1
|
Zarth K, Holand BL, Zoche E, Schaan CW, Lukrafka JL, Bosa VL. Nutritional risk and functionality of children and adolescents hospitalized with COVID-19. Eur J Pediatr 2024; 183:1223-1230. [PMID: 38087095 DOI: 10.1007/s00431-023-05274-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/29/2023] [Accepted: 10/08/2023] [Indexed: 01/10/2024]
Abstract
To evaluate the association between nutritional risk and functionality of children and adolescents hospitalized with COVID-19 at admission and discharge. METHODS Retrospective cross-sectional study with patients under 19 years old, positive for SARS-COV-2 by RT-PCR test, from February 2020 to May 2022. The STRONGKids screening (Screening Tool Risk On Nutritional Status and Growth) was used to assess nutritional risk on hospital admission and the Functional Status Scale (FSS-Brazil) to determine the functionality of patients on admission and discharge. Data was collected from hospital medical records. Poisson regressions with crude robust variance were used to test the association between nutritional risk and functional status at admission, with adjustments for the age, length of stay, and presence of complex chronic conditions. RESULTS Of the 217 patients, 55.7% (n = 121) were boys with a median age of 6 years (IQ 0-12), 58.5% (n = 127) had at least one complex chronic condition, 64% (n = 139) had medium/high nutritional risk, and 23.9% (n = 52) had some degree of dysfunctionality upon admission and 14.6% (n = 31) upon discharge. By associating STRONGKids and the FSS-Brasil of hospital admission, it was observed that children with low nutritional risk had a mean global FSS lower (6.4 ± 0.7) than children with medium/high nutritional risk (7. 7 ± 2.8; p < 0.001). Children with low nutritional risk on admission also had a lower mean (6.1 ± 0.59) on the FSS at hospital discharge than children with medium/high nutritional risk (7.1 ± 2.5; p < 0.001). After adjustments, it was identified that the addition of one STRONGKids point increases by 36% (PR 1.36; 95%CI 1.15-1.62) the probability of the patient presenting some degree of functional impairment on admission. Conclusion: The study found a positive association between nutritional risk and functional impairment in hospitalized children and adolescents with COVID-19 on admission, even after adjusting for age, length of stay, and complex chronic conditions. Furthermore, patients with medium/high nutritional risk at admission also had worse functionality, both on admission and at discharge. WHAT IS KNOWN • Children and adolescents infected with COVID-19 tend to exhibit milder symptoms and lower hospitalization rates compared to adults, although severe cases and complications can occur. • A paucity of targeted investigations exists regarding the correlation between nutritional risk and functionality in children and adolescents with COVID-19. WHAT IS NEW • Children and adolescents with COVID-19 who presented with medium to high nutritional risk upon hospital admission demonstrated functional impairments, both at admission and hospital discharge.
Collapse
Affiliation(s)
- Kahena Zarth
- Graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, 2400 Ramiro Barcelos Street, Porto Alegre, State of Rio Grande do Sul, 90035-002, Brazil
| | - Bruna Luiza Holand
- Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ester Zoche
- Nutrition Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Janice Luisa Lukrafka
- Department of Physical Therapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Vera Lúcia Bosa
- Graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul, 2400 Ramiro Barcelos Street, Porto Alegre, State of Rio Grande do Sul, 90035-002, Brazil.
- Nutrition Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| |
Collapse
|
2
|
Ferguson CE, Tatucu-Babet OA, Amon JN, Chapple LAS, Malacria L, Myint Htoo I, Hodgson CL, Ridley EJ. Dietary assessment methods for measurement of oral intake in acute care and critically ill hospitalised patients: a scoping review. Nutr Res Rev 2023:1-14. [PMID: 38073417 DOI: 10.1017/s0954422423000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Quantification of oral intake within the hospital setting is required to guide nutrition care. Multiple dietary assessment methods are available, yet details regarding their application in the acute care setting are scarce. This scoping review, conducted in accordance with JBI methodology, describes dietary assessment methods used to measure oral intake in acute and critical care hospital patients. The search was run across four databases to identify primary research conducted in adult acute or critical care settings from 1st of January 2000-15th March 2023 which quantified oral diet with any dietary assessment method. In total, 155 articles were included, predominantly from the acute care setting (n = 153, 99%). Studies were mainly single-centre (n = 138, 88%) and of observational design (n = 135, 87%). Estimated plate waste (n = 59, 38%) and food records (n = 43, 28%) were the most frequent assessment methods with energy and protein the main nutrients quantified (n = 81, 52%). Validation was completed in 23 (15%) studies, with the majority of these using a reference method reliant on estimation (n = 17, 74%). A quarter of studies (n = 39) quantified completion (either as complete versus incomplete or degree of completeness) and four studies (2.5%) explored factors influencing completion. Findings indicate a lack of high-quality evidence to guide selection and application of existing dietary assessment methods to quantify oral intake with a particular absence of evidence in the critical care setting. Further validation of existing tools and identification of factors influencing completion is needed to guide the optimal approach to quantification of oral intake in both research and clinical contexts.
