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Tagi VM, Eletti F, Dolor J, Zuccotti G, Montanari C, Verduci E. Telemedicine in nutritional management of children with severe neurological impairment: implication for quality of life. Front Nutr 2024; 11:1452880. [PMID: 39224181 PMCID: PMC11366627 DOI: 10.3389/fnut.2024.1452880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
Children with severe neurological impairment (SNI) frequently present feeding problems requiring a close monitoring of their nutritional status. In addition to constant clinical monitoring of body composition and nutritional indexes in these patients, frequent reports of dietary intake and weight gain variations are useful to ensure proper nutritional management. Furthermore, non-oral feeding is often needed to avoid malnutrition or aspiration pneumonia, constantly necessitating medical assistance. Despite their necessity for frequent hospital accesses, these patients' disabilities represent an important obstacle to accessing care, generating anxiety and concern in children and their families. Telemedicine has proven to be a promising instrument for improving pediatric patients' healthcare in several fields. By breaking down geographical and temporal barriers, telehealth may represent a valuable tool to implement in clinical practice, in order to improve patients' outcomes and quality of life. The aim of this narrative review is to provide an overview of the main nutritional issues in children with SNI, the potential implications of telemedicine in their management and the available evidence regarding the effects and benefits of telehealth.
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Affiliation(s)
- Veronica Maria Tagi
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Francesca Eletti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Jonabell Dolor
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Chiara Montanari
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Elvira Verduci
- Department of Health Sciences, University of Milan, Milan, Italy
- Metabolic Diseases Unit, Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
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Takezoe T, Murakami K, Fujishiro J, Horikawa M, Kubota M, Kanamori Y, Takahashi N, Nakano Y, Migita M, Matsufuji H, Sasaki S. Intake levels and main sources of nutrients for Japanese children with motor or intellectual disabilities. J Nutr Sci 2023; 12:e126. [PMID: 38155811 PMCID: PMC10753447 DOI: 10.1017/jns.2023.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/05/2023] [Accepted: 11/03/2023] [Indexed: 12/30/2023] Open
Abstract
Proper nutritional management is important for the growth and development of children with motor or intellectual disabilities; however, few studies have investigated the nutrient intake of children with disabilities. This study aimed to investigate the nutrient intake and food groups that are the main sources of nutrients for children with disabilities. This cross-sectional observational study included twenty-five children (mean age, 11⋅8 years) from five hospitals in Japan. Using a 3-d weighed dietary record, we estimated the daily nutrient intake and food and beverage sources that contributed to nutrient intake. The mean values of calcium, magnesium, iron, vitamin A, thiamine, riboflavin, and vitamin C intake were below the recommended dietary allowance, and those of dietary fiber and potassium were below the levels recommended by the Tentative Dietary Goal for Preventing Lifestyle-related Diseases (DG). In contrast, the mean intake values of fat, saturated fatty acids, and sodium were above the DG levels. Dairy products, meat, vegetables, and cereals were found to be the major contributors of nutrients. Increased intake of vegetables may help alleviate insufficient micronutrient intake in children with disabilities.
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Affiliation(s)
- Toshiko Takezoe
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kentaro Murakami
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Miwako Horikawa
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yutaka Kanamori
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Nagahisa Takahashi
- Department of Pediatrics, National Rehabilitation Center for Children with Disabilities, Tokyo, Japan
| | - Yuko Nakano
- Department of Pediatrics, Ashikaga Hospital, Tochigi, Japan
| | - Misato Migita
- Department of Pediatric Surgery, St. Luke's International Hospitals, Tokyo, Japan
| | - Hiroshi Matsufuji
- Department of Pediatric Surgery, St. Luke's International Hospitals, Tokyo, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo, Japan
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Johnston M, O'Sullivan T, Devine A, Wallace R, Costello L, Sambell R. Toddlers may be getting enough iron in long day-care services after all. J Hum Nutr Diet 2023; 36:1901-1911. [PMID: 37143380 DOI: 10.1111/jhn.13180] [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: 08/27/2022] [Accepted: 04/16/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Previous research has suggested that toddlers are not provided with adequate dietary iron in long-day care (LDC) services. However, the iron bioavailability provided is unknown. The present study aimed to investigate the amount and bioavailability of iron provided to toddlers aged 2-3 years at LDC services. METHODS A cross-sectional audit was conducted using a 2-day weighed food record of 30 LDC services. Iron provision (not child intake) in LDC services across Perth, Australia was compared with the estimated average requirements (EAR) and LDC services provision guidelines (50% of EAR = 2 mg/day based on a 14% bioavailability factor). Bioavailability was estimated per mealtime using haem and non-haem iron, ascorbic acid, animal protein, calcium, soy, eggs and phytates using two pre-existing algorithms (by A. P. Rickard and colleagues and H. Hallberg and H. Hulten). RESULTS Median iron supplied (2.52 mg/day, interquartile range [IQR] = 2.43-3.17) was above the 50% of EAR of 2.0 mg/day (p < 0.001). Median bioavailable iron was 0.6 mg/day (IQR = 0.54-0.8) using the method of Rickard et al. and 0.51 mg/day (IQR = 0.43, 0.76 using that of Hallberg and Hulthen). The top three foods contributing to iron provision were bread, breakfast cereals and beef. CONCLUSIONS Our results suggest that LDC services in Perth are meeting the minimum recommendation of provision of 50% of the iron EAR, and also that toddlers are provided with sufficient bioavailable iron. Future strategies should focus on promoting food combinations to maintain the iron bioavailability in meals currently served at LDC services.
