Opinions and practices of healthcare professionals on assessment of disease associated malnutrition in children: Results from an international survey.
Kansu Tanca, Aydan
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Background&aims:Lack of consensus on clinical indicators for the assessment of pediatric diseaseassociated malnutrition (DAM) may explain its under-recognition in clinical practice. This study surveyedthe opinions of health professionals (HP) on clinical indicators of DAM and barriers impeding routinenutritional screening in children.Methods:Web-based questionnaire survey (April 2013eAugust 2015) in Australia, Belgium, Israel, Spain,The Netherlands, Turkey and UK.Results:There were 937 questionnaires returned via local professional associations, of which 693 re-spondents fulfilled the inclusion criteria and were included in thefinal analysis; 315 pediatric gastro-enterologists and 378 pediatric dieticians. The most important clinical indicators of DAM were ongoingweight loss (80.4%), increased energy/nutrient losses (73.0%), suboptimal energy/macronutrient intake(68.6%), a high nutritional risk condition (67.2%) and increased energy/nutrient requirements (66.2%).Thesefindings were consistent across countries and professions. The most common approach to screenfor DAM was assessment of weight changes (85%), followed by the usage of growth charts (77e80%).Common perceived barriers for routine nutritional screening/assessment were low staff awareness(47.5%), no local policy or guidelines (33.4%) and lack of time to screen (33.4%).Conclusions:HP who routinely assess and treat children with DAM identified ongoing weight loss,increased losses, increased requirements, low intake and high nutritional risk conditions as the mostimportant clinical indicators of DAM. These clinical indicators should now serve as a basis to formclinical-based criteria for the identification of DAM in routine clinical practice. Low awareness, lack ofguidelines or local policy and lack of resources were the most important barriers of routine screening.©2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved