Prevalence and outcome of malnutrition in pediatric patients with chronic diseases: Focus on the settings of care

Antonella Diamanti, Emanuele Cereda, Teresa Capriati, Daniela Giorgio, Carla Brusco, Alessandra Liguori, Massimiliano Raponi

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Abstract

BACKGROUND: Information on disease-related malnutrition and related outcomes in pediatric patients with chronic diseases in different settings of care is not available.

METHODS: Consecutive eligible patients attending the out-patient clinic (n = 177) or admitted to the day-hospital clinic (n = 163) or to hospital (n = 201) were screened for the presence of malnutrition (BMI and/or height/length for age z-scores < -2). We recorded data on emergency care admissions to hospital that occurred during the 3 years before screening and related total days of stay, as well as data on emergency care admissions to hospital occurring within 6 months after screening.

RESULTS: Prevalence of malnutrition was 2-fold higher (P < 0.001) in in-patients (56.7% [95% CI, 49.6-63.7]) than in patients assessed at the out-patient (33.3% [95% CI, 26.4-40.8]) and day-hospital (28.3% [95% CI, 21.5-35.8]) clinics. Estimates were heterogeneous across diagnostic groups with higher rates in patients with neurologic (61%) and cardiac (56%) diseases. Stunting was more frequent among in-patients, who also had more evident nutritional derangements. Multivariate logistic regression (covariates: age, gender, healthcare setting and disease group), showed that malnutrition (OR = 1.86 [95% CI, 1.21-2.88]; P = 0.005) was significantly associated with prolonged hospitalization (≥15 days) in the 3 years before screening. In-patients were also more likely to have been hospitalized ≥15 days (using out-patients as reference category, OR = 2.24 [95% CI, 1.39-3.63], P = 0.001), but we did not find any modifying effect (interaction) of the setting of care on the association between malnutrition and prolonged hospitalization.

DISCUSSION: The rates of malnutrition in children with chronic diseases are very high and increase hospital care needs, especially when they are admitted to hospital. Nutritional care in this patient population is recommended.

Original languageEnglish
JournalClinical Nutrition
DOIs
Publication statusE-pub ahead of print - Jul 27 2018

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Malnutrition
Chronic Disease
Pediatrics
Outpatients
Emergency Medical Services
Hospitalization
Child Nutrition Disorders
Growth Disorders
Nervous System
Heart Diseases
Patient Care
Logistic Models
Delivery of Health Care
Population

Cite this

@article{7e5d56aabaf24333bc6fc9d5e6497f2e,
title = "Prevalence and outcome of malnutrition in pediatric patients with chronic diseases: Focus on the settings of care",
abstract = "BACKGROUND: Information on disease-related malnutrition and related outcomes in pediatric patients with chronic diseases in different settings of care is not available.METHODS: Consecutive eligible patients attending the out-patient clinic (n = 177) or admitted to the day-hospital clinic (n = 163) or to hospital (n = 201) were screened for the presence of malnutrition (BMI and/or height/length for age z-scores < -2). We recorded data on emergency care admissions to hospital that occurred during the 3 years before screening and related total days of stay, as well as data on emergency care admissions to hospital occurring within 6 months after screening.RESULTS: Prevalence of malnutrition was 2-fold higher (P < 0.001) in in-patients (56.7{\%} [95{\%} CI, 49.6-63.7]) than in patients assessed at the out-patient (33.3{\%} [95{\%} CI, 26.4-40.8]) and day-hospital (28.3{\%} [95{\%} CI, 21.5-35.8]) clinics. Estimates were heterogeneous across diagnostic groups with higher rates in patients with neurologic (61{\%}) and cardiac (56{\%}) diseases. Stunting was more frequent among in-patients, who also had more evident nutritional derangements. Multivariate logistic regression (covariates: age, gender, healthcare setting and disease group), showed that malnutrition (OR = 1.86 [95{\%} CI, 1.21-2.88]; P = 0.005) was significantly associated with prolonged hospitalization (≥15 days) in the 3 years before screening. In-patients were also more likely to have been hospitalized ≥15 days (using out-patients as reference category, OR = 2.24 [95{\%} CI, 1.39-3.63], P = 0.001), but we did not find any modifying effect (interaction) of the setting of care on the association between malnutrition and prolonged hospitalization.DISCUSSION: The rates of malnutrition in children with chronic diseases are very high and increase hospital care needs, especially when they are admitted to hospital. Nutritional care in this patient population is recommended.",
author = "Antonella Diamanti and Emanuele Cereda and Teresa Capriati and Daniela Giorgio and Carla Brusco and Alessandra Liguori and Massimiliano Raponi",
note = "Copyright {\circledC} 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.",
year = "2018",
month = "7",
day = "27",
doi = "10.1016/j.clnu.2018.07.008",
language = "English",
journal = "Clinical Nutrition",
issn = "0261-5614",
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TY - JOUR

