Volume 132, Issue 7 pp. 1482-1486

Original Reports

Demographic Risk Factors for Malnutrition in Patients With Cleft Lip and Palate

Zahrah M. Taufique MD, MBA,

Zahrah M. Taufique MD, MBA

orcid.org/0000-0001-6867-0666

ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.

Department of Otolaryngology – Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A.

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Paul J. Escher BA,

Paul J. Escher BA

University of Minnesota School of Medicine, Minneapolis, Minnesota, U.S.A.

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Tyler J. Gathman BS,

Tyler J. Gathman BS

orcid.org/0000-0002-3138-7469

University of Minnesota School of Medicine, Minneapolis, Minnesota, U.S.A.

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Amanda J. Nickel MPH,

Amanda J. Nickel MPH

Children's Research Institute, Children's Minnesota, Minneapolis, Minnesota, U.S.A.

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Daniel B. Lee PhD,

Daniel B. Lee PhD

Amherst H. Wilder Foundation, Saint Paul, Minnesota, U.S.A.

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Brianne B. Roby MD,

Brianne B. Roby MD

orcid.org/0000-0001-7244-3247

ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.

Department of Otolaryngology – Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A.

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Sivakumar Chinnadurai MD, MPH,

Corresponding Author

Sivakumar Chinnadurai MD, MPH

[email protected]

orcid.org/0000-0003-3966-3189

ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.

Department of Otolaryngology – Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A.

Send correspondence to Siva Chinnadurai, MD, MPH, Children's Minnesota ENT and Facial Plastic Surgery Clinic, 2530 Chicago Ave STE 450, Minneapolis, MN 55404. E-mail: [email protected]

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Zahrah M. Taufique MD, MBA,

Zahrah M. Taufique MD, MBA

orcid.org/0000-0001-6867-0666

ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.

Department of Otolaryngology – Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A.

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Paul J. Escher BA,

Paul J. Escher BA

University of Minnesota School of Medicine, Minneapolis, Minnesota, U.S.A.

Search for more papers by this author

Tyler J. Gathman BS,

Tyler J. Gathman BS

orcid.org/0000-0002-3138-7469

University of Minnesota School of Medicine, Minneapolis, Minnesota, U.S.A.

Search for more papers by this author

Amanda J. Nickel MPH,

Amanda J. Nickel MPH

Children's Research Institute, Children's Minnesota, Minneapolis, Minnesota, U.S.A.

Search for more papers by this author

Daniel B. Lee PhD,

Daniel B. Lee PhD

Amherst H. Wilder Foundation, Saint Paul, Minnesota, U.S.A.

Search for more papers by this author

Brianne B. Roby MD,

Brianne B. Roby MD

orcid.org/0000-0001-7244-3247

ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.

Department of Otolaryngology – Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A.

Search for more papers by this author

Sivakumar Chinnadurai MD, MPH,

Corresponding Author

Sivakumar Chinnadurai MD, MPH

[email protected]

orcid.org/0000-0003-3966-3189

ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.

Department of Otolaryngology – Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A.

Send correspondence to Siva Chinnadurai, MD, MPH, Children's Minnesota ENT and Facial Plastic Surgery Clinic, 2530 Chicago Ave STE 450, Minneapolis, MN 55404. E-mail: [email protected]

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First published: 19 October 2021

https://doi.org/10.1002/lary.29899

Citations: 3

Editor's Note: This Manuscript was accepted for publication on October 5, 2021.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Abstract

Objectives/Hypothesis

Patients with cleft lip and/or palate (CLP) are at increased risk of malnutrition. Acute and chronic malnutrition have been associated with elevated risk of postsurgical wound complications, adding morbidity and cost to patients and their families. To study the association between demographic factors, including insurance type, race, and median neighborhood income (MNI), and malnutrition in patients with CLP.

Study Design

Retrospective cohort study.

Methods

Retrospective review was performed in patients undergoing their first cleft-related surgery at a large tertiary pediatric hospital from 2006 to 2018. Demographic data, weight and height at surgery, type of insurance, race, and primary residential address were collected. Geocoded information on MNI was generated using patient address. World Health Organization Z-scores for weight-for-age (WFA) and height-for-age (HFA) were used as proxies for acute and chronic malnutrition, respectively. Linear regression models were generated to analyze the relationship of insurance type, race, and MNI on WFA and HFA Z-scores.

