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Nutritional Status as a Risk Factor for Appendiceal Perforation in Pediatric Acute Appendicitis: Systematic Review
Ciprian-Ioan Borca1,2, Cristiana-Smaranda Ivan1, Corneluta Fira-Mladinescu3,4
1Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
Children (Basel, Switzerland)
|March 28, 2026
Summary
Nutritional status in children with appendicitis is unclear. While obesity is not a reliable predictor of perforation, being underweight may indicate more severe disease. Biochemical markers show stronger associations with complicated appendicitis than BMI alone.
Area of Science:
- Pediatric Surgery
- Nutritional Science
- Clinical Epidemiology
Background:
- The link between a child's nutritional status and the severity of appendicitis, specifically perforation or complications, requires further clarification.
- Existing research presents conflicting findings regarding nutritional indicators and appendicitis outcomes in pediatric populations.
Purpose of the Study:
- To systematically review existing evidence on how anthropometric and biochemical nutritional markers relate to perforation and complicated appendicitis in children.
- To synthesize findings on the predictive value of various nutritional indicators for appendicitis severity in pediatric patients.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science for English-language studies published between January 2010 and January 2026.
- Studies involving pediatric participants (0-18 years) reporting Body Mass Index (BMI)-based measures or biochemical markers stratified by appendicitis perforation/complication status were included.
- Risk of bias was evaluated using the ROBINS-E tool.
Main Results:
- Fourteen observational studies were analyzed, revealing inconsistent associations between obesity and complicated appendicitis.
- Underweight status demonstrated a more consistent link with complicated appendicitis and poorer clinical outcomes.
- Biochemical markers (e.g., albumin, prealbumin) and inflammation-nutrition indices exhibited stronger and more consistent associations with perforated or complicated appendicitis compared to BMI categories.
Conclusions:
- BMI classifications alone are insufficient for reliably predicting perforation or complicated appendicitis in children.
- Albumin- and prealbumin-based indices appear more consistently associated with appendicitis severity, though causality is not established and may reflect underlying inflammation.
- Further prospective studies with standardized definitions are necessary to determine the prognostic value of these markers.
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