Impact of the HAS 2019 French guidelines on the frequency of hospital undernutrition in children

In 2019, the French National Authority for Health (Haute Autorit ⠂e de Sant ⠂e, HAS) published guidelines on the diagnosis of undernutrition. The present article focuses on the impact of switching from the 2012 guidelines of the Nutrition Committee of the French Paediatric Society (CNSFP) to the HAS guidelines on the frequency of hospital undernutrition in children. We selected for the period 2010-2019 from the ePINUT database: (1) all children aged more than 2 years with (2) clinically confirmed nutritional status in (3) French sites. The frequency of undernutrition was 15.4% vs. 28.8% using the CNSFP and HAS criteria, respectively (p < 0.01; n = 6304). When compared to non-malnourished children regardless of the criteria used, malnourished children: (1) stayed longer in hospital (CNSFP: 9.0 & PLUSMN; 11.8 vs. 6.5 & PLUSMN; 8.7 days, p < 0.01; HAS: 7.8 & PLUSMN; 10.1 vs. 6.4 & PLUSMN; 8.4 days, p < 0.01), (2) gained more weight during hospitalization (% of weight at admission) (CNSFP: +1.4 & PLUSMN; 4.1 vs. -0.3 & PLUSMN; 3.5%, p < 0.01; HAS: +2.3 & PLUSMN; 4.7 vs. -0.1 & PLUSMN; 3.4%, p < 0.01), and (3) received nutritional support more frequently during hospitalization (CNSFP: 20% vs. 5%, p < 0.01; HAS: 13% vs. 4%, p < 0.01). Switching to the HAS guidelines resulted in an almost twofold higher frequency of undernutrition in hospitalized children. Initiation of nutritional care remained low considering the nutritional status. The present study warrants interventional studies to determine which children may benefit more from nutritional therapy to improve their outcome. & COPY; 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

Automated summary

In 2019, the French National Authority for Health (HAS) published guidelines on the diagnosis of undernutrition. This study aimed to assess the impact of switching from the 2012 guidelines of the Nutrition Committee of the French Paediatric Society (CNSFP) to the HAS guidelines on the frequency of hospital undernutrition in children. The results showed that the frequency of undernutrition increased almost twofold when using the HAS criteria compared to the CNSFP criteria. Malnourished children had longer hospital stays, gained more weight during hospitalization, and received nutritional support more frequently.