Subjective Observation of Loss of Subcutaneous Fat and Muscle Tissue – Is that the Answer to Pediatric Hospital Malnutrition Screening?

Background: Hospital malnutrition is a prevalent issue with critically ill pediatric patients being at increased risk for nutritional loss. Nutritional risk screening has been associated with increased documentation of nutrition diagnosis and positive clinical outcomes, however, is not mandatory in developing countries. A nutrition screening tool that uses subjective examination of loss of subcutaneous fat and muscle tissue may be an efficient way to identify nutritional risk in hospitalized critical care pediatric patients. Objective: To determine whether loss of subcutaneous fat and muscle tissue in specific body locations was associated with moderate or severe malnutrition determined by SGA in pediatric critical care hospital units, and if loss of subcutaneous fat and muscle tissue differs by gender, age, or disease. Methods: Pediatric in-patients (n = 203), aged 1 month to 18 years old, in tuberculosis, burn, oncology, high dependency (HDU) and intensive care units (ICU) in two tertiary hospitals in Malawi were assessed for nutritional status using Subjective Global Assessment (SGA), Mid-upper arm circumference (MUAC), and weight for age Z-score (WAZ). The SGA form included four questions on weight, appetite, tolerance to food and fluids, and dietary intake, as well as a nutrition-focused physical exam. The nutrition-focused physical exam consisted of assessments of subcutaneous fat loss in two locations (below the eye, triceps/biceps) and eight locations for muscle tissue loss (temple, clavicle, shoulder, scapula, interosseous, knee, quadriceps, and calf). The analysis was focused on the assessment of loss of subcutaneous fat and muscle tissue in relation to malnutrition score determined by SGA. Results: The mean age and standard deviation of the study population was 5.32 years ± 4.80, with just over 55% of participants being male. Determined by SGA, moderate malnutrition prevalence was 70.9% and severe malnutrition prevalence was 13.8%. SGA alone identified more malnutrition (84.7%) than MUAC (20.5%) and WAZ (43%). Patients with cancer (100%) and organ-related disease (93.76%) had the highest rates of moderate and severe malnutrition. Loss of subcutaneous fat and muscle tissue in all body locations assessed were associated with moderate and severe malnutrition (p-value Conclusions: A nutritional screening tool that is efficient, valid, and allows for the screening of a large patient population in a short amount of time, is needed in Malawi. Although loss of subcutaneous fat and muscle tissue were significantly associated with moderate and severe malnutrition, moderate loss of muscle tissue in the quadriceps and calf had the highest odds of malnutrition. These results indicate that pediatric patients with moderate loss of muscle tissue in their quadriceps and calf should be treated with a high index of suspicion for malnutrition. While loss of subcutaneous fat and muscle were not significantly worse by gender, age, or disease, particular attention should be paid in patients of the male sex, aged 6 to 10 years old, and with cancer. These findings support increasing dietetic services to prevent and treat hospital malnutrition using simple screening tools, such as the one used in this sub-analysis