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Affiliation(s)
- Michaela Johnston
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Therese O'Sullivan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Nutrition & Health Innovation Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Amanda Devine
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Nutrition & Health Innovation Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Ruth Wallace
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Leesa Costello
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Ros Sambell
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Nutrition & Health Innovation Research Institute, Edith Cowan University, Joondalup, WA, Australia
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Pansrimangkorn K, Asvanit P, Santiwong B. Factors associated with dental caries experience of Thai preschool children with cerebral palsy. SPECIAL CARE IN DENTISTRY 2023; 43:40-46. [PMID: 35635839 DOI: 10.1111/scd.12732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 01/21/2023]
Abstract
AIM To investigate the factors association with dental caries experience in the primary dentition of Thai preschool children with cerebral palsy. METHODS AND RESULTS A cross-sectional study was conducted among sixty Thai preschool children with cerebral palsy, aged 3-6 years old. Caries experience was determined by identifying decayednon-cavitated and cavitated lesion, missing, and filled surfaces of deciduous teeth(dmfs). Sociodemographic data, CP motor types, dietary habits, oral health behaviors and dental plaque index were collected. Multiple linear regression analysis was carried out to identify the strength of the association between factors and dental caries experience. The prevalence of dental caries was 91.66%. The average dmfs was 20.30 ± 21.63 surfaces/individual. The multiple linear regression indicated that dmfs was significantly associated with snacking carbohydrate between meals more than two times/day (β ± SE = 0.372 ± 0.125; p = 0.004), spastic type of cerebral palsy (β ± SE = 0.309 ± 0.124; p = 0.015) and one-time daily tooth brushing (β ± SE = 0.306 ± 0.124; p = 0.017). CONCLUSIONS Nine out of 10 preschool children with CP experienced dental caries. Spastic type of CP had more risk to develop dental decay. Caries prevention for preschool children with CP should emphasis on controlling the frequency of carbohydrate snack no more than two times/day and reinforcing tooth brushing at least twice daily.
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Affiliation(s)
| | - Pornpun Asvanit
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Busayarat Santiwong
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Ohwada H, Nakayama T, Ishikawa-Takata K, Iwasaki N, Kanaya Y, Tanaka S. Total energy expenditure among children with motor, intellectual, visual, and hearing disabilities: a doubly labeled water method. Eur J Clin Nutr 2021; 75:1607-1617. [PMID: 33742160 DOI: 10.1038/s41430-021-00885-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/19/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Few studies have evaluated the total energy expenditure (TEE) of children with disabilities using the doubly labeled water (DLW) method; however, none have compared it by disability type. Furthermore, no large-scale studies have focused on the severity of motor disability (MD). We aimed to compare TEE in children with disabilities by disability type. METHODS In a cross-sectional study design, TEE was measured using the DLW method, anthropometry, and weighted food records. The following comparisons were made: (1) TEEs among four disability types and (2) TEEs of three subgroups classified by MD based on the Gross Motor Function Classification System (GMFCS). RESULTS In total, 256 children (138 boys; ages 6-15 years) were studied. The comparison between the four disability types for boys in all age categories revealed that TEE (kJ/d) was lowest in MD, followed by intellectual disability (ID), visual disability, and hearing disability (HD), in that order. TEE/fat-free mass (FFM) (kJ/FFMkg/d) was also lowest in MD and highest in HD. TEE (kJ/d) and TEE/FFM (kJ/FFMkg/d) were also lowest in MD and highest in HD in girls. For both boys and girls, TEE (kJ/d) and TEE/FFM (kJ/FFMkg/d) were higher in the MD subtype GMFCS I-II than in GMFCS III-IV and GMFCS V. CONCLUSIONS TEE differed, depending on the disability type, and was the lowest in MD and highest in HD for both boys and girls. Analysis by GMFCS classification revealed that greater severity of motor dysfunction resulted in lower TEE.
