title: Influence of obesity on clinical outcomes in hospitalized children: a systematic review.
abstract: OBJECTIVE
  Obesity is prevalent among hospitalized children. Knowledge of the relationship between obesity and outcomes in hospitalized children will enhance nutrition assessment and provide opportunities for interventions.
  
  
  OBJECTIVE
  To systematically review the existing literature concerning the impact of obesity on clinical outcomes in hospitalized children.
  
  
  METHODS
  PubMed, Web of Science, and EMBASE databases were searched for studies of hospitalized children aged 2 to 18 years with identified obesity and at least 1 of the following clinical outcomes: all-cause mortality, incidence of infections, and length of hospital stay. Cohort and case-control studies were included. Cross-sectional studies, studies of healthy children, and those without defined criteria for classifying weight status were excluded. The Newcastle-Ottawa Scale was used to assess study quality.
  
  
  RESULTS
  Twenty-eight studies (26 retrospective; 24 cohort and 4 case-control) were included. Of the 21 studies that included mortality as an outcome, 10 reported a significant positive relationship between obesity and mortality. The incidence of infections was assessed in 8 of the 28 studies; 2 reported significantly more infections in obese compared with nonobese patients. Of the 11 studies that examined length of stay, 5 reported significantly longer lengths of hospital stay for obese children. Fifteen studies (53%) had a high quality score. Larger studies observed significant relationships between obesity and outcomes. Studies of critically ill, oncologic or stem cell transplant, and solid organ transplant patients showed a relationship between obesity and mortality.
  
  
  CONCLUSIONS
  The available literature on the relationship between obesity and clinical outcomes is limited by subject heterogeneity, variations in criteria for defining obesity, and outcomes examined. Childhood obesity may be a risk factor for higher mortality in hospitalized children with critical illness, oncologic diagnoses, or transplants. Further examination of the relationship between obesity and clinical outcomes in this subgroup of hospitalized children is needed.
authors.affiliation: Center for Nutrition, Divisions of Gastroenterology and Nutrition, Boston Children’s Hospital, Boston, MA 02115, USA. lori.bechard@childrens.harvard.edu
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Bechard
authors.forename: Pamela
authors.initials: P
authors.lastname: Rothpletz-Puglia
authors.forename: Riva
authors.initials: R
authors.lastname: Touger-Decker
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Nilesh M
authors.initials: NM
authors.lastname: Mehta
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D009765:Obesity / Q000453:epidemiology; D010372:Pediatrics; D016896:Treatment Outcome