Assessment of paediatric malnutrition: Results from an international survey on current clinical practice and barriers

Abstract

Objectives and study: A lack of international consensus for the definition and assessment of paediatric malnutrition may lead to under-recognition of the problem in clinical practice. This survey aimed to 1) investigate which measurements health professionals consider the most important for the assessment of paediatric malnutrition; 2) identify barriers for routine nutritional screening/assessment; 3) explore differences across countries. Methods: A web-based questionnaire survey was sent out to paediatric gastroenterologists (MD) and dieticians (RD) in seven countries (the Netherlands, Belgium, UK, Australia, Israel, Spain and Turkey). The survey was distributed via the local professional associations in participating countries. Results: In total, 693 responders (Australia: n=89; Belgium: n=34; Israel: n=126; the Netherlands: n=73; Spain: n=139; Turkey: n=79; UK: n=153) completed the survey; 45% were MD and 55% RD with a different distribution of professions across countries (p<0.001). MD's and RD's had respectively a median of 15 (10;25) and 9 (3;14) years' experience in paediatrics. The majority worked in a tertiary (51%) and/or district general hospital (33%), with differences noted across countries. A total of 588 responded to the question regarding screening and assessment in routine clinical practice. Of these, 43 (7%) did not routinely screen for malnutrition (this was most prevalent in Australia (16%) and the least (0%) in The Netherlands; difference across countries: p=0.012). Differences were noted across countries in the way malnutrition is evaluated in routine clinical practice. Assessing weight changes was done most frequently overall (85%; most frequently in Israel (93%), least frequent in Australia (70%), p=0.004), followed by plotting weight for age (80%), weight for height/BMI (77%) and height for age (77%) on growth charts. The WHO charts were used by 60%, national growth charts by 36% and a combination of both by 12%; 17% used the CDC charts or national growth charts from another country. Body composition was routinely assessed by only 20% of the respondents (50% of the Spanish, followed by 13% of UK respondents, all other countries =10%, p<0.001). Only 3% routinely used disease-specific growth charts. Overall, screening tools were used by 23 % (Belgium, the Netherlands and UK: 40-50%, other countries =15%, p<0.001); the most popular tools were STRONGkids, PYMS and STAMP. Functional tests (e.g. grip strength) or energy levels were assessed by a minority of the respondents (14%) and was significantly (p=0.008) more frequently done in Israel (24%) and Australia (17%). Blood parameters such as inflammatory markers (31%), nutritional markers (51%) and micronutrients (43%) were assessed significantly (p<0.02) different across countries. Considering the most commonly perceived barriers for routine nutritional evaluation, low staff awareness on the role of nutrition on patient care (47%), lack of local policy or guidelines to screen for malnutrition (33%), lack of time (33%) and lack of dieticians to intervene (33%) were found most often, although differences existed across countries. Conclusion: Assessing changes in weight, and plotting weight for age were the most frequently proposed ways to assess paediatric malnutrition; body composition was recommended the least. Half of the respondents perceived low staff awareness and one-third a lack of local guidelines as barriers for the routine evaluation of the nutritional status.L6167697292017-06-16 <br />