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Nutrition Screening Pediatrics

Nutrition Screening Pediatrics

Welcome to the Nutrition Screening Pediatrics Systematic Review 
 
In the pediatric population, optimal nutritional status is crucial to ensure appropriate growth and development. Nutrition screening exists as an important precursor to dietitian notification that a nutrition problem may exist, thus sending a patient into the first step of the Nutrition Care Process. Use of valid and reliable nutrition screening tools that are appropriate for age and practice setting are important components of the screening process.

The scope of this project was to determine the validity and reliability of 14 pediatric nutrition screening tools to identify risk of malnutrition related to under- or over-nutrition and to determine if results varied according to users of the tools. Validity and reliability of mid-arm muscle circumference (MUAC) as a single screening indicator to detect risk of undernutrition in developed countries was also examined. Finally, the association between food insecurity and under- or over-nutrition was explored in order to determine if this factor should be considered during nutrition screening.

Key Findings
  • The most frequently examined tools were:  Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), Screening Tool for Risk on Nutritional status and Growth (STRONGkids) (13 studies each) and Paediatric Yorkhill Malnutrition Score (PYMS) (9 studies).
  • The workgroup concluded that tools with moderate to high validity and reliability that were based on Grade I (Strong) or Grade II (Fair) evidence were: STAMP, STRONGkids and PYMS in the inpatient setting, and the Nutrition Screening Tool for Cystic Fibrosis (NRST for CF) in the specialty/outpatient setting. No tools met these criteria in the community setting.
  • Differences in validity and reliability among different users of the tools were found, but the relevance of these findings is unclear. Grade II evidence.
  • MUAC demonstrated a low degree of validity and high reliability, based on Grade III (Limited) evidence.
  • The preponderance of evidence suggested no association between food insecurity status and underweight or overweight/obesity in the pediatric population in the US, though evidence was mixed with some suggestion of increased overweight/obesity with food insecurity compared to food security. Grade II evidence.

Manuscripts

Several articles resulting from this review have been published. Expand the section below titled Resources and Articles for article abstracts and citations.

Use the links on the left to view tool components and descriptions; validity and reliability criteria, definitions; and the evidence analysis. Expand the section below titled Project Team and Disclosures for a listing of individuals who contributed to the development of the systematic review, disclosures and project funding information.

  • Project Team and Disclosures (2018)

    The following individuals contributed their valuable time and expertise to this project:

    Workgroup Members

    • Patricia J. Becker, MS, CSP, CNSC, RDN, Chair
      Pediatric Dietitian, Dayton Children’s Hospital, Cincinnati, OH, USA
    • Sarah G. Bellini, PhD, CD, RDN
      Assistant Professor, Brigham Young University, Provo, UT, USA
    • Mark R. Corkins, MD, CNSC
      Professor of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
    • Bonnie A. Spear, PhD, MS, RDN, FAND
      Professor Pediatrics Emeritus, University of Alabama at Birmingham, Birmingham, AL, USA
    • Elizabeth Spoede, MS, CSP, RD, LD
      Clinical Nutrition Specialist & Pediatric Dietitian, Texas Children’s Hospital, Houston, TX, USA
    • Molly R. Wong Vega, MS, RDN, CSP, CSSD, LD
      Senior Dietitian, Texas Children’s Hospital; Memorial Hermann IRONMAN Sports Medicine Institute, Houston, TX, USA

    Project Leaders

    • Tami A. Piemonte, MS, RDN, LDN, Project Manager
      Independent Contractor, St. Petersburg, FL, USA
    • Mary Katherine Hoy, EdD, RD, Lead Analyst
      Nutritionists, ARS-USDA, Beltsville, MD, USA
    • Mary Rozga, PhD, RD, Academy Staff  
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Margaret J. Foster, MS, MPH, AHIP, Medical Librarian
      Texas A&M University, TAMU-Libraries, College Station, TX, USA
    • Deepa Handu, PhD, RN, Methodologist
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA

