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Luo B, Davidson ZE, O'Brien K, Volders E, Lu J, Dunlea K, Lazzari M, Billich N, Nguo K. Describing Energy Expenditure in Children with a Chronic Disease: A Systematic Review. Adv Nutr 2024; 15:100198. [PMID: 38432591 PMCID: PMC10987846 DOI: 10.1016/j.advnut.2024.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
Understanding energy expenditure in children with chronic disease is critical due to the impact on energy homeostasis and growth. This systematic review aimed to describe available literature of resting (REE) and total energy expenditure (TEE) in children with chronic disease measured by gold-standard methods of indirect calorimetry (IC) and doubly labeled water (DLW), respectively. A literature search was conducted using OVID Medline, Embase, CINAHL Plus, Cochrane, and Scopus until July 2023. Studies were included if the mean age of the participants was ≤18 y, participants had a chronic disease, and measurement of REE or TEE was conducted using IC or DLW, respectively. Studies investigating energy expenditure in premature infants, patients with acute illness, and intensive care patients were excluded. The primary outcomes were the type of data (REE, TEE) obtained and REE/TEE stratified by disease group. In total, 271 studies across 24 chronic conditions were identified. Over 60% of retrieved studies were published >10 y ago and conducted on relatively small population sizes (n range = 1-398). Most studies obtained REE samples (82%) rather than that of TEE (8%), with very few exploring both samples (10%). There was variability in the difference in energy expenditure in children with chronic disease compared with that of healthy control group across and within disease groups. Eighteen predictive energy equations were generated across the included studies. Quality assessment of the studies identified poor reporting of energy expenditure protocols, which may limit the validity of results. Current literature on energy expenditure in children with chronic disease, although extensive, reveals key future research opportunities. International collaboration and robust measurement of energy expenditure should be conducted to generate meaningful predictive energy equations to provide updated evidence that is reflective of emerging disease-modifying therapies. This study was registered in PROSPERO as CRD42020204690.
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Affiliation(s)
- Bethany Luo
- Department of Nutrition, Dietetics and Foods, Monash University, Melbourne, Victoria, Australia
| | - Zoe E Davidson
- Department of Nutrition, Dietetics and Foods, Monash University, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Katie O'Brien
- Department of Nutrition, Dietetics and Foods, Monash University, Melbourne, Victoria, Australia
| | - Evelyn Volders
- Department of Nutrition, Dietetics and Foods, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lu
- Department of Nutrition, Dietetics and Foods, Monash University, Melbourne, Victoria, Australia
| | - Kali Dunlea
- Department of Nutrition, Dietetics and Foods, Monash University, Melbourne, Victoria, Australia
| | - Matisse Lazzari
- Department of Nutrition, Dietetics and Foods, Monash University, Melbourne, Victoria, Australia
| | - Natassja Billich
- Department of Nutrition, Dietetics and Foods, Monash University, Melbourne, Victoria, Australia
| | - Kay Nguo
- Department of Nutrition, Dietetics and Foods, Monash University, Melbourne, Victoria, Australia
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Oftedal S, McCormack S, Stevenson R, Benfer K, Boyd RN, Bell K. The evolution of nutrition management in children with severe neurological impairment with a focus on cerebral palsy. J Hum Nutr Diet 2024. [PMID: 38196166 DOI: 10.1111/jhn.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024]
Abstract
Nutritional management of children with severe neurological impairment (SNI) is highly complex, and the profile of this population is changing. The aim of this narrative review was to give the reader a broad description of evolution of the nutritional management of children with SNI in a high resource setting. In the last decade, there has been an emphasis on using multiple anthropometric measures to monitor nutritional status in children with SNI, and several attempts at standardising the approach have been made. Tools such as the Feeding and Nutrition Screening Tool, the Subjective Global Nutrition Assessment, the Eating and Drinking Ability Classification System and the Focus on Early Eating and Drinking Swallowing (FEEDS) toolkit have become available. There has been an increased understanding of how the gut microbiome influences gastrointestinal symptoms common in children with SNI, and the use of fibre in the management of these has received attention. A new diagnosis, 'gastrointestinal dystonia', has been defined. The increased use and acceptance of blended food tube feeds has been a major development in the nutritional management of children with SNI, with reported benefits in managing gastrointestinal symptoms. New interventions to support eating and drinking skill development in children with SNI show promise. In conclusion, as the life expectancy of people with SNI increases due to advances in medical and nutrition care, our approach necessitates a view to long-term health and quality of life. This involves balancing adequate nutrition to support growth, development and well-being while avoiding overnutrition and its associated detrimental long-term effects.
