Main Article Content
Abstract
Highlights:
- Medium- and high-risk STRONGkids scores are related with low total lymphocyte count and serum albumin, which are related to hospital malnutrition, albeit indirectly.
- The use of STRONGkids with total lymphocyte count and serum albumin can detect the risk of hospital malnutrition in children.
Abstract:
Hospital malnutrition occurs in hospitalized patients who do not consume enough food while their nutritional requirements increase. It occurs particularly in children who have undergone gastrointestinal surgery. Despite the lack of a universal instrument for detecting hospital malnutrition, various parameters can be considered to assist in its identification. STRONGkids has demonstrated its efficiency in detecting malnutrition risk in children. Total lymphocyte count (TLC) and serum albumin are biochemical markers that are related to infection and protein leakage, which can worsen hospital malnutrition. The research objective was to analyze the correlation between STRONGkids and biochemical markers (TLC, serum albumin) to identify hospital malnutrition in children who underwent gastrointestinal surgery. This was a retrospective cross-sectional observational study utilizing medical records. The statistical analysis was conducted using SPSS 21. This study included 37 subjects, with a 24.32% hospital malnutrition incidence rate. The subjects were divided into two groups: hospital malnutrition (n=9) and non-hospital malnutrition (n=28). The STRONGkids of both groups at admission demonstrated a significant difference, while the albumin and TLC did not. The significantly different STRONGkids scores of both groups at admission correlated negatively with the length of hospital stay (LOS), body weight reduction, TLC, and albumin. Those parameters also did not correlate with hospital malnutrition. However, hospital malnutrition increased the risk of low albumin and TLC at discharge by 2.951 and 5.549 times, respectively. In conlusion, TLC and serum albumin cannot be used as independent markers for hospital malnutrition, but STRONGkids can be used in conjunction with TLC and serum albumin to identify hospital malnutrition risk.
Keywords
Article Details
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References
- Adigun T, Ogundoyin OO (2020). Prevalence of malnutrition and its correlates among children coming for elective general surgical procedures in a tertiary hospital of a developing country. Annals of Medical Research and Practice.
- Carter LE, Shoyele G, Southon S, et al (2020). Screening for pediatric malnutrition at hospital admission: Which screening tool is best? Nutrition Clinical Practice 35, 951–958. doi: 10.1002/ncp.10367.
- Ekaputri DS, Sidiartha IGL, Pratiwi IGAE (2021). Low total lymphocyte count as the risk of hospital acquired malnutrition in children. Molecular and Cellular Biomedical Sciences 5, 68. doi: 10.21705/mcbs.v5i2.191.
- Fedora K, Utamayasa IKA, Purwaningsih S (2019). Profile of acyanotic congenital heart defect in children at Dr. Soetomo General Hospital Surabaya Period of January–December 2016. JUXTA Jurnal Ilmiah Mahasiswa Kedoktteran Universitas Airlangga 10, 79. doi: 10.20473/juxta.V10I22019.79-83.
- Hu WH, Eisenstein S, Parry L, et al (2019). Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: A propensity score matching study. Nutrition Journal 18, 33. doi: 10.1186/s12937-019-0458-y
- Hulst JM, Huysentruyt K, Joosten KF (2020). Pediatric screening tools for malnutrition: An update. Current Opinion in Clinical Nutrition & Metabolic Care 23, 203–209. doi: 10.1097/mco.0000000000000644.
- Hulst JM, Zwart H, Hop WC, et al (2010). Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clinical Nutrition 29, 106–111. doi: 10.1016/j.clnu.2009.07.006.
- Hussen L, Tadesse E, Teferi DY (2020). Preoperative nutritional status and its consequences on abdominal surgery in Wolaita Zone, Southern Ethiopia: An institution-based observational study. Journal of Nutrition Metabolism 2020, 1–7. doi: 10.1155/2020/2324395.
- Ibrahim MK, Zambruni M, Melby CL, et al (2017). Impact of childhood malnutrition on host defense and infection. Clinical Microbiology Reviews 30, 919–971. doi: 10.1128/cmr.00119-16.
