TABLE 3.

Overview of nutritional assessment in pediatric chronic disease

Chronic disease	Anthropometric measurement	Problems in nutritional assessment	Etiology of malnutrition	Management and monitoring
Congenital heart disease	Weight-for-age (newborn)	•Fluid overload •Feeding intolerance •Water restriction	Hypermetabolic state	Diet
	Height-for-age (newborn)		Catabolic stress	Infants: breastmilk
	Weight-for-length			Perioperative: high-calorie formula
	TSFT			Immediate postoperative (0–3 d): nutrition 35–65/kg/d with reduction of REE
	MUAC
CKD	LM	•Muscle deficit •Water retention •Overestimation of lean mass •Underestimation of fat and protein mass	Toxin accumulation	Diet
	FM		Reduced satiety	Infants: breastmilk
	BMI		Nutrient depletion	Regular formula
	Skinfold thickness		Protein-energy wasting	Lower protein diet of 0.6–0.8 g/kg/d
	MUAC		Iron deficiency anemia	Restricted potassium: 40–120 mg/kg/d for infants, 30–40mg/kg/d for older children.
	DXA			Restricted sodium: 1500–2400 mg/d
	Isotope dilution			Periodic check-up: 3–4 mo
				Regular urine analysis
CLD	TSFT	•Ascites •Edema •Enlarged liver	Decreased in consumption	Diet
	Arm anthropometry		Increased energy requirements	Infants: breastmilk
	BMI		Fat malabsorption	Formula with <75% MCT
	DXA			Carbohydrate: 6–8 g/kg/d
				Protein: 2.5–3 g/kg/d
				Fat: 5–6 g/kg/d
Cancer	MUAC	•Tumor mass •Hydration (during chemotherapy) •Wasting of fat and skeletal muscle	Cancer cachexia	Diet
	TSFT		Increased nutrient requirements	Infants: breastmilk
	DXA		Therapy-induced toxicity	High-calorie formulas
				Individualized nutritional care plan (based on ideal body weight, BMI, and estimated energy needs)
				Screening nutrition status: every 4 wk

BMI, body mass index; CKD, chronic kidney disease; DXA, dual-energy X-ray absorptiometry; FM, fat mass; LM, lean mass; MCT, medium-chain triglyceride; MUAC, middle upper-arm circumference; REE, resting energy expenditure; TSFT, triceps skinfold thickness.