1 Specific Aspects of Childhood Nutrition
Key Words
Protein · Vitamin · Laboratory test · Malabsorption ·
Deficiency
Key Messages
- Identification and prevention of malnutrition is cru-
cial in the ill child - An understanding of the relationship between
measures of visceral protein status and inflamma-
tory responses and changes in fluid status is key
to avoid misinterpretation - The approach to evaluating vitamin deficiency
should be determined by an understanding of
predisposing conditions © 2015 S. Karger AG, Basel
Introduction
Laboratory tests may aid in the diagnosis of pri-
mary childhood malnutrition (resulting from in-
adequate intake) and are invaluable in guiding
therapeutic decisions in secondary malnutrition
(resulting from conditions of increased need for
or losses of substrate). Because nutritional status
is an independent predictor of outcome in the
sick child, strict attention to indicators of visceral
protein stores and vitamin or mineral deficiencies
is imperative.
Although signs and symptoms of specific nu-
trient deficiencies commonly overlap and multi-
ple deficiencies are frequently encountered, a ju-
dicious approach to ordering laboratory tests is
recommended. While a rather comprehensive list
of laboratory tests is presented here, clinical sus-
picion should guide the selection of specific in-
vestigations. Depending on the clinical labora-
tory facilities, turnaround time on certain tests
may preclude their usefulness in the acute set-
ting. Familiarity with these limitations will help
to avoid ordering tests that do not contribute
meaningfully to the management of a child. Ta-
ble 1 provides a summary of the laboratory tests
discussed here, including their normal values,
signs and symptoms of the deficiency state, and
pitfalls to avoid in their interpretation.
P r o t e i n
Assessment of visceral protein stores is commonly
made by measuring serum proteins ( table 2 ), most
commonly albumin, prealbumin (transthyretin)
and retinol-binding protein. Interpretation of
Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 23–28
DOI: 10.1159/000360314
1.2 Nutritional Assessment
1.2.4 Use of Laboratory Measurements in
Nutritional Assessment
Ryan W. Himes Robert J. Shulman