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Neonatal Malnutrition Diagnoses Align Differently With Body Composition Outcomes: A Retrospective Cohort Analysis Evaluating 3 Different Growth Standards

Year: 2026

Type: article

Abstract: BACKGROUND: Proposed neonatal malnutrition criteria exist for nutritional assessment. Recommendations differ regarding which growth chart to use after premature birth. OBJECTIVE: This study compared malnutrition classification across Fenton, Olsen, and International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH) growth charts; examined their associations with body composition; and evaluated discrepancies in identifying fat-free mass (FFM) deficit and fat mass (FM) excess in preterm infants. DESIGN: This was a retrospective cohort study of preterm infants who underwent air displacement plethysmography. PARTICIPANTS AND SETTING: Two hundred eighty-five preterm infants (<37 weeks) from 4 Ohio neonatal intensive care units (2012-2023) were included. After excluding 22 infants for early air displacement plethysmography assessments (at or before 14 days) and 5 for gestational age <23 weeks + 4 days, 258 remained. MAIN OUTCOME MEASURES: Main outcomes were malnutrition diagnosis using weight z score decline from birth to air displacement plethysmography assessment for each growth chart and FFM and FM z scores. STATISTICAL ANALYSES PERFORMED: Linear regression models compared relationships between weight z score change amongst the 3 growth charts and with FFM and FM z scores. κ Coefficient and Bowker or McNemar test assessed malnutrition agreement between charts. Kruskal-Wallis test compared median body composition z scores across malnutrition categories. RESULTS: = 0.8 to 0.9) but statistically significant discrepancies in malnutrition classifications (Fenton vs INTERGROWTH κ = 0.46, 95% CI 0.36 to 0.57; INTERGROWTH vs Olsen κ = 0.49, 95% CI 0.36 to 0.61; Fenton vs Olsen κ = 0.69, 95% CI 0.61 to 0.77; P < .05). INTERGROWTH identified fewer cases of malnutrition (P < .0001). Weight z score change and size-for-gestational-age exhibited significant associations with body composition z scores (P < .0001). Fenton classified more malnutrition in infants with low FFM (46.1% vs 16.4%; P < .0001), whereas INTERGROWTH classified more infants with no malnutrition in those with high FM (94.8% vs 69%; P < .0001). CONCLUSIONS: Fenton growth chart is more likely than Olsen or INTERGROWTH to categorize infants with low FFM as having malnutrition.

Source: Journal of the Academy of Nutrition and Dietetics

DOI: 10.1016/j.jand.2026.156304