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.

Keywords: Children; Hospitalization; Malnutrition; Nutritional disorders; Prevalence.

Figure 1.

Distribution of nutritional disorders among hospitalized children aged 1 month to 18 years, stratified by (A) age, (B) hospital region, and (C) hospital level.

Figure 2.

Estimated burden of hospitalized children with PEM at tertiary-care hospitals. PEM, protein-energy malnutrition; THB, Thai baht.

Figure 3.

Difference between (A) length of hospital stay, (B) in-hospital mortality rates, and (C) hospital charges among inpatient discharges with and without a coded diagnosis of PEM by selected common diseases. PEM, protein-energy malnutrition; THB, Thai baht. ^***p<0.001.