Prevalence and severity of malnutrition in pediatric neurology outpatients with respect to underlying diagnosis and comorbid nutrition and feeding related problems

Abstract

This study aimed to determine prevalence and severity of malnutrition withrespect to underlying diagnosis and co-morbid nutrition and feeding relatedproblems in pediatric neurology outpatients. A total of 1,057 pediatricneurology outpatients (7.2±5.4 years, 56.9% males) were included. Data onpatient demographics, neurological diagnosis, anthropometrics and NutritionalQuestionnaire (NQ) for co-morbid feeding difficulties and nutritional problemswere recorded. Epilepsy (45.2%) was the most common diagnosis, whileprevalence of acute malnutrition was 17.7%. Nutritional support resultedin a significant decrease in the percentage of malnourished patients (from17.1% to 6.7%, p˂0.001) and significant improvement in weight for heightscores (increased to 81.42±8.17, p=0.045). In NQ-10 item assessment, atleast one item was positive in 66.0% (gastrointestinal in 54.3%) of acutelymalnourished patients, more commonly in severe acute malnutrition. NQ 4-item set of “red flags” revealed that prolonged meal time, meal time stressfulto child or parent, lack of weight gain not just weight loss and cough duringfeeding were evident in 45.2%, 46.8%, 36.7% and 14.8% of patients withacute malnutrition, respectively; and more common in patients with severemalnutrition. NQ 4-item set of “red flags” was associated with high sensitivity(95%) and specificity (88%) in detection of malnutrition. In conclusion, ourfindings in a cohort of pediatric neurology outpatients revealed that 17.1%of overall patients were acutely malnourished along with higher prevalence ofmalnutrition in underlying diagnosis of cerebral palsy and higher likelihoodof nutritional problems and feeding difficulties in severe malnutrition. Giventhe association of 6-month nutritional support with improved anthropometricsand decreased percentage of malnourished patients, our findings indicate thatincreased awareness of nutritional status and nutritional support is essentialfor the care of neurologically impaired children with potential benefit ofidentifying early feeding/swallowing related signs of malnutrition.