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Affiliation(s)
- Hiroko Ohwada
- Department of Health and Nutrition, Yamagata Prefectural Yonezawa University of Nutrition Sciences, 6-15-1 Torimachi, Yonezawa, Yamagata, Japan.
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Kyoto, Japan
| | - Kazuko Ishikawa-Takata
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.,Faculty of Applied Biosciences, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-ku, Tokyo, Japan
| | - Nobuaki Iwasaki
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Yuki Kanaya
- Department of Health and Nutrition, Yamagata Prefectural Yonezawa University of Nutrition Sciences, 6-15-1 Torimachi, Yonezawa, Yamagata, Japan
| | - Shigeho Tanaka
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.,Faculty of Nutrition, Kagawa Nutrition University, 3-9-21 Chiyoda, Sakado, Saitama, Japan
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A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labelled water. Eur J Clin Nutr 2019; 74:669-681. [PMID: 31391548 DOI: 10.1038/s41430-019-0480-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 02/01/2023]
Abstract
Assessing energy intake (EI) in children and adolescents is essential for monitoring population nutrition trends and interpreting clinical outcomes. The aim of this review was to examine the validity of dietary assessment methods for estimating EI in children and adolescents when compared with total energy expenditure (TEE) measured using doubly labelled water (DLW). Six online databases were searched to identify articles published in English. Studies were included if they were conducted in participants aged ≤18 years, if they estimated EI via a dietary assessment method, and if they compared this estimate to TEE measured using the DLW method. The search strategy identified 345 articles, of which 13 articles (12 studies) (n = 306 children) met the selection criteria. Five studies were carried out in children aged 5-11 years with dietary intake of children reported by parents/caregivers. The most common dietary assessment methods used were food frequency questionnaires (n = 5) and weighed food records (n = 4). All methods were found to have some level of misreporting. Child characteristics including weight status, age, and sex were not found to consistently influence the accuracy of reported EI. Five studies employing technology-assisted approaches for assessing dietary intake in children were identified and reported mixed findings. Validity studies using DLW remain sparse in the literature. Studies including participants less than 5 years or older than 11 years, and from diverse ethnicities and socioeconomic backgrounds are warranted to explore other demographic differences that may affect the accuracy of dietary assessment methods. While reported in few studies, technology-assisted methods were found to perform equally well in estimating intakes when compared to DLW and other traditional forms of dietary assessment.
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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. [PMID: 28737572 DOI: 10.1097/mpg.0000000000001646] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Feeding difficulties are frequent in children with neurological impairments and can be associated with undernutrition, growth failure, micronutrients deficiencies, osteopenia, and nutritional comorbidities. Gastrointestinal problems including gastroesophageal reflux disease, constipation, and dysphagia are also frequent in this population and affect quality of life and nutritional status. There is currently a lack of a systematic approach to the care of these patients. With this report, European Society of Gastroenterology, Hepatology and Nutrition aims to develop uniform guidelines for the management of the gastroenterological and nutritional problems in children with neurological impairment. METHODS Thirty-one clinical questions addressing the diagnosis, treatment, and prognosis of common gastrointestinal and nutritional problems in neurological impaired children were formulated. Questions aimed to assess the nutritional management including nutritional status, identifying undernutrition, monitoring nutritional status, and defining nutritional requirements; to classify gastrointestinal issues including oropharyngeal dysfunctions, motor and sensory function, gastroesophageal reflux disease, and constipation; to evaluate the indications for nutritional rehabilitation including enteral feeding and percutaneous gastrostomy/jejunostomy; to define indications for surgical interventions (eg, Nissen Fundoplication, esophagogastric disconnection); and finally to consider ethical issues related to digestive and nutritional problems in the severely neurologically impaired children. A systematic literature search was performed from 1980 to October 2015 using MEDLINE. The approach of the Grading of Recommendations Assessment, Development, and Evaluation was applied to evaluate the outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation using the nominal voting technique. Expert opinion was applied to support the recommendations where no randomized controlled trials were available.
