Nutritional risk and nutritional status in children with surgical disorders of the intestine and anorectal region: rationale for perioperative nutritional support
TL;DR
STRONGkids screening at admission should be combined with anthropometric assessment and, when indicated in older children, body-composition analysis, because of the high prevalence of nutritional risk, malnutrition, and deficits in metabolically active body compartments.
Abstract
Background
Nutritional abnormalities in children undergoing surgery for intestinal and anorectal disorders may remain unrecognized when assessment is limited to body weight and height and may progress during surgical treatment. Combining nutritional-risk screening with assessment of actual nutritional status allows determination of the scope of examination and timely planning of support in the perioperative period.
Aim
To assess nutritional risk at admission in children with diseases of the intestine and anorectal region, characterize nutritional status and its changes in the perioperative period, and, based on the findings, substantiate an algorithm for nutritional support.
Methods
This prospective single-center observational study included 50 children aged 6 months to 17 years 9 months (median 2.9 years) treated from September 2023 to January 2025. Nutritional risk was determined within the first 24 hours after admission using the Russian-language version of STRONGkids tool. Anthropometric indices and serum total protein, albumin, prealbumin, transferrin, and C-reactive protein were assessed at admission and on postoperative day 7. Bioelectrical impedance analysis was performed in 21 children older than 5 years. The total duration of treatment and the duration of the stages of the perioperative period were recorded separately.
Results
Moderate nutritional risk was identified in 22 children (44%) and high risk in 25 (50%); malnutrition was present in 12 (24%), and growth retardation in 5 (10%). The STRONGkids score was inversely correlated with body mass index-for-age z score (rs = –0.51, n = 48, p 0.001). Among 21 children assessed by bioelectrical impedance, lean-mass deficit was found in 12 (57%) and active-cell-mass deficit in 14 (67%); the corresponding mean z scores were –1.2 and –1.6. Serum transport proteins were not sufficient as stand-alone criteria for malnutrition. Hospitalization and its individual stages were longer in patients at high nutritional risk.
Conclusion
STRONGkids screening at admission should be combined with anthropometric assessment and, when indicated in older children, body-composition analysis. The high prevalence of nutritional risk, malnutrition, and deficits in metabolically active body compartments supports early individualized, predominantly oral or enteral, nutritional support that continues after surgery.