Outcomes of a nutrition audit in a tertiary paediatric hospital: implications for service improvement

OBJECTIVE: To examine the process of anthropometric assessment of nutritional status in a tertiary paediatric hospital, to identify the barriers and to make recommendations for service improvement. METHODS: The accuracy of height and weight scales in wards was checked. Dietitians measured height and weight of a representative sample of 245 inpatients and checked whether these measurements had been recorded on bed charts. Patients were classified as overweight, obese or under-nourished. Diagnoses and procedures were obtained for each patient. Funding implications were modelled for inappropriate coding of nutritional status. RESULTS: The barriers to nutritional assessment and management of nutritional comorbidities were: (i) inaccurate height scales in seven out of 12 wards; (ii) under-recording of height and weight on patient bed charts (73% height missing, 12% both height and weight missing); (iii) under-reporting of obesity and under-nutrition in medical notes (one of eight obese patients, and none of 28 undernourished patients, reported); and (iv) low referral rate of obese or under-nourished children to dietetic services (two of 42 overweight/obese patients referred, five of 28 undernourished patients referred). Funding simulation showed that if under-nourished patients were correctly diagnosed then the potential facility reimbursement would have increased by $A52 326. CONCLUSIONS: Barriers to nutritional assessment can lead to failure to diagnose and treat both over- and under-nutrition, thereby affecting quality of patient care, and may have financial implications for hospitals. Suggestions for service improvement include provision of accurate equipment, adequate training of staff undertaking nutritional assessments and clear definitions of staff responsibilities in all aspects of the process.     

Assessment of nutritional status and nutritional risk in hospitalized Iranian children

Aims: This study aimed to define the nutritional state of children admitted to a tertiary Iranian hospital and to evaluate nutritional risk score tools in these children. Methods: The anthropometry of hospitalized and healthy children from the same community was determined. Three nutritional risk score tools were applied to all inpatients. Results: One hundred and nineteen inpatients were recruited along with a comparison group of 100 children. The prevalence of under‐nutrition in the inpatient group was 25.2% and 3% in the community group (p < 0.0001). Obesity/overweight was more prevalent in the community group than the inpatients (22% versus 2.5%: p = 0.04). Severely malnourished children had a longer hospital stay than those with normal nutrition (p < 0.0001). The nutritional risk score tools identified between 83% and 90% of the malnourished patients in the moderate and high‐risk groups. The STRONG_kids tool correlated more strongly with anthropometric measurements than the other tools. The length of hospital stay was associated with risk status (p = 0.004). Conclusion: Hospitalized Iranian children have higher rates of under‐nutrition than healthy children from the same community. NRS tools were able to identify children at nutritional risk; however, variable utility was observed. Further assessment of NRS tools in the developing setting is required.     

Changing patterns of under- and over-nutrition in South African children-future risks of non-communicable diseases

Under- and over-nutrition in children in KwaZulu-Natal, South Africa was investigated comparing data collected from primary school children in a rural district (643 children aged 8-11 years in 1994) with secondary data from the National Schools Study (16,179 children, 4-11 years in 1994), the Vitamin A Consultative Group Study (408 children, 2-5 years in 1994) and the Income Dynamics Study (1,593 children, 2-11 years in 1998). Stunting and wasting (WHO/NCHS guidelines) and overweight and obesity (International Obesity Task Force guidelines) were retrospectively analysed from these studies and compared in the children aged 4-5 and 8-11 years. There was moderate stunting in 10-25%, wasting in 1-6%, 5-24% were overweight and 1-10% obese. Girls in the National Schools Study (p<0.005) and in the primary datasets (p=0.02) had a significantly higher prevalence of overweight than boys; girls (1.4%) were also more obese than boys (0.9%) in the Schools Study (p=0.002), and the boys significantly more stunted (p<0.005) and wasted (p<0.005). An increasing prevalence of overweight and obesity was seen in both the 4-5- and 8-11-year age-groups. The finding that moderate stunting co-exists with overweight and obesity suggests that patterns of under- and over-nutrition in South African children are changing and might indicate the early stages of a complex nutritional transition. Action is required to prevent the future risk of non-communicable diseases.     