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Boyd RN, Davies PSW, Ziviani J, Trost S, Barber L, Ware R, Rose S, Whittingham K, Sakzewski L, Bell K, Carty C, Obst S, Benfer K, Reedman S, Edwards P, Kentish M, Copeland L, Weir K, Davenport C, Brooks D, Coulthard A, Pelekanos R, Guzzetta A, Fiori S, Wynter M, Finn C, Burgess A, Morris K, Walsh J, Lloyd O, Whitty JA, Scuffham PA. PREDICT-CP: study protocol of implementation of comprehensive surveillance to predict outcomes for school-aged children with cerebral palsy. BMJ Open 2017; 7:e014950. [PMID: 28706091 PMCID: PMC5734266 DOI: 10.1136/bmjopen-2016-014950] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cerebral palsy (CP) remains the world's most common childhood physical disability with total annual costs of care and lost well-being of $A3.87b. The PREDICT-CP (NHMRC 1077257 Partnership Project: Comprehensive surveillance to PREDICT outcomes for school age children with CP) study will investigate the influence of brain structure, body composition, dietary intake, oropharyngeal function, habitual physical activity, musculoskeletal development (hip status, bone health) and muscle performance on motor attainment, cognition, executive function, communication, participation, quality of life and related health resource use costs. The PREDICT-CP cohort provides further follow-up at 8-12 years of two overlapping preschool-age cohorts examined from 1.5 to 5 years (NHMRC 465128 motor and brain development; NHMRC 569605 growth, nutrition and physical activity). METHODS AND ANALYSES This population-based cohort study undertakes state-wide surveillance of 245 children with CP born in Queensland (birth years 2006-2009). Children will be classified for Gross Motor Function Classification System; Manual Ability Classification System, Communication Function Classification System and Eating and Drinking Ability Classification System. Outcomes include gross motor function, musculoskeletal development (hip displacement, spasticity, muscle contracture), upper limb function, communication difficulties, oropharyngeal dysphagia, dietary intake and body composition, participation, parent-reported and child-reported quality of life and medical and allied health resource use. These detailed phenotypical data will be compared with brain macrostructure and microstructure using 3 Tesla MRI (3T MRI). Relationships between brain lesion severity and outcomes will be analysed using multilevel mixed-effects models. ETHICS AND DISSEMINATION The PREDICT-CP protocol is a prospectively registered and ethically accepted study protocol. The study combines data at 1.5-5 then 8-12 years of direct clinical assessment to enable prediction of outcomes and healthcare needs essential for tailoring interventions (eg, rehabilitation, orthopaedic surgery and nutritional supplements) and the projected healthcare utilisation. TRIAL REGISTRATION NUMBER ACTRN: 12616001488493.
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Affiliation(s)
- Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Peter SW Davies
- Children's Nutrition Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Ziviani
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Stewart Trost
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Robert Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Stephen Rose
- CSIRO Australian e-Health Research Centre, Canberra, Australia
- Medical Imaging, Diagnostic and Interventional Neuroradiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Kristie Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Christopher Carty
- Queensland Children's Motion Analysis Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Steven Obst
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Priya Edwards
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Megan Kentish
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Lisa Copeland
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Kelly Weir
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Clinical Governance, Education and Research, Gold Coast Health, Brisbane, Queensland, Australia
| | - Camilla Davenport
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
- Children's Nutrition Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Denise Brooks
- Children's Nutrition Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Alan Coulthard
