Assessment of nutritional status in hospitalized children

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Relevance.Currently, there is no single standard algorithm capable of objectively assessing nutritional status in the screening mode[1].In Russia, about 20-40% of children admitted to hospital have signs of nutritional deficiencies. Against the background of infectious disease, namely, fever, a catabolic reaction is initiated, which leads to a negative balance of nutrients in the body due to increased loss of minerals and vitamins, proteins and aggravates the course and outcome of the disease. The state of the child's body, which experiences a pronounced protein deficiency, forms a vicious circle in the form of immune dysfunction [2, 3]. Proteins are a component of immunity and make up three groups: immunoglobulins (antibodies), interferons and proteins of the main histocompatibility complex, as well as lymphocytes, which have a protein structure in their structure. Early screening and correction of nutritional deficiencies will increase the effectiveness of therapeutic treatment, disease outcomes, reduce the risk of complications and decrease the number of bed days in hospital [4].

Purpose of the study. Comprehensive assessment of nutritional status in patients hospitalized in the infectious disease hospital of Voronezh. Voronezh.
Materials and methods. The present study was conducted on the basis of BOOZ VO ODKB ¹2 Voronezh from September to December 2023.48 children aged 0 to 18 years took part in the present study. In the course of the research work we collected complaints and anamnesis, clinical examination, measured anthropometric parameters of children (height, weight, BMI (body mass index), measured thickness under the scapula (mm), triceps thickness (mm), thigh circumference (cm), shoulder circumference (cm), calculated the volume of shoulder muscles, percentage of body fat), assessment of physical development using the mobile application AnthrometricCalculatoronline of the World Health Organization (WHO3), assessment of basic laboratory parameters (erythrocytes, color index (CI), hemoglobin, leukocytes, lymphocytes, absolute number of lymphocytes, total protein, albumin, ferritin, C-reactive protein). We also used the STRONGkids questionnaire (Screening Tool for Risk of Nutritional Status and Growth), a screening method to assess the risk of nutritional deficiencies, a record of comorbidities, and a 1-day food diary. Patients were calculated daily caloric intake with regard to basic metabolic energy (BME) according to WHO formulas, taking into account conversion factors and actual kcal intake. Methods of nonparametric statistics were used to analyze the obtained data.

The results of the study. We examined 48 hospitalized children, of whom 54.2% were girls and 45.8% were boys. The following diagnoses were established in patients: pneumonia – 79.2% (mycoplasma etiology was confirmed in 58.3% of cases), acute bronchitis – 10.4%, acute upper respiratory tract infection–12.5%. 8.3% of children had concomitant chronic diseases: 2.08% each accounted for diabetes mellitus, pyelonephritis, epilepsy and bronchial asthma. Among the possible risk factors for malnutrition, functional constipation was detected in 16.7%, periodic vomiting in 8.3%, and systematic nausea in 4.2% of patients.In terms of height, the average indicator in patients was 135 [109;155.5] cm, in terms of weight, the average indicator in patients was 30 [17;48.75] kg, the average body mass index (BMI) in hospitalized children was 16.6 [15.8;19.91], the average indicator of the standard deviation coefficient of Standartdeviationscore(SDS) growth in patients it was 0.18 [0.75; 1.34], the average SDS weight index in patients was 0.36 [-0.26; 0.82], the average SDS BMI in hospitalized children was 0.32 [-0.41; 0.75].According to WHO standards, 75% of children have a BMI from -1 to +1. Protein-energy deficiency (BEN) of the 1st stage was detected in 4.25% of patients, grade 2 BEN – in 6.25%, grade 3 BEN – in 6.25%. Excess body weight was found in 4.25% of hospitalized patients, obesity of the 1st degree and obesity of the 2nd degree – 2% respectively. The shoulder muscle volume was calculated using a formula and interpreted according to percentile tables. The volume of the shoulder muscles reflects the supply of muscle tissue[3].Muscle mass deficiency is observed in 8.3%. The average thickness of subcutaneous fat under the shoulder blade was 5 [5;5] mm., the average hip circumference was 35 [27;43]cm., the average shoulder circumference was 20 [17.2;25] cm., the average shoulder muscle volume was 180,365[161.4;232.9].87.5% of patients have a triceps thickness below 25 percentile, according to gender and age (the average triceps thickness is 5 [5;7.5] mm.). Triceps thickness correlated with the percentage of body fat in children (p=0.001), while the average body fat content in hospitalized patients is 10.24 [10.24;13.225]%.Ferritin levels are below normal (below 30 ng/ml)64.6% of hospitalized children have it (the average ferritin index in hospitalized children is 21 [12;37]ng/l).39.6% of children have mild anemia (the average erythrocyte count in children is 4.45[4.1;4.6]x1012/L., the average CPU of patients is 0.81 [0.73;0.90]. The average amount of hemoglobin in children was 120 [108;130] g/l, the average leukocyte count in patients is 8.9 [6.95;10.375]x109/l, the average indicator of the relative content of lymphocytes in children is 42 [38.2;45]%, the average absolute lymphocyte count in children is 3.69 [2.77;4.47]x109/l. For total protein, the average in children was observed in the range of 67.5 [63;69] g/l, for albumin - 25 [21.25;30]g/l, for C-reactive protein - 15 [8;22.5] mg/l.When calculating the daily caloric content of the diet using basal metabolic energy (calculated according to the WHO formula), as well as using correction factors (growth factor, disease factor, activity factor), the required amount of kcal/day on average is 2264.2[1731.9; 2736.1]kcal/ day, and the actual consumption of kcal on average is 1350 [1105; 1600] kcal. The large difference between the actual and necessary intake of kcal may be related to the intoxication manifestations of the disease. The simplicity and accessibility of the STRONGkids methodology allows you to reliably and quickly assess the risk of malnutrition.
According to the STRONGkids0 questionnaire, no patient scored points (low risk of malnutrition), 95.8% of the subjects scored 1-3 points (moderate risk of malnutrition), 4 points – 4.2% (high risk of malnutrition).The more points patients scored according to the STRONGkids questionnaire, the lower their body mass index standard deviations (SDSMI) were (p=0.001), SDSIMT (p<0.05) and body fat percentage (p<0.05).Patients with pneumonia had significantly lower SDSIMT (p<0.05) and were more likely to have BEN than patients with acute bronchitis and acute respiratory infection (p<0.05).

