Relationship Between Nutritional Status and Severity of Cerebral Palsy: A Multicentre Cross-Sectional Study
DOI:
https://doi.org/10.2340/jrm.v55.4395Keywords:
undernutrition, cerebral palsy, motor dysfunction, dysphagia, childrenAbstract
Background: Nutritional problems are common in children with cerebral palsy (CP), yet the relationship between nutritional status and the severity of CP is unclear.
Objective: To describe the nutritional status and characteristics of children with CP, and to explore the relationship between severity of CP and nutritional status in children.
Methods: This multicentre cross-sectional study included children with CP in China. Weight and height were measured and converted to z-scores. Gross Motor Function Classification System (GMFCS), Eating and Drinking Ability Classification System (EDACS), Subjective Global Nutritional Assessment (SGNA), social life ability, and blood indicators were tested.
Results: All 1,151 participants were given oral-feeding and 50.8% of them demonstrated undernutrition. Compared with those in GMFCS or EDACS levels I–III, the odds of moderate and severe undernutrition were 2.6 and 8.9 times higher in GMFCS levels IV and V, and 4.3 and 12.6 times higher in EDACS levels IV and V, respectively. Except for serum 25-hydroxyvitamin D, no significant differences
were found in blood indicators among normal, undernourished and overnourished groups.
Conclusion: Degrees of undernutrition in children with CP are correlated with the severity of eating and drinking dysfunction and with gross motor impairment. Blood indicators may not reflect nutritional status in children with CP.
LAY ABSTRACT
Cerebral palsy is the most common physical disability in children in the world. Children with cerebral palsy may have a high risk of having malnutrition as a result of the high energy consumption and/or low energy intake. The former is mainly caused by the abnormal muscular tone, and the latter may emerge from the dysphagia and gastrointestinal problems. As for the optimization of nutritional status is integral to the overall health and clinical management of children with cerebral palsy, the nutritional status stands out for its clinical importance in this group. Children with cerebral palsy are affected by different degrees of motor dysfunction, and may also be faced with eating and drinking problems or limited daily life ability, it is not clear whether nutritional status and function are interrelated. What's more, it is believed that the blood tests may indicate the nutritional status, but it is not well understood. In this project we will look at the nutritional status of children with cerebral palsy in China and investigate the relationship between nutritional status and function and blood indicators. This will then allow clinicians and caregivers to formulate future policies to improve nutritional status for this group of children.
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Li N, Zhou P, Tang H, He L, Fang X, Zhao J, et al. In-depth analysis reveals complex molecular aetiology in a cohort of idiopathic cerebral palsy. Brain 2022; 145: 119-141. DOI: 10.1093/brain/awab209.
https://doi.org/10.1093/brain/awab209 DOI: https://doi.org/10.1093/brain/awab209
Sewell MD, Eastwood DM, Wimalasundera N. Managing common symptoms of cerebral palsy in children. BMJ 2014; 349: g5474. DOI: 10.1136/bmj.g5474.
https://doi.org/10.1136/bmj.g5474 DOI: https://doi.org/10.1136/bmj.g5474
Rempel G. The importance of good nutrition in children with cerebral palsy. Phys Med Rehabil Clin N Am 2015; 26: 39-56. DOI: 10.1016/j.pmr.2014.09.001.
https://doi.org/10.1016/j.pmr.2014.09.001 DOI: https://doi.org/10.1016/j.pmr.2014.09.001
Aydin K, Turkish Cerebral Palsy Study Group. A multicenter cross-sectional study to evaluate the clinical characteristics and nutritional status of children with cerebral palsy. Clin Nutr ESPEN 2018; 26: 27-34. DOI: 10.1016/j.clnesp.2018.05.002.
https://doi.org/10.1016/j.clnesp.2018.05.002 DOI: https://doi.org/10.1016/j.clnesp.2018.05.002
Aydın K, Kartal A, Keleş Alp E. High rates of malnutrition and epilepsy: two common comorbidities in children with cerebral palsy. Turk J Med Sci 2019; 49: 33-37. DOI: 10.3906/sag-1803-79.
https://doi.org/10.3906/sag-1803-79 DOI: https://doi.org/10.3906/sag-1803-79
Reyes FI, Salemi JL, Dongarwar D, Magazine CB, Salihu HM. Prevalence, trends, and correlates of malnutrition among hospitalized children with cerebral palsy. Dev Med Child Neurol 2019; 61: 1432-1438. DOI: 10.1111/dmcn.14329.
