Disease associated malnutrition correlates with length of hospital stay in children.
OBJECTIVE
Previous studies reported a wide range of estimated malnutrition prevalence (6-30%) in paediatric inpatients based on various anthropometric criteria. We performed anthropometry in hospitalised children and assessed the relationship between malnutrition and length of hospital stay (LOS) and complication rates.


METHODS
In a prospective multi-centre European study, 2567 patients aged 1 month to 18 years were assessed in 14 centres in 12 countries by standardised anthropometry within the first 24 h after admission. Body mass index (BMI) and height/length <-2 standard deviation scores (SDS, WHO reference) were related to LOS (primary outcome), frequency of gastrointestinal (diarrhoea and vomiting) and infectious complications (antibiotic use), weight change during stay (secondary outcomes) and quality of life.


RESULTS
A BMI <-2 SDS was present in 7.0% of the patients at hospital admission (range 4.0-9.3% across countries) with a higher prevalence in infants (10.8%) and toddlers aged 1-2 years (8.3%). A BMI <-2 to ≥-3 SDS (moderate malnutrition) and a BMI <-3 SDS (severe malnutrition) was associated with a 1.3 (CI95: 1.01, 1.55) and 1.6 (CI95: 1.27, 2.10) days longer LOS, respectively (p = 0.04 and p < 0.001). Reduced BMI <-2 SDS was also associated to lower quality of life, and more frequent occurrence of diarrhoea (22% vs 12%, p < 0.001) and vomiting (26% vs 14%, p < 0.001).


CONCLUSIONS
Disease associated malnutrition in hospitalised children in Europe is common and is associated with significantly prolonged LOS and increased complications, with possible major cost implications, and reduced quality of life. This study was registered at clinicaltrials.gov as NCT01132742.
Div. Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany.
Christina
C
Hecht
Div. Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany.
Martina
M
Weber
Div. Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany.
Veit
V
Grote
Clinical Nutrition Lab "Christos Mantzoros", Department of Nutrition and Dietetics, Alexander Technological Education Institute of Thessaloniki, Greece.
Efstratia
E
Daskalou
Department of Pediatric Emergency, Fondazione IRCCS Ca' Granada Ospedale Maggiore Policlinico, Milan, Italy.
Laura
L
Dell'Era
Department of Paediatric Gastroenterology, Hepatology and Nutrition, National Health Service Greater Glasgow and Clyde, Royal Hospital for Sick Children, Glasgow G3 8SJ, UK.
Diana
D
Flynn
Human Nutrition, School of Medicine, College of Medicine, Veterinary and Life Sciences, Royal Hospital for Sick Children, University of Glasgow, Glasgow G3 8SJ, UK.
Konstantinos
K
Gerasimidis
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Jeanne de Flandre Children's Hospital, Pediatric Clinical Investigation Centre, Inserm U995, Faculty of Medicine, University Lille 2, Lille, France.
Frederic
F
Gottrand
Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Corina
C
Hartman
Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Jessie
J
Hulst
Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Koen
K
Joosten
Clinical Nutrition Lab "Christos Mantzoros", Department of Nutrition and Dietetics, Alexander Technological Education Institute of Thessaloniki, Greece.
Thomais
T
Karagiozoglou-Lampoudi
Beatrix Children's Hospital, University Hospital Groningen, Groningen, The Netherlands.
Harma A
HA
Koetse
Children's Hospital Zagreb University Medical School, Croatia.
Sanja
S
Kolaček
Department of Paediatrics and Nutrition, The Children's Memorial Health Institute, Warsaw, Poland.
Janusz
J
Książyk
Children's Hospital Zagreb University Medical School, Croatia.
Tena
T
Niseteo
Department of Paediatrics and Nutrition, The Children's Memorial Health Institute, Warsaw, Poland.
Katarzyna
K
Olszewska
Pediatric Clinic II, Department of Clinical Science and Community Health, Fondazione IRCCS Ca' Granada Ospedale Maggiore Policlinico, Milan, Italy.
Paola
P
Pavesi
The Medical University of Warsaw, Department of Paediatrics, Poland.
Anna
A
Piwowarczyk
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Jeanne de Flandre Children's Hospital, Pediatric Clinical Investigation Centre, Inserm U995, Faculty of Medicine, University Lille 2, Lille, France.
Julien
J
Rousseaux
Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Raanan
R
Shamir
Childrens Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
Peter B
PB
Sullivan
The Medical University of Warsaw, Department of Paediatrics, Poland.
Hania
H
Szajewska
Childrens Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
Angharad
A
Vernon-Roberts
Div. Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany. Electronic address: office.koletzko@med.uni-muenchen.de.
Berthold
B
Koletzko
D000293:Adolescent; D000298:Adolescent, Hospitalized; D015992:Body Mass Index; D002648:Child; D015362:Child Nutrition Disorders; D002673:Child, Hospitalized; D002675:Child, Preschool; D003967:Diarrhea; D004066:Digestive System Diseases / Q000150:complications; D005060:Europe / Q000453:epidemiology; D005260:Female; D006130:Growth Disorders; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000209:etiology*; D018529:Nutritional Support; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000150:complications; D014839:Vomiting
Anthropometry; Hospitalized children; Length of hospital stay; Malnutrition; Short stature; Under-nutrition