Diagnosing Pediatric Malnutrition

Abstract

The publication of the landmark paper "Defining Pediatric Malnutrition: A Paradigm Shift Toward Etiology-Related Definitions" launched a new era in diagnosing pediatric malnutrition. This work introduced the paradigm shift of etiology-related definitions-nonillness and illness related-and the use of anthropometric z scores to help identify and describe children with malnutrition (undernutrition) in the developed world. Putting the new definition into practice resulted in some interesting observations: (1) Etiology-related definitions result in etiology-related interventions. (2) Illness-related malnutrition cannot always be immediately "fixed." (3) Using z scores in clinical practice often puts the burden of proof on the clinician to show that a child is not malnourished, rather than the other way around. (4) Children with growth failure severe enough to be admitted with "failure to thrive" should always be assessed for malnutrition, and when they meet the criteria, malnutrition should be documented and coded. The publication of the consensus statement came next, announcing the evidence-informed, consensus-derived pediatric malnutrition indicators. Since the indicators are a work in progress, clinicians are encouraged to use them and give feedback through an iterative process. This review attempts to respond to the consensus statement's call to action by thoughtfully appraising the indicators and making recommendations for future review. Coming together as a healthcare community to identify pediatric malnutrition will ensure that this vulnerable population is not overlooked. Outcomes research will validate the indicators and result in new discoveries of effective ways to prevent and treat pediatric malnutrition.

Assessment of nutritional status in children with kidney diseases—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

“…There are many factors that may contribute to undernutrition in children with CKD, including uremia, metabolic acidosis, and GI disorders, as discussed throughout this text [2]. Extensive research on malnutrition in pediatric populations, with PEW as a subtype of malnutrition, has been published by the American Society for Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics [57][58][59]. There is also guidance on evaluation of PEW, also referred to as uremic failure to thrive or cachexia, in the pediatric predialysis population.…”

Crianças menores de 5 anos ainda morrem por desnutrição?

“…This may be a result of metabolic deficiencies in which there is a decrease in nutrient absorption or of irregular consumption of nutrients. 1,4,6 The etiology of malnutrition is classified into three dimensions, which are immediate, underlying, and structural. The immediate causes are related to insufficient diet in quality and quantity and to some routine diseases of the pediatric period.…”

Catch-up growth is a better indicator of undernutrition than thresholds for stunting

“…A slowly increasing number of articles in the current literature start to question if stunting is the single indicator to reliably detect poor child nutrition. In 2014, Becker et al (28) and later Bouma (29) stated that cut-offs at −2 height SDS and −1 height SDS for diagnosing moderate and mild undernutrition are not useful and should be replaced either by combinations of indicators, such as loss in lean body mass, infections, delayed wound healing and others.…”