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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
PubMed

Insights

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.
Abstract

Keywords:
appendiceal perforationbody mass indexcomplicated appendicitisnutritional statusobesitypediatric appendicitisserum albuminunderweight

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