Background: The association between nutritional status and perforation or complicated appendicitis in children remains uncertain. Objective: To review evidence on anthropometric and biochemical nutritional indicators in relation to perforation and complicated appendicitis in pediatric acute appendicitis. Methods: PubMed, Scopus, and Web of Science were searched for peer-reviewed English-language studies published from 1 January 2010 to 1 January 2026, with supplementary citation searching and Google Scholar screening. Eligible studies included participants aged 0–18 years and reported BMI-based measures and/or biochemical nutritional markers (e.g., albumin, prealbumin, or derived inflammation–nutrition indices) stratified by perforation or complicated appendicitis. Risk of bias was assessed using ROBINS-E. Results: Fourteen observational studies were included. Associations between obesity and perforation or complicated appendicitis were inconsistent, and large registry-based analyses did not identify obesity as an independent predictor after adjustment. Underweight status was more consistently associated with complicated disease and adverse clinical course. Biochemical markers and inflammation–nutrition indices showed more consistent associations with perforated or complicated appendicitis than BMI categories, with several studies reporting moderate-to-high discrimination for severe disease. Conclusions: BMI-based classifications alone did not reliably predict perforation or complicated appendicitis. Albumin- and prealbumin-based indices were more consistently associated with disease severity, but the observational evidence does not establish causality and may reflect inflammatory severity at presentation. Prospective studies with standardized definitions and marker assessment are needed to evaluate incremental prognostic value beyond symptom duration and clinical severity scores.
Borca et al. (Thu,) studied this question.