- Jordan N, Ranuh IGMRG, Sari GM (2020). Profile of diarrheal patients aged less than five years old hospitalized in Dr. Soetomo General Hospital Surabaya in 2016-2018. JUXTA Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga 11, 45. doi: 10.20473/juxta.V11I22020.45-50.
- Juliaty A (2016). Malnutrisi rumah sakit pada bangsal anak Rumah Sakit Dr. Wahidin Sudirohusodo Makassar. Sari Pediatri 15, 65. doi: 10.14238/sp15.2.2013.65-8.
- Kondrup J (2003). ESPEN guidelines for nutrition screening 2002. Clinical Nutrition 22, 415–421. doi: 10.1016/S0261-5614(03)00098-0.
- Koofy N El, Eldin HMN, Mohamed W, et al (2021). Impact of preoperative nutritional status on surgical outcomes in patients with pediatric gastrointestinal surgery. Clinical and Experimental Pediatrics 64, 473–479. doi: 10.3345/cep.2020.00458.
- Lee YJ (2018). Nutritional screening tools among hospitalized children: From past and to present. Pediatric Gastroenterology, Hepatology & Nutrition 21, 79. doi: 10.5223/pghn.2018.21.2.79.
- Loftus TJ, Brown MP, Slish JH, et al (2019). Serum levels of prealbumin and albumin for preoperative risk stratification. Nutrition in Clinical Practice 34, 340–348. doi: 10.1002/ncp.10271.
- Malekiantaghi A, AsnaAshari K, Shabani-Mirzaee H, et al (2022). Evaluation of the risk of malnutrition in hospitalized children by PYMS, STAMP, and STRONGkids tools and comparison with their anthropometric indices: A cross-sectional study. BMC Nutrition 8, 33. doi: 10.1186/s40795-022-00525-8.
- Maryani E, Prawirohartono EP, Nugroho S (2017). Faktor prediktor malnutrisi rumah sakit pada anak. Sari Pediatri 18, 278. doi: 10.14238/sp18.4.2016.278-284.
- Mehta NM, Compher C (2009). A.S.P.E.N. clinical guidelines: Nutrition support of the critically ill child. Journal of Parenteral and Enteral Nutrition 33, 260– 276. doi: 10.1177/0148607109333114.
- Moeeni V, Walls T, Day AS (2014). The STRONGkids nutritional risk screening tool can be used by paediatric nurses to identify hospitalised children at risk. Acta Paediatrica 103, e528–e531. doi: 10.1111/apa.12768.
- Mosquera C, Koutlas NJ, Edwards KC, et al (2016). Impact of malnutrition on gastrointestinal surgical patients. Journal of Surgical Research 205, 95–101. doi: 10.1016/j.jss.2016.05.030.
- Permsombut N, Chindavijak, Teawprasert P (2013). Nutrition screening tools and prediction of malnutrition incidence in major abdominal surgery patients at a tertiary hospital in Bangkok, Thailand. Pharmaceutical Sciences Asia 40, 26–34.
- Planas M, Álvarez-Hernández J, León-Sanz M, et al (2016). Prevalence of hospital malnutrition in cancer patients: A sub-analysis of the PREDyCES® study. Supportive Care in Cancer 24, 429–35. doi: 10.1007/s00520-015-2813-7.
- Rad HS (2019). Nutrition in Hospitalized Children.
- Robinson R (2015). Low serum albumin and total lymphocyte count as predictors of 30 day hospital readmission in patients 65 years of age or older. PeerJ 3, e1181. doi: 10.7717/peerj.1181.
- Rocha NP, Fortes RC (2015). Total lymphocyte count and serum albumin as predictors of nutritional risk in surgical patients. ABCD Arquivos Brasileiros de Cirurgia Digistiva (Sí£o Paulo) 28, 193–6. doi: 10.1590/ S0102-6720 2015 000300012.
- dos Santos CA, Ribeiro AQ, Rosa C de OB, et al (2019). Nutritional risk in pediatrics by StrongKids: A systematic review. European Journal of Clinical Nutrition 73, 1441–9. doi: 10.1038/s41430-018-0293-9
- Sekiyama M, Jiang H, Gunawan B, et al (2015). Double burden of malnutrition in rural West Java: Household-level analysis for father-child and mother- child pairs and the association with dietary intake. Nutrients 7, 8376–8391. doi: 10.3390/nu7105399.
