Malnutrition Risk in Hospitalized Pediatric Patients: Its Relationship with Nutritional Status and Anthropometric Measurements

Abstract

Aim: Malnutrition is known to increase mortality and morbidity, delay recovery, prolong hospital stay, and increase treatment costs. Screening and assessment of nutritional status in hospitalized pediatric patients are important for the early identification, appropriate management, and prevention of progression of malnutrition. This study aimed to determine the risk of malnutrition in hospitalized pediatric patients using the Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), to evaluate the relationship between malnutrition risk, nutritional status, and anthropometric measurements, and to investigate other factors potentially associated with malnutrition risk.

Materials and Methods: This descriptive and cross-sectional study was conducted between March and June 2017 with pediatric patients hospitalized in a state hospital and private hospitals located in the Famagusta district of the Turkish Republic of Northern Cyprus (TRNC). Face-to-face interviews were conducted with the participants throughout the study period, and the STRONGkids was used to assess malnutrition risk. Anthropometric assessments included measurements of body weight, height, body mass index (BMI), and mid-upper arm circumference (MUAC). In addition, the nutritional status of the participants was evaluated using a 24-hour dietary recall.

Results: The study was conducted with a total of 151 pediatric patients, of whom 44.4% were male and 55.6% were female (median age: 4.0 years). No statistically significant difference was found between STRONGkids scores according to age groups (p>0.05). When differences in energy and macronutrient intake among malnutrition risk groups were examined, children under five years of age and those aged five years and older with moderate/high malnutrition risk had significantly lower energy (kcal), protein (g), carbohydrate (g), and fat(g) intake compared with those at low risk (p<0.05). Among anthropometric measurements, body weight (kg), BMI (kg/m²), and MUAC (cm) were found to be significantly lower in children under five years of age with moderate/high malnutrition risk (p<0.05), whereas only BMI (kg/m²) values were significantly lower in children aged five years and older with moderate/high malnutrition risk (p<0.05). Furthermore, multivariable logistic regression analysis showed that each one year increase in age increased the risk of malnutrition by 1.36-fold [OR=1.361 (1.091–1.697), p=0.006], whereas each one gram increase in protein intake and each one unit increase in BMI (kg/m²) decreased the risk of malnutrition by 10.6% [OR=0.894 (0.856–0.934), p=0.000] and 27.8% [OR=0.722 (0.549–0.950), p=0.020], respectively. In addition, children who were unable to consume the meals provided by the hospital had a 23.8-fold higher risk of malnutrition (OR=23.757, p=0.003).

Conclusion: In this study, pediatric patients with moderate/high malnutrition risk were found to have lower energy and macronutrient intake as well as lower BMI values. Increasing age was associated with an increased risk of malnutrition, whereas higher protein intake and BMI were associated with a reduced risk. Additionally, the inability to consume hospital-provided meals was identified as an important factor increasing malnutrition risk. These findings suggest that dietary intake, anthropometric measurements, and screening tools should be evaluated together in the early screening and assessment of malnutrition in pediatric patients. Further longitudinal studies with larger sample sizes are needed to investigate these relationships more comprehensively.