https://doi.org/10.1111/dmcn.14329 DOI: https://doi.org/10.1111/dmcn.14329
Pinto VV, Alves L, Mendes FM, Ciamponi AL. The nutritional state of children and adolescents with cerebral palsy is associated with oral motor dysfunction and social conditions: a cross sectional study. BMC Neurol 2016; 16: 55. DOI: 10.1186/s12883-016-0573-8.
https://doi.org/10.1186/s12883-016-0573-8 DOI: https://doi.org/10.1186/s12883-016-0573-8
Polack S, Adams M, O'banion D, Baltussen M, Asante S, Kerac M, et al. Children with cerebral palsy in Ghana: malnutrition, feeding challenges, and caregiver quality of life. Dev Med Child Neurol 2018; 60: 914-921. DOI: 10.1111/dmcn.13797.
https://doi.org/10.1111/dmcn.13797 DOI: https://doi.org/10.1111/dmcn.13797
Speyer R, Cordier R, Kim JH, Cocks N, Michou E, Wilkes-Gillan S. Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses. Dev Med Child Neurol 2019; 61: 1249-1258. DOI: 10.1111/dmcn.14316.
https://doi.org/10.1111/dmcn.14316
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy. Dev Med Child Neurol Suppl 2007; 109: 8-14.
Romano C, van Wynckel M, Hulst J, Broekaert I, Bronsky J, Dall'Oglio L, et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J Pediatr Gastroenterol Nutr 2017; 65: 242-264. DOI: 10.1097/MPG.0000000000001646.
https://doi.org/10.1097/MPG.0000000000001646 DOI: https://doi.org/10.1097/MPG.0000000000001646
World Health Organizatio (WHO) Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006; 450: 76-85. DOI: 10.1111/j.1651-2227.2006.tb02378.x.
https://doi.org/10.1111/j.1651-2227.2006.tb02378.x DOI: https://doi.org/10.1111/j.1651-2227.2006.tb02378.x
Becker PJ, Nieman Carney L, Corkins MR, Monczka J, Smith E, Smith SE, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). J Acad Nutr Diet 2014; 114: 1988-2000. DOI: 10.1016/j.jand.2014.08.026.
https://doi.org/10.1016/j.jand.2014.08.026 DOI: https://doi.org/10.1016/j.jand.2014.08.026
Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol 2008; 50: 744-750. DOI: 10.1111/j.1469-8749.2008.03089.x.
https://doi.org/10.1111/j.1469-8749.2008.03089.x DOI: https://doi.org/10.1111/j.1469-8749.2008.03089.x
Sellers D, Mandy A, Pennington L, Hankins M, Morris C. Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy. Dev Med Child Neurol 2014; 56: 245-251. DOI: 10.1111/dmcn.12352.
https://doi.org/10.1111/dmcn.12352 DOI: https://doi.org/10.1111/dmcn.12352
Zhang ZX, Zuo QH, Lei ZW. Re-standardization of social life ability scale for Chinese infant-junior school student. Chin J Clin Psychol 1995; 3: 12-15.
Peng T, Zhao Y, Fu C, Huang S, Zhou H, Li J, et al. A study of validity and reliability for Subjective Global Nutritional Assessment in outpatient children with cerebral palsy. Nutr Neurosci 2021; 12: 2570-2576. DOI: 10.1080/1028415X.2021.1990463.
https://doi.org/10.1080/1028415X.2021.1990463 DOI: https://doi.org/10.1080/1028415X.2021.1990463
Stevenson RD. Use of segmental measures to estimate stature in children with cerebral palsy. Arch Pediatr Adolesc Med 1995; 149: 658-662. DOI: 10.1001/archpedi.1995.02170190068012.
https://doi.org/10.1001/archpedi.1995.02170190068012 DOI: https://doi.org/10.1001/archpedi.1995.02170190068012
Wang F, Cai Q, Shi W, Jiang H, Li N, Ma D, et al. A cross-sectional survey of growth and nutritional status in children with cerebral palsy in west China. Pediatr Neurol 2016; 58: 90-97. DOI: 10.1016/j.pediatrneurol.2016.01.002.
https://doi.org/10.1016/j.pediatrneurol.2016.01.002 DOI: https://doi.org/10.1016/j.pediatrneurol.2016.01.002
Jahan I, Muhit M, Hardianto D, Karim T, Al Imam MH, Das MC, et al. Nutritional status of children with cerebral palsy in remote Sumba Island of Indonesia: a community-based key informants study. Disabil Rehabil 2021; 43: 1819-1828. DOI: 10.1080/09638288.2019.1676833.
