Prevalence and outcome of malnutrition in pediatric patients with chronic diseases: Focus on the settings of care
Prevalence and outcome of malnutrition in pediatric patients with chronic diseases: Focus on the settings of care
复制标题
DOI：
10.1016/j.clnu.2018.07.008
复制
发表时间：
2019-08-01
影响因子：
6.3
通讯作者：
Raponi, Massimiliano
中科院分区：
文献类型：
--
作者：
Diamanti, Antonella;Cereda, Emanuele;Raponi, Massimiliano
背景资料：目前尚无关于慢性病儿科患者在不同护理环境中与疾病相关的营养不良和相关结局的信息。对连续前往门诊就诊（n = 177）或入住日间医院诊所（n = 163）或住院（n = 201）的符合条件的患者进行了营养不良筛查（BMI和/或年龄z分数的身高/身长< -2）。我们记录了筛查前3年内发生的急诊入院数据和相关的总住院天数，以及筛查后6个月内发生的急诊入院数据。结果：营养不良的发生率是住院患者（P < 0.001）（56.7% [95% CI，49.6 - 63.71）），而在门诊（33.3% [95% CI，26.4-40.81）和日间医院（28.3% [95% CI，21.5-35.81））评估的患者中。诊断组间的估计值存在异质性，神经系统疾病（61%）和心脏疾病（56%）患者的发生率较高。在住院病人中，发育迟缓更为常见，他们也有更明显的营养紊乱。多变量logistic回归分析（协变量：年龄、性别、医疗环境和疾病组）显示，筛选前3年内营养不良（OR = 1.86 [95%CI，1.21-2.88]; P = 0.005）与住院时间延长（>= 15天）显著相关。住院患者也更有可能住院≥ 15天（以门诊病人为参照组，OR = 2.24 [95%CI，1.39-3.63），P = 0.001），但未发现任何改变作用（相互作用）的护理设置之间的关联营养不良和长期住院。讨论：患有慢性病的儿童营养不良的比例很高，增加了医院护理的需求，特别是在他们入院时。建议对该患者人群进行营养护理。(C)2018爱思唯尔有限公司和欧洲临床营养与代谢学会。All rights reserved.
Background: Information on disease-related malnutrition and related outcomes in pediatric patients with chronic diseases in different settings of care is not available.Methods: Consecutive eligible patients attending the out-patient clinic (n = 177) or admitted to the day hospital clinic (n = 163) or to hospital (n = 201) were screened for the presence of malnutrition (BMI and/or height/length for age z-scores < -2). We recorded data on emergency care admissions to hospital that occurred during the 3 years before screening and related total days of stay, as well as data on emergency care admissions to hospital occurring within 6 months after screening.Results: Prevalence of malnutrition was 2-fold higher (P < 0.001) in in-patients (56.7% [95% CI, 49.6 -63.71) than in patients assessed at the out-patient (33.3% [95% CI, 26.4-40.81) and day-hospital (28.3% [95% CI, 21.5-35.81) clinics. Estimates were heterogeneous across diagnostic groups with higher rates in patients with neurologic (61%) and cardiac (56%) diseases. Stunting was more frequent among inpatients, who also had more evident nutritional derangements. Multivariate logistic regression (covariates: age, gender, healthcare setting and disease group), showed that malnutrition (OR = 1.86 [95% CI, 1.21-2.88]; P = 0.005) was significantly associated with prolonged hospitalization (>= 15 days) in the 3 years before screening. In-patients were also more likely to have been hospitalized >= 15 days (using outpatients as reference category, OR = 2.24 [95% CI, 1.39-3.63), P = 0.001), but we did not find any modifying effect (interaction) of the setting of care on the association between malnutrition and prolonged hospitalization.Discussion: The rates of malnutrition in children with chronic diseases are very high and increase hospital care needs, especially when they are admitted to hospital. Nutritional care in this patient population is recommended. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.