Relationship of nutritional status with tuberculin sensitivity

Objective  To estimate the prevalence of under- nutrition among school children and to find out the relationship between nutritional status and tuberculin sensitivity. Methods  A cross sectional study was carried out among 3335 children between 5–8 years of age attending 60 schools in Bangalore city selected by stratified random sampling. The nutritional anthropometric indices were calculated using reference median as recommended by World Health Organization, classified according to standard deviation units termed as Z-scores. The nutritional status of the children was assessed by Weight for age, Height for age and Bio-mass-index (BMI). Results  Depending upon the method for classifying nutritional status, the prevalence of under-nutrition (including mild and severe under-nutrition) varied between 14.9–29.8%. The prevalence of severe under-nutrition varied from 2.9–6.7%. The frequency distributions of reaction sizes were found to be similar among children classified by nutritional status. The differences in proportions of significant reactions (=10mm) and mean tuberculin reaction sizes between children classified by nutritional status were not found to be statistically significant. Conclusion  Tuberculin sensitivity was not influenced by nutritional status among apparently healthy school children.     

Measuring the financial and productivity burden of paediatric hospitalisation on the wider family network

Aim

To estimate the non‐medical out‐of‐pocket costs for families with a child in hospital.

Methods

This study was a survey of 225 parents of paediatric inpatients on nine wards of an Australian public paediatric teaching hospital on two separate days. Our primary outcomes were the costs associated with: (i) time taken off work to care for the child in hospital; (ii) time off work or contributed by family and friends to care for other dependents; and (iii) travel, meals, accommodation and incidental expenses during the child's stay. Demographic data included postcode (to assess distance, socio‐economic status and remoteness), child's age, ward and whether this was their child's first admission.

Results

Mean patient age was 6.5 years (standard deviation 5.2). On an average per patient day basis, parents took 1.12 days off work and spent 0.61 (standard deviation 0.53) nights away from home, with 83.8% of nights away at the child's bedside. Parents spent Australian dollars (AUD)89 per day on travel and AUD36 on meals and accommodation. Total costs (including productivity costs) were AUD589 per patient day. Higher costs per patient day were correlated with living in a more remote area (0.48) and a greater travel distance to the hospital (0.41). A higher number of days off work was correlated (0.69) with number of school days missed.

Conclusion

These results demonstrate the considerable time and financial resources expended by families caring for a child in hospital and are important inputs in evaluating health‐care interventions that affect risk of hospitalisation and length of stay in paediatric care.     

Obesity in children and adolescents with acquired brain injury

OBJECTIVES: To measure the prevalence of obesity and to assess associated clinical factors in children and adolescents with acquired brain injury (ABI). STUDY DESIGN: This cross-sectional study included 88 subjects aged between 2.4-17.7 years attending the Brain Injury Clinic at a tertiary paediatric hospital. Body mass index (BMI) and BMI z-scores were calculated. Obesity and overweight were defined using the International Obesity Taskforce cut-points. Associations were examined between BMI z-scores and the following: ABI severity, mobility level, duration from injury and presence of radiological injury. RESULTS: The prevalence of obesity in this population (obese = 15%) was higher than those in Australian children and adolescents (1995 National Nutrition Survey) while the prevalence of overweight (19.3%) was comparable. There was a linear trend for the participants to have a higher BMI z-score with increasing level of mobility (F = 6.91, df 1.70, p = 0.011). CONCLUSION: There is no data about obesity in children and adolescents with ABI. The study with limited statistical power suggests that obesity is prevalent in this population and increases with increasing level of mobility. Further studies are required to address the issue of obesity and related complications in this population.     

Overweight/obesity in adolescents with phenylketonuria: protective and predisposing factors

ObjectiveTo estimate the prevalence and factors associated with overweight/obesity development in adolescents with early diagnosed phenylketonuria treated exclusively by diet.MethodologyIn this cross-sectional study anthropometric measurements, serum phenylalanine levels, and 10 metabolites associated with lipid and carbohydrate metabolism were analyzed in 101 adolescents aged 10–20 years. Adolescents were categorized into overweight/obesity and eutrophic/low body mass index groups. These patients were compared using Student's t-test, Pearson's chi-square test, Wald's chi-square test for multivariate analysis. Further, to verify whether the prevalence of overweight/obesity found in the study population was similar to that in the general population, the authors compared the nutritional status of 46 patients aged 13–17 years with that of healthy students of the same age from the National School Health Survey using the chi-square test for adherence. The significance threshold was p < 0.5.ResultsThe prevalence of overweight/obesity in adolescents was 27.7%. There was no difference in prevalence between sexes. Older age was a protective factor and Increased Homeostasis Model Assessment Insulin Resistance index and high phenylalanine and low-density lipoprotein cholesterol levels were predictive factors for overweight/obesity. The equality hypothesis was not rejected in the comparison of nutritional states of 46 patients aged 13–17 years and healthy students of the same age.ConclusionThe prevalence of overweight/obesity in phenylketonuria adolescents was similar to what is found in healthy adolescents.     

MRSA at an English children's hospital from 1998 to 2003.

AIMS: To investigate the epidemiological and clinical aspects of MRSA among inpatients and outpatients presenting to hospital. METHODS: Analysis of demographic, epidemiological, and clinical data collected on 385 children first identified as having MRSA between January 1998 and December 2003 in a 250 bed English children's hospital. RESULTS: There were 267 inpatients and 118 outpatients. The number of new cases of MRSA declined from 72 in 1998 to 52 in 2003, whereas hospital activity increased. Ninety nine (37.1%) inpatients acquired MRSA outside the hospital; a further 90 occurred among 31 clusters of cases. One hundred and seventy eight (66.7%) inpatients were aged <2 years; cardiac services and paediatric & neonatal surgery accounted for 59.6% of cases. Dermatology and A&E accounted for 51.7% of outpatients; 73.8% of outpatients had recently previously attended the hospital. A total of 13.9% of inpatients with MRSA developed bacteraemia; MRSA accounted for 15% of Staphylococcus aureus bacteraemias. The risk of MRSA bacteraemia in colonised patients, and the proportion of S aureus bacteraemias that were MRSA, varied between specialties. Intravascular devices were the most common source of MRSA bacteraemia (63.4% of cases). The mortality rate was 7.3%. CONCLUSIONS: Enhanced surveillance of MRSA can identify at-risk patient groups, thus facilitating targeting of control measures. The absence of a link between numbers of cases of acquisition of MRSA and bacteraemia suggests that the rise in MRSA bacteraemia may not solely reflect an increase in MRSA prevalence in children in the UK. The need for larger epidemiological studies is emphasised.     

Nutritional status disorders prevalence rates in a sample of pediatric oncology Day Hospital patients]

BACKGROUND: Nutritional status is more important in children than in adults because it is necessary to support normal growth and development. In industrialized countries the prevalence of nutritional status disorders in the pediatric population are as follows: 35-40% of children are overweight/obese, while the underweight status disappeared in some reports or, when it is present, it is associated with other diseases. The aim of this study was to investigate the prevalence rates of nutritional status disorders among an unselected sample of Pediatric Oncology Day Hospital patients. METHODS: Anthropometric parameters of weight and height have been measured in patients affected with solid tumor either on-therapy or off-therapy (0-24 mo). Then Real Body Weight (% RBW) was estimated referring to National Center for Health Statistic percentiles. The sample was then divided into 4 weight classes (under-weight, normal-weight, over-weight and obese) according to % RBW. RESULTS: Overweight patients (overweight + obese) were 44.4%, and 13.9% underweight. Dividing the patients according to whether they are on-therapy or off-therapy, the prevalence of overweight was 36.9% in the former group and 52.9% in the latter, and the underweight prevalence was 26.3 vs 0%. CONCLUSIONS: Our preliminary data show that in this sample of patients on treatment obesity and overweight are present in a similar percentage of the healthy population, but underweight status prevalence is 26.3%. In the sample of patients off-therapy the underweight status disappeared while the overweight status increased. These data suggest that nutritional assessment in oncologic patients is required in order to provide nutritional strategies.     