- Setiati S, Harimurti K, Dewiasty E, et al (2013). Profile of food and nutrient intake among Indonesian elderly population and factors associated with energy intake: A multi-centre study. Acta Medica Indonesiana 45, 265–274.
- Song T, Mu Y, Gong X, et al (2017). Screening for nutritional risk in hospitalized children with liver disease. Asia Pacific Journal of Clinical Nutrition 26, 1107–1112. doi: 10.6133/apjcn.022017.06.
- Susetyowati, Hamam H, Mohammad H, et al (2018). Comparison of nutrition screening and assessment parameters in predicting length of hospital stay. Journal of Nutrition Medicine and Diet Care. doi: 10.23937/2572-3278.1510030.
- Tappenden KA, Quatrara B, Parkhurst ML, et al (2013). Critical role of nutrition in improving quality of care. Journal of Parenteral and Enteral Nutrition 37, 482–497. doi: 10.1177/0148607113484066.
- Tette EMA, Sifah EK, Nartey ET (2015). Factors affecting malnutrition in children and the uptake of interventions to prevent the condition. BMC Pediatrics 15, 189. doi: 10.1186/s12887-015-0496-3.
- Thibault R, Abbasoglu O, Ioannou E, et al (2021). ESPEN guideline on hospital nutrition. Clinical Nutrition 40, 5684–5709. doi: 10.1016/j.clnu.2021.09.039.
- Tommy T, Dimiati H, Abdullah MN, et al (2022). The performance of STRONGkids in the early detection of hospital malnutrition. Paediatrica Indonesiana 62, 192–197. doi: 10.14238/pi62.3.2022.192-7.
- Tosato F, Bucciol G, Pantano G, et al (2015). Lymphocytes subsets reference values in childhood. Cytometry Part A. 87: 81–85. doi: 10.1002/cyto.a.22520
- Tuokkola J, Hilpi J, Kolho KL, et al (2019). Nutritional risk screening-A cross-sectional study in a tertiary pediatric hospital. Journal of Health, Population, and Nutrition 38, 8. doi: 10.1186/s41043- 019-0166-4.
- Wahyuhadi J (2018). Pedoman pelayanan RSUD Dr. Soetomo: Buku saku : Pegangan bagi pemberi layanan dalam menjaga mutu dan keselamatan pasien. Airlangga University Press.
- Wicaksono H (2016). Nutritional status affects incidence of pneumonia in underfives. Folia Medica Indonesiana 51, 285. doi: 10.20473/fmi.v51i4.2861.
- Widjaja NA, Angelika D, Hidayati SN, et al (2016). Perbandingan jumlah limfosit total pada anak gizi buruk dengan infeksi dan tanpa infeksi HIV. Sari Pediatri 15, 99. doi: 10.14238/sp15.2.2013.99-104.
- Zhang K, Qin W, Zheng Y, et al (2022). Malnutrition contributes to low lymphocyte count in early-stage coronavirus disease-2019. Frontiers in Nutrition. doi: 10.3389/fnut.2021.739216.
References
Adigun T, Ogundoyin OO (2020). Prevalence of malnutrition and its correlates among children coming for elective general surgical procedures in a tertiary hospital of a developing country. Annals of Medical Research and Practice.
Carter LE, Shoyele G, Southon S, et al (2020). Screening for pediatric malnutrition at hospital admission: Which screening tool is best? Nutrition Clinical Practice 35, 951–958. doi: 10.1002/ncp.10367.
Ekaputri DS, Sidiartha IGL, Pratiwi IGAE (2021). Low total lymphocyte count as the risk of hospital acquired malnutrition in children. Molecular and Cellular Biomedical Sciences 5, 68. doi: 10.21705/mcbs.v5i2.191.
Fedora K, Utamayasa IKA, Purwaningsih S (2019). Profile of acyanotic congenital heart defect in children at Dr. Soetomo General Hospital Surabaya Period of January–December 2016. JUXTA Jurnal Ilmiah Mahasiswa Kedoktteran Universitas Airlangga 10, 79. doi: 10.20473/juxta.V10I22019.79-83.
Hu WH, Eisenstein S, Parry L, et al (2019). Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: A propensity score matching study. Nutrition Journal 18, 33. doi: 10.1186/s12937-019-0458-y
Hulst JM, Huysentruyt K, Joosten KF (2020). Pediatric screening tools for malnutrition: An update. Current Opinion in Clinical Nutrition & Metabolic Care 23, 203–209. doi: 10.1097/mco.0000000000000644.
Hulst JM, Zwart H, Hop WC, et al (2010). Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clinical Nutrition 29, 106–111. doi: 10.1016/j.clnu.2009.07.006.
Hussen L, Tadesse E, Teferi DY (2020). Preoperative nutritional status and its consequences on abdominal surgery in Wolaita Zone, Southern Ethiopia: An institution-based observational study. Journal of Nutrition Metabolism 2020, 1–7. doi: 10.1155/2020/2324395.
Ibrahim MK, Zambruni M, Melby CL, et al (2017). Impact of childhood malnutrition on host defense and infection. Clinical Microbiology Reviews 30, 919–971. doi: 10.1128/cmr.00119-16.
Jordan N, Ranuh IGMRG, Sari GM (2020). Profile of diarrheal patients aged less than five years old hospitalized in Dr. Soetomo General Hospital Surabaya in 2016-2018. JUXTA Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga 11, 45. doi: 10.20473/juxta.V11I22020.45-50.
Juliaty A (2016). Malnutrisi rumah sakit pada bangsal anak Rumah Sakit Dr. Wahidin Sudirohusodo Makassar. Sari Pediatri 15, 65. doi: 10.14238/sp15.2.2013.65-8.
Kondrup J (2003). ESPEN guidelines for nutrition screening 2002. Clinical Nutrition 22, 415–421. doi: 10.1016/S0261-5614(03)00098-0.
Koofy N El, Eldin HMN, Mohamed W, et al (2021). Impact of preoperative nutritional status on surgical outcomes in patients with pediatric gastrointestinal surgery. Clinical and Experimental Pediatrics 64, 473–479. doi: 10.3345/cep.2020.00458.
Lee YJ (2018). Nutritional screening tools among hospitalized children: From past and to present. Pediatric Gastroenterology, Hepatology & Nutrition 21, 79. doi: 10.5223/pghn.2018.21.2.79.
Loftus TJ, Brown MP, Slish JH, et al (2019). Serum levels of prealbumin and albumin for preoperative risk stratification. Nutrition in Clinical Practice 34, 340–348. doi: 10.1002/ncp.10271.
Malekiantaghi A, AsnaAshari K, Shabani-Mirzaee H, et al (2022). Evaluation of the risk of malnutrition in hospitalized children by PYMS, STAMP, and STRONGkids tools and comparison with their anthropometric indices: A cross-sectional study. BMC Nutrition 8, 33. doi: 10.1186/s40795-022-00525-8.
Maryani E, Prawirohartono EP, Nugroho S (2017). Faktor prediktor malnutrisi rumah sakit pada anak. Sari Pediatri 18, 278. doi: 10.14238/sp18.4.2016.278-284.
Mehta NM, Compher C (2009). A.S.P.E.N. clinical guidelines: Nutrition support of the critically ill child. Journal of Parenteral and Enteral Nutrition 33, 260– 276. doi: 10.1177/0148607109333114.
Moeeni V, Walls T, Day AS (2014). The STRONGkids nutritional risk screening tool can be used by paediatric nurses to identify hospitalised children at risk. Acta Paediatrica 103, e528–e531. doi: 10.1111/apa.12768.
Mosquera C, Koutlas NJ, Edwards KC, et al (2016). Impact of malnutrition on gastrointestinal surgical patients. Journal of Surgical Research 205, 95–101. doi: 10.1016/j.jss.2016.05.030.
Permsombut N, Chindavijak, Teawprasert P (2013). Nutrition screening tools and prediction of malnutrition incidence in major abdominal surgery patients at a tertiary hospital in Bangkok, Thailand. Pharmaceutical Sciences Asia 40, 26–34.
Planas M, Álvarez-Hernández J, León-Sanz M, et al (2016). Prevalence of hospital malnutrition in cancer patients: A sub-analysis of the PREDyCES® study. Supportive Care in Cancer 24, 429–35. doi: 10.1007/s00520-015-2813-7.