Results

About 313 patients met inclusion criteria. Increasing MNI predicted increasing WFA Z-score (0.05 increase in WFA per $1,000 increase, P = .047) as well as HFA Z-score (0.09 increase in HFA per $1,000 increase, P = .011). The effect of MNI was not independently modified by race for either WFA (P = .841) nor HFA (P = .404). Race and insurance type did not predict WFA or HFA.

Conclusions

Lower MNI is a significant independent risk factor for acute and chronic malnutrition in children with CLP. Combined with previous investigation linking malnutrition to surgical outcomes in this population, this offers a target area for intervention to improve patient outcomes.

Level of Evidence

3 Laryngoscope, 132:1482–1486, 2022

BIBLIOGRAPHY

1Tanaka SA, Mahabir RC, Jupiter DC, Menezes JM. Updating the epidemiology of cleft lip with or without cleft palate. Plast Reconstr Surg 2012; 129: 511e–518e.
10.1097/PRS.0b013e3182402dd1
CAS PubMed Web of Science® Google Scholar
2Dixon MJ, Marazita ML, Beaty TH, Murray JC. Cleft lip and palate: understanding genetic and environmental influences. Nat Rev Genet 2011; 12: 167–178.
10.1038/nrg2933
CAS PubMed Web of Science® Google Scholar
3Baylis AL, Pearson GD, Hall C, et al. A quality improvement initiative to improve feeding and growth of infants with cleft lip and/or palate. Cleft Palate Craniofac J 2018; 55: 1218–1224.
10.1177/1055665618766058
PubMed Web of Science® Google Scholar
4Escher PJ, Zavala H, Lee D, Roby BB, Chinnadurai S. Malnutrition as a risk factor in cleft lip and palate surgery. Laryngoscope 2020; 131: E2060–E2065. https://doi.org/10.1002/lary.29209.
10.1002/lary.29209
PubMed Web of Science® Google Scholar
5Rees CA, Monuteaux MC, Raphael JL, Michelson KA. Disparities in pediatric mortality by neighborhood income in United States emergency departments. J Pediatr 2020; 219: 209–215.e3.
10.1016/j.jpeds.2019.09.016
PubMed Web of Science® Google Scholar
6O'Connor GT, Quinton HB, Kneeland T, et al. Median household income and mortality rate in cystic fibrosis. Pediatrics 2003; 111: e333–e339.
10.1542/peds.111.4.e333
PubMed Web of Science® Google Scholar
7Manson S, Schroeder J, Van Riper D, Kugler T, Ruggles S. IPUMS National Historical Geographic Information System: Version 15.0 [dataset]. Minneapolis, MN: IPUMS; 2020.
Google Scholar
8 World Health Organization. WHO child growth standards. Available at: https://www.who.int/childgrowth/standards/Technical_report.pdf. Accessed November 5, 2020.
Google Scholar
9 World Health Organization. WHO child growth standards and the identification of severe acute malnutrition in infants and children. A Joint Statement by the World Health Organization and the United Nations Children's Fund. Available at: https://apps.who.int/iris/bitstream/handle/10665/44129/9789241598163_eng.pdf?ua=1. Accessed November 5, 2020.
Google Scholar
10de Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr 2016; 12: 12–26.
10.1111/mcn.12231
PubMed Web of Science® Google Scholar
11Cubitt J, Hodges A, Galiwango G, van Lierde K. Malnutrition in cleft lip and palate children in Uganda. Eur J Plast Surg 2012; 35: 273–276.
10.1007/s00238-011-0620-z
Google Scholar
12 World Health Organization. Anthropometric calculator version 3.1. Available at: www.who.int.childgrowth/software/en/. Accessed September 28, 2020.
Google Scholar
13Schumacher D, Borghi E, Polonsky J. anthro: Computation of the WHO child growth standards (R package). Available at: https://cran.rproject.org/web/packages/anthro/anthro.pdf. Accessed September 28, 2020.
Google Scholar
14de Onis M, Onyango A, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85: 661–668.
Web of Science® Google Scholar
15Hardeman RR, Medina EM, Kozhimannil KB. Structural racism and supporting black lives - the role of health professionals. N Engl J Med 2016; 375: 2113–2115.
10.1056/NEJMp1609535
PubMed Web of Science® Google Scholar
16Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav 1995; 36: 80–94.
10.2307/2626958
CAS Web of Science® Google Scholar
17Colvin JD, Zaniletti I, Fieldston ES, et al. Socioeconomic status and in-hospital pediatric mortality. Pediatrics 2013; 131: e182–e190.
10.1542/peds.2012-1215
PubMed Web of Science® Google Scholar
