Document Type : original article
Authors
- Masoud Khorshidi 1
- Zahra Fazelifarsani 2
- Sayeh Hatefi 2
- Parisa Torabi 3
- Mina Minaii 4
- Mahmood Hajipour 1
- Beheshteh Olang 2
- Amirhossein Hosseini 1
- Ahmad Khaleghnezhad Tabari 5
- Naghi Dara 2
- Farid Imanzadeh 2
- Aliakbar Sayyari 2
1 Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Department of Nutrition, Ministry of Health and Education, Tehran, Iran.
4 Department of Nutrition, Ministry of Health and Education, Tehran, Iran
5 Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract
Background: Malnutrition undermines the beneficial outcomes of clinical interventions and also increases hospital costs. Therefore, this study aimed to estimate the prevalence of malnutrition through a multicenter observational study at the time of admission and discharge in Iranian hospitalized children and adolescents.
Methods: The present cross-sectional study was performed on children and adolescents aged one month to 18 years from three Iranian public tertiary pediatric hospitals located in different cities of Iran. To determine the participants’ nutritional status, Z-score of the weight for height (for those with 1month to 5years of age) and Z-score of BMI (for ≥5 to 18-year-old patients) were calculated using the WHO growth standards. Data were analyzed using SPSS version 23.
Results: Information about 1499 patients was collected. At the time of admission, 64% of the participants had a good nutritional status, 15.5% were at high risk of wasting, 8.4% were wasted, and 12.1% were severely wasted. Among 295 malnourished patients, the nutritional status of 182 patients (63%) had been improved at the time of discharge. Also, 23% of all subjects with normal nutritional status at the admission time (85 participants), were at risk of malnutrition at discharge. The prevalence of moderate and severe malnutrition at the discharge time was about 20%.
Conclusion: More than one-third of the hospitalized children had moderate or severe malnutrition or were at high risk. Although the prevalence of malnutrition decreased somewhat during hospitalization, some children were not malnourished at the time of admission and were malnourished at discharge.
Keywords
- Mohammadi M, Raiegan V, Akbar A, Mirzaei M, Zahednezhad H, Jalali R, et al. Prevalence of underweight in Iranian children: a systematic review and meta-analysis. Tehran University Medical Journal TUMS Publications. 2018; 76(4):241-9.
- Moradi Y, Shadmani FK, Mansori K, Hanis SM, Khateri R, Mirzaei H. Prevalence of underweight and wasting in Iranian children aged below 5 years: a systematic review and meta-analysis. Korean journal of pediatrics. 2018; 61(8):231.
- Stratton RJ, Green CJ, Elia M. Disease-related malnutrition: an evidence-based approach to treatment: Cabi; 2003.
- Beheshti M, ZADEH FI, Shahidi N. Evaluation of the nutritional status in children admitted to the neurology ward of mofid children’s hospital. Iranian Journal of Child Neurology. 2010; 3(4):51-7.
- Villares M, Manuel J, Varea Calderón V, Bousoño García C, Lama Moré R, Redecillas Ferreiro S, et al. Evaluación del estado nutricional de niños ingresados en el hospital en España: estudio DHOSPE (Desnutrición Hospitalaria en el Paciente Pediátrico en España). Nutrición Hospitalaria. 2013; 28(3):709-18.
- Joosten KF, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Current opinion in pediatrics. 2008; 20(5):590-6.
- Kyle ÚG, Kossovsky MP, Karsegard VL, Pichard C. Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clinical Nutrition. 2006; 25(3):409-17.
- Imanzadeh F, Olang B, Khatami K, Hosseini A, Dara N, Rohani P, et al. Assessing the prevalence and treatment of malnutrition in hospitalized children in Mofid Children's Hospital during 2015-2016. Archives of Iranian medicine. 2018; 21(7):302-9.
- Sayyari A-A, Imanzadeh F, Moradi M, Javaherizadeh H, Shamshiri A-R. Evaluation of nutritional status in children hospitalized in Mofid Children’s Hospital, Tehran, Iran. Gastroenterology Review/Przegląd Gastroenterologiczny. 2013; 8(2):120-5.
- Kliegman R, Behrman R, Jenson H, Stanton B. Nelson textbook of pediatrics E-book: Elsevier health sciences. 2007.
- Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, et al. Malnutrition at hospital admission—contributors and effect on length of stay: a prospective cohort study from the Canadian Malnutrition Task Force. Journal of Parenteral and Enteral Nutrition. 2016; 40(4):487-97.
- Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clinical nutrition. 2008; 27(1):5-15.
- Campanozzi A, Russo M, Catucci A, Rutigliano I, Canestrino G, Giardino I, et al. Hospital-acquired malnutrition in children with mild clinical conditions. Nutrition. 2009; 25(5):540-7.
- Taheri F, SHARIFZADEH GR, NASIRI A. Prevalence of malnutrition in 1-36 month old children hospitalized in Valiyy-e-Asr Hospital of Birjand. 2006.
- Shaughnessy EE, Kirkland LL. Malnutrition in hospitalized children: a responsibility and opportunity for pediatric hospitalists. Hospital pediatrics. 2016; 6(1):37-41.
- Dehghani SM, Javaherizadeh H, Heydari M, Honar N, Ataollahi M, Ilkhanipour H, et al. Stunting, wasting, and mid upper arm circumference status among children admitted to Nemazee Teaching Hospital. Nutricion hospitalaria. 2018; 35(1):33-7.
- Pfau BT, Li BU, Murray RD, Heitlinger LA, McClung HJ, Hayes JR. Differentiating cyclic from chronic vomiting patterns in children: quantitative criteria and diagnostic implications. Pediatrics. 1996; 97(3):364-8.
- Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV, et al. Practice guidelines for the management of infectious diarrhea. Clinical infectious diseases. 2001; 32(3):331-51.
- Organization WH. diarrhoea 2022 [Available from: https://www.who.int/health-topics/diarrhoea#tab=tab_1.
- Bergström J. Anorexia and malnutrition in hemodialysis patients. Blood purification. 1992; 10(1):35-9.
- Nicolini A, Ferrari P, Masoni MC, Fini M, Pagani S, Giampietro O, et al. Malnutrition, anorexia and cachexia in cancer patients: a mini-review on pathogenesis and treatment. Biomedicine & Pharmacotherapy. 2013; 67(8):807-17.
- Chumlea WC, Guo SS, Steinbaugh ML. Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons. Journal of the American Dietetic Association. 1994; 94(12):1385-91.
- Organization WH. Physical status: The use of and interpretation of anthropometry, Report of a WHO Expert Committee. 1995.
- Mohseni M, Aryankhesal A, Kalantari N. Prevalence of Malnutrition among Iran’s Under Five-Year-Old Children and the Related Factors: A Systematic Review and Meta-Analysis. Iranian Journal of Pediatrics. 2018; 28(1).
- Nouri Saeidlou S, Babaei F, Ayremlou P. Malnutrition, overweight, and obesity among urban and rural children in north of west Azerbijan, Iran. Journal of obesity. 2014; 2014:541213.
- Veghari G. The relationship of ethnicity, socio-economic factors and malnutrition in primary school children in north of Iran: a cross-sectional study. Journal of research in health sciences. 2012; 13(1):58-62.
- Malek A, Hashemi M, Anjomrooz M, Torabi P, Imani B. Malnutrition and medical nutrition therapy in hospitalized children: a case study of using national malnutrition screening tools in northeastern Iran. African health sciences. 2019; 19(1):1566-73.
- Moeeni V, Walls T, Day AS. Assessment of nutritional status and nutritional risk in hospitalized Iranian children. Acta Paediatrica. 2012; 101(10):e446-e51.
- Hendricks KM, Duggan C, Gallagher L, Carlin AC, Richardson DS, Collier SB, et al. Malnutrition in Hospitalized Pediatric Patients: Current Prevalence. Archives of Pediatrics & Adolescent Medicine. 1995; 149(10):1118-22.
- Aurangzeb B, Whitten K, Harrison B, Mitchell M, Kepreotes H, Sidler M, et al. Prevalence of malnutrition and risk of under-nutrition in hospitalized children. Clinical nutrition. 2012; 31(1):35-40.
- Jafari-Adli S, Jouyandeh Z, Qorbani M, Soroush A, Larijani B, Hasani-Ranjbar S. Prevalence of obesity and overweight in adults and children in Iran; a systematic review. Journal of Diabetes & Metabolic Disorders. 2014; 13(1):121.
- Shiva S, Vaziri N, Khamnian Z, Hosseini S, Fotoohi A. The prevalence of malnutrition in a pediatric hospital of Tabriz City, Iran, in 2016. Chronic Diseases Journal. 2019; 7(3):148-52.
- White M, Dennis N, Ramsey R, Barwick K, Graham C, Kane S, et al. Prevalence of malnutrition, obesity and nutritional risk of Australian pediatric inpatients: A national one‐day snapshot. Journal of pediatrics and child health. 2015; 51(3):314-20.
- Yaflar D, AN TE, Sema YALVAÇ SA, Fügen ÇULLU Ç, RAfi AA. Nutritional status of patients hospitalized in pediatric clinics. Turk J Gastroenterol. 2005; 16(4):212-6.
- Farhangi H, Bakhtiari E, Pourbadakhshan N. Nutritional Risk Assessment in Children with Cancer: A Longitudinal Study in North East of Iran. International Journal of Pediatrics. 2019; 7(1):8805-13.
- Huysentruyt K, Goyens P, Alliet P, Bontems P, Van Hautem H, Philippet P, et al. More training and awareness are needed to improve the recognition of undernutrition in hospitalized children. Acta paediatrica. 2015; 104(8):801-7.
- Souza TT, Sturion CJ, Faintuch J. Is the skeleton still in the hospital closet? A review of hospital malnutrition emphasizing health economic aspects. Clinical nutrition. 2015; 34(6):1088-92.
- Kubrak C, Jensen L. Malnutrition in acute care patients: a narrative review. International journal of nursing studies. 2007; 44(6):1036-54.
- Bunting J, Weaver L. Anthropometry in a children's hospital: a study of staff knowledge, use and quality of equipment. Journal of human nutrition and dietetics. 1997; 10(1):17-23.
- Cummings EA, John H, Davis HS, McTimoney CM. Documentation of growth parameters and body mass index in a pediatric hospital. Pediatrics & child health. 2005; 10(7):391-4.
- Ramsden L, Day AS. Pediatric growth charts: How do we use them and can we use them better? Journal of pediatrics and child health. 2012; 48(1):22-5.
- Kim S, Lee EH, Yang HR. Current status of nutritional support for hospitalized children: a nationwide hospital-based survey in South Korea. Nutrition research and practice. 2018; 12(3):215-21.
- Milani S, Wright C, Purcell O, Macleod I, Gerasimidis K. Acquisition and utilization of anthropometric measurements on admission in a pediatric hospital before and after the introduction of a malnutrition screening tool. Journal of Human Nutrition and Dietetics. 2013; 26(3):294-7.