- Medical Imaging, Diagnostic and Interventional Neuroradiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Rebecca Pelekanos
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, Instituto Di Ricovero E Cura A Carattere Scientifico (IRCCS), Pisa, Italy
| | - Simona Fiori
- Department of Developmental Neuroscience, Instituto Di Ricovero E Cura A Carattere Scientifico (IRCCS), Pisa, Italy
| | - Meredith Wynter
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Christine Finn
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Kym Morris
- Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), The University of Queensland, Brisbane, Queensland, Australia
| | - John Walsh
- Medical Imaging, Diagnostic and Interventional Neuroradiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Queensland Children's Motion Analysis Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
- Department of Paediatric Orthopaedics, The Mater Health Services, Brisbane, Queensland, Australia
| | - Owen Lloyd
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Jennifer A Whitty
- Norwich Medical School, University of East Anglia, Norwich, UK
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Neumeyer AM, Cano Sokoloff N, McDonnell E, Macklin EA, McDougle CJ, Misra M. Bone microarchitecture in adolescent boys with autism spectrum disorder. Bone 2017; 97:139-146. [PMID: 28088646 PMCID: PMC6309443 DOI: 10.1016/j.bone.2017.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/07/2017] [Accepted: 01/10/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Boys with autism spectrum disorder (ASD) have lower areal bone mineral density (aBMD) than typically developing controls (TDC). Studies of volumetric BMD (vBMD) and bone microarchitecture provide information about fracture risk beyond that provided by aBMD but are currently lacking in ASD. OBJECTIVES To assess ultradistal radius and distal tibia vBMD, bone microarchitecture and strength estimates in adolescent boys with ASD compared to TDC. DESIGN/METHODS Cross-sectional study of 34 boys (16 ASD, 18 TDC) that assessed (i) aBMD at the whole body (WB), WB less head (WBLH), hip and spine using dual X-ray absorptiometry (DXA), (ii) vBMD and bone microarchitecture at the ultradistal radius and distal tibia using high-resolution peripheral quantitative CT (HRpQCT), and (iii) bone strength estimates (stiffness and failure load) using micro-finite element analysis (FEA). We controlled for age in all groupwise comparisons of HRpQCT and FEA measures. Activity questionnaires, food records, physical exam, and fasting levels of 25(OH) vitamin D and bone markers (C-terminal collagen crosslinks and N-terminal telopeptide (CTX and NTX) for bone resorption, N-terminal propeptide of Type 1 procollagen (P1NP) for bone formation) were obtained. RESULTS ASD participants were slightly younger than TDC participants (13.6 vs. 14.2years, p=0.44). Tanner stage, height Z-scores and fasting serum bone marker levels did not differ between groups. ASD participants had higher BMI Z-scores, percent body fat, IGF-1 Z-scores, and lower lean mass and aBMD Z-scores than TDC at the WB, WBLH, and femoral neck (P<0.1). At the radius, ASD participants had lower trabecular thickness (0.063 vs. 0.070mm, p=0.004), compressive stiffness (56.7 vs. 69.7kN/mm, p=0.030) and failure load (3.0 vs. 3.7kN, p=0.031) than TDC. ASD participants also had 61% smaller cortical area (6.6 vs. 16.4mm2, p=0.051) and thickness (0.08 vs. 0.22mm, p=0.054) compared to TDC. At the tibia, ASD participants had lower compressive stiffness (183 vs. 210kN/mm, p=0.048) and failure load (9.4 vs. 10.8kN, p=0.043) and 23% smaller cortical area (60.3 vs. 81.5mm2, p=0.078) compared to TDC. A lower proportion of ASD participants were categorized as "very physically active" (20% vs. 72%, p=0.005). Differences in physical activity, calcium intake and IGF-1 responsiveness may contribute to group differences in stiffness and failure load. CONCLUSION Bone microarchitectural parameters are impaired in ASD, with reductions in bone strength estimates (stiffness and failure load) at the ultradistal radius and distal tibia. This may result from lower physical activity and calcium intake, and decreased IGF-1 responsiveness.
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Affiliation(s)
- Ann M Neumeyer
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA 02421, United States; Harvard Medical School, Boston, MA 02115, United States.
