Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 20;12(3):390.
doi: 10.3390/children12030390.

Nutritional Status, Social Determinants of Health and Clinical Outcomes in Critically Ill Children

Yash Desai  1 , Andrea Marroquín  2 , Paola Hong-Zhu  3 , Nicole Knebusch  2 , Stephanie Vazquez  2 , Marwa Mansour  2 , Thomas P Fogarty  2 , M Hossein Tcharmtchi  2 , Fernando Stein  2 , Jorge A Coss-Bu  2
Affiliations

Nutritional Status, Social Determinants of Health and Clinical Outcomes in Critically Ill Children

Yash Desai et al. Children (Basel). .

Abstract

Introduction: Childhood malnutrition remains a risk factor for morbidity and mortality. Children admitted to the Pediatric Intensive Care Unit (PICU) are at a higher risk of worsening nutritional status with adverse clinical outcomes. The burden of malnutrition is strongly linked to various well-defined social determinants of health, including race, socioeconomic status, and geography, as these factors influence household food insecurity. This study aimed to analyze the interrelationships of nutritional status, social determinants of health, and health outcomes in critically ill children.

Methods: Retrospective cohort study of 6418 critically ill children admitted to PICU from January 2014 to December 2017. Demographic and anthropometric measurements were collected upon admission and outcomes. Based on the patient's zip code, and median household income, we estimated the percentage of the population living in poverty, and the percentage of the population experiencing food insecurity for 5912 children.

Results: The prevalence of underweight, chronic, and acute malnutrition was 13.2%, 17.9%, and 5.6%, respectively. Malnourished children had longer duration of mechanical ventilation and longer PICU and hospital lengths of stay (LOS) compared to nourished children. Underweight and chronic malnutrition were associated with higher mortality. Hispanic children had the highest prevalence of poverty level, while non-Hispanic Black children had the highest food insecurity level and lowest median income. Ethnicity was not associated with mortality.

Conclusions: Malnourished critically ill children who were disproportionately non-Hispanic Black, Hispanic, and Asian had worse hospital outcomes, including prolonged hospital and PICU length of stay, increased time on mechanical ventilation, and a higher risk of mortality.

Keywords: critically ill; intensive care; malnutrition; outcomes; pediatrics; socioeconomic status.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Mehta N.M., Duggan C.P. Nutritional Deficiencies During Critical Illness. Pediatr. Clin. N. Am. 2009;56:1143–1160. doi: 10.1016/j.pcl.2009.06.007. - DOI - PMC - PubMed
    1. Hulst J., Joosten K., Zimmermann L., Hop W., van Buuren S., Büller H., Tibboel D., van Goudoever J. Malnutrition in Critically Ill Children: From Admission to 6 Months after Discharge. Clin. Nutr. 2004;23:223–232. doi: 10.1016/S0261-5614(03)00130-4. - DOI - PubMed
    1. Campos-Miño S., Figueiredo-Delgado A., Zárate P., Zamberlan P., Muñoz-Benavides E., Coss-Bu J.A. Malnutrition and Nutrition Support in Latin American PICUs: The Nutrition in PICU (NutriPIC) Study. Pediatr. Crit. Care Med. 2023;24:1033–1042. doi: 10.1097/PCC.0000000000003337. - DOI - PubMed
    1. Amoroso L. The Second International Conference on Nutrition: Implications for Hidden Hunger. World Rev. Nutr. Diet. 2016;115:142–152. doi: 10.1159/000442100. - DOI - PubMed
    1. Vassilakou T. Childhood Malnutrition: Time for Action. Children. 2021;8:103. doi: 10.3390/children8020103. - DOI - PMC - PubMed

LinkOut - more resources