Disease-related malnutrition in children and role of oral nutrition supplement

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  • I Gusti Lanang Sidiartha Department of Child Health, Medical School, Universitas Udayana, Indonesia
  • I Gusti Ayu Putu Eka Pratiwi Department of Child Health, Medical School, Universitas Udayana, Indonesia
  • Ida Bagus Subanada Department of Child Health, Medical School, Universitas Udayana, Indonesia
Keywords: Chronic Disease, Malnutrition, Oral Nutrition Supplement

Abstract

Background Disease-related malnutrition (DRM) is a common complication in chronic diseases. An oral nutrition supplement (ONS) is a formula with high energy density which is commonly used to treat malnutrition.

Objective To identify the prevalence of DRM in children with chronic disease and evaluate the benefits of ONS.

Methods A retrospective study was conducted at Prof. IGNG Ngoerah Hospital, Denpasar, Bali. Data were collected from medical records of patients who were admitted from January to December 2021. Inclusion criteria were patients aged 1-18 years  with chronic diseases. Patients with organomegaly, edema, and incomplete medical record data were excluded. Disease-related malnutrition was defined as weight-for-height (for < 5 years of age) or BMI-for-age < -2SD (for > 5 years of age), according to the WHO growth charts. Subjects who received ONS for more than 80% of total energy during hospitalization were classified as part of the ONS group and the rest as standard group. Several variables between ONS and standard group were analyzed and considered significant if P value < 0.05.

Results Of 313 subjects with chronic disease, 139 (44.4%) were diagnosed with DRM.  Among of 139 subjects with DRM, a total of 64 subjects were analyzed in the ONS and standard feeding groups. No significant difference was found between groups with regards to age, gender, weight, height, white blood cell count, and lymphocyte cell count. Subjects with severe malnutrition significantly more classified as an ONS group than subjects with moderate malnutrition (P=0.001). Mean length of hospital stay was significantly shorter in the ONS group [11.8 (SD 6.7) days] than in the standard group [16.1 (SD 6.6) days]; (P=0.012).

Conclusion Malnutrition related to chronic disease in children is prevalent. Use of ONS is associated with a shorter length of hospital stay. Thus, routine nutritional status assessment to identify malnutrition in children with chronic disease is needed to treat with ONS in order to improve prognoses.