Conclusions. The STRONGkids scale can be used for screening assessment of the risk of malnutrition in the pediatric hospital of an infectious diseases hospital, as it is accessible and informative. According to the scale, the majority of hospitalized children have a moderate risk of malnutrition, so it is important to assess the nutritional status in the emergency department, for earlier restoration of sufficient and rational intake of nutrients, minerals and protein.Patients with pneumonia have lower BMI and are more likely to have BEN, which is due to the duration and severity of the disease, as well as due to the physiological and metabolic characteristics of the body (rapid active growth, high need for nutrients, morphofunctional immaturity of different parts of the digestive system) this leads to the progression of protein-energy deficiency, in order to prevent it, it is necessary to immediately carry out nutritional support.In the prodromal period, the phase of symptom onset and the height of the disease, patients consume less calories / day relative to the required norm, which affects the immune response, therefore it is necessary to adjust the diet throughout the disease, achieving rationality and balance.

 

About the authors

Angelina Sergeevna Proshina

N.N. Burdenko Voronezh State Medical University

Email: linochka.proshina.01@bk.ru
ORCID iD: 0009-0005-5639-2263
ResearcherId: KBB-8421-2024

Student, 5th year

Russian Federation, 394036,Russia,Voronezh,Studencheskaya, 10.

Svetlana Vladimirovna Shtukaturova

N.N. Burdenko Voronezh State Medical University

Email: sshtukaturovaa@mail.ru
ORCID iD: 0009-0002-1109-8907

Студент,5 курс

Russian Federation, 394036,Russia,Voronezh,Studencheskaya, 10.

Yulia Yurievna Razuvaeva

N.N. Burdenko Voronezh State Medical University

Email: yu.yu.razuvaeva@yandex.ru
ORCID iD: 0000-0003-2410-4544

4th year postgraduate student in the specialty 3.1.21 Pediatrics

Russian Federation, 394036,Russia,Voronezh,Studencheskaya, 10.

Vera Sergeyevna Ledneva

Voronezh State Medical University named after N.N. Burdenko

Email: lvsmed@yandex.ru
ORCID iD: 0000-0002-8819-3382

Doctor of Medical Sciences, Head of the Department of Faculty and Palliative Pediatrics, Voronezh State Medical University named after N.N. Burdenko

Russian Federation, 394036, Voronezh, st. Student, 10

Irina Anatolyevna Bavykina

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: i-bavikina@yandex.ru
ORCID iD: 0000-0003-1062-7280

Doctor of Medical Sciences, Associate Professor, Department of Faculty and Palliative Pediatrics, Voronezh State Medical University named after N.N. Burdenko

Russian Federation, 394036, Voronezh, st. Student, 10

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