Collapse
Affiliation(s)
- Clare E Ferguson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Oana A Tatucu-Babet
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Jenna N Amon
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lauren Malacria
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ivy Myint Htoo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Division of Clinical Trials and Cohort Studies, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
- Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Saueressig C, Luft VC, Dall'Alba V. Measurement of mid-arm circumference as a starting point for nutritional assessment of patients with decompensated cirrhosis: A prospective cohort study. J Hum Nutr Diet 2023; 36:116-125. [PMID: 35822512 DOI: 10.1111/jhn.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/27/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The mid-arm circumference (MAC) is an accessible, quick, and inexpensive measurement, which can be performed at the bedside only with a measuring tape. In this sense, the present study aims to suggest MAC cut-off values to assess the nutritional status and its association with mortality of hospitalised patients with decompensated cirrhosis. METHODS A prospective cohort study was performed with decompensated cirrhotic patients. Nutritional status was assessed by MAC and Subjective Global Assessment (SGA). Considering the SGA as the reference standard and based on receiver operating characteristic curve analysis, the MAC cut-off values with the best sensitivity and specificity were selected. Predictors of mortality were identified using multivariate analysis. RESULTS The study included 100 patients with a mean ± SD age of 60.1 ± 10.3 years. The median follow-up time was 11.2 months and overall mortality was 60%. Considering malnutrition assessed by SGA as the reference standard, the area under the curve of MAC for women and men was 0.947 (95% confidence interval [CI] = 0.878-1.000) and 0.813 (95% CI = 0.694-0.932). The MAC cut-off values of ≤ 28 cm for women and ≤ 30 cm for men reached a sensitivity and specificity of 85.5% and 71%, respectively. According to multivariate analysis, a low MAC was significantly associated with mortality (hazard ratio = 2.41; 95% CI = 1.20-4.84). CONCLUSIONS The MAC cut-off values had satisfactory accuracy for men and women in predicting malnutrition. Additionally, a low MAC was an independent predictor of mortality. Thus, these MAC cut-off values can be used as the first step of nutritional assessment to prioritise patients who require more detailed assessment.
Collapse
Affiliation(s)
- Camila Saueressig
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Porto Alegre, Brazil
| | - Vivian C Luft
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Porto Alegre, Brazil.,Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Porto Alegre, Brazil.,Department of Nutrition, Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Porto Alegre, Brazil.,Nutrition and Dietetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Valesca Dall'Alba
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Porto Alegre, Brazil.,Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Porto Alegre, Brazil.,Department of Nutrition, Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Porto Alegre, Brazil.,Nutrition and Dietetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
4
|
Papier I, Sagi-Dain L, Chermesh I, Mashiach T, Banasiewicz T. Absence of oral nutritional support in low food intake inpatients is associated with an increased risk of hospital-acquired pressure injury. Clin Nutr ESPEN 2022; 51:190-198. [PMID: 36184204 DOI: 10.1016/j.clnesp.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Hospital-acquired pressure injury (HAPI) incidence is a common burden in hospitals. Decreased food intake leading to malnutrition compromises body tissues involved in pressure injury occurrence. However, most tools for predicting pressure injuries do not include daily food intake monitoring nor consider further nutritional interventions. This study aimed to investigate clinical practices for food intake monitoring and its association with predicting HAPI risk, together with Norton Scale use, and whether the initiation or absence of oral nutritional supplements (ONS), separately from other nutritional interventions, was associated with HAPI incidence in low food intake inpatients, who consumed less than 50% of requirements. METHODS This observational cohort study covered a one-year period (08/2018-07/2019). Demographic and clinical data were extracted from computerized files of patients hospitalized ≥7 days, aged ≥60 years, and who ate orally. Patients receiving enteral or parenteral nutrition were excluded. Differences were studied between groups without and with HAPI grade ≥2. Subgroups divided by Norton Scale and intake, Norton Scale and albumin levels, food intake and initiation (or not) of any nutritional intervention versus ONS only, were examined for the consistency of association with HAPI. RESULTS Of the 5155 admissions during the study period, 895 patients fulfilled the inclusion criteria: 48% female, mean age 77.6 ± 9.1 years, 11% with MUST score ≥2. Nutritional intake was reported in 76% of patients, of them 22% had low food intake, and 9% of the study group developed HAPI grade ≥2. Regarding HAPI incidence, no differences were found between groups divided by MUST scores. Independent risk factors significantly associated with HAPI were Norton <14, albumin levels <3 g/dl, and low food intake. Not providing ONS in low food intake patients had an adjusted 3.49-fold (95%CI 1.57-7.75) increase in HAPI risk (6-fold for non-adjusted relative risk). CONCLUSION Failure to initiate ONS as part of nutritional support in low food intake patients is associated with high HAPI risk in these patients. Consequently, monitoring of daily food intake for identifying low intake patients should be integrated into routinely used tools such as the Norton Scale, and adherence to nutritional protocols should be addressed.
Collapse
Affiliation(s)
- Irena Papier
- Nursing Department, Rambam Health Care Campus, Haifa, Israel.
| | - Lena Sagi-Dain
- Genetics Institute, Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Irit Chermesh
- Institute of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
| | - Tanya Mashiach
- Department of Epidemiology, Rambam Health Care Campus, Haifa, Israel.
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland.
| |
Collapse
|