Pediatric Nutrition in Practice

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

1