Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Indicators Recommended for the Identification and Documentation of Pediatric Malnutrition (Undernutrition)

Abstract

The Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition, utilizing an evidence-informed, consensus-derived process, recommend that a standardized set of diagnostic indicators be used to identify and document pediatric malnutrition (undernutrition) in routine clinical practice. The recommended indicators include z scores for weight for height/length, body mass index for age, length/height for age, or mid-upper arm circumference when a single data point is available. When two or more data points are available, indicators may also include weight-gain velocity (younger than 2 years of age), weight loss (2 to 20 years of age), deceleration in weight for length/height z score, and inadequate nutrient intake. The purpose of this consensus statement is to identify a basic set of indicators that can be used to diagnose and document undernutrition in the pediatric population (ages 1 month to 18 years). The indicators are intended for use in multiple settings, such as acute, ambulatory care/outpatient, residential care, etc. Several screening tools have been developed for use in hospitalized children. However, identifying criteria for use in screening for nutritional risk is not the purpose of this paper. Clinicians should use as many data points as available to identify and document the presence of malnutrition. The universal use of a single set of diagnostic parameters will expedite the recognition of pediatric undernutrition, lead to the development of more accurate estimates of its prevalence and incidence, direct interventions, and promote improved outcomes. A standardized diagnostic approach will also inform the prediction of the human and financial responsibilities and costs associated with the prevention and treatment of undernutrition in this vulnerable population, and help to further ensure the provision of high-quality, cost-effective, nutrition care.

Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU*

“…However, weight alone may be misleading as a marker of nutrition, especially in the PICU population where fluid shifts are commonly present during the acute phase of illness. Weight for height or BMI may provide a better index of nutritional status and were recently recommended as primary indicators of nutritional status and growth in children [31]. Lean body mass may be a better predictor of outcomes compared to weight alone [32].…”

Nutrition characteristics and morbidity of adolescents (15-17 years) of Kyrgyz Republic

“…We compared obtained data with current recommended norms of consumption for food ingredients, energy and food products for different population groups of Kyrgyz Republic (19). The malnutrition levels for children and adolescents were defined according to the generally accepted standards (13). The data were analyzed using software package Analysis ToolPack -VBA, EXCEL -6.0…”

Optimizing Enteral Nutrition for Growth in Pediatric Chronic Kidney Disease (CKD)

“…The Chronic Kidney Disease in Children (CKiD) study (15), a large collaborative of children from North America with CKD who are not yet on dialysis, further defined these criteria in the context of pediatrics, including reference points which are pediatric specific, and also included poor growth in the diagnostic criteria, notably a height less than the third percentile or a decrease in growth velocity of more than 10%. This criteria is supported by general pediatric literature (16), including a joint position paper from the Academy of Nutrition and Dietetics (AND) and the American Society of Enteral and Parenteral Nutrition (ASPEN), noting that severe height stunting indicates repeat infections and/or chronic inadequate nutrition (17). The CKiD study revealed 7–20% of pediatric CKD patients have PEW (15).…”