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New anthropometric classification scheme of preoperative nutritional status in children: a retrospective observational cohort study.

ABSTRACT: Objective:WHO uses anthropometric classification scheme of childhood acute and chronic malnutrition based on low body mass index (BMI) ('wasting') and height for age ('stunting'), respectively. The goal of this study was to describe a novel two-axis nutritional classification scheme to (1) characterise nutritional profiles in children undergoing abdominal surgery and (2) characterise relationships between preoperative nutritional status and postoperative morbidity. Design:This was a retrospective observational cohort study. Setting:The setting was 50 hospitals caring for children in North America that participated in the American College of Surgeons National Surgical Quality Improvement Program Paediatric from 2011 to 2013. Participants:Children >28 days who underwent major abdominal operations were identified. Interventions/main predictor:The cohort of children was divided into five nutritional profile groups based on both BMI and height for age Z-scores: (1) underweight/short, (2) underweight/tall, (3) overweight/short, (4) overweight/tall and (5) non-outliers (controls). Main outcome measures:Multiple variable logistic regressions were used to quantify the association between 30-day morbidity and nutritional profile groups while adjusting for procedure case mix, age and American Society of Anaesthesiologists class. Results:A total of 39?520 cases distributed as follows: underweight/short (656, 2.2%); underweight/tall (252, 0.8%); overweight/short (733, 2.4%) and overweight/tall (1534, 5.1%). Regression analyses revealed increased adjusted odds of composite morbidity (35%) and reintervention events (75%) in the underweight/short group, while overweight/short patients had increased adjusted odds of composite morbidity and healthcare-associated infections (43%), and reintervention events (79%) compared with controls. Conclusion:Stratification of preoperative nutritional status using a scheme incorporating both BMI and height for age is feasible. Further research is needed to validate this nutritional risk classification scheme for other surgical procedures in children.

SUBMITTER: Stey A

PROVIDER: S-EPMC6203011 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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New anthropometric classification scheme of preoperative nutritional status in children: a retrospective observational cohort study.

Stey Anne A Ricks-Oddie Joni J Innis Sheila S Rangel Shawn J SJ Moss R Lawrence RL Hall Bruce L BL Dibbins Albert A Skarsgard Erik D ED

BMJ paediatrics open 20181012 1

<h4>Objective</h4>WHO uses anthropometric classification scheme of childhood acute and chronic malnutrition based on low body mass index (BMI) ('wasting') and height for age ('stunting'), respectively. The goal of this study was to describe a novel two-axis nutritional classification scheme to (1) characterise nutritional profiles in children undergoing abdominal surgery and (2) characterise relationships between preoperative nutritional status and postoperative morbidity.<h4>Design</h4>This was ...[more]

PMID: 30397667

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Project description:BackgroundThe association between malnutrition and postoperative acute kidney injury (AKI) has not been well studied. In this study, the authors examined the association between preoperative nutritional status and postoperative AKI in older patients who underwent major abdominal surgery, as well as the predictive value of malnutrition for AKI.Materials and methodsThe authors retrospectively included patients aged 65 or older who underwent major elective abdominal surgery. The nutritional status of the patient was evaluated using three objective nutritional indices, such as the geriatric nutritional risk index (GNRI), the prognostic nutritional index (PNI), and the controlling nutritional status (CONUT). AKI was determined using the KDIGO criteria. The authors performed logistic regression analysis to investigate the association between preoperative nutritional status and postoperative AKI, as well as the predictive value of nutritional scores for postoperative AKI.ResultsA total of 2775 patients were included in the study, of which 707 (25.5%), 291 (10.5%), and 517 (18.6%) had moderate to severe malnutrition according to GNRI, PNI, and CONUT calculations. After surgery, 144 (5.2%) patients developed AKI, 86.1% at stage 1, 11.1% at stage 2, and 2.8% at stage 3 as determined by KDIGO criteria. After adjustment for traditional risk factors, worse nutritional scores were associated with a higher AKI risk. In addition to traditional risk factors, these nutritional indices improved the predictive ability of AKI prediction models, as demonstrated by significant improvements in integrated discrimination and net reclassification.ConclusionsPoor preoperative nutritional status, as assessed by GNRI, PNI, and CONUT scores, was associated with an increased risk of postoperative AKI. Incorporating these scores into AKI prediction models improved their performance. These findings emphasize the need for screening surgical patients for malnutrition risk. Further research is needed to determine whether preoperative malnutrition assessment and intervention can reduce postoperative AKI incidence.

