Registered Dietitian Nutritionist Consultation Is Associated With Improvement in Nutritional Status in Chronically Ill Children: A Retrospective, Cohort Study

IF 5.2 2区医学 Q2 NUTRITION & DIETETICS

Journal of the Academy of Nutrition and Dietetics Pub Date : 2025-11-01 Epub Date: 2025-05-28 DOI:10.1016/j.jand.2025.05.011

Mary Beth Feuling MS, RD , Julia Hilbrands MS, MPH, RD, CSP , Kyndal Hettich MS, RD-AP , Jessica Kopesky MS, RD , Nicole Martin RD, CSP , Regina McCarthy MS, RD , Kristen Osinski MS , Rebecca Pipkorn RD , Amber Smith MBA , Rodney A. Sparapani PhD , Bi Q. Teng MS , Praveen S. Goday MBBS, FAAP

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引用次数: 0

Abstract

Background

The influence of care provided by a registered dietitian nutritionist (RDN) to malnourished children is not well described.

Objective

To compare nutrition outcomes of malnourished, chronically ill children with and without RDN involvement in outpatient care.

Design

Retrospective cohort study of malnourished children who had ≥1 complex chronic condition with a follow-up period of at least 2 years during which improvement in body mass index-for-age z score (BMIz) and clinical outcomes were assessed.

Participants

Chronically ill children initially aged 2 to 5 years with malnutrition were divided into those seen (RDN group) or not seen (non-RDN group) by an RDN in an outpatient setting 60 days from the nadir BMIz. Of 841 patients, 240 (28.5%) were in the RDN group vs 601 patients (71.5%) in the non-RDN group.

Main outcome measures

Changes in BMIz at 6 months and 2 years and clinical outcomes (number of hospitalizations, total hospital days, and total procedure days) between 6 months and 2 years.

Statistical analyses performed

Group differences were tested using the Wilcoxon rank-sum test and Pearson χ² test. A regression mixed model analysis of the BMIz outcome estimating the RDN group effect while adjusting for confounders was performed.

Results

Patients in the RDN group had worse median BMIz at baseline (–2.08) vs the non-RDN group (–1.80) (P = .0002) and more chronic illnesses throughout the study period. BMIz progressed in both groups, although improvements in BMIz were better in the RDN group (all P values < .05). The clinical outcomes were all worse in the RDN group (P < .0001). The regression mixed model found a 0.14 BMIz improvement for the RDN group (P = .0057).

Conclusions

Despite being more malnourished and sicker overall, an RDN visit for chronically ill, malnourished children was associated with an improvement in BMIz but not with other clinical outcomes.

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注册营养师咨询与慢性病儿童营养状况改善相关：一项回顾性队列研究。

背景：注册营养师（RDN）提供的护理对营养不良儿童的影响尚未得到很好的描述。目的：比较有和没有注册营养师（RDN）参与门诊护理的营养不良、慢性疾病儿童的营养结局。设计：对患有≥1种复杂慢性疾病（CCC）的营养不良儿童进行回顾性队列研究，随访至少2年，评估bmi -年龄z评分（BMIz）的改善情况和临床结果。参与者：年龄为2-5岁的营养不良慢性疾病儿童被分为观察组（RDN组）和未观察组（非RDN组）。在841例患者中，240例（28.5%）属于RDN组，601例（71.5%）属于非RDN组。主要结局指标：6个月和2年的bmi变化以及6个月至2年的临床结局（住院次数、总住院天数和总手术天数）。进行统计学分析：采用Wilcoxon秩和检验和Pearson卡方检验检验组间差异。对BMIz结果进行回归混合模型分析，估计RDN组效应，同时调整混杂因素。结果：与非RDN组（-1.80）相比，RDN组患者在基线时的中位bmz（-2.08）更差（p值= 0.0002），并且在整个研究期间有更多的慢性疾病。两组的BMIz都有进展，尽管RDN组的BMIz改善更好(所有p值结论：尽管总体上更营养不良，慢性疾病，营养不良儿童的RDN访问与BMIz改善有关，但与其他临床结果无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the Academy of Nutrition and Dietetics NUTRITION & DIETETICS-

CiteScore

7.20

自引率

10.40%

发文量

649

审稿时长

68 days

期刊介绍： The Journal of the Academy of Nutrition and Dietetics is the premier source for the practice and science of food, nutrition, and dietetics. The monthly, peer-reviewed journal presents original articles prepared by scholars and practitioners and is the most widely read professional publication in the field. The Journal focuses on advancing professional knowledge across the range of research and practice issues such as: nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, foodservice systems, leadership and management, and dietetics education.