Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit

Clinics (Sao Paulo). 2008 Jun;63(3):357-62. doi: 10.1590/s1807-59322008000300012.


Critical illness has a major impact on the nutritional status of both children and adults. A retrospective study was conducted to evaluate the incidence of hospital malnutrition at a pediatric tertiary intensive care unit (PICU). Serum concentrations of IL-6 in subgroups of well-nourished and malnourished patients were also evaluated in an attempt to identify those with a potential nutritional risk.

Methods: A total of 1077 patients were enrolled. Nutritional status was evaluated by Z-score (weight for age). We compared mortality, sepsis incidence, and length of hospital stay for nourished and malnourished patients. We had a subgroup of 15 patients with severe malnutrition (MN) and another with 14 well-nourished patients (WN). Cytokine IL-6 determinations were performed by enzyme-linked immunosorbent assay.

Results: 53% of patients were classified with moderate or severe malnutrition. Similar amounts of C- reactive protein (CRP) were observed in WN and MN patients. Both groups were able to increase IL-6 concentrations in response to inflammatory systemic response and the levels followed a similar evolution during the study. However, the mean values of serum IL-6 were significantly different between WN and MN patients across time, throughout the study (p = 0.043).

Discussion: a considerable proportion of malnourished patients need specialized nutritional therapy during an intensive care unit (ICU) stay. Malnutrition in children remains largely unrecognized by healthcare workers on admission.

Conclusions: The incidence of malnutrition was very high. Malnourished patients maintain the capacity to release inflammatory markers such as CRP and IL-6, which can be considered favorable for combating infections On the other hand, this capacity might also have a significant impact on nutritional status during hospitalization.

MeSH terms

  • Adolescent
  • Biomarkers / blood
  • C-Reactive Protein / analysis
  • Child
  • Child, Preschool
  • Critical Illness / epidemiology*
  • Enzyme-Linked Immunosorbent Assay
  • Humans
  • Incidence
  • Intensive Care Units, Pediatric / statistics & numerical data*
  • Interleukin-6 / blood*
  • Length of Stay
  • Malnutrition / blood
  • Malnutrition / epidemiology*
  • Nutritional Status / physiology
  • Retrospective Studies
  • Sepsis / epidemiology
  • Severity of Illness Index
  • Time Factors


  • Biomarkers
  • Interleukin-6
  • C-Reactive Protein