Registered Dietitian Nutritionist Consultation Is Associated With Improvement in Nutritional Status in Chronically...

The influence of care provided by a registered dietitian nutritionist (RDN) to malnourished children is not well described.

To compare nutrition outcomes of malnourished, chronically ill children with and without RDN involvement in outpatient care.

Retrospective cohort study of malnourished children who had ≥1 complex chronic condition with a follow-up period of at least 2 years during which improvement in body mass index-for-age z score (BMIz) and clinical outcomes were assessed.

Chronically ill children initially aged 2 to 5 years with malnutrition were divided into those seen (RDN group) or not seen (non-RDN group) by an RDN in an outpatient setting 60 days from the nadir BMIz. Of 841 patients, 240 (28.5%) were in the RDN group vs 601 patients (71.5%) in the non-RDN group.

Changes in BMIz at 6 months and 2 years and clinical outcomes (number of hospitalizations, total hospital days, and total procedure days) between 6 months and 2 years.

Group differences were tested using the Wilcoxon rank-sum test and Pearson χ² test. A regression mixed model analysis of the BMIz outcome estimating the RDN group effect while adjusting for confounders was performed.

Patients in the RDN group had worse median BMIz at baseline (-2.08) vs the non-RDN group (-1.80) (P = .0002) and more chronic illnesses throughout the study period. BMIz progressed in both groups, although improvements in BMIz were better in the RDN group (all P values < .05). The clinical outcomes were all worse in the RDN group (P < .0001). The regression mixed model found a 0.14 BMIz improvement for the RDN group (P = .0057).

Despite being more malnourished and sicker overall, an RDN visit for chronically ill, malnourished children was associated with an improvement in BMIz but not with other clinical outcomes.