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Malnutrition in Children


The appropriate assessment of nutrition and on-going review of growth are important aspects of monitoring children. Overall, hospitalised children have higher rates of under-nutrition, or their underlying condition may mean that they are more likely to become undernourished during their illness. These nutritional risks may impact adversely upon their underlying condition (delayed recovery or more complications) and may also lead a more prolonged stay in hospital. Both have implications upon health care costs.

The overall hypothesis of these studies was that the optimal use of Nutritional Risk Screening (NRS) tools in children will lead to earlier detection of children at risk of malnutrition, both in developed and developing countries.

Three NRS tools (STRONGkids, PYMS and STAMP) have been developed in Europe. These three tools were applied to 119 and 162 hospitalised children (in Iran and NZ) respectively. STRONGkids was shown to be the most reliable and feasible tool in both settings. This tool was then evaluated by paired nursing and paediatrician assessments, showing substantial agreement.

Two NRS tools were also applied to patients with Cystic Fibrosis in Iran and NZ, with direct comparison to each patient’s full evaluation by their clinical team. One tool (McDonald) showed the potential of identifying malnourished patients in Iran.

In conclusion, NRS tools have the potential to significantly improve the recognition of under-nutrition in hospitalised children and children with chronic disease.

Research Endeavours

Over the last while, a number of studies have focused upon the evaluation and implementation of Nutritional Risk Screening (NRS) tools in children. These studies have included children in NZ and in overseas settings, and have included general groups and those with specific diseases (e.g. cystic fibrosis). Generally, these studies have sought to develop optimal approaches for a local setting to ensure that this aspect of child health is enhanced.

Additional work is planned to further advance and progress this area of research. These activities will include children with other chronic health conditions and help to further evaluate tools and their utility.

Research Outputs

Examples of publications arising from these activities:

Moeeni V, Walls T, Day AS.
Assessment of nutritional status and nutritional risk in hospitalised Iranian children.
Acta Paediatrica. 2012; 101: e446-51.

Moeeni V, Day AS.
Nutritional Risk Screening tools in hospitalised children.
International Journal of Child Health and Nutrition. 2012; 1: 39-43

Moeeni V, Walls T, Day AS.
Nutritional status and nutrition risk screening in hospitalized children.
Acta Paediatrica, 2013; 102: e419-423

Moeeni V, Walls T, Day AS.
The STRONGkids nutritional risk screening tool can be used by paediatric nurses to identify hospitalised children at risk.
Acta Paediatr. 2014: 103; e528-31.

Moeeni V, Pattemore P, Shojaee P, Kianifar H, Walls T, Day AS.
The prospective assessment of nutrition in children with Cystic Fibrosis.
Int J Child Health Nutr. 2015; 4: 129-34.

For further information:

Dr Vesal Moeeni, MD, PhD
Department of Paediatrics, University of Otago, Christchurch
PO Box 4345, Christchurch 8140, New Zealand
Tel +64 3 372 6718

Professor Andrew Day
Professor and Head of Department
Department of Paediatrics, University of Otago, Christchurch
PO Box 4345, Christchurch 8140, New Zealand
Tel +64 3 372 6718