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  1. Chen, Seong Ting, Soo, Kah Leng, Azriani Ab Rahman, Van Rostenberghe, Hans, Sakinah Harith
    MyJurnal
    Objectives: This study was conducted with two objectives, i) to assess the prevalence of malnutrition among children and adolescents with learning disability (LD) in Kelantan, a rural state located at the north-eastern region of Peninsular Malaysia; and ii) to examine the associations of participants’ socioeconomic and feeding characteristics with their body mass index (BMI).

    Methods: A total of 271 children and adolescents with LD aged between 4 to 19 years old were recruited from 32 community-based rehabilitation centres using purposive sampling method. Standing height and body weight of participants were measured. Socioeconomic and feeding information were obtained from their primary caregivers through interviews using structured questionnaire. Multiple linear regression analyses were performed to examine the associations of socioeconomic and feeding characteristics with participants’ BMI.

    Results: The prevalence of underweight among children and adolescents with LD was 22.5%; while another 22.1% of them were overweight and obese. Multiple linear regression models showed that being Down’s syndrome (Adjusted regression coefficient β=2.63, p
  2. Ong SH, Chen ST
    J Trop Pediatr, 2020 10 01;66(5):461-469.
    PMID: 31943107 DOI: 10.1093/tropej/fmz085
    BACKGROUND: It is recommended to screen hospitalized children to identify those at risk of malnutrition. Constricted schedule in tertiary care settings calls for the needs of a less burdensome yet effective nutrition screening tool. This study aimed to validate the use of Paediatric Nutrition Screening Tool (PNST) among hospitalized children in a Malaysian tertiary hospital.

    METHODS: This cross-sectional study recruited children below 18 years old admitting into general paediatric ward in a public hospital. The PNST and Subjective Global Nutritional Assessment (SGNA) were performed on 100 children (64 boys and 36 girls). The objective measurements include anthropometry (z-scores for weight, height and body mass index), dietary history and biochemical markers were measured. These were used to classify malnutrition as per Academy of Nutrition and Dietetics/American Society of Parental and Enteral Nutrition (AND/ASPEN) Consensus Statement for identification of paediatric malnutrition and WHO growth standards for children. Cohen's kappa was computed to report the level of agreement.

    RESULTS: The PNST identified 57% of hospitalized children as being at risk of malnutrition. In this study, there was a stronger agreement between PNST with AND/ASPEN malnutrition classification (k = 0.602) as when PNST was compared with WHO (k = 0.225) and SGNA (k = 0.431). The PNST shows higher specificity (85.29%) and sensitivity (78.79%) when compared with AND/ASPEN than with WHO malnutrition criteria (55.81% specificity and 66.67% sensitivity).

    CONCLUSION: This study showed the usefulness of routine use of PNST for screening the malnutrition risk of hospitalized children in Malaysian tertiary hospital settings.

  3. Ong SH, Chen ST
    J Trop Pediatr, 2022 Jan 07;68(1).
    PMID: 35134248 DOI: 10.1093/tropej/fmac007
    BACKGROUND: Children with identified developmental disabilities (IDD) experience a higher risk of growth retardation. Anthropometric indicator is one common objective measurement used to determine malnutrition in those children. A comprehensive nutritional assessment tool should be introduced to offer a more robust approach in understanding their nutritional problems.

    OBJECTIVE: To determine the use of Subjective Global Nutrition Assessment (SGNA) as a nutrition assessment tool for children with IDD in comparison to the anthropometric indicators.

    METHODS: This cross-sectional study was conducted in local community settings. IDD included in this study were autism spectrum disorder (ASD), Down syndrome (DS) and cerebral palsy (CP). SGNA and anthropometry measurements including weight, height, mid-upper arm circumference and triceps skinfolds were performed on 93 children with IDD (40 ASD, 26 DS and 27 CP) aged 5-18 years. Cohen's Kappa, sensitivity, specificity and its 95% confidence interval were calculated between SGNA and anthropometric indicators for the agreement in determining malnutrition status of the children.

    RESULTS: SGNA identified a lower prevalence of malnutrition in children with IDD in comparison to the use of anthropometric indicators. SGNA obtained a moderate-to-fair agreement (above 80% agreement, except height-for-age parameter) and sensitivity (25.71-59.09%) against the use of a single anthropometric indicator in identifying the malnutrition status of the children.

    CONCLUSIONS: The use of SGNA as an adjunct to body mass index-for-age as an anthropometric measurement for diagnosing malnutrition in children and adolescents with IDD is recommended.

  4. Ong SH, Chen ST, Chee WSS
    Nutr Clin Pract, 2023 Aug;38(4):889-898.
    PMID: 36811458 DOI: 10.1002/ncp.10971
    BACKGROUND: Identification and management of malnutrition among pediatric hospitalized patients is critical for improved clinical outcomes and recovery. This study investigated the use of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (AND/ASPEN) pediatric malnutrition diagnosis in comparison with the Subjective Global Nutritional Assessment (SGNA) tool and single anthropometric indicators (weight, height, body mass index, and mid-upper arm circumference) among hospitalized children.

    METHODS: A cross-sectional study was conducted among 260 children admitted to general medical wards. SGNA and anthropometric measurements were used as references. Kappa agreement, diagnostic values, and area under the curve (AUC) were analyzed to evaluate the diagnostic ability of the AND/ASPEN malnutrition diagnosis tool. Logistic binary regression was performed to determine the predictive ability of each malnutrition diagnosis tool on the length of hospital stay.

    RESULTS: The AND/ASPEN diagnosis tool detected the highest malnutrition rate (41%) among the hospitalized children in comparison with the reference methods. This tool demonstrated fair specificity of 74% and sensitivity of 70% compared with the SGNA. It obtained a weak agreement in determining the presence of malnutrition by kappa (0.06-0.42) and receiver operating characteristic curve analysis (AUC = 0.54-0.72). The use of the AND/ASPEN tool obtained an odds ratio of 0.84 (95% CI, 0.44-1.61; P = 0.59) in predicting the length of hospital stay.

    CONCLUSIONS: The AND/ASPEN malnutrition tool is an acceptable nutrition assessment tool for hospitalized children in general medical wards.

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