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Compared with body mass index (BMI), lean body mass and fat-free mass are strongly associated with lung function in children and adolescents with cystic fibrosis (CF). Methods of measuring body composition in youth with CF are often unreliable, expensive, or not clinically feasible. Grip strength (GS), a measure of muscle function, is used as a surrogate for muscle mass and is an indicator of nutrition status. This quality improvement project explored the feasibility of measuring GS in medically stable youth with CF, aged 6-21 years. A total 361 GS measurements were performed by using a digital hand dynamometer in youth from a single CF center. Using reference tables that were created for this project by merging data from the 2011-2012 and 2013-2014 National Health and Nutrition Examination Surveys, youth with CF were found to be weaker than age- and gender-matched peers, even when controlled for differences in size. A positive association (P < .001) was found between GS percentile and lung function, as measured by forced expiratory volume in 1 second percent predicted (FEV1pp). Statistical analysis revealed that both BMI percentile and absolute GS (AGS) percentile were positively associated with FEV1pp and with each other, primarily at the lower levels of BMI percentile (

The publication of the landmark paper "Defining Pediatric Malnutrition: A Paradigm Shift Toward Etiology-Related Definitions" launched a new era in diagnosing pediatric malnutrition. This work introduced the paradigm shift of etiology-related definitions-nonillness and illness related-and the use of anthropometric z scores to help identify and describe children with malnutrition (undernutrition) in the developed world. Putting the new definition into practice resulted in some interesting observations: (1) Etiology-related definitions result in etiology-related interventions. (2) Illness-related malnutrition cannot always be immediately "fixed." (3) Using z scores in clinical practice often puts the burden of proof on the clinician to show that a child is not malnourished, rather than the other way around. (4) Children with growth failure severe enough to be admitted with "failure to thrive" should always be assessed for malnutrition, and when they meet the criteria, malnutrition should be documented and coded. The publication of the consensus statement came next, announcing the evidence-informed, consensus-derived pediatric malnutrition indicators. Since the indicators are a work in progress, clinicians are encouraged to use them and give feedback through an iterative process. This review attempts to respond to the consensus statement's call to action by thoughtfully appraising the indicators and making recommendations for future review. Coming together as a healthcare community to identify pediatric malnutrition will ensure that this vulnerable population is not overlooked. Outcomes research will validate the indicators and result in new discoveries of effective ways to prevent and treat pediatric malnutrition.

Introduction: Malnutrition is common in hospitalized patients in the United States. In 2010, 80,710 of 6,280,710 hospitalized children 3 times higher than those wi...

Background Malnutrition is a significant problem for hospitalized patients in the United States. Nutrition assessment is an important step in recognizing malnutrition; however, it is not always performed using consistent parameters. Methods A survey among U.S. American Society for Parenteral and Enteral Nutrition (ASPEN) members was conducted to collect data on nutrition assessment parameters used in hospitals and to establish how facilities use their electronic health record (EHR) to permit data retrieval and outcome reporting. Results The survey was developed by the ASPEN Malnutrition Committee and was sent to 5487 U.S. ASPEN members, with 489 responding for a 9% response rate. Ninety-eight percent of adult and 93% of pediatric respondents indicated a registered dietitian completed the nutrition assessment following a positive nutrition screen. Variables most frequently used among adult respondents included usual body weight, ideal body weight, and body mass index. Among pediatric respondents, weight-for-age and height-for-age percentiles and length/height-for-age percentile were most frequently used. Both adult and pediatric respondents indicated use of physical assessment parameters, including muscle and fat loss and skin assessment. Eighty-seven percent of adult and 77% of pediatric respondents indicated they are using the Academy of Nutrition and Dietetics (Academy) and ASPEN Consensus Malnutrition Characteristics for Adult and Pediatric Malnutrition, respectively. Overall, 97% of respondents indicated nutrition assessment documentation was completed via an EHR. Of all respondents, 61% indicated lack of clinical decision support within their EHR. Conclusion This survey demonstrated significant use of the Academy/ASPEN malnutrition consensus characteristics.

Survivorship after pediatric HCT has increased over the past decade. Focus on long-term care and well-being remains critical due to risk of poor dietary habits and exaggerated sedentary behavior, which can lead to muscle weakness, increased risk for obesity, and cardiometabolic disorders. Nutrition and physical activity are key factors in survivorship; however, data are limited. Comprehensive nutritional assessments, including nutrition-focused physical examination, grip strength, and food/activity surveys, were completed in 36 pediatric HCT survivors (aged 2-25 years). Patients were divided into undernutrition, normal-nutrition, and overnutrition categories. Fifty percent of participants were classified as normal nutrition, 22% undernutrition, and 28% overnutrition. Few patients met the U.S. Dietary Guidelines recommended intake for vegetables, fiber, saturated fat, and So FAS. Patients in the undernutrition group demonstrated significantly lower grip strength than those in the normal- and overnutrition groups. When grip strength was normalized to body mass, patients in the overnutrition group had the highest prevalence of weakness. Using NHANES reference data, maximum grip strength and NGS cutoffs were identified that could significantly distinguish the nutrition groups. Comprehensive nutritional assessments and grip strength measurements are feasible, non-invasive, easy to perform, and inform both under- and overnutrition in pediatric HCT survivors.