Prevalence of child malnutrition at a university hospital using the World Health Organization criteria and bioelectrical impedance data

Abstract

Malnutrition constitutes a major public health concern worldwide and serves as an indicator of hospitalized patients' prognosis. Although various methods with which to conduct nutritional assessments exist, large hospitals seldom employ them to diagnose malnutrition. The aim of this study was to understand the prevalence of child malnutrition at the University Hospital of the Ribeirão Preto Medical School, University of São, Brazil. A cross-sectional descriptive study was conducted to compare the nutritional status of 292 hospitalized children with that of a healthy control group (n=234). Information regarding patients' weight, height, and bioelectrical impedance (i.e., bioelectrical impedance vector analysis) was obtained, and the phase angle was calculated. Using the World Health Organization (WHO) criteria, 35.27% of the patients presented with malnutrition; specifically, 16.10% had undernutrition and 19.17% were overweight. Classification according to the bioelectrical impedance results of nutritional status was more sensitive than the WHO criteria: of the 55.45% of patients with malnutrition, 51.25% exhibited undernutrition and 4.20% were overweight. After applying the WHO criteria in the unpaired control group (n=234), we observed that 100.00% of the subjects were eutrophic; however, 23.34% of the controls were malnourished according to impedance analysis. The phase angle was significantly lower in the hospitalized group than in the control group (P<0.05). Therefore, this study suggests that a protocol to obtain patients' weight and height must be followed, and bioimpedance data must be examined upon hospital admission of all children.

Figure 1. Example of the bioelectrical impedance vector analysis (BIVA) classification for female patients at 6 and 7 years of age. Classifications for the hospitalized (A ) and control (B ) groups are shown.

Figure 2. Map of correspondence for nutritional status according to body mass index for age of the patients in the hospitalized group by medical specialties. OS: severe obesity; O: obesity; S: overweight; RS: risk of being overweight; E: eutrophic; M: thinness; MG: severe thinness; IMUNO: immunology; GASTRO: gastroenterology; REUMAT: rheumatology; NEPHRO: nephrology; CARDIO: cardiology; ONCO: oncology/hematology; PNEUMO: pulmonology; ENDOCR: endocrinology.

Figure 3. Map of correspondence for nutritional status according to body mass index for age in the hospitalized (A ) and control (B ) groups. OS: severe obesity; O: obesity; S: overweight; RS: risk of being overweight; E: eutrophic; M: thinness; MG: severe thinness; NO: not breastfed; YES: breastfed.