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Development of an instrument to assess nutritional risk factors for children infected with human immunodeficiency
1Division of Clinical Immunology and Allergy, Childrens Hospital of Los Angeles, University of Southern California School of Medicine, USA.
Insights
A new instrument effectively identifies nutritional risk in children with human immunodeficiency virus (HIV). This tool uses anthropometric, dietary, and medical data for reliable monitoring and improved patient outcomes.
Area of Science:
- Pediatric Nutrition
- Infectious Diseases
- Public Health
Background:
- Nutritional status is critical for children with human immunodeficiency virus (HIV).
- Effective tools are needed to assess and monitor nutritional risk in this vulnerable population.
- Existing methods may not adequately capture the multifaceted nutritional challenges faced by HIV-infected children.
Purpose of the Study:
- To develop a simple and effective instrument for evaluating and monitoring nutritional risk in children with HIV.
- To create a reliable tool that integrates various data points for comprehensive risk assessment.
- To provide healthcare professionals with a practical method for nutritional surveillance in pediatric HIV care.
Main Methods:
- Instrument development involved expert consultation (physicians, nutritionists, social workers).
- Data collection included sociodemographic, anthropometric, biochemical, dietary, and medical factors from 39 HIV-infected children.
- Nutritional risk was graded, and reliability and validity were assessed using statistical analyses, including correlation coefficients and analysis of variance.
Main Results:
- Eleven factors demonstrated strong reliability, including anthropometric measures (height/age, weight/age, BMI), clinical class, and serum albumin.
- Anthropometric, dietary intake, and medical data proved to be reliable indicators of nutritional risk.
- The refined instrument, after removing less effective items, was found to be reliable and a valid predictor of nutritional risk.
Conclusions:
- The developed instrument is a reliable and valid tool for assessing nutritional risk in children with HIV.
- It effectively integrates key indicators, offering a practical approach to nutritional monitoring.
- This tool can aid in timely interventions, potentially improving health outcomes for HIV-infected children.
Objective:
To produce a simple and effective instrument to evaluate and monitor the nutritional risk of children infected with the human immunodeficiency virus (HIV).
Design:
The test instrument was developed in consultation with 5 physicians, 5 nutritionists, and 5 social workers with expertise in caring for HIV-infected children. Patient information was collected through medical record review for 19 sociodemographic, 10 anthropometric, 4 biochemical, 6 dietary intake, and 19 medical factors. As a part of routine nutrition care, anthropometric data were obtained and the caregiver was asked to complete a 3-day diet record. Also recorded were the most recent CD4+ T-cell numbers and serum HIV p24 antigen and plasma HIV RNA levels.
Subjects/Setting:
Thirty-nine HIV-infected children were selected using quota sampling; that is, subjects were stratified by clinical class as defined by the Centers for Disease Control and Prevention.
Statistical Analysis:
The severity or degree of potential nutritional risk in each section (anthropometric, biochemical, dietary intake, and medical data) was graded (0 to 4, 0 = low risk) and summed. Reliability of internal consistency was determined through covariance matrixes. Validity was determined through Pearson product moment correlation coefficients to measure convergent and divergent validity; predictive validity was determined using analysis of variance. Correlation for validity was compared to 6 selected dependent variables: weight for height, weight growth velocity, lean body mass, serum albumin level, CD4+ T-cell numbers, and quantitative plasma HIV RNA levels.
Results:
Of the 38 factors that were analyzed for reliability, 11 fell in the strongly reliable range: height for age, weight for age, clinical class, somatic protein stores, mid-arm circumference, weight for height, serum albumin, immunologic status, body mass index, energy intake, and opportunistic infection.
Conclusions:
Anthropometric, dietary intake, and medical data were reliable indicators of nutritional risk. The entire instrument was reliable after 8 of the weakest items were removed. The instrument was found to be valid and a good predictor of nutritional risk in HIV-infected children.