19/3/2024

JOURNAL APPRAISAL
EFFECT OF MALNUTRITION ON LENGTH OF HOSPITAL STAY IN CHILDREN

PRESENTER: BRENDA PHANG JOO YEE, SUPERVISOR: DR SYAZWANI

 including individuals
who meet certain
criteria and are
COHORT STUDY CONSECUTIVE SAMPLING available during the
data collection period
in a sequential manner
INTRODUCTION

• Malnutrition refers to de iciencies or excesses in nutrient intake, imbalance of essential

nutrients or impaired nutrient utilization.

• Double burden of malnutrition consists of both undernutrition and overweight and

obesity, as well as diet-related noncommunicable diseases.

• Malnutrition negatively a ects, in particular, morbidity, mortality, length of stay (LOS),

quality of life, complications, and treatment costs in hospitalised patients.
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• Often overlooked in hospitalised patients while addressing the presenting symptoms
• Children with severe malnutrition are easily recognisable, whereas those with
moderate or mild malnutrition are often overlooked.
OBJECTIVE

• To determine the prevalence of malnutrition in hospitalised paediatric patients

• To classify patients with malnutrition
• To evaluate the e ect of malnutrition on length of stay in hospital
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 METHODOLOGY
• Patients aged 5 months - 18 years who were
INCLUSION hospitalized in the Department of Pediatrics of the
CRITERIA Adana City Training and Research Hospital between
May 1st, 2018, and December 31st, 2018

• LOS of more than one month

EXCLUSION • Those with an associated chronic disease, immune
CRITERIA de iciency, previously diagnosed with malnutrition
and those diagnosed with malignancy
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METHODOLOGY

DEMOGRAPHIC DATA Age, Gender, Diagnosis, Co morbid conditions, LOS for treatment

Anthropometric Measurement same scale and same height rod

using non-elastic tapeline with 1-mm intervals at the mid-point

CLINICAL DATA Mid-upper Arm Circumference
between the acromion and olecranon (left elbow slightly lexed)

mid-point between acromion and olecranon of the left arm

Triceps Skinfold Thickness
using a Harpenden skinfold caliper with a precision of 0.1 mm
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 GOMEZ WATERLOW
CLASSIFICATION CLASSIFICATION
• Strength:
• uses weight for height (recent alteration of
• Strength: nutritional status) and height for age (nutrition
• based on 2 simple parameters (weight, age) over long period) - more informative and
comprehensive
• Limitations: • normal, stunted, wasted or wasted and stunted
• assume that all children of a particular age will child can be easily identi ied
have same weight
• may be misleading in sudden acute episode • Limitations:
of malnutrition • requires standards of weight for age ratio
• dif icult to use in ield as it requires
measurement of height or length
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 MID-UPPER ARM WHO
CIRCUMFERENCE CLASSIFICATION

• Strength:
 icant.
Numerical parametric
mean ± standard deviation
variables

Non-parametric variables median (minimum-maximum)

Categorical variables percentage (%)

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RESULT
NATIONALITY AND PRESENCE OF CHRONIC ILLNESS PLAYS A SIGNIFICANT ROLE IN AFFECTING NUTRITIONAL STATUS OF PATIENT
NATIONALITY PLAYS A SIGNIFICANT ROLE IN AFFECTING NUTRITIONAL STATUS OF PATIENT
The present study also made a separate evaluation of 741 patients without chronic disease in terms of the rate of malnutrition
and LOS because the rate of malnutrition may increase in the presence of chronic disease and with the e ect of chronic disease
course. In this group of patients, LOS was longer among those with malnutrition than in those without malnutrition (p=0.046).

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CONCLUSION
1. The highest risk group for malnutrition was patients aged below 2 years with highest
growth rate.

2. Underlying chronic disease is a signi icant risk factor for malnutrition.

3. Higher rate of malnutrition in refugee patients than in native population.

4. Both mid-upper arm circumference and triceps skinfold thickness was lower in
patients with malnutrition. Skin-fold thickness and weight gain increment is directly
proportional to fat deposition (which is the irst trigger for growth).

5. Recurrent infections, particularly acute gastroenteritis and respiratory tract

infections impair the nutritional status of the child and cause malnutrition by
promoting a catabolic state.
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JOURNAL APPRAISAL
SECTION A: ARE THE RESULTS OF THE STUDY VALID?

1. Did the study address a clearly focused issue?

Yes.

Clearly stated the aim of study is to determine the e ect of malnutrition on length of hospital
stay.

2. Was the cohort recruited in an acceptable way?

Yes and no.

Single center cohort study, might not represent general population.

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3. Was the nutritional status accurately measured to minimise bias?

Yes.

The anthropometric measurement, mid-upper arm circumference and tricep skin fold
thickness were performed by same investigator using same instrumentation with
accurate precision.

4. Have the authors identi ied all important confounding factors?

Yes.
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SECTION B: WHAT ARE THE RESULTS?

1. What are the results of this study?

Patients with malnutrition had a longer stay in hospital than those without malnutrition and that the
duration of hospitalisation increased with increasing severity of malnutrition.

2. How precise are the results?

The result likely to be precise as the length of stay was statistically signi icant after multivariate
analysis.

3.Do you believe the results?

Yes.

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SECTION C: WILL THE RESULTS HELP LOCALLY?

1. Can the results be applied to the local population?

Yes.

2. Do the results of this study it with other available evidence?

Yes.

3. What are the implications of this study for practice?

Proper assessment of nutritional status upon admission alongside main reason for
hospitalisation will be bene icial to decrease length of stay and reducing complication rates.
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 • Malnutrition which is often
overlooked while addressing the
primary illness, decreases
treatment success and increases

TAKE HOME
hospitalisation duration and
treatment costs.

• Evaluations of nutritional status in

MESSAGE
hospitalised patients, paying
appropriate attention to
malnutrition while addressing the
main reason for hospitalisation, and
incorporating nutritional support
into the treatment plan will be
bene icial to patients in terms of
decreasing LOS and reducing
complication rates.
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THANK YOU