Hastanede Yatan Pediatrik Hastalarda Antropometrik Bir Parametre Olarak Adduktör polisis Kas Kalınlığı Ölçümü

Betül Oruçoğlu, Mendane Saka, Özlem Bekem Soylu, Zeynep Akışın

Özet


Özet

Amaç: Adduktör polisis kas kalınlığı (APKK) ölçümü yetişkin ve yaşlı bireylerde vücut kas dokusu ve dolayısıyla yetersiz beslenmenin değerlendirilmesinde kullanılabilen bir yöntemdir. Pediatrik popülasyonda APKK ölçümünün kullanımına ilişkin sınırlı sayıda çalışma bulunmaktadır. Bu çalışma ile hastanede yatan pediatrik hastalarda malnütrisyon durumunun belirlenmesinde Adduktör polisis kas kalınlığı ölçümününün etkinliğinin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Çalışma; Ekim 2019-Mart 2020 tarihleri arasında XXXX Hastanesi’ne yatış işlemi gerçekleştirilen, 4 - 9 yaş aralığında 236 çocuk hastanın dahil edildiği kesitsel bir çalışmadır. Hastaların besin alımları, antropometrik ölçümleri ve APKK ölçümleri kaydedilmiştir. Hastalarda malnütrisyon oluşma riskinin belirlenmesinde STRONGkids (Screening Tool for Risk of impared Nutritional Status and Growth) ve PNRS (Pediatric Nutritional Risk Score), beslenme durumunun değerlendirilmesinde ise SGNA (Subjective Global Nutritional Assessment) pediatrik nütrisyonel tarama araçları kullanılmıştır.

Bulgular: Bireylerin yaş ortalaması 6,29 ± 1,78 yıl olup, %51,7’sini (n=122) kız, %48,3’ünü (n=114) ise erkek hastalar oluşturmaktadır. Hastaların antropometrik ölçümlerinin tümü ile APKK ölçümleri arasında pozitif yönlü ve güçlü bir korelasyon tespit edilmiştir (p<0,05). Adduktör polisis kas kalınlığı ölçümleri ile hastanede yatış süresi arasındaki korelasyon negatif yönlü ve zayıf bulunmuştur (p<0,05). Şiddetli malnütrisyonlu (SGNA ile değerlendirilen) ve beslenme bozukluğı riski yüksek (STRONGKids ve PNRS ile değerlendirilen) hastaların APKK ölçüm değerlerinin daha düşük olduğu saptanmıştır (p<0,05). Adduktör polisis kas kalınlığı (mm) için kesim noktası (SGNA referans standart alındığında) 4,5 mm olup, malnütrisyon tanısı koymadaki duyarlılığı %89,7, seçiciliği %37,0 ve eğri altında kalan alan (AUC) 0,70 (%95 CI: 0,63 – 0,77) bulunmuştur (p<0,05).

Sonuç: Bu çalışma ile APKK ölçümünün hastanede yatan pediyatrik hastalarda yetersiz beslenmenin saptanmasında kullanılabilecek non-invaziv, düşük maliyetli, objektif ve hızlı uygulanan bir yöntem olduğu belirlenmiştir.

Anahtar kelimeler: Pediatrik hastalar, beslenme durumu, malnütrisyon, Adduktör polisis kası

Abstract

Objective: The adductor pollicis muscle thickness (APMT) is a promising method for evaluation of muscle loss and, consequently, malnutrition in adult and elderly patients. There are limited studies on the use of APTM measurement in the pediatric population. In this study, it was aimed to evaluate the effectiveness of APMT measurements in determining malnutrition status in hospitalized pediatric patients.

Material and Methods: This was a cross-sectional study in which 236 pediatric patients aged 4-9 years who were admitted to XXX Hospital were included. Data collection took place between October 2019 and March 2020. Food intake, anthropometric and APMT measurements of the patients were recorded. The STRONGkids (Screening Tool for Risk of Impaired Nutritional Status and Growth), PNRS (Pediatric Nutritional Risk Score), and SGNA (Subjective Global Nutritional Assessment) pediatric nutritional screening tools were used to evaluate the nutritional status of the patients.

Results: The mean age of subjects was 6,29±1,78 years; 51,7% (n=122) were female and 48,3% (n=114) were male. There was a positive correlation between APMT and all anthropometric measurements of the patients (p <0,05).  The longer hospital stay was observed in patients with reduced APMT (p <0,05). There were also significant associations of severe malnutrition (assessed by the SGNA) and high nutritional risk (assessed by the STRONGkids and PNRS) with reduced APMT (p <0,05). The cut-off point for APMT (when SGNA was taken as the reference standard) was 4,5 mm, in diagnosing malnutrition, its sensitivity was 89,7%, specificity was 37,0% and the area under the curve (AUC) was 0,70 (95% CI: 0,63 – 0,77) (p <0,05).

Conclusions: The APMT is a non-invasive, low-cost, objective, and rapid method that can be used in the detection of malnutrition in hospitalized pediatric patients.

Keywords: Pediatric patients, nutritional status, malnutrition, Adductor pollicis muscle thickness


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