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Nutritional Status, Social Determinants of Health and Clinical Outcomes in Critically Ill Children
Yash Desai1, Andrea Marroquín2, Paola Hong-Zhu3
1McGovern Medical School, UTHealth, Houston, TX 77030, USA.
Insights
Critically ill children with malnutrition, particularly those from minority ethnic groups, face worse outcomes, including longer hospital stays and higher mortality. Social determinants like poverty and food insecurity are key factors.
Area of Science:
- Pediatric Intensive Care
- Clinical Nutrition
- Health Disparities
Background:
- Childhood malnutrition is a significant risk factor for morbidity and mortality.
- Critically ill children in the Pediatric Intensive Care Unit (PICU) are particularly vulnerable to nutritional decline and adverse outcomes.
- Social determinants of health, including race, socioeconomic status, and geography, are linked to food insecurity and malnutrition.
Purpose of the Study:
- To investigate the complex interplay between nutritional status, social determinants of health, and clinical outcomes in critically ill children.
- To identify specific social factors contributing to malnutrition in this vulnerable pediatric population.
Main Methods:
- A retrospective cohort study analyzed data from 6418 critically ill children admitted to the PICU between January 2014 and December 2017.
- Nutritional status was assessed using anthropometric measurements upon admission.
- Social determinants, including poverty and food insecurity, were estimated for 5912 children based on zip code and median household income.
Main Results:
- The prevalence of underweight, chronic, and acute malnutrition was 13.2%, 17.9%, and 5.6%, respectively.
- Malnourished children experienced longer mechanical ventilation durations, PICU stays, and hospital lengths of stay (LOS).
- Underweight and chronic malnutrition were associated with increased mortality risk, with non-Hispanic Black and Hispanic children showing higher rates of food insecurity and poverty.
Conclusions:
- Malnourished critically ill children, especially those from disproportionately affected racial and ethnic minority groups (non-Hispanic Black, Hispanic, Asian), exhibit poorer hospital outcomes.
- These adverse outcomes include extended PICU and hospital LOS, increased mechanical ventilation time, and a higher risk of mortality.
- Addressing social determinants of health is crucial for improving outcomes in malnourished critically ill children.
Introduction:
Childhood malnutrition remains a risk factor for morbidity and mortality. Children admitted to the Pediatric Intensive Care Unit (PICU) are at a higher risk of worsening nutritional status with adverse clinical outcomes. The burden of malnutrition is strongly linked to various well-defined social determinants of health, including race, socioeconomic status, and geography, as these factors influence household food insecurity. This study aimed to analyze the interrelationships of nutritional status, social determinants of health, and health outcomes in critically ill children.
Methods:
Retrospective cohort study of 6418 critically ill children admitted to PICU from January 2014 to December 2017. Demographic and anthropometric measurements were collected upon admission and outcomes. Based on the patient's zip code, and median household income, we estimated the percentage of the population living in poverty, and the percentage of the population experiencing food insecurity for 5912 children.
Results:
The prevalence of underweight, chronic, and acute malnutrition was 13.2%, 17.9%, and 5.6%, respectively. Malnourished children had longer duration of mechanical ventilation and longer PICU and hospital lengths of stay (LOS) compared to nourished children. Underweight and chronic malnutrition were associated with higher mortality. Hispanic children had the highest prevalence of poverty level, while non-Hispanic Black children had the highest food insecurity level and lowest median income. Ethnicity was not associated with mortality.
Conclusions:
Malnourished critically ill children who were disproportionately non-Hispanic Black, Hispanic, and Asian had worse hospital outcomes, including prolonged hospital and PICU length of stay, increased time on mechanical ventilation, and a higher risk of mortality.
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