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Affiliation(s)
- Stina Oftedal
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Siobhan McCormack
- Department of Child Development and Neurodisability, Children's Health Ireland at Tallaght, Dublin, Ireland
- Department of Paediatrics, School of Medicine, University of Galway, Galway, Ireland
| | - Richard Stevenson
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Katherine Benfer
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
| | - Kristie Bell
- Queensland Cerebral Palsy Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland Child Health Research Centre, Brisbane, Queensland, Australia
- Dietetics and Food Services, Children's Health Queensland, South Brisbane, Queensland, Australia
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Borsani B, Biganzoli G, Penagini F, Bosetti A, Pendezza E, Perico V, Biganzoli E, Verduci E, Zuccotti GV. Resting energy expenditure in children and adolescents with cerebral palsy: accuracy of available prediction formulas and development of population-specific methods. Front Pediatr 2023; 11:1097152. [PMID: 37681200 PMCID: PMC10481865 DOI: 10.3389/fped.2023.1097152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 07/26/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Energy requirements are difficult to estimate in children with cerebral palsy (CP). Resting energy expenditure (REE), necessary to implement personalized nutritional interventions, is most commonly estimated using prediction formulae since indirect calorimetry, the reference method, is not available in all nutrition units. The aims of the present study were: (1) to evaluate the accuracy of the most commonly used REE prediction formulae developed for healthy children, in children with CP; (2) to assess the accuracy of the REE population-specific formula for CP children proposed in our preliminary report; (3) to develop new population-specific methods. Methods REE was measured by indirect calorimetry in 100 children and adolescents with spastic quadriplegic cerebral palsy (SQCP) and estimated on the basis of predictive formulas selected by the clinicians [World Health Organization (WHO), Harris-Benedict, Schofield weight, Schofield weight & height, Oxford, Mifflin formulae and a population-specific formula for CP children developed in our preliminary report]. Results 100 children with SQCP (35 girls, 35%) classified as level V according to gross motor function classification system (GMFCS-V); 64% with oral nutrition, 29% total enteral nutrition (nasogastric tube feeding, percutaneous endoscopic gastrostomy, percutaneous endoscopic transgastric jejunostomy) and 7% mixed nutrition. The median (IQR) REE was 41.96 (17.5) kcal/kg/day.Statistical analysis highlighted a proportional bias between the indirect calorimetry and all considered predictive formulae for REE determination. By studying the relationship between the bias and the mean values of REE, specific conversion equations were obtained. With a pre-specified model having as predictors the variable weight and the variable Triceps Skinfold (TSF) and, as response the variable REE measured by indirect calorimetry, a predictive nomogram was developed to estimate the REE in this population of children. Conclusions We suggest using predictive formulae for healthy children with caution, and where possible carrying out indirect calorimetry to assess REE in children with CP. However, we propose a new tool which could be developed to become an additional help for assessment of REE in the clinical practice.Future objectives will be to obtain a larger sample size, in a multicenter perspective study, to build a specific predictive model for the REE of the studied population.
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Affiliation(s)
- Barbara Borsani
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Giacomo Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Francesca Penagini
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Alessandra Bosetti
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Veronica Perico
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Milan, Italy
| | - Elvira Verduci
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, University of Milan, Milan, Italy
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Zenitani M, Hosoda H, Nose S, Kangawa K, Kawahara H, Oue T. Importance of plasma ghrelin levels with special reference to nutritional metabolism and energy expenditure in pediatric patients with severe motor and intellectual disabilities. Clin Nutr ESPEN 2021; 42:180-187. [PMID: 33745575 DOI: 10.1016/j.clnesp.2021.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/23/2021] [Accepted: 01/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS Nutritional metabolism is complex in pediatric patients with severe motor and intellectual disability (SMID), and therefore, appropriate estimation of the energy requirements is difficult. Focusing on ghrelin's role in energy metabolism regulation, we investigated plasma ghrelin levels in pediatric SMID patients and analyzed its nutritional significance as a regulatory marker of energy reserve. METHODS Fasting plasma total, acyl, and des-acyl ghrelin levels in 40 patients with SMID, including cerebral palsy (CP) (n = 20) and muscular disease (MD) (n = 8), and healthy controls (n = 13) were investigated. The correlations of plasma ghrelin levels with anthropometry, blood nutritional markers, energy intake, and resting energy expenditure (REE) measured with indirect calorimetry were analyzed. A p value < 0.05 was considered significant. RESULTS SMID patients had significantly higher acyl ghrelin, and lower body mass index (BMI), z-scores of body weight (BW), body height and BMI, and albumin than controls. CP patients had significantly higher total and acyl ghrelin, z-score of the mid-upper arm circumference (MUAC), retinol-binding protein, transthyretin, creatinine, and glucose than MD patients. Total and acyl ghrelin in CP patients and des-acyl ghrelin in MD patients had significant negative correlations with MUAC and upper arm fat area. In CP patients, total and acyl ghrelin had significant positive correlations with REE/BW (kcal/kg), and total ghrelin was predictive of REE/BW (r2 = 0.625, p < 0.0001). CONCLUSIONS An increase in acyl ghrelin observed in SMID patients possibly indicates energy reserve deficiency. In CP patients, total and acyl ghrelin inversely reflected total body fat mass, resulting in strongly positive correlations with REE/BW. The measurement of plasma ghrelin may be useful to assess nutritional metabolism and energy reserve in pediatric SMID patients, such as CP and MD patients.
