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Published on: February 14, 2021
Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease
A E Wiskin1, D R Owens, V R Cornelius
1NIHR Biomedical Research Unit (Nutrition, Diet & Lifestyle), Southampton, UK.
Insights
Nutrition screening tools show varied agreement in children with inflammatory bowel disease. Some tools may underestimate malnutrition risk, highlighting the need for careful assessment in chronic pediatric conditions.
Area of Science:
- Pediatric Nutrition
- Clinical Assessment
- Gastroenterology
Background:
- Growing interest in pediatric nutrition risk assessment tools for identifying children needing nutritional support.
- Limited data exists on the clinical application and inter-tool agreement of non-disease-specific screening tools.
Purpose of the Study:
- To examine the concurrent validity of four pediatric nutrition screening tools.
- To assess the agreement between different tools and anthropometric measures of malnutrition in children with inflammatory bowel disease.
Main Methods:
- Evaluated four nutrition screening tools: STAMP, STRONGkids, PYMS, and PNRS.
- Assessed 46 children diagnosed with inflammatory bowel disease.
- Determined malnutrition severity using anthropometry and ICD-10 criteria.
Main Results:
- Good agreement observed between STAMP, STRONGkids, and PNRS (kappa > 0.6).
- Modest agreement (kappa = 0.3) between PYMS and other scores; PYMS identified 23 children at low risk, unlike other tools.
- No agreement between screening tools and anthropometric malnutrition (kappa < 0.1); only 3 children with anthropometric malnutrition were scored high risk.
Conclusions:
- The clinical relevance of current nutrition screening tools for children with chronic diseases like IBD remains uncertain.
- Potential exists to under-recognize nutritional impairment and risk in pediatric inflammatory bowel disease patients.
Background:
There has been increasing interest in the use of nutrition risk assessment tools in paediatrics to identify those who need nutrition support. Four non-disease specific screening tools have been developed, although there is a paucity of data on their application in clinical practice and the degree of inter-tool agreement.
Methods:
The concurrent validity of four nutrition screening tools [Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), Screening Tool for Risk On Nutritional status and Growth (STRONGkids), Paediatric Yorkhill Malnutrition Score (PYMS) and Simple Paediatric Nutrition Risk Score (PNRS)] was examined in 46 children with inflammatory bowel disease. Degree of malnutrition was determined by anthropometry alone using World Health Organization International Classification of Diseases (ICD-10) criteria.
Results:
There was good agreement between STAMP, STRONGkids and PNRS (kappa > 0.6) but there was only modest agreement between PYMS and the other scores (kappa = 0.3). No children scored low risk with STAMP, STRONGkids or PNRS; however, 23 children scored low risk with PYMS. There was no agreement between the risk tools and the degree of malnutrition based on anthropometric data (kappa < 0.1). Three children had anthropometry consistent with malnutrition and these were all scored high risk. Four children had body mass index SD scores < -2, one of which was scored at low nutrition risk.
Conclusions:
The relevance of nutrition screening tools for children with chronic disease is unclear. In addition, there is the potential to under recognise nutritional impairment (and therefore nutritional risk) in children with inflammatory bowel disease.
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