Nutritional status of students in Kocaeli,Turkey: A population‐based study

Background: The aim of this study was to determine the nutritional status of students in Kocaeli, Turkey. Methods: This cross‐sectional study was carried out among the students of secondary schools in Kocaeli. Of the students, 2491 subjects were selected using multi‐stage stratified sampling. Results: Of the students, 51.1% were male and 48.9% were female. Mean age was 14.35 ± 1.87 (range 10.1–19.8) in overall subjects, 14.38 ± 1.87 in boys and 14.31 ± 1.85 in girls. The prevalence of obesity and of overweight was estimated as 7.3% and 11.8%, respectively. Also, 3.1% of the subjects were underweight and 2.9% were thin. The rate of obesity was 1.5 times higher in girls and that of overweight was 1.2 times higher in girls. Similarly, students aged 15 years old and younger were 1.2 times more obese and 1.7 times more overweight than older students. Students living in urban areas had a higher prevalence of obesity and of overweight. Conclusion: Nutritional problems in students should be dealt with by some regulations in schools; for example, providing healthy food in schools or food aid, particularly in poor regions.     

MRSA at an English children's hospital from 1998 to 2003

Aims: To investigate the epidemiological and clinical aspects of MRSA among inpatients and outpatients presenting to hospital. Methods: Analysis of demographic, epidemiological, and clinical data collected on 385 children first identified as having MRSA between January 1998 and December 2003 in a 250 bed English children''s hospital. Results: There were 267 inpatients and 118 outpatients. The number of new cases of MRSA declined from 72 in 1998 to 52 in 2003, whereas hospital activity increased. Ninety nine (37.1%) inpatients acquired MRSA outside the hospital; a further 90 occurred among 31 clusters of cases. One hundred and seventy eight (66.7%) inpatients were aged <2 years; cardiac services and paediatric &; neonatal surgery accounted for 59.6% of cases. Dermatology and A&;E accounted for 51.7% of outpatients; 73.8% of outpatients had recently previously attended the hospital. A total of 13.9% of inpatients with MRSA developed bacteraemia; MRSA accounted for 15% of Staphylococcus aureus bacteraemias. The risk of MRSA bacteraemia in colonised patients, and the proportion of S aureus bacteraemias that were MRSA, varied between specialties. Intravascular devices were the most common source of MRSA bacteraemia (63.4% of cases). The mortality rate was 7.3%. Conclusions: Enhanced surveillance of MRSA can identify at-risk patient groups, thus facilitating targeting of control measures. The absence of a link between numbers of cases of acquisition of MRSA and bacteraemia suggests that the rise in MRSA bacteraemia may not solely reflect an increase in MRSA prevalence in children in the UK. The need for larger epidemiological studies is emphasised.     

Increasing prevalence of obesity in South Australian 4-year-olds: 1995-2002

OBJECTIVE: To determine prevalence of, and trends in, overweight and obesity in South Australian children aged 4 years during the period 1995-2002. METHODS: Data from 114 669 children collected as part of Child and Youth Health 'preschool health assessments' of 4-year-olds throughout the state in the years 1995-2002 were analysed. Body mass index was calculated from height and weight data and prevalence of overweight and obesity for males and females determined using a standard world-wide definition. Yearly prevalence rates were compared for changes over time. RESULTS: Rates of overweight and obesity have increased over the period 1995-2002. In 1995, of females 12.8% were overweight or obese (obese 3.5%). Of males 10.2% were overweight or obese (obese 3.2%). The equivalent figures in 2002 were for females 21.4% (obese 5.8%) and males 17.3% (obese 4.1%). Rates of overweight and obesity were greater in females than males in all years (except obesity rate in 1995). CONCLUSION: Data from this large, consecutive yearly dataset of South Australian 4-year-old children show a significant increase in the rates of overweight and obesity. Much of this increase appears to have occurred in the mid-to-late 1990s. It is uncertain if these changes have plateaued at this time. These results reinforce rising obesity prevalence as a significant child health issue. They also indicate that obesity is seen as early as the preschool years; with implications for theories of causation and for prevention and treatment strategies.     

