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Association between admission body mass index and outcomes in critically ill children: A systematic review and meta-analysis.
Clin Nutr. 2021 05; 40(5):2772-2783.CN

Abstract

BACKGROUND & AIMS

The association between nutritional status at pediatric intensive care unit (PICU) admission with clinical outcomes remains unclear. We conducted this systematic review to summarize the overall impact of PICU admission body mass index (BMI) on clinical outcomes.

METHODS

We searched the following medical databases from inception through May 2020: PubMed, Excerpta Medica database (Embase), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Web of Science. We included studies on patients ≤18 years old admitted to a PICU that investigated the effect of BMI on mortality, PICU or hospital length of stay (LOS), or duration of mechanical ventilation (MV). Classification of underweight, overweight, and obese were based on each study's criteria.

RESULTS

There was a total of 21,558 patients from 20 included studies. 12,936 (60.0%), 2965 (13.8%), 2182 (10.1%), 3348 (15.5%) were normal weight, underweight, overweight, and obese patients, respectively. Relative to normal weight patients, underweight (OR 1.32, 95% CI 0.89-1.98; p = 0.171) and overweight/obese patients (OR 1.10, 95% CI 0.86-1.42; p = 0.446) did not have an increase risk in mortality. There was also no difference in duration of MV, PICU and hospital LOS between all three weight categories. Included studies were heterogeneous and lacked standardized nutritional categorization. Sensitivity analysis including only studies that used BMI z-scores as nutritional classification (n = 5) revealed that underweight patients had higher odds of mortality compared to patients with normal weight (OR 1.61, 95% CI 1.35-1.92; p < 0.001); studies that used percentiles as classification did not reveal any differences in mortality. Sensitivity analysis including only studies containing mixed PICU cohorts (i.e., excluding specialized cohorts e.g., congenital heart surgeries, burns) revealed higher mortality odds in underweight patients (OR 1.53, 95% CI 1.25-1.87; p < 0.001) and overweight/obese patients (OR 1.51, 95% CI 1.14-2.01; p = 0.004) relative to normal weight patients.

CONCLUSIONS

Our systematic review did not reveal any association between PICU admission BMI status and outcomes in critically ill children. Further investigation with standardized nutrition status classification on admission, stratified by patient subgroups, is needed to clarify the association between nutritional status and clinical outcomes of PICU patients.

Authors+Show Affiliations

Duke-NUS Medical School, 8 College Rd, 169857, Singapore.Department of Nutrition and Dietetics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore.Duke-NUS Medical School, 8 College Rd, 169857, Singapore.Children's Intensive Care Unit, Division of Nursing, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore.Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore.Duke-NUS Medical School, 8 College Rd, 169857, Singapore; Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore. Electronic address: lee.jan.hau@singhealth.com.sg.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

33933743

Citation

Toh, Samantha, et al. "Association Between Admission Body Mass Index and Outcomes in Critically Ill Children: a Systematic Review and Meta-analysis." Clinical Nutrition (Edinburgh, Scotland), vol. 40, no. 5, 2021, pp. 2772-2783.
Toh S, Ong C, Sultana R, et al. Association between admission body mass index and outcomes in critically ill children: A systematic review and meta-analysis. Clin Nutr. 2021;40(5):2772-2783.
Toh, S., Ong, C., Sultana, R., Kirk, A. H. P., Koh, J. C., & Lee, J. H. (2021). Association between admission body mass index and outcomes in critically ill children: A systematic review and meta-analysis. Clinical Nutrition (Edinburgh, Scotland), 40(5), 2772-2783. https://doi.org/10.1016/j.clnu.2021.04.010
Toh S, et al. Association Between Admission Body Mass Index and Outcomes in Critically Ill Children: a Systematic Review and Meta-analysis. Clin Nutr. 2021;40(5):2772-2783. PubMed PMID: 33933743.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between admission body mass index and outcomes in critically ill children: A systematic review and meta-analysis. AU - Toh,Samantha, AU - Ong,Chengsi, AU - Sultana,Rehena, AU - Kirk,Angela Hui Ping, AU - Koh,Janine Cynthia, AU - Lee,Jan Hau, Y1 - 2021/04/18/ PY - 2021/01/12/received PY - 2021/03/23/revised PY - 2021/04/03/accepted PY - 2021/5/3/pubmed PY - 2021/9/3/medline PY - 2021/5/2/entrez KW - Body mass index KW - Critical care KW - Intensive care unit KW - Nutrition KW - Pediatric SP - 2772 EP - 2783 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 40 IS - 5 N2 - BACKGROUND & AIMS: The association between nutritional status at pediatric intensive care unit (PICU) admission with clinical outcomes remains unclear. We conducted this systematic review to summarize the overall impact of PICU admission body mass index (BMI) on clinical outcomes. METHODS: We searched the following medical databases from inception through May 2020: PubMed, Excerpta Medica database (Embase), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Web of Science. We included studies on patients ≤18 years old admitted to a PICU that investigated the effect of BMI on mortality, PICU or hospital length of stay (LOS), or duration of mechanical ventilation (MV). Classification of underweight, overweight, and obese were based on each study's criteria. RESULTS: There was a total of 21,558 patients from 20 included studies. 12,936 (60.0%), 2965 (13.8%), 2182 (10.1%), 3348 (15.5%) were normal weight, underweight, overweight, and obese patients, respectively. Relative to normal weight patients, underweight (OR 1.32, 95% CI 0.89-1.98; p = 0.171) and overweight/obese patients (OR 1.10, 95% CI 0.86-1.42; p = 0.446) did not have an increase risk in mortality. There was also no difference in duration of MV, PICU and hospital LOS between all three weight categories. Included studies were heterogeneous and lacked standardized nutritional categorization. Sensitivity analysis including only studies that used BMI z-scores as nutritional classification (n = 5) revealed that underweight patients had higher odds of mortality compared to patients with normal weight (OR 1.61, 95% CI 1.35-1.92; p < 0.001); studies that used percentiles as classification did not reveal any differences in mortality. Sensitivity analysis including only studies containing mixed PICU cohorts (i.e., excluding specialized cohorts e.g., congenital heart surgeries, burns) revealed higher mortality odds in underweight patients (OR 1.53, 95% CI 1.25-1.87; p < 0.001) and overweight/obese patients (OR 1.51, 95% CI 1.14-2.01; p = 0.004) relative to normal weight patients. CONCLUSIONS: Our systematic review did not reveal any association between PICU admission BMI status and outcomes in critically ill children. Further investigation with standardized nutrition status classification on admission, stratified by patient subgroups, is needed to clarify the association between nutritional status and clinical outcomes of PICU patients. SN - 1532-1983 UR - https://www.unboundmedicine.com/medline/citation/33933743/Association_between_admission_body_mass_index_and_outcomes_in_critically_ill_children:_A_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0261-5614(21)00202-8 DB - PRIME DP - Unbound Medicine ER -