Undernutrition and Obesity Are Associated with Adverse Clinical Outcomes in Hospitalized Children and Adolescents with Acute Pancreatitis

Abstract

Background: Adult studies demonstrated that extremes of nutritional status adversely impact clinical outcomes in acute pancreatitis (AP). With rising prevalence of undernutrition/obesity in children, we analyzed the effect of nutritional status on the clinical outcomes in children and adolescents with acute pancreatitis. Methodology: We analyzed the Kids’ Inpatient Database (KID) between 2003 and 2016 to include all patients with a primary diagnosis of AP using specific International Classification of Diseases (ICD) codes. We classified into (1) undernutrition, (2) obesity and (3) control groups, based on ICD codes, and we compared severe acute pancreatitis and healthcare utilization (length of stay and hospitalization costs). Results: Total number of AP admissions was 39,805. The prevalence of severe AP was higher in the undernutrition and obesity groups than the control group (15.7% vs. 5.8% vs. 3.5% respectively, p < 0.001). Multivariate analyses demonstrated that undernutrition and obesity were associated with 2.5 and 1.6 times increased risk of severe AP, p < 0.001. Undernutrition was associated with an additional six days of hospitalization and almost $16,000 in hospitalization costs. Obesity was associated with an additional 0.5 day and almost $2000 in hospitalization costs, p < 0.001. Conclusion: Undernutrition and obesity were associated with greater severity of AP, as well as prolonged hospitalization stay and costs. It is imperative for treating clinicians to be aware of these high-risk groups to tailor management and strive for improved outcomes.

Nutrition management and pancreatitis in children: new insights

“…In a single-center retrospective study by Vasilescu et al [12] showed that malnutrition was significantly associated with prolonged length of hospital stay (16.5 days) when compared to 10.6 days (normal weight) and 10.7 days (obesity). Thavamani et al [13] also showed similar findings using the Kids' Inpatient Database. This study showed that undernutrition was associated with an increased length of hospital stay of an additional 6 days with an additional $16,000 in hospitalization cost [13].…”

“…Thavamani et al [13] also showed similar findings using the Kids' Inpatient Database. This study showed that undernutrition was associated with an increased length of hospital stay of an additional 6 days with an additional $16,000 in hospitalization cost [13]. This study also showed that both undernutrition and obesity are associated with significantly increased severity of AP of 2.5 times and 1.6 times for undernutrition and obesity respectively.…”

Acute pancreatitis in children: risk factors, management, and outcomes

“…Disease severity classifications were determined in 2017 by an expert panel and are determined by the presence or absence of local complications, transient (<48 h), or prolonged organ failure (>48 h) [36]. Recent studies suggest that undernutrition, obesity, and trauma or drug-induced risk factors are associated with more severity [8,38,39,40 ]. Much effort has been made to determine risk stratification tools [41][42][43]; however, efforts have previously been limited by prior lack of consensus severity classifications or inability to validate across different populations [36].…”

“…Disease severity classifications were determined in 2017 by an expert panel and are determined by the presence or absence of local complications, transient (<48 h), or prolonged organ failure (>48 h) [36]. Recent studies suggest that undernutrition, obesity, and trauma or drug-induced risk factors are associated with more severity [8,38,39,40 ▪ ].…”

Predictive value of adipokines for the severity of acute pancreatitis: a meta-analysis

“…The death rate of SAP is as high as 15%-35% [1], posing a serious threat to population health. According to clinical studies, obesity, as an independent risk factor for the development of AP could increase AP morbidity and mortality [2][3][4][5].…”