Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Nutritional risk in pediatrics by StrongKids: a systematic review

European Journal of Clinical Nutrition volume 73, pages 1441–1449 (2019)Cite this article

Subjects

Abstract

Background/objective

The nutritional risk in hospitalized children and adolescents is a frequent and under-diagnosed reality. There is still no consensus regarding the best nutritional screening method in pediatrics, with StrongKids being one of the existing proposals. A systematic review was performed to evaluate the scientific evidence about StrongKids, with emphasis on the world frequency of nutritional risk, associations of interest in health, validation and reproducibility studies.

Methods

Databases Pubmed, Lilacs, Scielo, ScienceDirect, Web of Science, Scopus and Cochrane Library were searched, using keyword “StrongKids,” without limit on the year of publication, in English, Spanish, and Portuguese.

Results

From 125 papers initially identified, 22 original were included in analysis. The sample size ranged from 43 to 2874, with a maximum of 44 hospitals. The frequency of nutritional risk (medium or high) ranged from 35.7 to 100%. The nutritional risk was mainly associated with acute and/or chronic malnutrition already installed, lower anthropometric indexes and longer length of hospital stay. The method presented satisfactory inter-rater and intra-rater agreements and was validated in the three studies performed with this proposal.

Conclusions

The prevalence of nutritional risk in hospitalized children and adolescents is high. StrongKids is a valid, easy-to-use, and reproducible method, with significant associations of interest in health.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Cao J, Peng L, Li R, Chen Y, Li X, Mo B, et al. Nutritional risk screening and its clinical significance in hospitalized children. Clin Nutr. 2014;33:432–6.

    Article  Google Scholar 

  2. Secker DJ, Jeejeebhoy KN. Subjective Global Nutritional Assessment for children. Am J Clin Nutr. 2007;85:1083–9.

    Article  CAS  Google Scholar 

  3. Joosten KF, Hulst JM. Malnutrition in pediatric hospital patients: current issues. Nutrition. 2011;27:133–7.

    Article  Google Scholar 

  4. Charney P. Nutrition screening vs nutrition assessment: how do they differ? Nutr Clin Pract. 2008;23:366–72.5.

    Article  Google Scholar 

  5. Joosten KF, Hulst JM. Nutritional screening tools for hospitalized children: methodological considerations. Clin Nutr. 2014;33:1–5.

    Article  Google Scholar 

  6. Reilly HM, Martineau JK, Moran A, Kennedy H. Nutritional screening - evaluation and implementation of a simple nutrition risk score. Clin Nutr. 1995;14:269–73.

    Article  CAS  Google Scholar 

  7. Sermet-Gaudelus I, Poisson-Salomon AS, Colomb V, Brusset MC, Mosser F, Berrier F, et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr. 2000;72:64–70.

    Article  CAS  Google Scholar 

  8. McCarthy H, Dixon M, Crabtree I, Eaton-Evans MJ, McNulty H. The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) for use by healthcare staff. J Hum Nutr Diet. 2012;25:311–8.

    Article  CAS  Google Scholar 

  9. Gerasimidis K, Keane O, Macleod I, Flynn DM, Wright CM. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr. 2010;104:751–6.

    Article  CAS  Google Scholar 

  10. Hulst JM, Zwart H, Hop WC, Joosten KF. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr. 2010;29:106–11.

    Article  Google Scholar 

  11. Teixeira AF, Viana KDAL. Nutritional screening in hospitalized pediatric patients: a systematic review. J Pediatr. 2016;92:343–52.

    Article  Google Scholar 

  12. Ling RE, Hedges V, Sullivan PB. Nutritional risk in hospitalised children: an assessment of two instruments. e-Spen. 2011;6:e153–e157.

    Article  Google Scholar 

  13. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. Available from: www.prisma-statement.org.

  14. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  CAS  Google Scholar 

  15. Song T, Mu Y, Gong X, Ma W, Li L. Screening for nutritional risk in hospitalized children with liver disease. Asia Pac J Clin Nutr. 2017;26:1107–12.

    CAS  PubMed  Google Scholar 

  16. Beser OF, Cokugras FC, Erkan T, Kutlu T, Yagci RV. Evaluation of malnutrition development risk in hospitalized children. Nutrition. 2018;48:40–7.

    Article  Google Scholar 

  17. Bang YK, Park MK, Ju YS, Cho KY Clinical significance of nutritional risk screening tool for hospitalised children with acute burn injuries: a cross-sectional study. J Hum Nutr Diet. 2017. https://doi.org/10.1111/jhn.12518.

  18. Li D, Chen X, Fu K, Yang J, Feng J. Preoperative nutritional status and its impact on cholangitis after Kasai portoenterostomy in biliary atresia patients. Pediatr Surg Int. 2017;33:901–6.

    Article  Google Scholar 

  19. Galera-Martínez R, Moráis-López A, Rivero de la Rosa MD, Escartín-Madurga L, López-Ruzafa E, Ros-Arnal I, et al. Reproducibility and inter-rater reliability of 2 paediatric nutritional screening tools. J Pediatr Gastroenterol Nutr. 2017;64:e65–e70.

    Article  Google Scholar 

  20. Chourdakis M, Hecht C, Gerasimidis K, Joosten KF, Karagiozoglou-Lampoudi T, Koetse HA, et al. Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population. Am J Clin Nutr. 2016;103:1301–10.

    Article  CAS  Google Scholar 

  21. Campos LSK, Neumann LD, Rabito EI, de Mello ED, Vallandro JP. Nutritional risk assessment in hospitalized children: a comparison of pediatric subjective global assessment and STRONGkids screening tool with anthropometric indicators. Sci Med. 2015;25:ID21948.

