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A nutritional screening test for use in children and adolescents with juvenile rheumatoid arthritis
C J Henderson1, D J Lovell, D J Gregg
1Special Treatment Center for Juvenile Arthritis, Children's Hospital Medical Center, University of Cincinnati, OH 45229-2899.
Insights
A new screening test using arm circumference can identify protein-energy malnutrition (PEM) in children with juvenile rheumatoid arthritis (JRA). This simple tool aids healthcare professionals in timely referrals for nutritional support.
Area of Science:
- Pediatric Rheumatology
- Nutritional Science
- Clinical Assessment
Background:
- Protein-energy malnutrition (PEM) affects approximately 35% of pediatric patients with juvenile rheumatoid arthritis (JRA).
- A significant gap exists in dietetic care, with fewer than 8% of children with rheumatic diseases receiving specialized nutritional support.
- Early identification of PEM is crucial for managing JRA complications.
Purpose of the Study:
- To develop and validate a practical nutritional screening test for PEM in JRA patients.
- To enable early detection and referral for nutritional intervention by healthcare professionals.
Main Methods:
- A nutritional assessment of 74 JRA patients was performed using an 11-variable profile of anthropometric and biochemical measurements.
- Sensitivity, specificity, predictive values, and validity index were calculated for various nutritional variables.
- Arm circumference (AC) at or below the 10th percentile was evaluated as a screening tool against expert dietitian review.
Main Results:
- Arm circumference at or below the 10th percentile demonstrated strong performance characteristics for PEM screening in JRA.
- The selected screening method showed high sensitivity (0.80), specificity (0.86), positive predictive value (0.90), and index of validity (0.88).
- Ease of measurement makes AC a practical tool for routine clinical use.
Conclusions:
- Arm circumference measurement is a reliable and efficient screening tool for identifying PEM in children with JRA.
- Implementation of this screening test can improve nutritional care and outcomes for JRA patients.
- This validated screening method supports timely referrals to dietitians for comprehensive nutritional management.
Abstract:
Protein-energy malnutrition (PEM) has been demonstrated in about 35% of patients with juvenile rheumatoid arthritis (JRA), but fewer than 8% of children with rheumatic diseases were reported in a national survey to have been seen by a pediatric dietitian. We demonstrate the development of a nutritional screening test for PEM in patients with JRA for use by all health care professionals. Nutritional assessment of 74 patients with JRA was conducted using a standardized 11 variable profile comprised of upper body anthropometric and biochemical measurements. The sensitivity, specificity, predictive values and index of validity were calculated for individual and selected clusters of nutritional variables to predict the need for referral for PEM compared to the independent review by 2 pediatric dietitians to refer or not refer to a dietitian for further evaluation or care. Arm circumference less than or equal to 10th percentile for age and sex matched norms was selected as the screening test for PEM in patients with JRA due to a combination of excellent measurement characteristics (sensitivity 0.80, specificity 0.86, positive predictive value 0.90, negative predictive value 0.73, index of validity 0.88) and ease of measurement.