Defining Pediatric Malnutrition (original) (raw)

2013, Journal of Parenteral and Enteral Nutrition

Evaluation of nutrition status and provision of adequate nutrition are crucial components in the overall management of children during illness because malnutrition is prevalent and affects normal growth, development, other clinical outcomes, and resource utilization. 1 Large-scale international studies have attributed a majority of all childhood deaths to undernutrition, with high relative risks of mortality for severe malnutrition. 2,3 In the developed world, malnutrition is predominantly related to disease, chronic conditions, trauma, burns, or surgery (henceforth referred to as illness-related malnutrition in this article). Illness-related malnutrition in children may be attributed to nutrient loss, increased energy expenditure, decreased nutrient intake, or altered nutrient utilization. These factors are seen frequently in relation to acute illnesses such as trauma, burns, and infections, as well as chronic diseases such as cystic fibrosis, chronic kidney disease, malignancies, congenital heart disease (CHD), gastrointestinal (GI) diseases, and neuromuscular diseases. In addition to the anthropometric changes in acute malnutrition, chronic malnutrition may be characterized by stunting (decreased height velocity). Although several studies have reported a prevalence of illness-related malnutrition of 6%-51% in hospitalized children, this condition is probably underrecognized. 4-6 Lack of uniform definitions, heterogeneous nutrition screening practices, and failure to prioritize nutrition as part of patient care are some of the factors responsible for underrecognition of the prevalence of malnutrition and its impact on clinical outcomes. To date, a uniform definition of malnutrition in children has remained elusive. Current terminologies such as protein-energy malnutrition, marasmus, and kwashiorkor describe the effects of malnutrition but do not account for the variety of etiologies and dynamic interactions that are relevant to nutrition depletion in children. A better definition of malnutrition is essential to reach the following goals: (a) early identification of those at risk of malnutrition, (b) comparison of malnutrition prevalence between studies and centers, (c) development of uniform screening tools, (d) development of thresholds for intervention, (e) collection of meaningful nutrition data, and (f) evidence-based analysis of the impact of malnutrition and its treatment on patient outcomes. 7 To address this issue, an interdisciplinary American Society for 972P ENXXX10.1177/0148607113479972Journ