https://doi.org/10.1080/09638288.2019.1676833 DOI: https://doi.org/10.1080/09638288.2019.1676833
Leonard M, Dain E, Pelc K, Dan B, De Laet C. Nutritional status of neurologically impaired children: impact on comorbidity. Arch Pediatr 2020; 27: 95-103. DOI: 10.1016/j.arcped.2019.11.003.
https://doi.org/10.1016/j.arcped.2019.11.003 DOI: https://doi.org/10.1016/j.arcped.2019.11.003
Caselli TB, Lomazi EA, Montenegro M, Bellomo-Brandão MA. Assessment of nutritional status of children and adolescents with spastic quadriplegic cerebral palsy. Arq Gastroenterol 2017; 54: 201-205. DOI: 10.1590/S0004-2803.201700000-32.
https://doi.org/10.1590/s0004-2803.201700000-32 DOI: https://doi.org/10.1590/s0004-2803.201700000-32
Ruiz Brunner M, Cieri ME, Rodriguez Marco MP, Schroeder AS, Cuestas E. Nutritional status of children with cerebral palsy attending rehabilitation centers. Dev Med Child Neurol 2020; 62: 1383-1388. DOI: 10.1111/dmcn.14667.
https://doi.org/10.1111/dmcn.14667 DOI: https://doi.org/10.1111/dmcn.14667
Heyn PC, Tagawa A, Pan Z, Thomas S, Carollo JJ. Prevalence of metabolic syndrome and cardiovascular disease risk factors in adults with cerebral palsy. Dev Med Child Neurol 2019; 61: 477-483. DOI: 10.1111/dmcn.14148.
https://doi.org/10.1111/dmcn.14148 DOI: https://doi.org/10.1111/dmcn.14148
Benfer KA, Weir KA, Bell KL, Nahar B, Ware RS, Davies PSW, et al. Oropharyngeal dysphagia in children with cerebral palsy: comparisons between a high- and low-resource country. Disabil Rehabil 2017; 39: 2404-2412. DOI: 10.1080/09638288.2016.1229363.
https://doi.org/10.1080/09638288.2016.1229363 DOI: https://doi.org/10.1080/09638288.2016.1229363
Speyer R, Cordier R, Kim JH, Cocks N, Michou E, Wilkes-Gillan S. Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses. Dev Med Child Neurol 2019; 61: 1249-1258.
https://doi.org/10.1111/dmcn.14316 DOI: https://doi.org/10.1111/dmcn.14316
Huysentruyt K, Geeraert F, Allemon H, Prinzie P, Roelants M, Ortibus E, et al. Nutritional red flags in children with cerebral palsy. Clin Nutr 2020; 39: 548-553. DOI: 10.1016/j.clnu.2019.02.040.
https://doi.org/10.1016/j.clnu.2019.02.040 DOI: https://doi.org/10.1016/j.clnu.2019.02.040
Martínez de Zabarte Fernández JM, Ros Arnal I, Peña Segura JL, García Romero R, Rodríguez Martínez G. Caregiver burden in patients with moderate-severe cerebral palsy. The influence of nutritional status. An Pediatr (Engl Ed) 2021; 94: 311-317. Spanish. DOI: 10.1016/j.anpedi.2020.06.020. DOI: https://doi.org/10.1016/j.anpede.2020.06.008
https://doi.org/10.1016/j.anpedi.2020.06.020 DOI: https://doi.org/10.1016/j.anpedi.2020.06.020
Alvarez Zaragoza C, Vasquez Garibay EM, García Contreras AA, Larrosa Haro A, Romero Velarde E, Rea Rosas A, et al. Bone mineral density and nutritional status in children with quadriplegic cerebral palsy. Arch Osteoporos 2018; 13: 17. DOI: 10.1007/s11657-018-0434-8.
https://doi.org/10.1007/s11657-018-0434-8 DOI: https://doi.org/10.1007/s11657-018-0434-8
Jesus AO, Stevenson RD. Optimizing nutrition and bone health in children with cerebral palsy. Phys Med Rehabil Clin N Am 2020; 31: 25-37. DOI: 10.1016/j.pmr.2019.08.001.
https://doi.org/10.1016/j.pmr.2019.08.001 DOI: https://doi.org/10.1016/j.pmr.2019.08.001
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Copyright (c) 2023 Yiting Zhao, Hongmei Tang, Tingting Peng, Jinling Li, Liru Liu, Chaoqiong Fu, Hongyu Zhou, Shiya Huang, Yuan Huang, Peishan Zeng, Wenda Wang, Lu He, Kaihsou Xu, and Research Group
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