    Evidence Analysts

    • Lisa A. Davis, MS, RD
      Dietitian/Nutritionist, University of Wisconsin Hospital & Clinics, Madison, WI, USA
    • Sharon Foley, PhD, RDN
      Assistant Professor, Rush University, Chicago, IL, USA
    • Namibia Lebron-Torres, MS
      MPH Candidate, Tufts University School of Medicine, Boston, MA, USA
    • Christiane L.  Meireles, PhD, RDN, LD
      Clinical Assistant Professor, University of Texas Health San Antonio, San Antonio, TX, USA
    • Keiy C. Murofushi, MS, RDN
      Executive Director, Cedars Sinai Medical Center, Beverly Hills, CA, USA
    • Jessica Soldavini, MPH, RD, LDN
      Graduate Research Assistant, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
    • Amy Yahiro, RD, LDN
      Clinical Dietitian, Edward Hines Jr. Veterans Affairs Hospital, Chicago, IL, USA

    Financial Contributors

    • Commission on Dietetic Registration
    • Academy of Nutrition and Dietetics


    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • Patricia Becker: Provided consultant services to The Cincinnati Children’s Home; received compensation from Abbott Nutrition for speaking services
    • Bonnie Spear: Received grant funding from Bureau of Maternal and Child Health


     

  • Resources and Articles (2018)

    The following resources from this project are available:

    • Validity and Reliability of Pediatric Nutrition Screening Tools for Hospital, Outpatient, and Community Settings: A 2018 Evidence Analysis Center Systematic Review. Background: Nutrition screening tools are used to identify risk of malnutrition or change in risk of malnutrition. However, it is unclear which tools have demonstrated high validity, reliability, and agreement. Objective: Our aim was to conduct a systematic review of valid and reliable pediatric nutrition screening tools for identifying malnutrition risk (under- or overnutrition), and to determine whether there are differences in validity and reliability according to users of the tools. Methods: A literature search using Medline, Embase, and CINAHL databases was conducted to identify relevant research published between 1995 and May 2017 examining validity and reliability of nutrition screening tools in the pediatric population. A multidisciplinary workgroup developed eligibility criteria, data were extracted and summarized, risk of bias was assessed, and evidence strength was graded, according to a standard process. Results: Twenty-nine studies met inclusion criteria. Thirteen pediatric nutrition screening tools designed for various settings were included in the review (seven inpatient/hospital, three outpatient or specialty setting, and three community). The most frequently examined tools were the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth (13 studies each), and Paediatric Yorkhill Malnutrition Score (nine studies). No tools demonstrated high validity. Reliability and agreement were reported infrequently. Conclusions: Nutrition screening tools with good/strong or fair evidence and moderate validity included the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth, and Paediatric Yorkhill Malnutrition Score in the inpatient setting and Nutrition Risk Screening Tool for Children and Adolescents with Cystic Fibrosis in the specialty setting. No tools in the community setting met these criteria. While differences in validity and reliability measures among tool users were found, the significance of these findings is unclear. Limitations included few studies examining each tool, heterogeneity between studies examining a common tool, and lack of tools that included currently recommended indicators to identify pediatric malnutrition. J Acad Nutr Diet. 2020;120(2):288-318.
       
    • Food Insecurity and Pediatric Malnutrition Related to Under- and Overweight in the United States: An Evidence Analysis Center Systematic Review. Both food insecurity and malnutrition are associated with adverse health outcomes in the pediatric population. However, the research on the relationship between these factors has been inconsistent, leading to uncertainty regarding whether or how evaluation of food insecurity should be incorporated into nutrition screening or the nutrition care process. The objective of this systematic review was to determine the association between food insecurity and malnutrition related to undernutrition or overnutrition (defined by anthropometrics) in the pediatric population in the United States. A literature search was conducted using Medline, Embase, and CINAHL databases for studies published from January 2002 through November 2017. A total of 23 studies (19 cross-sectional and 4 prospective cohort studies) met inclusion criteria and were included in qualitative analysis. In 6 studies, there was no overall relationship between food insecurity and underweight. All included studies examined the relationship between food insecurity status and overweight/obesity and results were mixed, with large cross-sectional studies demonstrating a positive relationship between food insecurity and overweight/obesity. There were no clear patterns according to subpopulation. Evidence quality was graded as fair due to heterogeneity in how food insecurity was measured and populations included as well as inconsistency in results. Use of a 2-item food insecurity screening tool may allow for efficient, effective screening of food insecurity in order to identify potential contributors overweight and obesity. J Acad Nutr Diet. Published May 10, 2020.