Association between nutritional status and subject

Authors: Koen Joosten Kelly van der Velde Pieter Joosten Hans Rutten Jessie Hulst Karolijn Dulfer

Publish Date: 2015/09/11

Volume: 25, Issue: 4, Pages: 969-977

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Abstract

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 schoolsOverall 642 children median age 98 years IQR 77–115 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 riskscreening tool STRONGkids Subjective health status was assessed with EQ5DOverall 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  selfcare 17  usual activities 19  pain/discomfort 22  and anxiety/depression 22  in chronically ill children Their mean visual analogue scale score VAS was 730 SD 111 Malnutrition medication usage and younger age explained 38  of the variance of the VAS scoreThe 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 profilescreening tools to identify these childrenIn the Netherlands approximately 300000 children have a chronic disease this is 10  of all children 1 When admitted to a hospital these children with a chronic disease have a higher risk of malnutrition than previously healthy children 2 Moreover these children have a higher prevalence of chronic malnutrition compared with those without an underlying disease 3 Malnutrition may adversely affect physical mental and social aspects of the child’s health 4 5 6 Possible effects of malnutrition on physical health are impaired growth lowered immunity and even mortality 7 8 Malnutrition has also been associated with impaired development of executive functions and lower school achievements 5 6 In addition it may also be related to an increased incidence of attention deficit problems aggressive behaviour 9 and an increased risk of emotional social and cognitive impairments 10 Moreover children and adolescents with a chronic condition may report an impaired subjective health status compared with healthy peers 11After hospitalization chronically ill children may suffer from sequelae even though their chronic disease is stable In the Netherlands most children with a chronic disease will attend regular primary schools at the age of 4 years However those children with sequelae necessitating medical care may need to attend special schools for chronically ill children Jelsma and Ramma 12 reported that children with functional impairments in special schools ranging from learning disabilities to movement disorders reported more problems on the mobility and selfcare dimensions compared with children at regular schoolsBecause of the medical sequelae in chronically ill children in special schools there is a higher risk of malnutrition and therefore it is important to increase awareness about the nutritional status and practices in these children Since it was recently shown that malnutrition was associated with a lower subjective health status in hospitalized chronically ill children 13 it might be hypothesized that malnutrition in chronically ill children attending special schools is also associated with a lower subjective health status

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