Low Total Lymphocyte Count as the Risk of Hospital Acquired Malnutrition in Children

Dian Sulistya Ekaputri, I Gusti Lanang Sidiartha, I Gusti Ayu Putu Eka Pratiwi


Background: Hospital Acquired Malnutrition (HAM) is characterized by inadequate nutritional therapy and the risk of developing malnutrition during the hospital stay. In clinical practice, there are many measurements to determine nutritional status. Total lymphocyte count (TLC) is associated with impaired function of immune system in malnutrition. The purpose of this study was to evaluate the prognostic value of TLC to the occurrence of HAM in pediatric patients.

Materials and Methods: This an observational study with a prospective cohort design. Subjects were assessed for weight at the first day of hospitalization, then the subjects were followed until they were discharged. Body weight was re-measured on discharge to determine the presence or absence of HAM. This research was conducted at Sanglah Hospital from May-December 2019. Subjects who met the inclusion and exclusion criteria were enrolled in the study.

Results: Among 120 subjects, 55 subjects or 45.8% were malnourished on admission. Subjects with a low TLC compared to a normal TLC had a 3.9-fold risk of experiencing hospital acquired malnutrition (95% Confidence Interval: 1.59 to 7.19, p=0.001). Subjects who had a low TLC had HAM of 61.8%, while subjects who had a normal TLC had HAM of 32.3%. In multivariate analysis, low TLC was the only risk factor for HAM in this research.

Conclusion: This study proved that low TLC is the risk of HAM. Total lymphocyte count could be used as predictor of the risk of HAM in hospitalization children.

Keywords: hospital malnutrition, total lymphocyte, children

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Ghosh-Jerath S, Singh A, Jerath N, Gupta S, Racine EF. Undernutrition and severe acute malnutrition in children. BMJ. 2017; 359: j4877-88, CrossRef.

Sidiartha IGL. Insidens Malnutrisi Rawat Inap pada Anak Balita di Rumah Sakit Umum Pusat Sanglah Denpasar. Sari Pediatri. 2016; 9(6): 381, CrossRef.

Juliaty A. Malnutrisi rumah sakit pada bangsal anak Rumah Sakit Dr. Wahidin Sudirohusodo Makassar. Sari Pediatri. 2016; 15(2): 65-9, CrossRef.

Beser OF, Cokugras FC, Erkan T, Kutlu T, Yagci, RV. Evaluation of malnutrition development risk in hospitalized children. Nutr J. 2018; 48: 40-7, CrossRef.

McCarthy A, Delvin E, Marcil V, Belanger V, Marchand V, Boctor D, et al. Prevalence of malnutrition in pediatric hospitals in developed and in-transition countries: the impact of hospital practices. Nutrients. 2019; 11(2): 1-18, CrossRef.

Walker WA, Watkins JB, Duggan C. Nutrition in pediatrics. Basic science and clinical applications. 4th ed. London: BC Decker; 2008, article.

Tyastarini AT, Saraswati MR. Hubungan jumlah limfosit total dengan status nutrisi pada pasien diabetes melitus tipe 2 rawat inap di Rumah Sakit Umum Pusat Sanglah Denpasar tahun 2014. E Jurn Med. 2017; 6(8): 1-8, article.

Nah EH, Kim S, Cho S, Cho HI. Complete blood count reference intervals and patterns of changes across pediatric, adult, and geriatric ages in korea. Ann Lab Med. 2018; 38(6): 503-11, CrossRef.

Gouveia MAC, Silva GAP. Hospital malnutrition in pediatric patients: a review. Ann Nutr Disord & Ther. 2017; 4(2): 1042-8, CrossRef.

Tuokkola J, Hilpi J, Kolho KL, Orell H, Merras-Salmio L. Nutritional risk screening-a cross-sectional study in a tertiary pediatric hospital. J Health Popul Nutr. 2019; 38(1): 8, CrossRef.

Ong SH, Chee WSS, Lapchmanan LM, Ong SN, Lua ZC, Yeo JX. Validation of the subjective global nutrition assessment (SGNA) and screening tool for the assessment of malnutrition in paediatrics (STAMP) to identify malnutrition in hospitalized Malaysian children. J Trop Pediatr. 2019; 65(1): 39-45, CrossRef.

Ibrahim MK, Zambruni M, Melby CL, Melby PC. Impact of childhood malnutrition on host defense and infection. Clin Microbiol Rev. 2017; 30(4): 919-71, CrossRef.

Keller U. Nutritional laboratory markers in malnutrition. J Clin Med. 2019; 8(6): 775, CrossRef.

Rocha NP, Fortes RC. Total lymphocyte count and serum albumin as predictors of nutritional risk in surgical patients. Arq Bras Cir Dig. 2015; 28(3): 193-6, CrossRef.

González Madroño A, Mancha A, Rodríguez FJ, de Ulibarri JI, Culebras J. The use of biochemical and immunological parameters in nutritional screening and assessment. Nutr Hosp. 2011; 26(3): 594-601, CrossRef.

Naess A, Nilssen SS, Mo R, Eide GE, Sjursen H. Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection. 2017; 45(3): 299-307, CrossRef.

Hecht C, Weber M, Grote V, Daskalou E, Dell'Era L, Flynn D, et al. Disease associated malnutrition correlates with length of hospital stay in children. Clin Nutr. 2015; 34(1): 53-9, CrossRef.

Cohen S, Danzaki K, Maciver NJ. Nutritional effects on T‐cell immunometabolism. Eur J of Immunol. 2017; 47(2): 225-35, CrossRef.

DOI: https://doi.org/10.21705/mcbs.v5i2.191

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Cell and BioPharmaceutical Institute