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Guidelines updated for pediatric malnutrition diagnoses
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A recent report in Nutrition in Clinical Practice expanded on new treatment guidelines for pediatric patients with malnutrition in order to improve identification and therapy.
“Malnutrition is an ongoing problem among chronically ill hospitalized pediatric patients,” Stacey S. Beer, MPH, of the department of nutrition at Texas Children’s Hospital, and colleagues wrote. “However, it is only diagnosed in approximately 4% of patients despite prevalence rates reported between 24% and 50% worldwide.”
The newly published guidelines expand on a definition of malnutrition published by the American Society for Parenteral and Enteral Nutrition (ASPEN). It defines malnutrition 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.”
This definition works as a guideline that codifies the diagnosis of malnutrition to five domains: anthropometrics, growth, chronicity, etiology and impact on functional status. The researchers expanded this definition to better identify populations where current recommendations can be problematic and to improve the identification and treatment of malnutrition in a hospital setting.
Beer and colleagues amended the ASPEN guidelines by recommending that when clinicians diagnose malnutrition, they:
- place particular emphasis on mid-upper arm circumference when taking anthropometric measurements;
- understand that anthropometric values are not the only determining factor for malnutrition;
- use z scores instead of percentiles to calculate diminished growth;
- use an accurate and dependable system for calculating z scores;
- use a physical assessment in the context of a subjective goal assessment; and,
- understand that there are causes of malnutrition other than lack of food intake, such as resting energy expenditure and infection.
The guidelines included information on quantifying the effects of malnutrition on pediatric patients, including the physical, immunity and cognitive impacts. Suggested methods to measure malnutrition are the inclusion of hand grip strength tests, monitoring for micro deficiencies and use of the Pediatric Quality of Life Inventory tool in lieu of neurocognitive testing equipment.
The researchers also suggested changing guidelines for measuring growth velocity, allowing thresholds to be similar across all age groups and extending beyond a measurement period of 2 years.
“Further areas of research include use of mid-upper-arm circumference in larger patient populations and special populations, growth velocity across all age groups, appropriate dietary intake for standard periods of time, how to interpret fat and muscle stores in terms of delayed/advanced Tanner stage, and bone age,” Beer and colleagues wrote. – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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