Project description:BackgroundMalnutrition is significantly associated with unfavourable outcomes, but there is little high-level evidence to elucidate the association of malnutrition with losing walking independence (LWI) after hip fracture surgery. This study aimed to assess the association between preoperative nutritional status evaluated by the Controlling Nutritional Status (CONUT) score and walking independence at 180 days postoperatively in Chinese older hip fracture patients.MethodsThis prospective cohort study included 1958 eligible cases from the SSIOS database. The restricted cubic spline (RCS) was used to assess the dose-effect relationship between the CONUT score and recovery of walking independence. Propensity score matching (PSM) was performed to balance potential preoperative confounders, and multivariate logistic regression analysis was applied to assess the association between malnutrition and LWI with perioperative factors for further adjustment. Furthermore, inverse probability treatment weighting (IPTW) and sensitivity analyses were performed to test robustness of the results and the Fine and Grey hazard model was applied to adjust the competing risk of death. Subgroup analyses were used to determine potential population heterogeneity.ResultsWe found a negative relationship between the preoperative CONUT score and recovery of walking independence at 180 days postoperatively, and that moderate-to-severe malnutrition evaluated by the CONUT score was independently associated with a 1.42-fold (95%CI, 1.12-1.80; P=0.004) increased risk of LWI. The results were overall robust. And in the Fine and Grey hazard model, the result was still statistically significant despite the apparent decrease in the risk estimate from 1.42 to 1.21. Furthermore, significant heterogeneities were observed in the subgroups of age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, Charlson's comorbidity index (CCI) and surgical delay (P for interaction < 0.05).ConclusionPreoperative malnutrition is a significant risk factor for LWI after hip fracture surgery, and nutrition screening on admission would generate potential health benefits.

Project description:BackgroundEarly life nutrition plays a critical role in the development of better health and nutrition in adulthood. However, assessing the nutritional status of Bangladeshi children and adolescents through measurement of body composition using skinfold thickness is barely studied. The current study aims to determine children's body composition and nutritional status, and contributing factors among children aged 2 to 15 years in the northern part of Bangladesh.MethodsThis is a descriptive cross-sectional study done in Bangladesh. Anthropometric methods, including multiple skinfold thickness and basic anthropometric and socio-demographic characteristics, were used. Body composition was calculated from multiple skinfold thicknesses using the standard regression equation. Nutritional status was measured using Z score according to WHO 2007 reference standard. A total of 330 children from Naogaon, Bogra and Kurigram districts in Bangladesh were examined from April 2019 to September 2019.ResultsThe Nutritional status of 2-15 years old child is exceedingly poor in the northern part of Bangladesh. Fat mass and fat-free mass were higher among children from Kurigram district than from Bogra and Naogaon district. Body fat percentages and arm fat area were greater among female children than males. The overall prevalence of stunting, underweight and wasting was around 25%, 32% and 29%, respectively, and the rate was higher among girls and children aged 2-5 years. The average SD score for weight-for-age, height-for-age, and BMI-for-age was -1.295, -0.937 and -1.009. The median weight-for-age and height-for-age Z scores of boys and girls were below the WHO reference percentile rank. Girls were twice (OR:1.951, CI:1.150-3.331) as likely to suffer from being underweight than boys. Children who don't practice handwashing are three times (OR:3.531, CI:1.657-7.525) more likely to be underweight. Children become underweight and stunted when their family income is not sufficient to maintain their nutritional requirements.ConclusionsThe children of the three northern districts had a poor nutritional status, and family income was the potential contributing factor. Therefore, interventions like the promotion of income-generating activities and integrated approaches to ensuring food diversification could be an option to address the nutritional problem of children of the three northern districts of Bangladesh.

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New anthropometric classification scheme of preoperative nutritional status in children: a retrospective observational cohort study.

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New anthropometric classification scheme of preoperative nutritional status in children: a retrospective observational cohort study.

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