Nutritional assessment tools for children

Figure 1. Table 4 Advantages and disadvantages of methods used to assess body composition. Creatinine Height Index CHI Creatine is metabolized to creatinine at a more or less stable rate, and reflects the amount of muscle mass [ 37 ]. Magnetic Resonance Tomography MRT and Computed Tomography CT Magnetic resonance tomography MRT and computed tomography CT allow the quantification of fat mass and fat-free mass, giving information about the fat distribution and enabling an estimation of skeletal muscle mass.

Further Methods Used to Measure Body Composition Several other methods are available, mainly for research purposes due to their complexity. Biochemical Analysis There is no single parameter that can thoroughly assess nutritional status or monitor nutritional therapy. Table 5 Laboratory values to detect malnutrition and monitor nutritional status [ 41 ].

Clinical Evaluation 3. Physical Examination Physical examination is an objective method of detecting clinical signs and symptoms of nutritional deficiencies of vitamins and minerals e. Table 6 Clinical signs and symptoms of micronutrient deficiencies [ 40 , 42 ].

Physical Function Functional measurements are increasingly important in nutritional assessment. Innovative technologies that improve dietary assessment have been proposed recently, and can be classified into four principal groups according to the technological features that each of them incorporate [ 46 , 47 , 48 , 49 , 50 ]: — Manual dietary assessment —The user inserts all required data e.

This method replaces the paper-based methods of dietary assessment into an electronic form by the use of pictures, video, text, or voice without the inclusion of automatic features. These data are then analyzed by nutrition experts who use standardized methods e. No automation features are usually incorporated. Table 7 Macronutrient requirements for adults.

Quality of Life The assessment of quality of life is a more subjective parameter that is being increasingly included in nutritional assessment. Conclusions and Outlook Malnutrition is a frequent threat in hospitals, and is associated with negative outcomes.

Screening A Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties? Author Contributions Conceptualization, E. Conflicts of Interest The authors declare no conflicts of interest.

References 1. Sorensen J. Dupertuis Y. Food intake in hospitalised patients: A prospective comprehensive hospital survey. Schwegler I. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Sun Z. Nutritional Risk Screening as a predictor of postoperative outcomes in patients undergoing abdominal surgery: A systematic review and meta-analysis of prospective cohort studies.

Imoberdorf R. Prevalence of undernutrition on admission to Swiss hospitals. Studley H. Percentage of weight loss: A basic indicator of surgical risk in patients with chronic peptic ulcer. Nutr Hosp.

Meguid M. Complications of abdominal operations for malignant disease. Pikul J. Degree of preoperative malnutrition is predictive of postoperative morbidity and mortality in liver transplant recipients. Soeters P. Advances in understanding and assessing malnutrition. Guo W. Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS and its relationship with postoperative results.

Lieffers J. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Schiesser M. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery.

Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery. Sungurtekin H. The influence of nutritional status on complications after major intraabdominal surgery.

Donini L. Systematic review of nutritional status evaluation and screening tools in the elderly. Foley N. Which reported estimate of the prevalence of malnutrition after stroke is valid? Bauer J. Evaluation of nutritional status in older persons: Nutritional screening and assessment.

Schindler K. How nutritional risk is assessed and managed in European hospitals: A survey of 21, patients findings from the — cross-sectional nutritionDay survey. Van Bokhorst-de van der Schueren M. Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting.

Kondrup J. ESPEN guidelines for nutrition screening Nutritional risk screening NRS : A new method based on an analysis of controlled clinical trials.

Schuetz P. Individualized nutritional support in medical inpatients at nutritional risk: A randomized clinical trial. Weekes C. Anthony P. Nutrition screening tools for hospitalized patients. Raslan M. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients.

Charney P. Nutrition screening vs. Detsky A. What is subjective global assessment of nutritional status? Classical article. Koom W. Nutritional status of patients treated with radiotherapy as determined by subjective global assessment. British Dietetic Association. Parenteral and Enteral Nutrition Group. A Pocket Guide to Clinical Nutrition. Han T. Lower leg length as an index of stature in adults.

