PRINCIPLE
The principle of the Simple Evaluation of Food Intake Junior (SEFI Junior®) rests on the same foundations/concept as SEFI® Adult. SEFI® Junior allows a visual assessment of food intake, carried out by the patient himself (feasibility validated for children aged 10 and over, see clinical study below), his parents, or with the assistance of a healthcare professional. This assessment is made using an analog scale or by selecting the portions consumed.
It thus allows to diagnose or rule out malnutrition in children, particularly those aged over 10.
PATIENTS
SEFI Junior® is suitable for all children aged between 10 and 18 hospitalised for acute pathologies in paediatric surgery or paediatric medicine. A score above 7 out of 10 suggests the absence of malnutrition.
USE
Visual assessment of food intake using SEFI Junior®, carried out by the patient themselves or one of their parents, the two being highly correlated (see clinical study below), helps in the diagnosis of malnutrition. The French National Authority for Health has included reduced food intake as an aetiological criterion for diagnosing malnutrition in children and adults.(13)
SEFI® is part of the procedure for diagnosing malnutrition and should help to improve its care.
For adults, experts recommend the use of an analogue scale to assess patients' food intake (see Use).
In children, the experts recommended the need to develop visual or verbal analogue assessment methods of food intake, following the example of existing tools for adults, and further studies to validate them(19, 20) (see clinical study below).
SEFI Junior® is easy to use and can be executed in two ways:
1. A visual analogue scale
The patient or at least one of their parents is asked to answer : “Can you indicate the quantities you are currently eating between 0 and 10?” or “Can you indicate the quantities your child is currently eating between 0 and 10?”.
Using the cursor on the graduated scale from ‘nothing at all’ to ‘as usual’, the patient or their parent indicates the quantities they have consumed. The result, between 0 and 10, is to read on the verso.
2. Visual assessment of portions consumed
The patient is instructed to : “Indicate the portion you ate at your last meal (lunch or dinner)”.
Using the cursor, the patient or at least one of their parents identifies the portions eaten at his/her last meal (lunch or dinner). As demonstrated with adults (see Interpretation), the caregiver could also carry out this assessment, particularly when serving the meal tray.
Instructions for the caregiver:
The caregiver is asked to enter in the computerised patient file the portion eaten, as declared by the patient or at least one of his/her parents, at the last meal (lunch or evening), or as observed directly when the meal tray is served.
CLINICAL STUDY
Published as abstracts(21-23), article submitted for publication
A French multicentre prospective observational clinical study was carried out on 363 patients with an average age of 13.5±2.1 years, 55% of whom were boys and 61% of whom had a chronic disease. The visual assessment of food intake was carried out with SEFI Junior® independently with the child and one of his parents, without them being aware of the other's answers.
The diagnosis of malnutrition was based on the following criteria :
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body mass index (BMI) < 18.5 according to the International Obesity Task Force (IOTF), by age,
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Waterlow Index (WI) < 90%,
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expected height-for-age ratio <95%.
RESULTS
The study results revealed that:
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The feasibility of SEFI Junior® with children or one of their parents was 100%.
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The correlation between the SEFI Junior® scores given by the child and one of his parents was high: Spearman's rho coefficient = 0.87, P<0.0001.
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The mean SEFI Junior® score was 7.8±2.5, and 29% of patients reported a SEFIJ Junior® score <7.
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The prevalence of malnutrition varied between 7.2 and 26.2% depending on the criteria used.
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The overall performance of the SEFI Junior® <7 in diagnosing malnutrition was measured by areas under the curve (AUC): AUC ranging from 0.53 [95% confidence interval (CI), 0.45-0.61] (expected height-for-age ratio) to 0.62 [0.55-0.68] (WI).
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The overall performance of the SEFI Junior® <7 for the diagnosis of malnutrition was best in acute illness: vs. BMI IOTF<17 (AUC=0.74 [95% CI, 0.52-0.96], specificity 65.7, negative predictive value (NPV) 97.9%), vs. expected height-for-age ratio <95% (AUC=0.69 [0.54-0.83], specificity 66.7, NPV 89.4%), vs. WI <90% (AUC=0.68 [0.52-0.85], specificity 71.2, NPV 78.7%).
CONCLUSION
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The SEFI Junior® is highly feasible and enable to rule out a diagnosis of malnutrition in children aged 10 to 18 hospitalised for an acute illness.
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It could therefore be included in the diagnostic strategy for malnutrition in older children in hospital.