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Affiliation(s)
- Masahiro Zenitani
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Hiroshi Hosoda
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan.
| | - Satoko Nose
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Kenji Kangawa
- National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan.
| | - Hisayoshi Kawahara
- Department of Pediatric Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
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Foster BA, Lane JE, Massey E, Noelck M, Green S, Austin JP. The Impact of Malnutrition on Hospitalized Children With Cerebral Palsy. Hosp Pediatr 2020; 10:1087-1095. [PMID: 33154081 PMCID: PMC7684553 DOI: 10.1542/hpeds.2020-0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Children with cerebral palsy (CP) and other medical complexity comprise an outsized proportion of health care use. In this review, we describe the current science of assessment of nutritional status for children with CP, outline a systematic approach to assessing their nutritional status, delineate ramifications of malnutrition on hospitalization-associated outcomes, and identify knowledge gaps and means of addressing those gaps using quality improvement and clinical research tools. Methods to accurately assess body composition and adiposity in this population by using skinfolds, age, sex, and activity level are available but are not widely used. There are limitations in our current method of estimating energy needs in children with CP, who are at higher risk of both obesity and micronutrient deficiencies. There is some evidence of an association between malnutrition, defined as either underweight or obesity, and hospitalization-associated outcomes in children generally, although we lack specific data for CP. The gaps in our current understanding of optimal nutritional status and between current science and practice need to be addressed to improve health outcomes for this vulnerable patient population.
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Affiliation(s)
| | - Jennifer E Lane
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth Massey
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Michelle Noelck
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Sarah Green
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Jared P Austin
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
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Więch P, Ćwirlej-Sozańska A, Wiśniowska-Szurlej A, Kilian J, Lenart-Domka E, Bejer A, Domka-Jopek E, Sozański B, Korczowski B. The Relationship Between Body Composition and Muscle Tone in Children with Cerebral Palsy: A Case-Control Study. Nutrients 2020; 12:nu12030864. [PMID: 32213841 PMCID: PMC7146599 DOI: 10.3390/nu12030864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 01/10/2023] Open
Abstract
The monitoring of children with cerebral palsy (CP) should include a precise assessment of the nutritional status to identify children and adolescents at risk of nutrition disorders. Available studies assessing the nutritional status of children with CP mainly focus on the relationship between body composition and the coexistence of motor dysfunctions, frequently overlooking the role of muscle tone. Therefore, the aim of this study was to assess the relationship between body composition and muscle tone in children with CP. In a case-control study (n = 118; mean age 11 y; SD = 3.8), the children with CP presented various stages of functional capacities, corresponding to all the levels in gross motor function classification system (GMFSC), and muscle tone described by all the grades in Ashworth scale. The control group consisted of healthy children and adolescents, strictly matched for gender and age in a 1:1 case-control manner. The children with CP were found with significantly lower mean values of fat-free mass (FFM kg = 29.2 vs. 34.5, p < 0.001), muscle mass (MM kg = 18.6 vs. 22.6, p < 0.001), body cell mass (BCM kg = 15.1 vs. 18.3, p < 0.001), and total body water (TBW L = 23.0 vs. 26.7, p < 0.001). The same differences in body composition were identified with respect to gender (p < 0.01 respectively). Moreover, children with higher muscle tone (higher score in Ashworth scale) were found with significantly lower values of fat mass (FM), FFM, MM, BCM, and TBW (p < 0.05). The findings showed lower parameters of body composition in the children with CP compared to the healthy children, and a decrease in the parameters coinciding with higher muscle tone in the study group. This observation suggests that it is necessary to measure muscle tone while assessing nutritional status of children with CP.
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Affiliation(s)
- Paweł Więch
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
- Correspondence: ; Tel.: +48667192696
| | - Agnieszka Ćwirlej-Sozańska
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Agnieszka Wiśniowska-Szurlej
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Justyna Kilian
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Ewa Lenart-Domka
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
- Clinical Regional Rehabilitation and Education Centre for Children and Adolescents in Rzeszow, 35-301 Rzeszow, Poland
| | - Agnieszka Bejer
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Elżbieta Domka-Jopek
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Bernard Sozański
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland; (A.Ć.-S.); (A.W.-S.); (J.K.); (E.L.-D.); (A.B.); (E.D.-J.); (B.S.)
| | - Bartosz Korczowski
- Institute of Medical Sciences, College of Medical Sciences of the University of Rzeszow, University of Rzeszow, 35–959 Rzeszow, Poland;
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Claßen M, Schmidt-Choudhury A. Ernährungsprobleme und Unterernährung bei schwer neurologisch beeinträchtigten Kindern und Jugendlichen. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-0726-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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