Infant and young child feeding practices and nutritional status in Bhutan

In South Asia, childhood undernutrition persists while overweight is increasing. Internationally recommended infant and young child feeding (IYCF) practices promote healthy nutritional status; however, little is known about IYCF in Bhutan, investigated here using 2015 National Nutrition Survey data. WHO/UNICEF IYCF indicators, anthropometry and household socio‐economic status were available for 441 children <24 months. Stunting, wasting, and underweight prevalence (2) prevalence was 6%. In survey‐design‐adjusted analyses, 52% of mothers of 0‐ to 5‐month olds reported exclusive breastfeeding (EBF), with EBF less common for girls than boys (OR: 0.2 [95% CI: 0.1–0.9]). Although 61% of children were breastfed at 2 years and 75% of children >6 months met a minimum daily meal frequency, only 18% of children 6–23 months met minimum dietary diversity. IYCF was unassociated with risk of stunting, wasting, or underweight, possibly due to relatively low prevalence of anthropometric failure and small sample size. However, currently‐breastfed children were less often overweight [OR: ~0.1 (95% upper limit ≤1.0)]. Neither breastfeeding nor most complementary feeding practices differed by socio‐economic status, but children in the highest two fifth of a wealth index had 7.8 (1.3–46.9) and 5.3 (1.1–25.2) times greater odds than children in the lowest fifth of meeting minimum dietary diversity criteria. Low rates of EBF, given possible protection of breastfeeding against overweight, and inadequate dietary diversity offer evidence to guide future program interventions to improve nutritional status of young children.     

重庆城区婴幼儿超重与肥胖状况及影响因素的研究

目的：了解重庆城区婴幼儿超重与肥胖现况及其危险因素,为儿童肥胖早期干预提供依据。方法：采用分层整群抽样的方法,对生后1月龄的2139名儿童进行3、6、9、12和18月龄的生长监测、评估和问卷调查。以18月龄是否超重与肥胖为应变量进行多元回归分析。结果：（1）婴儿超重与肥胖检出率生后前半年增长迅速,6月龄达26.04%,之后逐渐降低,至18个月龄时为15.89%。（2）Logistic回归分析显示父亲营养状况、儿童出生时、6月龄、9月龄和12月龄的营养状况、3月龄喂养方式、12月龄蔬菜进食频次、18月龄甜饮料添加频次以及18月龄上床时间共9个因素与18月龄儿童超重与肥胖显著相关。结论：重庆城区婴幼儿超重与肥胖现状突出,存在多种因素共同作用,应给予早期综合干预。     

Overweight and obesity in 6- to 14-year-old Czech children in 1991: protective effect of breast-feeding

OBJECTIVE: To assess the impact of breast-feeding on childhood overweight/obesity in an Eastern European socialist society with relatively homogeneous lifestyles. STUDY DESIGN: Cross-sectional survey data collected in 1991 on 33,768 school-children aged 6 to 14 years in the Czech Republic were analyzed by using multiple logistic regression analyses (main outcome body mass index [BMI] >90th percentile [overweight] and BMI >97th percentile [obesity]). RESULTS: Overall prevalence of overweight (obesity) was lower in breast-fed children: ever breast-fed (9.3%; 95% CI, 8.9-9.6 [3.2%; 95% CI, 3.0-3.4]) compared with never breast-fed (12.4%; 95% CI, 11.3-13.6 [4.4%; 95% CI, 3.7-5.2]). The effect of breast-feeding on overweight/obesity did not diminish with age in children 6 to 14 years old and could not be explained by parental education, parental obesity, maternal smoking, high birth weight, watching television, number of siblings, and physical activity. Adjusted odds ratios for breast-feeding were for overweight 0.80 (95% CI, 0.71-0.90) and for obesity 0.80 (95% CI, 0.66-0.96). CONCLUSIONS: A reduced prevalence of overweight/obesity was associated with breast-feeding in a setting where socioeconomic status was homogeneous. This suggests that the effect of breast-feeding on the prevalence of obesity is not confounded by socioeconomic status.     

