Influence of Obesity on Clinical Outcomes in Hospitalized Children

Abstract

Importance Obesity is prevalent among hospitalized children. Knowledge of the relationship between obesity and outcomes in hospitalized children will enhance nutrition assessment and provide opportunities for interventions. Objective To systematically review the existing literature concerning the impact of obesity on clinical outcomes in hospitalized children. Evidence Acquisition PubMed, Web of Science, and EMBASE databases were searched for studies of hospitalized children aged 2 to 18 years with identified obesity and at least 1 of the following clinical outcomes: all-cause mortality, incidence of infections, and length of hospital stay. Cohort and case-control studies were included. Cross-sectional studies, studies of healthy children, and those without defined criteria for classifying weight status were excluded. The Newcastle-Ottawa Scale was used to assess study quality. Results Twenty-eight studies (26 retrospective; 24 cohort and 4 case-control) were included. Of the 21 studies that included mortality as an outcome, 10 reported a significant positive relationship between obesity and mortality. The incidence of infections was assessed in 8 of the 28 studies; 2 reported significantly more infections in obese compared with nonobese patients. Of the 11 studies that examined length of stay, 5 reported significantly longer lengths of hospital stay for obese children. Fifteen studies (53%) had a high quality score. Larger studies observed significant relationships between obesity and outcomes. Studies of critically ill, oncologic or stem cell transplant, and solid organ transplant patients showed a relationship between obesity and mortality. Conclusions and Relevance The available literature on the relationship between obesity and clinical outcomes is limited by subject heterogeneity, variations in criteria for defining obesity, and outcomes examined. Childhood obesity may be a risk factor for higher mortality in hospitalized children with critical illness, oncologic diagnoses, or transplants. Further examination of the relationship between obesity and clinical outcomes in this subgroup of hospitalized children is needed.

Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU*

“…In children admitted for status asthmaticus, obesity was a significant predictor of PICU stay [36]. Pediatric cohorts with critical illness, cancer, solid organ and stem cell transplantation have a mortality association with obesity [37]. In our current study, children who were obese or underweight had significantly longer hospital stays but their odds of acquiring an infection were not higher.…”

Childhood obesity and in-hospital asthma resource utilization

“…[1][2][3] Recent studies have demonstrated worsened pediatric in-hospital outcomes, including mortality and increased resource utilization, for children with obesity across a range of diagnoses. [4][5][6][7][8][9][10] Although the mechanisms driving the association between obesity and in-hospital outcomes are not fully known, for asthma it is believed that adipocytes expressing inflammatory markers create a low level of systemic inflammation, thereby increasing the severity of allergic-type illnesses and decreasing the response to anti-inflammatory medications, such as steroids. [11][12][13][14][15][16][17][18] The relationship of obesity and in-hospital asthma outcomes is of particular interest because status asthmaticus is the most common reason for admission in children aged 3 to 12 years, accounting for approximately 150,000 admissions (7.4% of all hospitalizations for children and adolescents) and $835 million in hospital costs annually.…”

Diagnóstico nutricional en lactantes menores con cardiopatía congénita: comparación de dos clasificaciones antropométricas

“…En esta clasificación aparecen diagnósticos más específicos como los desnutridos crónicos activos o descompensados que corresponde a aquellos niños que tienen compromiso de talla pero que además su estado nutricional es deficiente en peso para esa talla como también están los niños desnutridos crónicos sobre compensados, es decir, el aporte de energía está siendo excesivo en el manejo de su recuperación nutricional. Por lo cual realizar un correcto diagnóstico nutricional nos orienta los requerimientos de energía de un niño, sobretodo cuando existe evidencia que tanto malnutrición por déficit como por exceso otorga mayor morbilidad 16,18 . La CAI no es específica de niños con CC, por lo que esta clasificación es útil en niños que cursen por distintas causas con compromiso de talla.…”