T1 - Prevalence and outcome of malnutrition in pediatric patients with chronic diseases

T2 - Focus on the settings of care

AU - Diamanti, Antonella

AU - Cereda, Emanuele

AU - Capriati, Teresa

AU - Giorgio, Daniela

AU - Brusco, Carla

AU - Liguori, Alessandra

AU - Raponi, Massimiliano

N1 - Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

PY - 2018/7/27

Y1 - 2018/7/27

N2 - BACKGROUND: Information on disease-related malnutrition and related outcomes in pediatric patients with chronic diseases in different settings of care is not available.METHODS: Consecutive eligible patients attending the out-patient clinic (n = 177) or admitted to the day-hospital clinic (n = 163) or to hospital (n = 201) were screened for the presence of malnutrition (BMI and/or height/length for age z-scores < -2). We recorded data on emergency care admissions to hospital that occurred during the 3 years before screening and related total days of stay, as well as data on emergency care admissions to hospital occurring within 6 months after screening.RESULTS: Prevalence of malnutrition was 2-fold higher (P < 0.001) in in-patients (56.7% [95% CI, 49.6-63.7]) than in patients assessed at the out-patient (33.3% [95% CI, 26.4-40.8]) and day-hospital (28.3% [95% CI, 21.5-35.8]) clinics. Estimates were heterogeneous across diagnostic groups with higher rates in patients with neurologic (61%) and cardiac (56%) diseases. Stunting was more frequent among in-patients, who also had more evident nutritional derangements. Multivariate logistic regression (covariates: age, gender, healthcare setting and disease group), showed that malnutrition (OR = 1.86 [95% CI, 1.21-2.88]; P = 0.005) was significantly associated with prolonged hospitalization (≥15 days) in the 3 years before screening. In-patients were also more likely to have been hospitalized ≥15 days (using out-patients as reference category, OR = 2.24 [95% CI, 1.39-3.63], P = 0.001), but we did not find any modifying effect (interaction) of the setting of care on the association between malnutrition and prolonged hospitalization.DISCUSSION: The rates of malnutrition in children with chronic diseases are very high and increase hospital care needs, especially when they are admitted to hospital. Nutritional care in this patient population is recommended.

AB - BACKGROUND: Information on disease-related malnutrition and related outcomes in pediatric patients with chronic diseases in different settings of care is not available.METHODS: Consecutive eligible patients attending the out-patient clinic (n = 177) or admitted to the day-hospital clinic (n = 163) or to hospital (n = 201) were screened for the presence of malnutrition (BMI and/or height/length for age z-scores < -2). We recorded data on emergency care admissions to hospital that occurred during the 3 years before screening and related total days of stay, as well as data on emergency care admissions to hospital occurring within 6 months after screening.RESULTS: Prevalence of malnutrition was 2-fold higher (P < 0.001) in in-patients (56.7% [95% CI, 49.6-63.7]) than in patients assessed at the out-patient (33.3% [95% CI, 26.4-40.8]) and day-hospital (28.3% [95% CI, 21.5-35.8]) clinics. Estimates were heterogeneous across diagnostic groups with higher rates in patients with neurologic (61%) and cardiac (56%) diseases. Stunting was more frequent among in-patients, who also had more evident nutritional derangements. Multivariate logistic regression (covariates: age, gender, healthcare setting and disease group), showed that malnutrition (OR = 1.86 [95% CI, 1.21-2.88]; P = 0.005) was significantly associated with prolonged hospitalization (≥15 days) in the 3 years before screening. In-patients were also more likely to have been hospitalized ≥15 days (using out-patients as reference category, OR = 2.24 [95% CI, 1.39-3.63], P = 0.001), but we did not find any modifying effect (interaction) of the setting of care on the association between malnutrition and prolonged hospitalization.DISCUSSION: The rates of malnutrition in children with chronic diseases are very high and increase hospital care needs, especially when they are admitted to hospital. Nutritional care in this patient population is recommended.

U2 - 10.1016/j.clnu.2018.07.008

DO - 10.1016/j.clnu.2018.07.008

M3 - Article

C2 - 30097363

JO - Clinical Nutrition

JF - Clinical Nutrition

SN - 0261-5614

ER -