    Article  Google Scholar 

  22. Costa MV, Pastore CA. Herramienta de cribado nutricional versus valoración nutricional antropométrica de niños hospitalizados: cuál método se asocia mejor con la evolución clínica? Arch Latinoam Nutr. 2015;65:12–20.

    Google Scholar 

  23. Mărginean O, Pitea AM, Voidăzan S, Mărginean C. Prevalence and assessment of malnutrition risk among hospitalized children in Romania. J Health Popul Nutr. 2014;32:97–102.

    PubMed  PubMed Central  Google Scholar 

  24. Moeeni V, Walls T, Day AS. Nutritional status and nutrition risk screening in hospitalized children in New Zealand. Acta Paediatr. 2013;102:e419–23.

    Article  Google Scholar 

  25. Huysentruyt K, Alliet P, Muyshont L, Rossignol R, Devreker T, Bontems P, et al. The STRONG(kids) nutritional screening tool in hospitalized children: a validation study. Nutrition. 2013;29:1356–61.

    Article  Google Scholar 

  26. Moeeni V, Walls T, Day AS. Assessment of nutritional status and nutritional risk in hospitalized Iranian children. Acta Paediatr. 2012;101:e446–51.

    Article  Google Scholar 

  27. Vallandro JP, da Silveira Klein Campos L, Neumann LD, de Mello ED Adductor muscle thickness of the thumb: a new and reliable parameter for nutritional assessment of pediatric inpatients. Clin Nutr. 2018; pii: S0261-5614(18)30073-6. https://doi.org/10.1016/j.clnu.2018.02.010.

  28. Durakbaşa ÇU, Fettahoğlu S, Bayar A, Mutus M, Okur H. The prevalence of malnutrition and effectiveness of STRONGkids tool in the identification of malnutrition risks among pediatric surgical patients. Balk Med J. 2014;31:313–21.

    Article  Google Scholar 

  29. Spagnuolo MI, Liguoro I, Chiatto F, Mambretti D, Guarino A. Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting. Ital J Pediatr. 2013;39:81.

    Article  Google Scholar 

  30. Oliveira TC, Albuquerque IZ, Stringhini MLF, Mortoza AS, Morais BA. The nutritional status of hospitalized children and adolescents: a comparison between two nutritional assessment tools with anthropometric parameters. Rev Paul Pediatr. 2017;35:273–80.

    Article  Google Scholar 

  31. Joosten K, van der Velde K, Joosten P, Rutten H, Hulst J, Dulfer K. Association between nutritional status and subjective health status in chronically ill children attending special schools. Qual Life Res. 2016;25:969–77.

    Article  Google Scholar 

  32. Moeeni V, Walls T, Day AS. The STRONGkids nutritional risk screening tool can be used by paediatric nurses to identify hospitalised children at risk. Acta Paediatr. 2014;103:e528–31.

    Article  Google Scholar 

  33. Wiskin AE, Owens DR, Cornelius VR, Wootton SA, Beattie RM. Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. J Hum Nutr Diet. 2012;25:319–22.

    Article  CAS  Google Scholar 

  34. Kramer CV, Allen S. Malnutrition in developing countries. Paediatr Child Health. 2015;25:422–7.

    Article  Google Scholar 

  35. Amaral TF, Matos LC, Tavares MM, Subtil A, Martins R, Nazaré M, et al. The economic impact of disease-related malnutrition at hospital admission. Clin Nutr. 2007;26:778–84.

    Article  Google Scholar 

  36. Guest JF, Panca M, Baeyens JP, de Man F, Ljungqvist O, Pichard C, et al. Health economic impact of managing patients following a community-based diagnosis of malnutrition in the UK. Clin Nutr. 2011;30:422–9.

    Article  Google Scholar 

  37. Maxim LD, Niebo R, Utell MJ. Screening tests: a review with examples. Inhal Toxicol. 2014;26:811–28.

    Article  CAS  Google Scholar 

  38. Skipper A, Ferguson M, Thompson K, Castellanos VH, Porcari J. Nutrition screening tools: an analysis of the evidence. JPEN J Parenter Enter Nutr. 2012;36:292–8.

    Article  Google Scholar 

Download references

Author contributions

CAS had primary responsibility for the review protocol development, carried out the literature search, extracted the data, and wrote the manuscript. AQR: carried out the literature search, extracted the data, and the wrote the manuscript. COBR: participated in the selection of articles and in the preparation of the manuscript. VEA: revised the data analysis and wrote the manuscript. SCCF: supervised the design and the execution of the review. All authors have read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Federal University of Viçosa, Minas Gerais, Brazil

    Carolina Araújo dos Santos, Andréia Queiroz Ribeiro, Carla de Oliveira Barbosa Rosa & Sylvia do Carmo Castro Franceschini

  2. Pontifical Catholic University of Minas Gerais, Minas Gerais, Brazil

    Vânia Eloisa de Araújo

Authors
  1. Carolina Araújo dos Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andréia Queiroz Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carla de Oliveira Barbosa Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vânia Eloisa de Araújo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sylvia do Carmo Castro Franceschini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carolina Araújo dos Santos.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

dos Santos, C.A., Ribeiro, A.Q., Rosa, C.d.O.B. et al. Nutritional risk in pediatrics by StrongKids: a systematic review. Eur J Clin Nutr 73, 1441–1449 (2019). https://doi.org/10.1038/s41430-018-0293-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-018-0293-9

This article is cited by

Search

Advanced search

Quick links