Rad HS (2019). Nutrition in Hospitalized Children.
Robinson R (2015). Low serum albumin and total lymphocyte count as predictors of 30 day hospital readmission in patients 65 years of age or older. PeerJ 3, e1181. doi: 10.7717/peerj.1181.
Rocha NP, Fortes RC (2015). Total lymphocyte count and serum albumin as predictors of nutritional risk in surgical patients. ABCD Arquivos Brasileiros de Cirurgia Digistiva (Sí£o Paulo) 28, 193–6. doi: 10.1590/ S0102-6720 2015 000300012.
dos Santos CA, Ribeiro AQ, Rosa C de OB, et al (2019). Nutritional risk in pediatrics by StrongKids: A systematic review. European Journal of Clinical Nutrition 73, 1441–9. doi: 10.1038/s41430-018-0293-9
Sekiyama M, Jiang H, Gunawan B, et al (2015). Double burden of malnutrition in rural West Java: Household-level analysis for father-child and mother- child pairs and the association with dietary intake. Nutrients 7, 8376–8391. doi: 10.3390/nu7105399.
Setiati S, Harimurti K, Dewiasty E, et al (2013). Profile of food and nutrient intake among Indonesian elderly population and factors associated with energy intake: A multi-centre study. Acta Medica Indonesiana 45, 265–274.
Song T, Mu Y, Gong X, et al (2017). Screening for nutritional risk in hospitalized children with liver disease. Asia Pacific Journal of Clinical Nutrition 26, 1107–1112. doi: 10.6133/apjcn.022017.06.
Susetyowati, Hamam H, Mohammad H, et al (2018). Comparison of nutrition screening and assessment parameters in predicting length of hospital stay. Journal of Nutrition Medicine and Diet Care. doi: 10.23937/2572-3278.1510030.
Tappenden KA, Quatrara B, Parkhurst ML, et al (2013). Critical role of nutrition in improving quality of care. Journal of Parenteral and Enteral Nutrition 37, 482–497. doi: 10.1177/0148607113484066.
Tette EMA, Sifah EK, Nartey ET (2015). Factors affecting malnutrition in children and the uptake of interventions to prevent the condition. BMC Pediatrics 15, 189. doi: 10.1186/s12887-015-0496-3.
Thibault R, Abbasoglu O, Ioannou E, et al (2021). ESPEN guideline on hospital nutrition. Clinical Nutrition 40, 5684–5709. doi: 10.1016/j.clnu.2021.09.039.
Tommy T, Dimiati H, Abdullah MN, et al (2022). The performance of STRONGkids in the early detection of hospital malnutrition. Paediatrica Indonesiana 62, 192–197. doi: 10.14238/pi62.3.2022.192-7.
Tosato F, Bucciol G, Pantano G, et al (2015). Lymphocytes subsets reference values in childhood. Cytometry Part A. 87: 81–85. doi: 10.1002/cyto.a.22520
Tuokkola J, Hilpi J, Kolho KL, et al (2019). Nutritional risk screening-A cross-sectional study in a tertiary pediatric hospital. Journal of Health, Population, and Nutrition 38, 8. doi: 10.1186/s41043- 019-0166-4.
Wahyuhadi J (2018). Pedoman pelayanan RSUD Dr. Soetomo: Buku saku : Pegangan bagi pemberi layanan dalam menjaga mutu dan keselamatan pasien. Airlangga University Press.
Wicaksono H (2016). Nutritional status affects incidence of pneumonia in underfives. Folia Medica Indonesiana 51, 285. doi: 10.20473/fmi.v51i4.2861.
Widjaja NA, Angelika D, Hidayati SN, et al (2016). Perbandingan jumlah limfosit total pada anak gizi buruk dengan infeksi dan tanpa infeksi HIV. Sari Pediatri 15, 99. doi: 10.14238/sp15.2.2013.99-104.
Zhang K, Qin W, Zheng Y, et al (2022). Malnutrition contributes to low lymphocyte count in early-stage coronavirus disease-2019. Frontiers in Nutrition. doi: 10.3389/fnut.2021.739216.