Malnutrition among Hospitalized Children in the United States: Changing Prevalence, Clinical Correlates, and Practice Patterns between 2002 and 2011

Carvalho-Salemi, Jennifer; Salemi, Jason L.; Vega, Molly Wong; Spooner, Kiara K.; Juarez, Marisa; Beer, Stacey; Canada, Nicki L.

doi:10.1016/j.jand.2017.02.015

Cited by 47 publications

(74 citation statements)

References 31 publications

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“…Previous studies have suggested that minorities and economically disadvantaged children are less likely to have a documented diagnosis of malnutrition in the general hospitalized pediatric population . In this study, a higher prevalence of CDM was documented in Hispanic and African American populations.…”

Section: Discussionsupporting

confidence: 42%

“…On the other hand, familiarity with the diagnosis may also play a role and specialists who frequently deal with and treat malnutrition, such as gastroenterologists and nutritionists, may be more likely to recognize and document malnutrition. Similarly, because academic and urban hospital teams are more likely to be specialized, research oriented, and multidisciplinary, this may also contribute to greater recognition and documentation of malnutrition, as noted in previous studies …”

Section: Discussionmentioning

confidence: 80%

“…Another explanation of the notable increase in the documented rates of malnutrition may be the hospitalized patient mix. Between 2004 and 2009, for example, the number of children with chronic and complex conditions increased, leading to a greater number of patients at risk of malnutrition being admitted to the hospital throughout the years …”

Section: Discussionmentioning

confidence: 99%

“…Malnutrition in children with CP is associated with surgical complications, increased mortality, decreased level of societal participation, and, overall, a lower quality of life . Although it is well known that children with CP are generally undernourished, malnutrition is poorly recognized in the general hospitalized pediatric population . The complexity of CP can add an additional challenge in the recognition and subsequent diagnosis of malnutrition in this patient population.…”

mentioning

confidence: 99%

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Prevalence, trends, and correlates of malnutrition among hospitalized children with cerebral palsy

Reyes

Salemi

Dongarwar

et al. 2019

Develop Med Child Neuro

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Aim This cross‐sectional study characterized the prevalence, trends, sociodemographic factors, and clinical factors that are associated with a coded diagnosis of malnutrition (CDM) among hospitalized children with cerebral palsy (CP) in the USA. Method We used data from the 2002 to 2015 National Inpatient Sample database and restricted the analysis to hospitalized children with CP between 2 and 17 years of age. International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis codes for CP, malnutrition, and comorbidities associated with CP were used to characterize hospitalizations for this population. Logistic regression models were conducted to identify the sociodemographic factors and comorbidities associated with a diagnosis of malnutrition. Results The average documented rate of CDM among hospitalized children with CP was 7.9% and nearly doubled during the study period. The model suggests that younger age, non‐white ethnicity, lower income, and non‐private insurance/payer status were associated with increased odds of documented malnutrition. Concomitant inpatient diagnoses of epilepsy, dysphagia, scoliosis, reflux, and constipation were associated with higher rates of CDM. Interpretation The rate of CDM in hospitalized patients with CP is well under the estimated clinical prevalence of 30% to 40%. Multiple sociodemographic, hospital, and clinical factors are associated with higher rates of CDM. What this paper adds The documented rate of malnutrition in hospitalized children with cerebral palsy (CP) averaged 7.9% yearly. For hospitalized children with CP, documentation of malnutrition nearly doubled between 2002 and 2015. Economically disadvantaged and minority ethnic groups had a greater likelihood of malnutrition documentation. Inpatient malnutrition documentation was more likely with some comorbidities indicative of greater impairments. Gastrointestinal disorders increased the likelihood of an inpatient‐documented diagnosis of malnutrition.

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Section: Discussionsupporting

confidence: 42%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Prevalence, trends, and correlates of malnutrition among hospitalized children with cerebral palsy

Reyes

Salemi

Dongarwar

et al. 2019

Develop Med Child Neuro

View full text Add to dashboard Cite

show abstract

“…The frequency of PEM among AMI in our study was 3.5%, which is in a similar range as is reported in other studies on administrative datasets. PEM was 2.6%, 6.1%, and 7.2% among children, adults with cirrhosis, or adults with ulcerative colitis, respectively . These frequencies are much less than what has been reported in primary studies that directly measure PEM with validated measures.…”