18Wang C, Guttmann A, To T, Dick PT. Neighborhood income and health outcomes in infants: how do those with complex chronic conditions fare? Arch Pediatr Adolesc Med 2009; 163: 608–615.
10.1001/archpediatrics.2009.36
PubMed Web of Science® Google Scholar
19Victorino CC, Gauthier AH. The social determinants of child health: variations across health outcomes - a population-based cross-sectional analysis. BMC Pediatr 2009; 9: 53.
10.1186/1471-2431-9-53
PubMed Web of Science® Google Scholar
20 United Nations Children's Fund, World Health Organization and World Bank Group. Joint child malnutrition estimates 2017. WHO; 2017. Available at: http://apps.who.int/gho/data/node.wrapper.nutrition-2016. Accessed September 15, 2020.
Google Scholar
21Casey PH, Szeto K, Lensing S, Bogle M, Weber J. Children in food-insufficient, low-income families prevalence, health, and nutrition status arrest. Arch Pediatr Adolesc Med 2001; 155: 508–514.
10.1001/archpedi.155.4.508
CAS PubMed Web of Science® Google Scholar
22Nieman CL, Tunkel DE, Boss EF. Do race/ethnicity or socioeconomic status affect why we place ear tubes in children? Int J Pediatr Otorhinolaryngol 2016; 88: 98–103.
10.1016/j.ijporl.2016.06.029
PubMed Web of Science® Google Scholar
23Robinette JW, Charles ST, Gruenewald TL. Neighborhood socioeconomic status and health: a longitudinal analysis. J Community Health 2017; 42: 865–871.
10.1007/s10900-017-0327-6
PubMed Web of Science® Google Scholar
24Chan PS, McNally B, Vellano K, Tang Y, Spertus JA. Association of neighborhood race and income with Survival after out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2020; 9:e014178.
10.1161/JAHA.119.014178
CAS PubMed Web of Science® Google Scholar
25Anderson BR, Fieldston ES, Newburger JW, Bacha EA, Glied SA. Disparities in outcomes and resource use after hospitalization for cardiac surgery by neighborhood income. Pediatrics 2018; 141:e20172432.
10.1542/peds.2017-2432
PubMed Web of Science® Google Scholar
26Kapral MK, Fang J, Chan C, et al. Neighborhood income and stroke care and outcomes. Neurology 2012; 79: 1200–1207.
10.1212/WNL.0b013e31826aac9b
PubMed Web of Science® Google Scholar
27Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health 2001; 55: 111–122.
10.1136/jech.55.2.111
CAS PubMed Web of Science® Google Scholar
28Krukowski RA, West DS, Harvey-Berino J, Elaine PT. Neighborhood impact on healthy food availability and pricing in food stores. J Community Health 2010 Jun; 35: 315–320. https://doi.org/10.1007/s10900-010-9224-y.
10.1007/s10900-010-9224-y
PubMed Web of Science® Google Scholar
29 Minnesota Department of Human Services. Income and asset limits. Available at: https://mn.gov/dhs/people-we-serve/adults/health-care/health-care-programs/programs-and-services/income-asset-limits.jsp. Accessed November 5, 2020.
Google Scholar
30 Minnesota State Demographic Center. Income & poverty. Available at: https://mn.gov/admin/demography/data-by-topic/income-poverty. Accessed June 8, 2021.
Google Scholar
31Clay J. Minnesota Cost of Living Study Annual Report 2016. Minnesota Department of Employment and Economic Development. Available at: https://www.leg.mn.gov/docs/2016/mandated/160558.pdf. Accessed June 8, 2021.
Google Scholar
32 2018 Poverty guidelines. ASPE, Available at: aspe.hhs.gov/2018-poverty-guidelines. Accessed May 5, 2021.
Google Scholar
33Mode NA, Evans MK, Zonderman AB. Race, neighborhood economic status, income inequality and mortality. PLoS One 2016; 11:e0154535.
10.1371/journal.pone.0154535
PubMed Web of Science® Google Scholar
34 2019 United States census quick facts. Available at: https://www.census.gov/quickfacts/fact/table/US/PST045219. Accessed September 13, 2021.
Google Scholar

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Volume132, Issue7

July 2022

Pages 1482-1486

Demographic Risk Factors for Malnutrition in Patients With Cleft Lip and Palate

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Information

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Demographic Risk Factors for Malnutrition in Patients With Cleft Lip and Palate

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

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