湖南省农村义务教育学龄儿童实施“营养改善计划”后营养状况评价

目的调查湖南省农村学龄儿童2012~2015学年的营养健康状况,评价"义务教育学生营养改善计划"(简称"营养改善计划")的实施效果。方法对湖南省实施"营养改善计划"的6~14岁学龄儿童的营养状况进行评估,并分析该计划实施后其营养状况的变化趋势。资料来源于"农村义务教育学生营养改善计划营养健康状况监测评估系统"内湖南省农村义务教育学生2012~2015年4个学年的监测数据。结果 2015年湖南省农村义务教育阶段学龄儿童除6岁组女性身高高于全国农村平均水平外,其余各年龄组学龄儿童身高、体重平均水平均低于全国平均水平,差异具有统计学意义(P0.05)。"营养改善计划"实施后,生长迟缓率呈下降趋势(P0.05),但消瘦率上升(P0.05);同时超重/肥胖率呈上升的趋势(P0.05);贫血率呈下降趋势(P0.05)。结论 "营养改善计划"的实施在湖南省农村学龄儿童中取得了一定的成效,但未能使学龄儿童的营养状况得到明显改善,超重/肥胖和营养不良现象尚同时存在,建议应进一步完善学龄儿童营养改善措施,改善儿童营养状况。     

Prevalencia de sobrepeso y obesidad en Aragón y variaciones según condicionantes de salud

IntroductionChildhood obesity is a serious global health problem that is continuously increasing worldwide. Many studies suggest that socioeconomic factors are related to the development of obesity. The objective of our study was to analyse the prevalence of overweight and obesity in Aragón, calculated applying the World Health Organization (WHO) growth standards, and to study its association with socioeconomic factors.Material and methodsWe collected data for the entire paediatric population of Aragón aged 2–14 years. We classified each child as normal weight, overweight or obese based on the body mass index. We calculated prevalences by province and basic health care zone. To analyse differences in relation to social inequalities, we used the Aragón deprivation index as an indicator of socioeconomic status.ResultsThe final sample consisted of 161 335 children aged 2–14 years, 51% male and 49% female. The overall prevalence of excess weight was 31.1% (17.7% overweight and 13.3% obesity) and was significantly higher in boys. We found a high frequency of under-recording in health records (65%).There was a direct association between the deprivation index and the prevalence of obesity and overweight throughout Aragón, with a significant strong correlation in urban areas, where socioeconomic factors explained up to 66.4% of obesity and 48.9% of body weight excess.ConclusionsIn Aragón, the prevalence of obesity and excess weight is high and associated with low family socioeconomic status.     

A study of growth parameters and prevalence of overweight and obesity in school children from delhi

OBJECTIVE: (1) To assess the height, weight and body mass index (BMI) of school children from Delhi and generate percentile charts as appropriate for age, gender and socio-economic status. (2) To determine the prevalence of overweight and obesity in school children from low and upper socioeconomic status (LSES and USES respectively). DESIGN: Cross sectional evaluation of anthropometric parameters in Delhi school children (5-18 years) from different geographical zones. SETTING: Government schools (non-fee paying) and Private Schools (fee paying) in Delhi. SUBJECTS: 21485 children, 8840 (3566 boys, 5274 girls) from government schools and 12645 (6197 boys, 6448 girls) from private schools. Methods: Subjects underwent assessment of height and weight and calculation of BMI. Children were classified as normal, overweight and obese as per IOTF guidelines. Height, weight and BMI percentile charts specific for the socioeconomic status were generated using the LMS method. Prevalence of overweight and obesity was assessed and compared between the two socio-economic groups. RESULTS: A significant difference was noted in height, weight and BMI between LSES and USES. The prevalence of overweight and obesity in USES children was 16.75 % and 5.59 % in boys and 19.01 % and 5.03 % in girls respectively. CONCLUSIONS: There is a significant disparity in anthropometric parameters between children from USES and LSES, with a high prevalence of overweight and obesity in USES children.