Application of data normalization in the analysis and screening of the nutritional status and malnutrition risks in pediatric patients with acute lymphoblastic leukemia

Abstract

Objective To evaluate the nutrional status and malnutrition risks of hospitalized children with acute lymphoblastic leukemia (ALL), provide nutrition support for subsequent treatment, lower nutritional risks and improve therapeutic effects; to complete the statistical analysis of height and weight across age through data normalization. Methods A total of 592 children diagnosed ALL from August 2014 to September 2016 at Beijing Children's Hospital were enrolled, and the directly measured height and weight which reflected the nutritional status of children were collected and normalized. Nutritional risk screening was completed by STAMP screening tool and the nutritional status was evaluated by three Z scores HAZ<-2, WAZ<-2 and WHZ<-2. The effects of nutrition intervention were investigated by weight, hemoglobin and albumin changes between before and after L-asp treatment. Results The Z score test showed that there was no significant difference between the nutritional status of pretreatment ALL patients(0.34% growth retardation, 2.36% lower body weight, 0.17% emaciation) and normal healthy children (3% malnutrition); after comparing the STAMP nutritional risk assessment and t test results for children with ALL, it was found that the proportion of children with high malnutrition risk ( score≥4 ) was 9.71%, which had a strong correlation with body mass index; the children with body mass index less than 0.80(50% children having malnutrition) or greater than 1.30(20% children having malnutrition) had a higher risk of malnutrition, and the body mass indexof the high-risk group(0.852 kg/m2) were significantly lower than that of the low risk group(1.051 kg/m2, score≤3 ); there were significant differences in height and weight between children with STAMP≤3 and STAMP≥4 (all P<0.05) Nutritional interventions made no significant weight change during treatment; For children with STAMP≤3 and STAMP≥4 in L-asp treatment, the hemoglobin value changed from (87.46±19.27)g/L to (95.12±13.51)g/L and (101.55±21.97)g/L to (95.05±11.22)g/L respectively (all P=0.001); The albumin of children with STAMP≤3 changed from (40.63±4.149)g/L to (41.20±5.266)g/L in treatment and that of children with STAMP≥4 changed from (40.96±8.429)g/L to (42.17±3.574)g/L in treatment(P=0.20, 0.05). Conclusion There are no obvious indications of malnutrition in children with ALL, but nearly 10 % of them have malnutrition risks. Special dietary guidance is needed during the treatment. Nutrition intervention is effective in the treatment of L-asp. Normalized data is more convenient to use in statistical analysis with more accurate results, which can be used as a supplementary method for cross-age group statistical analysis of children's height, weight and other parameters. Key words: Malnutrition; Risk screening; Evaluation; Data normalization