References

1. Meyer F, Valentini L. Disease-related malnutrition and sarcopenia as determinants of clinical outcome. Visc Med. 2019;35:282–91. DOI: https://doi.org/ doi: 10.1159/000502867.
2. Correia MITD, Perman MI, Waitzberg DL. Hospital malnutrition in Latin America: A systematic review. Clin Nutr. 2017;36:958–67. DOI: https://doi.org/10.1016/j.clnu.2016.06.025.
3. Reber E, Schönenberger KA, Vasiloglou MF, Stanga Z. Nutritional risk screening in cancer patients: the first step toward better clinical outcome. Front Nutr. 2021;8:1–9. DOI: https://doi.org/10.3389/fnut.2021.603936.
4. Sidiartha IGL, Wati DK, Subanada IB, Suwarba IGNM. High C-reactive protein/albumin ratio increased risk of acute malnutrition during hospitalization in pediatric patients. Int J Health Sci (Qassim). 2020;4:32–8. DOI: https://doi.org/10.29332/ijhs.v4n3.453.
5. Hiesmayr M, Tarantino S, Moick S, Laviano A, Sulz I, Mouhieddine M, et al. Hospital malnutrition, a call for political action: A public health and nutritionday perspective. J Clin Med. 2019;8:2048. DOI: https://doi.org/10.3390/jcm8122048.
6. Peccatori N, Ortiz R, Rossi E, Calderon P, Conter V, García Y, et al. Oral nutritional supplementation in children treated for cancer in low- and middle-income countries is feasible and effective: The experience of the Children’s Hospital Manuel De Jesus Rivera ‘La Mascota’ in Nicaragua. Mediterr J Hematol Infect Dis. 2018;10: 1–6. DOI: https://doi.org/10.14202/vetworld.2017.716-720_old.
7. Khanna D, Yalawar M, Saibaba PV, Bhatnagar S, Ghosh A, Jog P, et al. Oral nutritional supplementation improves growth in children at malnutrition risk and with picky eating behaviors. Nutrients. 2021;13:3590. DOI: https://doi.org/10.3390/nu13103590.
8. Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 29 Tahun 2019 Tentang Penanggulangan Masalah Gizi Bagi Anak Akibat Penyakit.
9. WHO. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. [cited 2021 November 16]. Available from: https://www.who.int/publications/i/item/924154693X.
10. De Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660–7. DOI: https://doi.org/10.2471/BLT.07.043497.
11. Mokkink LB, van der Lee JH, Grootenhuis MA, Offringa M, Heymans HS; Dutch National Consensus Committee Chronic Diseases and Health Conditions in Childhood. Defining chronic diseases and health conditions in childhood (0-18 years of age): National consensus in the Netherlands. Eur J Pediatr. 2008;167:1441–7. DOI: https://doi.org/10.1007/s00431-008-0697-y.
12. Sidiartha IGL, Suwarba IGN, Pratiwi I. Efek suplementasi oral nutrition supplement terhadap kejadian malnutrisi dan prognosis penyakit pada anak rawat inap. Prosiding Seminar Nasional Sains dan Teknologi 2021 Online via Webex Meeting; 2021 Nov 24-26; Denpasar. Denpasar: Udayana Press; 2021. p.361-6.
13. Triarico S, Rinninella E, Attinà G, Romano A, Maurizi P, Mastrangelo S, et al. Nutritional status in the pediatric oncology patients. Front Biosci (Elite Ed). 2022;14:4. DOI: https://doi.org/10.31083/j.fbe1401004.
14. Gomes F, Baumgartner A, Bounoure L, Bally M, Deutz NE, Greenwald JL, et al. Association of nutritional support with clinical outcomes among medical inpatients who are malnourished or at nutritional risk: an updated systematic review and meta-analysis. JAMA Netw Open. 2019;2: 1–14. DOI: https://doi.org/10.1001/jamanetworkopen.2019.15138.
15. Ghosh AK, Kishore B, Shaikh I, Satyavrat V, Kumar A, Shah T, et al. Effect of oral nutritional supplementation on growth and recurrent upper respiratory tract infections in picky eating children at nutritional risk: a randomized, controlled trial. J Int Med Res. 2018; 46: 2186–201. DOI: https://doi.org/10.1177/0300060518757355.
16. Liang R, Chen GY, Fu SX, et al. Benefit of oral nutritional supplements for children with acute lymphoblastic leukaemia during remissioninduction chemotherapy: a quasi-experimental study. Asia Pac J Clin Nutr. 2018;27:144–7. DOI: https://doi.org/10.6133/apjcn.032017.04.
17. Hubbard GP, Fry C, Sorensen K, Casewell C, Collins L, Cunjamalay A, et al. Energy-dense, low-volume paediatric oral nutritional supplements improve total nutrient intake and increase growth in paediatric patients requiring nutritional support: results of a randomised controlled pilot trial. Eur J Pediatr. 2020;179:1421–30. DOI: https://doi.org/10.1007/s00431-020-03620-9.
18. Zhang Z, Li F, Hannon BA, Hustead DS, Aw MM, Liu Z, et al. Effect of oral nutritional supplementation on growth in children with undernutrition: a systematic review and meta?analysis. Nutrients. 2021;13:3036. DOI: https://doi.org/10.3390/nu13093036.
19. Pimiento JM, Evans DC, Tyler R, Barrocas A, Hernandez B, Araujo-Torres K, et al; ASPEN Value Project Scientific Advisory Council. Value of nutrition support therapy in patients with gastrointestinal malignancies: a narrative review and health economic analysis of impact on clinical outcomes in the United States. J Gastrointest Oncol. 2021;12:864–73. DOI: https://doi.org/10.21037/jgo-20-326.
Published
2023-11-20
How to Cite
1.
Sidiartha IG, Pratiwi IGAP, Subanada I. Disease-related malnutrition in children and role of oral nutrition supplement. PI [Internet]. 20Nov.2023 [cited 22Feb.2024];63(6):450-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/3209
Section
Pediatric Nutrition & Metabolic Disease
Received 2022-10-11
Accepted 2023-11-20
Published 2023-11-20