisted of 4 items: (1) subjective clinical assessment, (2) high risk disease, (3) nutritional intake, (4) weight loss. Measurements of weight and length were performed. SD-scores <-2 for weight-for-height and height-for-age were considered to indicate acute and chronic malnutrition respectively. A total of 424 children were included. Median age was 3.5 years and median hospital stay was 2 days. Sixty-two percent of the children were classified "at risk" of developing malnutrition by the STRONG(kids) tool. Children at risk had significantly lower SD-scores for weight-for-height, a higher prevalence of acute malnutrition and a longer hospital stay compared to children with no nutritional risk. The nutritional risk screening tool STRONG(kids) was successfully applied to 98% of the children. Using this tool, a significant relationship was found between having a "high risk" score, a negative SD-score in weight-for-height and a prolonged hospital stay. Copyright 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition).

Patricia Becker, Liesje Carney, Mark Corkins … (2015)

The Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), utilizing an evidence-informed, consensus-derived process, recommend that a standardized set of diagnostic indicators be used to identify and document pediatric malnutrition (undernutrition) in routine clinical practice. The recommended indicators include z scores for weight-for-height/length, body mass index-for-age, or length/height-for-age or mid-upper arm circumference when a single data point is available. When 2 or more data points are available, indicators may also include weight gain velocity (<2 years of age), weight loss (2-20 years of age), deceleration in weight for length/height z score, and inadequate nutrient intake. The purpose of this consensus statement is to identify a basic set of indicators that can be used to diagnose and document undernutrition in the pediatric population ages 1 month to 18 years. The indicators are intended for use in multiple settings (eg, acute, ambulatory care/outpatient, residential care). Several screening tools have been developed for use in hospitalized children. However, identifying criteria for use in screening for nutritional risk is not the purpose of this paper. Clinicians should use as many data points as available to identify and document the presence of malnutrition. The universal use of a single set of diagnostic parameters will expedite the recognition of pediatric undernutrition, lead to the development of more accurate estimates of its prevalence and incidence, direct interventions, and promote improved outcomes. A standardized diagnostic approach will also inform the prediction of the human and financial responsibilities and costs associated with the prevention and treatment of undernutrition in this vulnerable population and help to further ensure the provision of high-quality, cost-effective nutritional care.

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Author and article information

Journal

Journal ID (publisher-id): nh

Title: Nutrición Hospitalaria

Abbreviated Title: Nutr. Hosp.

Publisher: Grupo Arán (Madrid, Madrid, Spain )

ISSN (Print): 0212-1611

ISSN (Electronic): 1699-5198

Publication date (Print and electronic): 2021

Volume: 38

Issue: spe2

Pages: 64-67

Affiliations

[5] Cuenca orgnameUniversidad de Castilla-La Mancha orgdiv1Facultad de Enfermería orgdiv2Departamento de Enfermería, Fisioterapia y Terapia Ocupacional Ecuador

[3] Madrid orgnameHospital La Moraleja orgdiv1Unidad de Gastroenterología y Nutrición España

[2] Madrid Madrid orgnameUniversidad Complutense de Madrid orgdiv1Grupo de Investigación VALORNUT-UCM (920030) Spain

[1] Madrid orgnameHospital San Rafael orgdiv1Unidad de Gastroenterología Pediátrica España

[4] Madrid Madrid orgnameUniversidad Complutense de Madrid orgdiv1Facultad de Farmacia orgdiv2Departamento de Nutrición y Ciencia de los Alimentos Spain

Article

Publisher ID: S0212-16112021000500015 Publisher ID: S0212-1611(21)03800200015

DOI: 10.20960/nh.3801

SO-VID: fa445819-a09d-4bfd-8907-efdf1668f038

License:

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Evaluando la desnutrición en pediatría, un reto vigente Translated title: Evaluating malnutrition in pediatrics, a current challenge

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Most cited references 16

Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions.

Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children.

Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition).

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