Section: Discussionmentioning

confidence: 65%

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition

Adejumo

Adegbala

et al. 2019

J Parenter Enteral Nutr

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Background Protein‐energy malnutrition (PEM) diminishes amino acid and energy availability, impairing the body's healing capability after injury, such as in myocardial damage following acute myocardial infarction (AMI). Aims We sought to investigate the influence of PEM on clinical outcomes of AMI. Methods We identified records with a primary discharge diagnosis of AMI from the Nationwide Inpatient Sample (2012–2014), stratified by concomitant PEM. We matched PEM to no‐PEM (1:1) using a greedy algorithm–based propensity methodology and estimated the impact of PEM on health outcomes (SAS 9.4). Results Of the 332,644 hospitalizations for AMI, 11,675 had concomitant PEM accounting for roughly $US 1.5 billion and over 119,792 hospital days. PEM was associated with older age (74.43‐ vs. 66.90‐years; P < 0.0001), female sex (49.19% vs. 38.44%; P < 0.0001), black race (12.78% vs. 10.46%; P < 0.0001), and higher comorbidity burden (Deyo > 3: 32.77% vs. 16.69%; P < 0.0001). After propensity matching, PEM was associated with higher mortality (Adjusted odds ratio [AOR]: 1.59 [1.46–1.73]), cardiogenic shock (AOR: 2.26 [2.08–2.44]), discharge to secondary facilities (AOR: 2.21 [2.10–2.33]), charges ($135,500 [$131,956–139,139] vs. $81,084 [$79,241–82,970]), cardiac artery bypass surgery (AOR:1.81 [1.66–1.97]), intra‐aortic balloon pump placement (AOR: 1.83 [1.65–2.04]) and longer length of stay (10.15‐ vs. 5.52‐days). Conclusions PEM is a predisposing factor for devastating clinical outcomes among AMI hospitalizations. Higher prevention, identification and management of PEM among high‐risk individuals (older age, female sex, and black race) residing in the community are needed.

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Body Mass Index and Associated Medical Expenditures in the US Among Privately Insured Individuals Aged 2 to 19 Years in 2018

et al. 2023

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ImportanceNearly 40% of US youth aged 2 to 19 years do not have a body mass index (BMI) in the healthy weight category. However, there are no recent estimates for BMI-associated expenditures using clinical or claims data.ObjectiveTo estimate medical expenditures among US youth across all BMI categories along with sex and age groups.Design, Setting, ParticipantsThis cross-sectional study used IQVIA’s ambulatory electronic medical records (AEMR) data set linked with IQVIA’s PharMetrics Plus Claims database from January 2018 through December 2018. Analysis was performed from March 25, 2022, through June 20, 2022. It included a convenience sample of a geographically diverse patient population from AEMR and PharMetrics Plus. The study sample included privately insured individuals with a BMI measurement in 2018 and excluded patients with pregnancy-related visits.ExposureBMI categories.Main Outcomes and MeasuresTotal medical expenditures were estimated using generalized linear model regression with γ distribution and log-link function. For out-of-pocket (OOP) expenditures, a 2-part model was used that included logistic regression to estimate the probability of positive expenditures followed by generalized linear model. Estimates were shown with and without accounting for sex, race and ethnicity, payer type, geographic region, age interacted with sex and BMI categories, and confounding conditions.ResultsThe sample included 205 876 individuals aged 2 to 19 years; 104 066 were male (50.5%) and the median age was 12 years. Compared with those with healthy weight, total and OOP expenditures were higher for all other BMI categories. Differences in total expenditures were highest for those with severe obesity ($909; 95% CI, $600-$1218) followed by underweight ($671; 95% CI, $286-$1055) compared with healthy weight. Differences in OOP expenditures were highest for those with severe obesity ($121; 95% CI, $86-$155) followed by underweight ($117; 95% CI, $78-$157) compared with healthy weight. Having underweight was associated with higher total expenditures at ages 2 to 5 years and 6 to 11 years by $679 (95% CI, $228-$1129) and $1166 (95% CI, $632-$1700), respectively; having severe obesity was associated with higher total expenditures at ages 2 to 5 years, 6 to 11 years, and 12 to 17 years by $1035 (95% CI, $208-$1863), $821 (95% CI, $414-$1227), and $1088 (95% CI, $594-$1582), respectively.Conclusions and RelevanceThe study team found medical expenditures to be higher for all BMI categories when compared with those with healthy weight. These findings may indicate potential economic value of interventions or treatments aimed at reducing BMI-associated health risks.

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Malnutrition among Hospitalized Children in the United States: Changing Prevalence, Clinical Correlates, and Practice Patterns between 2002 and 2011

Cited by 47 publications

References 31 publications

Prevalence, trends, and correlates of malnutrition among hospitalized children with cerebral palsy

Prevalence, trends, and correlates of malnutrition among hospitalized children with cerebral palsy

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition

Body Mass Index and Associated Medical Expenditures in the US Among Privately Insured Individuals Aged 2 to 19 Years in 2018

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