| | - Natalia Cano Sokoloff
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA 02421, United States
| | - Erin McDonnell
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Eric A Macklin
- Harvard Medical School, Boston, MA 02115, United States; Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Christopher J McDougle
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA 02421, United States; Harvard Medical School, Boston, MA 02115, United States
| | - Madhusmita Misra
- Harvard Medical School, Boston, MA 02115, United States; Pediatric Endocrine and Neuroendocrine Units, Massachusetts General Hospital, Boston, MA 02114, United States
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Scarpato E, Staiano A, Molteni M, Terrone G, Mazzocchi A, Agostoni C. Nutritional assessment and intervention in children with cerebral palsy: a practical approach. Int J Food Sci Nutr 2017; 68:763-770. [DOI: 10.1080/09637486.2017.1289502] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Elena Scarpato
- Department of Translational Medical Sciences – Section of Paediatrics, University of Naples “Federico II”, Naples, Italy
| | - Annamaria Staiano
- Department of Translational Medical Sciences – Section of Paediatrics, University of Naples “Federico II”, Naples, Italy
| | - Massimo Molteni
- Child Psychopathology Unit, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) “Eugenio Medea”, Lecco, Italy
| | - Gaetano Terrone
- Department of Translational Medical Sciences – Section of Paediatrics, University of Naples “Federico II”, Naples, Italy
| | - Alessandra Mazzocchi
- Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS “Cà Granda Ospedale Maggiore Policlinico”, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS “Cà Granda Ospedale Maggiore Policlinico”, Milan, Italy
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Oftedal S, Davies PS, Boyd RN, Stevenson RD, Ware RS, Keawutan P, Benfer KA, Bell KL. Body composition, diet, and physical activity: a longitudinal cohort study in preschoolers with cerebral palsy. Am J Clin Nutr 2017; 105:369-378. [PMID: 28077375 DOI: 10.3945/ajcn.116.137810] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/07/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Altered body composition in children with cerebral palsy (CP) could be due to differences in energy intake, habitual physical activity (HPA), and sedentary time. OBJECTIVE We investigated the longitudinal relation between the weight-for-age z score (WZ), fat-free mass (FFM), percentage of body fat (%BF), and modifiable lifestyle factors for all Gross Motor Function Classification System (GMFCS) levels (I-V). DESIGN The study was a longitudinal population-based cohort study of children with CP who were aged 18-60 mo (364 assessments in 161 children; boys: 61%; mean ± SD recruitment age: 2.8 ± 0.9 y; GMFCS: I, 48%; II, 11%; III, 15%; IV, 11%; and V, 15%). A deuterium dilution technique or bioelectrical impedance analysis was used to estimate FFM, and the %BF was calculated. Energy intake, HPA, and sedentary time were measured with the use of a 3-d weighed food diary and accelerometer wear. Data were analyzed with the use of a mixed-model analysis. RESULTS Children in GMFCS group I did not differ from age- and sex-specific reference children with typical development for weight. Children in GMFCS group IV were lighter-for-age, and children in GMFCS group V had a lower FFM-for-height than those in GMFCS group I. Children in GMFCS groups II-V had a higher %BF than that of children in GMFCS group I, with the exception of orally fed children in GMFCS group V. The mean %BF of children with CP classified them as overfat or obese. There was a positive association between energy intake and FFM and also between HPA level and FFM for children in GMFCS group I. CONCLUSIONS Altered body composition was evident in preschool-age children with CP across functional capacities. Gross motor function, feeding method, energy intake, and HPA level in GMFCS I individuals are the strongest predictors of body composition in children with CP between the ages of 18 and 60 mo.
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Affiliation(s)
- Stina Oftedal
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland Children's Health Research Center, .,Children's Nutrition Research Center, and
| | | | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland Children's Health Research Center
| | - Richard D Stevenson
- Division of Developmental Pediatrics, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Australia
| | - Piyapa Keawutan
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland Children's Health Research Center.,Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; and
| | - Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland Children's Health Research Center
| | - Kristie L Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland Children's Health Research Center.,Dietetics and Food Services, Lady Cilento Children's Hospital, Children's Health Queensland, South Brisbane, Australia
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Dietary Intakes and Nutritional Issues in Neurologically Impaired Children. Nutrients 2015; 7:9400-15. [PMID: 26580646 PMCID: PMC4663597 DOI: 10.3390/nu7115469] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 12/16/2022] Open
Abstract
Neurologically impaired (NI) children are at increased risk of malnutrition due to several nutritional and non-nutritional factors. Among the nutritional factors, insufficient dietary intake as a consequence of feeding difficulties is one of the main issues. Feeding problems are frequently secondary to oropharyngeal dysphagia, which usually correlates with the severity of motor impairment and presents in around 90% of preschool children with cerebral palsy (CP) during the first year of life. Other nutritional factors are represented by excessive nutrient losses, often subsequent to gastroesophageal reflux and altered energy metabolism. Among the non-nutritional factors, the type and severity of neurological impairment, ambulatory status, the degree of cognitive impairment, and use of entiepileptic medication altogether concur to determination of nutritional status. With the present review, the current literature is discussed and a practical approach for nutritional assessment in NI children is proposed. Early identification and intervention of nutritional issues of NI children with a multidisciplinary approach is crucial to improve the overall health and quality of life of these complex children.
