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Alenazi KA, Alanezi AA. Prevalence of Vitamin D Deficiency in Children With Cerebral Palsy: A Meta-Analysis. Pediatr Neurol 2024; 159:56-61. [PMID: 39137591 DOI: 10.1016/j.pediatrneurol.2024.03.021] [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: 10/10/2023] [Revised: 01/20/2024] [Accepted: 03/19/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Vitamin D deficiency stands out as a significant contributor to reduced bone mineral density in children diagnosed with cerebral palsy (CP). The objective of the meta-analysis was to estimate the prevalence of vitamin D deficiency in children with CP. METHODS This meta-analysis adhered to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guide. For children with CP aged between zero and 18 years with vitamin D deficiency, relevant articles were retrieved from PubMed, Scopus, ScienceDirect, and Cochrane. Following keywords were used: "cerebral palsy," "children," "childhood," "vitamin D," "vitamin D deficiency," "prevalence," and "frequency." Newcastle-Ottawa Scale was used to assess methodologic quality. Meta-analysis was performed using Stata 13.0. RESULTS In total, seven articles were considered suitable for inclusion in the meta-analysis of 411 articles initially identified. These studies involved a total of 430 children diagnosed with CP, ranging in age from zero to 18 years. Among the seven studies, two followed a cross-sectional approach, whereas the remaining five utilized a case-control design. Six of these studies were determined to have a low risk of bias, whereas one exhibited a moderate risk of bias. The combined prevalence of vitamin D deficiency in children with CP was determined to be 42.18% (95% confidence interval = 32.90% to 51.73%, I2 = 74.41%, and P < 0.001). CONCLUSIONS In conclusion, this meta-analysis reveals evidence of high prevalence of vitamin D deficiency in children with CP. This finding underscores the importance of addressing nutritional factors in the management of CP among pediatric populations.
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Hamid Namaganda L, Andrews C, Wabwire-Mangen F, Peterson S, Forssberg H, Kakooza-Mwesige A. Nutritional status and growth of children and adolescents with and without cerebral palsy in eastern Uganda: A longitudinal comparative analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001241. [PMID: 37310914 DOI: 10.1371/journal.pgph.0001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/25/2023] [Indexed: 06/15/2023]
Abstract
There is a need to understand the growth and burden of malnutrition in children with cerebral palsy (CP) in order to design appropriate inclusive nutrition strategies. We compared the nutritional status and four-year longitudinal growth of a population-based cohort of children and adolescents (C&A) with CP (n = 97; 2-17 years; 55/42 M/F), and an age and sex matched group without CP (n = 91; 2-17y; 50/41 M/F) in rural Uganda. The cohorts were assessed in 2015 and 2019 for weight, height, social demographic characteristics, and feeding related factors. Nutritional status was determined using the World Health Organization (WHO) Z-scores. Wilcoxon sign rank and Mann-Whitney tests were used to test within and between group differences. Multivariable linear regression was used to determine predictors of the change in growth. Approximately two thirds (62/97 (64%)) of C&A with CP were malnourished (with <-2SD in any of the WHO Z-scores), especially those with feeding difficulties (OR = 2.65; P = 0.032), and those who needed to be fed (OR = 3.8; P = 0.019). Both the CP and non-CP groups deviated negatively from the WHO reference growth curve for height, with a significantly slower growth in the CP group (median change score of height-for-age Z score (HAZ) between assessments = -0.80(-1.56, 0.31), p<0.01), than the non-CP group (median HAZ change score = -0.27(-0.92,0.34, p = 0.034). There was a statistically significant group difference in the median HAZ change score between the CP and non-CP groups (z = -2.21, p = 0.026). Severity of motor impairment measured by the Gross Motor Function Classification System (GMFCS-level) correlated negatively (r = -1.37,95%CI -2.67, -0.08) with the change in HAZ scores among the CP group. Children and adolescents with severe motor impairments exhibit an increased risk of malnutrition and growth retardation compared to their age matched peers without CP, which underscores the need to develop inclusive community-based nutrition strategies for children with cerebral palsy.