Reeves S. The relationship between arm-span measurement and height with special reference to gender and ethnicity. Bosy-Westphal A. Body composition analysis—What can be measured with practical value? Aktuel Ernahrungsmed. Kyle U. Bioelectrical impedance analysis—Part I: Review of principles and methods. Bioelectrical impedance analysis—Part II: Utilization in clinical practice. Forbes G. Urinary creatinine excretion and lean body mass.

Stratton R. MacDonald A. The advantages and limitations of cross-sectional body composition analysis. Support Palliat. Pirlich M. Leuenberger M. How to assess the nutritional status of my patient. Praxis Bern ; — Esper D. Utilization of nutrition-focused physical assessment in identifying micronutrient deficiencies. Norman K. Hand grip strength: Outcome predictor and marker of nutritional status.

Studenski S. Physical performance measures in the clinical setting. Food and Agriculture Organization of the United Nations. Forster H. Personalised nutrition: The role of new dietary assessment methods. Gemming L. Image-assisted dietary assessment: A systematic review of the evidence. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. Is the presence of a validated malnutrition screening tool associated with better nutritional care in hospitalized patients?

Nutritional screening in hospitalized pediatric patients: a systematic review. J Pediatr Rio J ; 92 — Elia M, Stratton RJ. Considerations for screening tool selection and role of predictive and concurrent validity.

Nutrition risk classification: a reproducible and valid tool for nurses. Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population. Am J Clin Nutr. Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. J Hum Nutr Diet. Bodenheimer T, Fernandez A. High and rising health care costs. Part 4: can costs be controlled while preserving quality?

Ann Intern Med. Subjective Global Nutritional Assessment for children. Statistical methods for assessing agreement between two methods of clinical measurement. Pediatric malnutrition: putting the new definition and standards into practice. Malnutrition in pediatric hospital patients: current issues. Association between nutritional status and outcomes in critically-ill pediatric patients - a systematic review. Nutritional status as a predictor of duration of mechanical ventilation in critically ill children.

An analytic appraisal of nutrition screening tools supported by original data with particular reference to age. Prediction of height from knee height in children with cerebral palsy and non-disabled children. Ann Hum Biol.

Stevenson RD. Use of segmental measures to estimate stature in children with cerebral palsy. Arch Pediatr Adolesc Med. Nutritional risk screening and assessment. J Clin Med. Screening for pediatric malnutrition at hospital admission: which screening tool is best? J Trop Pediatr. Support Center Support Center. Children should be weighed on admission to hospital and subsequently at least once a week. Frequency of weighing requires adjustment according to clinical condition on discussion with the multidisciplinary team.

Repeat weights should be recorded under similar conditions and at the same time of day as the original measurement. Infants and toddlers up to three years should always be weighed naked. Older children should be weighed with a minimum of clothing. Care should be taken when positioning the child on the scales to ensure an accurate measurement - the child should be placed centrally and the measurement should not be recorded until the child is still.

All weights should be recorded in kilograms. Weights should be recorded on a weight chart, observation chart and on the centile chart in the medical notes and in parent-held records.

Similarly, daily weights may reflect hydration rather than nutrition. A measurement of weight is of nutritional value only when reviewed in the light of previous weights and clinical history.

It should be noted that a measurement of weight should not be relied on as an accurate indication of nutritional status in children with significant oedema or solid tumours. Although not definitive, comparing weight, height and age can give useful clues to potential problems Box 1. Infants should be measured naked and by two people, using an appropriate measuring mat with head and footboard. The child should be placed supinely with the head held against the headboard and gentle downward pressure applied to the knees to ensure that the legs are straight and flat against the mat.

The standing height of an older child should be measured using an appropriate stadiometer. Shoes should be removed and the child asked to stand with feet together and heels, buttocks and shoulder blades in contact with the vertical measure.

How to use: nutritional assessment in children. Statistics from Altmetric. Nutrition Gastroenterology General Paediatrics Introduction One-fifth of children in hospitals are undernourished. Physiological background Growth reference standards Measurements of height and weight in children need to be interpreted relative to a reference population. Recommended nutrient intakes The UK Department of Health has published recommendations for children and adults for the intakes of most major macronutrients and micronutrients, in the form of Dietary Reference Values DRVs.

Footnotes Competing interests RMB has received sponsorship from Mead Johnson, Nestle and Nutricia in lieu of medical advisory work, invited lectures and conference attendance. Read the full text or download the PDF:.