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Benfer KA, Weir KA, Bell KL, Ware RS, Davies PSW, Boyd RN. Food and fluid texture consumption in a population-based cohort of preschool children with cerebral palsy: relationship to dietary intake. Dev Med Child Neurol 2015; 57:1056-63. [PMID: 25982341 DOI: 10.1111/dmcn.12796] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 11/27/2022]
Abstract
AIM To determine the texture constitution of children's diets and its relationship to oropharyngeal dysphagia (OPD), dietary intake, and gross motor function in young children with cerebral palsy (CP). METHOD A cross-sectional, population-based cohort study comprising 99 young children with CP (65 males, 35 females) aged 18 to 36 months (mean age 27mo; Gross Motor Function Classification System [GMFCS] level I, n=45; II, n=13; III, n=14; IV, n=10; V, n=17). CP subtypes were classified as spastic unilateral (n=35), spastic bilateral (n=49), dyskinetic (n=5), and other (n=10), in accordance with the criteria of the Surveillance of Cerebral Palsy in Europe. Habitual dietary intake of food textures, energy, and water were determined from parent-completed 3-day weighed food records. Parent-reported feeding ability of food textures was reported on the Pediatric Evaluation of Disability Inventory and a feeding questionnaire. OPD was classified based on clinical feeding assessment using the Dysphagia Disorders Survey (rated by a certified assessor, KAB) and a subjective Swallowing Safety Recommendation (classified by a paediatric speech pathologist, KAB). RESULTS Food/fluid textures were modified for 39% of children. Children with poorer gross motor function tended to receive a greater proportion of energy from fluids (GMFCS levels IV-V: β=0.9, p=0.002) in their diets and fewer chewable foods (level III: β=-0.7, p=0.03; levels IV-V: β=-1.8, p<0.001) compared to level I to II participants. Fluids represented a texture for which children frequently had OPD and the texture most frequently identified as unsafe (or recommended for instrumental assessment). INTERPRETATION These findings indicate that swallowing safety, feeding efficiency, and energy/water intake should be considered when providing feeding recommendations for children with CP.
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Affiliation(s)
- Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Kelly A Weir
- Speech Pathology Department, Royal Children's Hospital, Brisbane, Qld, Australia
| | - Kristie L Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Robert S Ware
- Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.,School of Population Health, The University of Queensland, Brisbane, Qld, Australia
| | - Peter S W Davies
- Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Qld, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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Sangermano M, D'Aniello R, Massa G, Albano R, Pisano P, Budetta M, Scuccimarra G, Papa E, Coppola G, Vajro P. Nutritional problems in children with neuromotor disabilities: an Italian case series. Ital J Pediatr 2014; 40:61. [PMID: 25000975 PMCID: PMC4130424 DOI: 10.1186/1824-7288-40-61] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 06/30/2014] [Indexed: 01/04/2023] Open
Abstract
Background and aims Several neuromotor disorders share exclusive, although often overlooked, nutritional problems. The objective of this study is therefore to delineate the frequency of malnutrition, evaluate the effectiveness of nutritional care, and identify issues needing to be possibly strengthened when caring for these patients into a general pediatrics department. Patients and methods The study included 30 patients, 21 males and 9 females, aged between 2 and 15 years, affected by cerebral palsy, epileptic encephalopathy, and severe psychomotor developmental delay. Nutritional status was assessed by a dietary questionnaire administered to parents to investigate feeding difficulties; 3 days food diary to quantify daily calorie intake; anthropometrical (weight, height/length, body mass index percentiles, plicometry, specific body segments measurement) and blood (blood count, serum iron, albumin, transferrin, calcium, phosphorus) parameters. Results More than 44% individuals of the study population was at risk of malnutrition, according to feeding difficulties, progressive depletion of weight, reduced daily calorie intake, reduced albumin and transferrin levels. This occurred despite a massive caregivers commitment, as documented by almost universal parental constant assistance during their long-duration meals. Conclusions Our results individuate the nutritional aspect being still a problem in the care of children with severe neuromotor disability.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Pietro Vajro
- Chair of Pediatrics, Department of Medicine and Surgery, Pediatrics Section, University of Salerno, Via Allende, 84081 Baronissi- Salerno, Italy.
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