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Affiliation(s)
- Lukia Hamid Namaganda
- CURIE Study Consortium, Iganga-Mayuge Health and Demographic Surveillance System, Iganga, Uganda
- Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Carin Andrews
- CURIE Study Consortium, Iganga-Mayuge Health and Demographic Surveillance System, Iganga, Uganda
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Fred Wabwire-Mangen
- CURIE Study Consortium, Iganga-Mayuge Health and Demographic Surveillance System, Iganga, Uganda
- Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
| | - Stefan Peterson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Policy Planning and Management, Makerere School of Public Health, Kampala, Uganda
| | - Hans Forssberg
- CURIE Study Consortium, Iganga-Mayuge Health and Demographic Surveillance System, Iganga, Uganda
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Angelina Kakooza-Mwesige
- CURIE Study Consortium, Iganga-Mayuge Health and Demographic Surveillance System, Iganga, Uganda
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
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Prevalence, severity, and predictors of malnutrition in Indian children with cerebral palsy and their impact on health-related quality of life. Eur J Pediatr 2023; 182:2433-2441. [PMID: 36917290 DOI: 10.1007/s00431-023-04930-4] [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: 09/18/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Although several studies have shown that undernutrition is frequent in children with cerebral palsy (CP), studies determining predictors of undernutrition and its impact on health-related quality of life (HRQoL) are scarce. This study aimed to assess the prevalence, severity, and predictors of malnutrition in children with CP and its impact on quality of life. This prospective study was performed between August 2019 and December 2021 in children with a clinical diagnosis of CP aged 2-18 years. We also intended to determine the socio-demographic and clinical predictors of undernutrition in these children and its impact on HRQoL, measured by the cerebral palsy quality of life (CPQoL)-Primary Caregiver reported version. Out of 569 (5.4 ± 2.8 years of age, 74% boys) children with CP, 71%, 44%, and 72% children were underweight, wasted, and stunted respectively, whereas 22%, 11%, and 21% were severely underweight, wasted and stunted respectively. Lower socioeconomic status, higher Gross Motor Function Classification System, and Manual Ability Classification System level were found to be significantly associated with the severity of stunting and underweight (p < 0.05), but not with wasting. CPQoL score in children with CP aged > 4 years was lower in patients with severe wasting, stunting, and underweight, as compared to their rest of the counterparts when adjusted for socio-demographic and other clinical variables (p < 0.05). Conclusion: Chronic undernutrition is more common than severe acute malnutrition in children with CP. The severity of undernutrition is an important predictor of impaired HRQoL in children with CP. What is Known: • Several studies have shown that undernutrition is frequent in children with cerebral palsy; however, studies determining predictors of undernutrition and its impact on health-related quality of life are scarce. What is New: • Our study identifies that lower socioeconomic status, higher Gross Motor Function Classification System, and Manual Ability Classification System level are significantly associated with the severity of stunting and being underweight. • Chronic undernutrition is more common than severe acute malnutrition in children with cerebral palsy. Its severity is an important predictor of impaired health-related quality of life in children with cerebral palsy.
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Aydın K, Dalgıç B, Kansu A, Özen H, Selimoğlu MA, Tekgül H, Ünay B, Yüce A. The significance of MUAC z-scores in diagnosing pediatric malnutrition: A scoping review with special emphasis on neurologically disabled children. Front Pediatr 2023; 11:1081139. [PMID: 36950173 PMCID: PMC10025394 DOI: 10.3389/fped.2023.1081139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/16/2023] [Indexed: 03/24/2023] Open
Abstract
This review by a panel of pediatric gastroenterology-hepatology-nutrition and pediatric neurology experts aimed to address the significance of mid-upper arm circumference (MUAC) assessment in diagnosis of pediatric malnutrition. Specifically, the potential utility of recently developed MUAC z-score tape in clinical practice for larger patient populations was addressed including the neurologically disabled children. In accordance with the evidence-based data, four statements were identified by the participating experts on the utility of MUAC z-score tape, including (1) MUAC z-scores correlate with body mass index (BMI) and weight for height/length (WFH/l) z-scores in diagnosing malnutrition; (2) MUAC z-score tape offers a higher sensitivity to diagnose the mild and moderate malnutrition and better ability to track the changes in nutritional status over time than the other single datapoint measurements; (3) Using single-step MUAC z-score tape in children with cerebral palsy (CP) seems to provide more reliable data on anthropometry; and (4) The clinical value of the tool in classifying secondary malnutrition in CP should be investigated in large-scale populations. In conclusion, enabling single-step estimation of nutritional status in a large-scale pediatric population regardless of age and within a wide range of weight, without formal training or the need for ancillary reference charts and calculators, MUAC z-tape offers a favorable tool for easier and earlier diagnosis of pediatric malnutrition. Nonetheless, further implementation of MUAC z-score screening in larger-scale and/or special populations is necessary to justify its utility in relation to other primary anthropometric indicators in diagnosis of malnutrition as well as in treatment monitoring in the community and hospital setting.
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Affiliation(s)
- Kürşad Aydın
- Department of Pediatric Neurology, Medipol University Faculty of Medicine, Istanbul, Türkiye
| | - Buket Dalgıç
- Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Aydan Kansu
- Department of Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Hasan Özen
- Department of Pediatric Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
- Correspondence: Hasan Özen
| | - Mukadder Ayşe Selimoğlu
- Department of Pediatric Gastroenterology, Memorial Atasehir and Bahcelievler Hospitals, Istanbul, Türkiye
| | - Hasan Tekgül
- Department of Pediatric Neurology, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Bülent Ünay
- Department of Pediatric Neurology, Gulhane Faculty of Medicine, Ankara, Türkiye
| | - Aysel Yüce
- Department of Pediatric Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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Fogarasi A, Fazzi E, Smorenburg ARP, Mazurkiewicz-Beldzinska M, Dinopoulos A, Pobiecka A, Schröder-van den Nieuwendijk D, Kraus J, Tekgül H, Kraus J, Dinopoulos A, Koutsaki M, Fogarasi A, Baranello G, Bertoli S, Caramaschi E, Cordelli DM, De Amicis R, Fazzi E, Forchielli ML, Guerra A, Lividini A, Marchiò M, Rossi A, Nieuwendijk DSVD, Fliciński J, Gurda B, Lemska A, Matheisel A, Mazurkiewicz-Beldzinska M, Niwinska Z, Pawłowicz M, Sawicka A, Steinborn B, Szmuda M, Winczewska-Wiktor A, Zawadzka M, Pobiecka A, Arhan E, Aydin K, Bayram E, Carman KB, Edem P, Ertem D, Goktas ÖA, Gungor S, Haliloglu G, Kansu A, Kömür M, Mutlu A, Kırsaçlıoğlu CT, Okuyaz Ç, Özgör B, Ozturk Y, Sager SG, Sarıgeçili E, Selimoglu MA, Serin HMÖ, Teber ST, Tekgül H, Thomas G, Turkdogan D, Volkan B, Yarar C, Yilmaz SK. The PURPLE N study: objective and perceived nutritional status in children and adolescents with cerebral palsy. Disabil Rehabil 2022; 44:6668-6675. [PMID: 34473588 DOI: 10.1080/09638288.2021.1970255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To obtain information on characteristics, management, current objective nutritional status and perception of nutritional status of children with cerebral palsy (CP) from healthcare professionals (HCPs) and caregivers. MATERIALS AND METHODS A detailed survey of several items on eight main topics (general characteristics, motor function, comorbidities, therapies, anthropometry, feeding mode and problems and perceived nutritional status) was developed and tested for the study. Correlation between nutritional status and Gross Motor Function Classification System (GMFCS) levels was assessed using continuous variables (Z-scores for weight-for-age, height-for-age, weight-for-height, and body mass index-for-age), and categorical variables (being malnourished, stunted, or wasted). HCP and caregiver perceptions of the child's nutritional status as well as agreement between perceived and objective nutritional status and agreement between perceived nutritional status and concerns about the nutritional status were analyzed. RESULTS Data were available for 497 participants from eight European countries. Poorer nutritional status was associated with higher (more severe) GMFCS levels. There was minimal agreement between perceived and objective nutritional status, both for HCPs and caregivers. Agreement between HCP and caregiver perceptions of the child's nutritional status was weak (weighted kappa 0.56). However, the concerns about the nutritional status of the child were in line with the perceived nutritional status. CONCLUSIONS The risk of poor nutritional status is associated with more severe disability in children and adolescents with CP. There is a mismatch between HCP and caregiver perceptions of participants' nutritional status as well as between subjective and objective nutritional status. Our data warrant the use of a simple and objective screening tool in daily practice to determine nutritional status in children and adolescents with CP. Clinical trial registration: ClinicalTrials.gov Identifier: NCT03499288 (https://clinicaltrials.gov/ct2/show/NCT03499288). IMPLICATIONS FOR REHABILITATIONUse of the ESPGHAN recommendations and simple screening tools in daily practice is needed to improve nutritional care for individuals with CP.Attention should be paid to the differences in the perception of nutritional status of individuals with CP between professionals and caregivers to improve appropriate referral for nutritional support.Objective measures rather than the professional's perception need to be used to define the nutritional status of individuals with CP.
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Affiliation(s)
- Andras Fogarasi
- Child Neurology Department, Bethesda Children's Hospital, Budapest, Hungary
| | - Elisa Fazzi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ana R P Smorenburg
- Department of Specialized Nutrition, Danone Nutricia Research, Utrecht, The Netherlands
| | | | - Argirios Dinopoulos
- 3rd Department of Pediatrics, Attikon General Hospital, University of Athens, Athens, Greece
| | - Alena Pobiecka
- Department of Pediatrics, University Hospital Trnava, Slovakia
| | | | - Josef Kraus
- Department of Child Neurology, University Hospital Motol, Czech Republic
| | - Hasan Tekgül
- Ege University School of Medicine, Pediatric Neurology, Izmir, Turkey
| | | | | | - Josef Kraus
- Department of Child Neurology, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | | | - Argirios Dinopoulos
- Pediatric Neurology Unit, 3rd Department of Pediatrics, University of Athens, Attikon General Hospital, Athens
| | - Maria Koutsaki
- Pediatric Neurology Unit, 3rd Department of Pediatrics, University of Athens, Attikon General Hospital, Athens
| | | | | | | | | | - Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan
| | - Elisa Caramaschi
- Department of Medical and Surgical Sciences of Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena
| | - Duccio Maria Cordelli
- Child Neurology and Psychiatry Unit, Department of Medical and Surgical Sciences (DIMEC), S. Orsola Hospital, University of Bologna
| | - Ramona De Amicis
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan
| | - Elisa Fazzi
- ASST Spedali Civili, Brescia, and University of Brescia, Brescia, Italy
| | - Maria Luisa Forchielli
- Pediatric Gastroenterology and Nutrition Clinic, AO Sant'Orsola - Malpighi, University of Bologna
| | - Azzurra Guerra
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena
| | - Althea Lividini
- Child Neurology and Psychiatry Unit, S. Orsola Hospital, University of Bologna
| | - Maddalena Marchiò
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena
| | - Andrea Rossi
- Child and Adolescent Neurology and Psychiatry Unit, Children Hospital, ASST Spedali Civili - Brescia
| | | | | | | | - Jędrzej Fliciński
- Chair and Department of Developmental Neurology, Poznan University of Medical Sciences
| | - Barbara Gurda
- Chair and Department of Developmental Neurology, Poznan University of Medical Sciences
| | - Anna Lemska
- Department of Developmental Neurology, Medical University of Gdańsk
| | | | | | - Zuzanna Niwinska
- Chair and Department of Developmental Neurology, Poznan University of Medical Sciences
| | - Małgorzata Pawłowicz
- Department of Developmental Neurology, Medical University of Gdańsk.,(current affiliations: Department of Pediatric Neurology.,Provincial Specialist Children's Hospital in Olsztyn, Olsztyn.,Department of Pathophysiology, Faculty of Medicine, Warmia and Mazury University in Olsztyn, Olsztyn, Poland)
| | | | - Barbara Steinborn
- Chair and Department of Developmental Neurology, Poznan University of Medical Sciences
| | - Marta Szmuda
- Department of Developmental Neurology, Medical University of Gdańsk
| | | | - Marta Zawadzka
- Department of Developmental Neurology, Medical University of Gdańsk
| | | | - Alena Pobiecka
- Department of Pediatrics, University Hospital Trnava, Slovakia
| | | | - Ebru Arhan
- Gazi University School of Medicine/Neurology, Gazi
| | - Kursad Aydin
- Gazi University, School of Medicine, Pediatric Neurology, Ankara
| | - Erhan Bayram
- Dokuz Eylul University School of Medicine, Pediatric Neurology, Izmir
| | - Kursat Bora Carman
- Division of Pediatric Intensive Care Unit, Eskişehir Osmangazi University Medical Faculty
| | - Pinar Edem
- Dokuz Eylul University School of Medicine, Pediatric Neurology, Izmir
| | - Deniz Ertem
- Marmara University School of Medicine/Gastroenterology, Istanbul
| | | | - Serdal Gungor
- Inonu University School of Medicine/Neurology, Malatya
| | - Goknur Haliloglu
- Hacettepe University Faculty of Medicine, Department of Pediatric Neurology, Ankara
| | - Aydan Kansu
- Ankara University School of Medicine/Gastroenterology, Ankara
| | | | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation/Developmental and Early Physiotherapy Unit, Ankara
| | | | - Çetin Okuyaz
- Division of Pediatric Neurology, Faculty of Medicine, Mersin University, Mersin
| | - Bilge Özgör
- Inonu University School of Medicine, Malatya
| | - Yesim Ozturk
- Dokuzeylul University School of Medicine/Gastroenterology, Izmir
| | | | | | | | | | - Serap Tıraş Teber
- University of Ankara Faculty of Medicine, Department of Child Neurology, Ankara
| | - Hasan Tekgül
- Ege University School of Medicine, Pediatric Neurology, Izmir
| | - Gülten Thomas
- Marmara University School of Medicine/Gastroenterology, Istanbul
| | | | - Burcu Volkan
- Marmara University School of Medicine/Gastroenterology, Istanbul
| | - Coşkun Yarar
- Department of Pediatric Neurology, Eskişehir Osmangazi University School of Medicine, Eskişehir
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Paker N, Yavuz Mollavelioglu T, Bugdaycı D, Ones K, Bardak AN, Karacan I, Yıkıcı I, Kesiktas FN. Vitamin D levels in children with cerebral palsy. J Pediatr Rehabil Med 2022; 16:163-169. [PMID: 36031913 DOI: 10.3233/prm-190622] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to assess serum vitamin D levels and related factors in children with cerebral palsy (CP). METHODS One hundred and nineteen children with CP between the ages of 1 year to 10 years 9 months who were admitted to the children's inpatient rehabilitation unit of a tertiary rehabilitation hospital between January 1, 2017, and December 31, 2018, were included in this study. Demographic and clinical characteristics were obtained from the patient files. CP types and serum 25 hydroxyvitamin D (25OHD) levels were recorded. Gross Motor Function Classification System (GMFCS) was used to assess the functional level. RESULTS Mean age was 5.1±2.9 years. Forty-two (35.3%) were girls, 105 (88.3%) were spastic, and 14 (11.7%) were ataxic and mixed type CP. Mean GMFCS level was 4 (IQR:2). Thirty-one (26.1%) were getting extra liquid feed while the rest were eating a normal diet. Mean serum 25OHD level was 27.4±15.7 (3-79) ng/mL. Vitamin D levels were normal in 68 children (57.1%), whereas 36 (30.3%) had vitamin D insufficiency and 15 (12.6%) showed vitamin D deficiency. Those whose serum vitamin D levels were within a normal range had a median age of 3.8 (IQR:4.2) years. On the other hand, mean age was 6.4 (4.3) years for those with low vitamin D level (p < 0.0001). Vitamin D level was 19.8 (21.4) ng/mL in those (n = 88) who had regular diets, whereas it was 31.0 [16] ng/mL in those (n = 31) who were getting extra liquid feed (p = 0.015). There was no statistically significant correlation between vitamin D level and gender, GMFCS, CP type, season or antiepileptic drug treatment. A binary logistic regression model showed that older age and having only regular meals were significant risk factors for low vitamin D. CONCLUSION In this study, 42.9% of the children with CP had low vitamin D. Older children with CP or those who had regular diets were higher risk groups in terms of low vitamin D.
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Affiliation(s)
- Nurdan Paker
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
| | | | - Derya Bugdaycı
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
| | - Kadriye Ones
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
| | - Ayse Nur Bardak
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
| | - Ilhan Karacan
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
| | | | - Fatma Nur Kesiktas
- University of Health Sciences Istanbul PMR Training Hospital, Istanbul, Turkey
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da Silva DCG, de Sá Barreto da Cunha M, de Oliveira Santana A, Dos Santos Alves AM, Pereira Santos M. Malnutrition and nutritional deficiencies in children with cerebral palsy: a systematic review and meta-analysis. Public Health 2022; 205:192-201. [PMID: 35339939 DOI: 10.1016/j.puhe.2022.01.024] [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: 06/29/2021] [Revised: 12/09/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This systematic review study and meta-analysis sought to estimate the prevalence of malnutrition and nutritional deficiencies in children with cerebral palsy (CP). STUDY DESIGN This is a systematic review and meta-analysis. METHODS The systematic review was conducted according to the PRISMA guidelines. The articles were chosen using the PubMed, Embase, Scopus, Web of Science, Cochrane Library, SciELO, and Lilacs databases and the bibliographical reference lists of the articles. No limitations were placed on the time of publication, but the articles had to include children from 0 to 18 years old with CP who presented the prevalence of malnutrition and nutritional deficiencies. The methodological quality of the articles was assessed using the verification list for analytical cross-sectional studies, the Newcastle-Ottawa scale, and the Cochrane Collaboration tool for randomized studies. The meta-analysis of proportions was conducted based on the prevalence data for malnutrition or nutritional deficiencies. The study is registered in PROSPERO under CRD number 42020175068. RESULTS Sixty-seven articles (N = 453,804) published between 1986 and 2019 were included. Most of the articles presented a low risk of bias and no publication was excluded for quality reasons. The most widely used anthropometric index for diagnosing nutritional status was weight-to-age and the estimated prevalence of malnutrition was 40% (95% CI = 28.0-53.0). Nutrient deficiency was investigated by nine publications, with hypocalcemia and reduced serum concentrations of zinc, copper, and vitamin D being reported the most. CONCLUSIONS We found a high rate of malnutrition in the population in this review, moreover, we suggest that some nutritional deficiencies are associated with food deficit and that the socio-economic and age factors of these children may relate with the poor nutritional outcome. This makes monitoring and personalized nutritional management necessary, in accordance with the characteristics and particularities of children with CP.
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Affiliation(s)
- D C G da Silva
- Universidade Federal do Oeste da Bahia, Barreiras, Bahia, Brazil.
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Jahan I, Muhit M, Al Imam MH, Ghose R, Chhetri AB, Badawi N, Khandaker G. Nutritional Status of Children with Cerebral Palsy in Gorkha, Nepal: Findings from the Nepal Cerebral Palsy Register. Nutrients 2021; 13:nu13082537. [PMID: 34444697 PMCID: PMC8399945 DOI: 10.3390/nu13082537] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The study aimed to define the burden and underlying risk factors of malnutrition among children with cerebral palsy (CP) in Gorkha district, Nepal. Methods: The first population-based register of children with CP in Gorkha, Nepal (i.e., Nepal CP Register—NCPR) was established in 2018. Children aged <18 years with confirmed CP were registered following standard protocol. Nutritional status was determined based on anthropometric measurements (height/length, weight, mid-upper-arm-circumference) following WHO guidelines. Descriptive analyses and adjusted logistic regression were completed. Results: Between June–October 2018, 182 children with CP were registered into the NCPR (mean (SD) age at assessment: 10.3 (5.0) years, 37.4% female). Overall, 51.7%, 64.1%, and 29.3% children were underweight, stunted, and thin, respectively. Furthermore, 14.3% of children with CP aged <5 years had severe wasting. Underweight and stunting were significantly higher among children with spastic CP (p = 0.02, p < 0.001) and/or Gross Motor Function Classification System (GMFCS) level (III–V) (p = 0.01, p < 0.001) and/or who were not enrolled in school (p = 0.01, p < 0.001). In adjusted analysis, GMFCS level III–V and non-attendance to school significantly increased the odds of stunting by 8.2 (95% CI 1.6, 40.8) and 4.0 (95% CI 1.2, 13.2) times, respectively. Conclusions: the high rate of different forms of undernutrition among children with CP in Gorkha, Nepal is concerning. Need-based intervention should be taken as priority to improve their nutritional outcome.
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Affiliation(s)
- Israt Jahan
- CSF Global, Dhaka 1213, Bangladesh; (M.M.); (M.H.A.I.); (R.G.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia;
- Correspondence: ; Tel.: +880-173-900-2305
| | - Mohammad Muhit
- CSF Global, Dhaka 1213, Bangladesh; (M.M.); (M.H.A.I.); (R.G.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
| | - Mahmudul Hassan Al Imam
- CSF Global, Dhaka 1213, Bangladesh; (M.M.); (M.H.A.I.); (R.G.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia;
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
| | - Ratul Ghose
- CSF Global, Dhaka 1213, Bangladesh; (M.M.); (M.H.A.I.); (R.G.)
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh
| | | | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW 2086, Australia;
- Grace Centre for Newborn Intensive Care, Sydney Children’s Hospital Network, Westmead, NSW 2145, Australia
| | - Gulam Khandaker
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia;
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
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9
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Podgórska-Bednarz J, Perenc L, Drużbicki M, Guzik A. Nutritional Disorders in a Group of Children and Adolescents with Syndromes or Diseases Involving Neurodysfunction. Nutrients 2021; 13:nu13061786. [PMID: 34073813 PMCID: PMC8225066 DOI: 10.3390/nu13061786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023] Open
Abstract
A study of the literature shows the lack of data on a comprehensive analysis of eating disorders in children with neurodysfunction, which constitute a clinical subgroup with an increased risk of abnormalities in this area. Therefore, the aim of this study was to determine the relationship between the coexistence of nutritional disorders and diseases or syndromes associated with neurodysfunction based on data collected during hospitalization at a rehabilitation center for children and adolescents. A retrospective analysis was carried out in a group of 327 children and adolescents aged 4–18 years. The study group covered various types of diseases or syndromes involving damage to the central nervous system. A retrospective analysis of baseline data (age, sex, main and additional diagnosis and Body Mass Index—BMI) was performed. Two assessment criteria of nutritional status were taken into account (z-score BMI and other previously published normative values). In the study group, malnutrition was found more frequently (18.0% of the respondents) than obesity (11.3% of the subjects). Hypothyroidism coexisting with malnutrition was identified in the study group (N% = 43.8%, p = 0.011) and malnutrition with tetraplegia in the subgroup of spastic cerebral palsy (N% = 34.2 %, p = 0.029).
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Affiliation(s)
- Justyna Podgórska-Bednarz
- Institute of Health Sciences, Medical College of Rzeszów University, Warzywna 1A, 35-310 Rzeszów, Poland; (L.P.); (M.D.); (A.G.)
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland
- Correspondence:
| | - Lidia Perenc
- Institute of Health Sciences, Medical College of Rzeszów University, Warzywna 1A, 35-310 Rzeszów, Poland; (L.P.); (M.D.); (A.G.)
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland
| | - Mariusz Drużbicki
- Institute of Health Sciences, Medical College of Rzeszów University, Warzywna 1A, 35-310 Rzeszów, Poland; (L.P.); (M.D.); (A.G.)
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland
| | - Agnieszka Guzik
- Institute of Health Sciences, Medical College of Rzeszów University, Warzywna 1A, 35-310 Rzeszów, Poland; (L.P.); (M.D.); (A.G.)
- Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland
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10
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Weide G, Huijing PA, Bar-On L, Sloot L, Buizer AI, