The Turkish Journal of Pediatrics
2018 , Vol 60 , Num 6
Prevalence and severity of malnutrition in pediatric neurology outpatients with respect to underlying diagnosis and comorbid nutrition and feeding related problems
1 Division of Child Neurology, Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey
DOI :
10.24953/turkjped.2018.06.012
Tekin H, Tekgül H, Yılmaz S, Arslangiray D, Reyhan H, Serdaroğlu
G, Gökben S. Prevalence and severity of malnutrition in pediatric neurology
outpatients with respect to underlying diagnosis and co-morbid nutrition and
feeding related problems. Turk J Pediatr 2018; 60: 709-717.
This study aimed to determine prevalence and severity of malnutrition with
respect to underlying diagnosis and co-morbid nutrition and feeding related
problems in pediatric neurology outpatients. A total of 1,057 pediatric
neurology outpatients (7.2±5.4 years, 56.9% males) were included. Data on
patient demographics, neurological diagnosis, anthropometrics and Nutritional
Questionnaire (NQ) for co-morbid feeding difficulties and nutritional problems
were recorded. Epilepsy (45.2%) was the most common diagnosis, while
prevalence of acute malnutrition was 17.7%. Nutritional support resulted
in a significant decrease in the percentage of malnourished patients (from
17.1% to 6.7%, p˂0.001) and significant improvement in weight for height
scores (increased to 81.42±8.17, p=0.045). In NQ-10 item assessment, at
least one item was positive in 66.0% (gastrointestinal in 54.3%) of acutely
malnourished patients, more commonly in severe acute malnutrition. NQ 4-
item set of `red flags` revealed that prolonged meal time, meal time stressful
to child or parent, lack of weight gain not just weight loss and cough during
feeding were evident in 45.2%, 46.8%, 36.7% and 14.8% of patients with
acute malnutrition, respectively; and more common in patients with severe
malnutrition. NQ 4-item set of `red flags` was associated with high sensitivity
(95%) and specificity (88%) in detection of malnutrition. In conclusion, our
findings in a cohort of pediatric neurology outpatients revealed that 17.1%
of overall patients were acutely malnourished along with higher prevalence of
malnutrition in underlying diagnosis of cerebral palsy and higher likelihood
of nutritional problems and feeding difficulties in severe malnutrition. Given
the association of 6-month nutritional support with improved anthropometrics
and decreased percentage of malnourished patients, our findings indicate that
increased awareness of nutritional status and nutritional support is essential
for the care of neurologically impaired children with potential benefit of
identifying early feeding/swallowing related signs of malnutrition.
Keywords :
pediatric neurology, anthropometrics, malnutrition, nutritional status, questionnaire