Epidemiological data on nutritional disorders and outcomes in hospitalized Thai children: an analysis of data from the National Health Database 2015-2019

Abstract

OBJECTIVES:Malnutrition in hospitalized patients is a frequently overlooked health issue. We aimed to assess the prevalence and pattern of nutritional disorders in hospitalized Thai children from the National Health Database. METHODS:Hospitalized children aged 1 month to 18 years diagnosed with nutritional disorders between 2015 and 2019 were retrospectively reviewed using the National Health Security Office data. Based on the International Classification of Diseases, 10th revision, Clinical Modification, nutritional disorders were classified into 3 major forms of malnutrition: undernutrition (E40-E46), overweight and obesity (E66), and micronutrient deficiencies (D50-D53, E50-E56, E58, E60-E61, and E63). RESULTS:Out of 5,188,033 hospitalized children, malnutrition was identified in 115,254 (2.2%). Protein-energy malnutrition (PEM), overweight and obesity, and micronutrient deficiencies were prevalent in 0.21%, 0.27%, and 1.81%, respectively. Among those with micronutrient deficiencies, 95.0% had iron deficiency anemia, 2.2% had vitamin D deficiency, and 0.7% had zinc deficiency. Children aged under 5 years mostly had PEM, followed by iron deficiency anemia. Teenagers commonly had obesity and vitamin D deficiency. Patients with PEM who were admitted with common diseases had significantly longer hospital stays and higher hospital costs and mortality rates than those without PEM. CONCLUSIONS:Hospitalized children had various nutritional disorders, particularly PEM, which was associated with higher morbidity and mortality. Nutritional screening tools should be utilized for the early detection and treatment of malnutrition. Specific International Classification of Diseases codes for nutritional care services and intervention should be available. Additionally, nutritional interventions should be reimbursed, along with nutritional education and empowerment of healthcare providers, to improve hospital care service and improve patient outcomes.

The Low Sensitivity and Specificity of a Nutrition Screening Tool in Real Circumstances in a Tertiary Care Hospital Setting

“…The prevalence of malnutrition in hospitalized patients from our study was higher than those previously reported [ 1 ]. The prevalence of malnutrition was also higher than that reported by NHSO [ 2 ]. The national data were based on ICD-10 cm codes entered into the computer system, which may be missing or malnutrition may not have been realized by the responsible physicians.…”

“…Therefore, a high prevalence of both acute malnutrition and stunting was found in our study. Tertiary-care hospitals in Thailand reported a higher rate of malnutrition than NHSO data [ 2 ].…”

“…The prevalence of acute malnutrition in hospitalized children ranged from 6.1 to 40.9% [ 1 ], depending on the method of data collection, study sites, or levels of healthcare. In Thailand, a nationwide prevalence of malnutrition in hospitalized children from all healthcare levels was 0.1–0.2% in 2015–2019 based on the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) from the National Health Securities Office (NHSO) [ 2 ]. A higher prevalence of malnourished children was reported in more complicated healthcare settings.…”