title: Association between nutritional status and subjective health status in chronically ill children attending special schools.
abstract: OBJECTIVE
  In hospitalized children with a chronic disease, malnutrition was associated with a lower subjective health status. In outpatient children with a chronic disease attending special schools, this association has never been studied. The aim of this study was to assess the association between nutritional status and subjective health status in chronically ill children attending special schools.
  
  
  METHODS
  Overall, 642 children, median age 9.8 years (IQR 7.7-11.5), 60 % male, 72 % Caucasian, were included in this prospective study in nine special schools for chronically ill children in the Netherlands. Overall malnutrition was assessed as: acute malnutrition (<-2 SDS for weight for height (WFH)) and chronic malnutrition (<-2 SDS for height for age). The malnutrition risk was assessed with the nutritional risk-screening tool STRONGkids. Subjective health status was assessed with EQ-5D.
  
  
  RESULTS
  Overall, 16 % of the children had overall malnutrition: 3 % acute and 13 % chronic malnutrition. Nurses reported 'some/severe problems' on the health status dimensions mobility (15 %), self-care (17 %), usual activities (19 %), pain/discomfort (22 %), and anxiety/depression (22 %) in chronically ill children. Their mean visual analogue scale score (VAS) was 73.0 (SD 11.1). Malnutrition, medication usage, and younger age explained 38 % of the variance of the VAS score.
  
  
  CONCLUSIONS
  The presence of overall malnutrition in chronically ill children attending special schools was associated with lower subjective health status, especially in younger children and in those with chronic medication usage. Therefore, it is important to develop and use profile-screening tools to identify these children.
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
authors.forename: Koen
authors.initials: K
authors.lastname: Joosten
authors.affiliation: Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Kelly
authors.initials: K
authors.lastname: van der Velde
authors.affiliation: VUmc School of Medical Sciences, Amsterdam, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Joosten
authors.affiliation: Ministry of Economic Affairs, The Hague, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Rutten
authors.affiliation: Department of Pediatric Gastroenterology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Jessie
authors.initials: J
authors.lastname: Hulst
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands. k.dulfer@erasmusmc.nl.|Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. k.dulfer@erasmusmc.nl.
authors.forename: Karolijn
authors.initials: K
authors.lastname: Dulfer
mesh_terms: D000293:Adolescent; D000298:Adolescent, Hospitalized; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology*; D002673:Child, Hospitalized; D002675:Child, Preschool; D002908:Chronic Disease / Q000523:psychology*; D059026:Diagnostic Self Evaluation; D004519:Education, Special; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009426:Netherlands; D009752:Nutritional Status; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012306:Risk; D012574:Schools; D012648:Self Care
keywords: Chronic disease; Nutritional status; Paediatrics; Prevalence malnutrition; Quality of life; Subjective health status