Lara Pompa, NE; (2017) Malnutrition Screening And Body Composition Measurements In Paediatric Patients With Complex Diagnosis: Translating Research Into Clinical Practice. Doctoral thesis , UCL (University College London).

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Abstract

BACKGROUND: Paediatric patients have a high risk for malnutrition, and there is an increasing consensus worldwide on the need to find better tools to identify the risk, diagnose, and manage this condition to avoid the long-term consequences in child health and development. OBJECTIVE: Evaluate the practical aspects of measuring body composition (BC) in paediatric patients with complex conditions, and their possible advantages over measurements of weight/height to predict clinical outcomes and as possible malnutrition diagnostic parameters; while also validating three paediatric malnutrition screening tools (MSTs). DESIGN: This prospective study recruited and measured 152 children 5-18yr with different anthropometric and BC techniques within 48hr of admission and at discharge to a tertiary level hospital. MSTs (PYMS, STAMP, STRONGkids) were completed on admission and data collected on clinical outcomes: length of stay, complications, and worsening nutritional status. RESULTS: BC measurements by different techniques are practical and acceptable overall in paediatric patients. Malnutrition was prevalent in 13-20% of patients, measured by different anthropometric/BC parameters. Patients were on average short and underweight compared to healthy children, and had abnormal BC (low lean mass, variable fat mass). The parameters were significantly associated with clinical outcomes, and there seemed to be an advantage for BC to predict increased LOS and complications. Similarly, malnutrition risk on admission varied depending on the MST used. STAMP and STRONGkids were significantly associated with baseline weight, height, lean and fat mass; while PYMS had better associations to clinical outcomes (increased LOS). CONCLUSION: Malnutrition is relatively common, and BC measurements seem to have a place in the diagnosis and possibly the nutritional management of paediatric patients. Future work with specific patient groups and outcomes should help clarify what parameters/tools are the most helpful to ultimately decrease the prevalence of hospital malnutrition.

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