title: A novel objective nutritional score for children on chronic peritoneal dialysis.
abstract: OBJECTIVE
  To establish a novel nutritional score based on a series of objective parameters capable of detecting protein-calorie malnutrition in children being treated with chronic peritoneal dialysis (CPD), to test the score in a healthy pediatric population, and to apply it to children on CPD to evaluate their nutritional status.
  
  
  METHODS
  264 healthy school children (mean age 8.69 +/- 3.26 years, range 3.05-14.98 years) and 29 patients treated with CPD for 1.75 +/- 1.02 years (mean age 10.54 +/- 6.28 years, range 2.8-15.24 years).
  
  
  METHODS
  Nutritional status was evaluated by means of three sets of measurements: anthropometric (A1 and A2) and bioimpedance analysis (BIA) measurements. Anthropometry included two sets of measures: set A1 consisted of height (H), weight (W), and body mass index (BMI); set A2 consisted of midarm muscle circumference (MAMC), arm muscle area (AMA), and arm fat area (AFA). The BIA measurements included reactance, phase angle, and distance. All parameters are expressed as standard deviation scores (SDS).Tanner's, Rolland-Cachera's, and Frisancho's data were used as references for H, W, BMI, MAMC, AMA, and AFA; personal data obtained from 551 healthy boys and girls were used for the BIA indices. The nine anthropometry and BIA parameters were given scores of 1 to 5: 5 = > 0 SDS, 4 = < or = 0 and > -1 SDS, 3 = < or = -1 and > -2 SDS, 2 = <-2 and > -3 SDS, and 1 = < or = -3 SDS. Average scores were established for each of A1, A2, and BIA, and then summed to obtain the anthropometry-BIA nutrition (ABN) score. To establish the cutoff value between normal nutritional status and malnutrition, the method was first applied to the 264 healthy children; distribution percentiles were calculated for each area score and the ABN score. The ABN score corresponding to the 3rd percentile was considered the limit of normality and then applied three times to the 29 children on CPD, for a total of 87 nutritional assessments.
  
  
  RESULTS
  The score corresponding to the 3rd percentile in the population of healthy children was 10.33. Among the CPD-treated children, 41.4% of the ABN scores were higher than 10.33 (indicating a state of normal nutrition) and 58.6% were lower (indicating various degrees of malnutrition). Severe malnutrition was found in only 1.1% of the cases. The values of all nine A1, A2, and BIA parameters, as well as serum albumin levels, were significantly higher in patients with an ABN score > 10.33 than in those with a score < 10.33.
  
  
  CONCLUSIONS
  The ABN score is a simple and objective method of assessing, in clinical practice, the nutritional status of children on CPD.
authors.affiliation: Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy. aedefonti@hotmail.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
authors.forename: Marina
authors.initials: M
authors.lastname: Picca
authors.forename: Fabio
authors.initials: F
authors.lastname: Paglialonga
authors.forename: Silvana
authors.initials: S
authors.lastname: Loi
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Grassi
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ardissino
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Marra
authors.forename: Luciana
authors.initials: L
authors.lastname: Ghio
authors.forename: Emilio
authors.initials: E
authors.lastname: Fossali
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000886:Anthropometry; D002648:Child; D002675:Child, Preschool; D017097:Electric Impedance; D005260:Female; D006801:Humans; D008297:Male; D009749:Nutrition Surveys; D009752:Nutritional Status; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011502:Protein-Energy Malnutrition / Q000175:diagnosis* / Q000209:etiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index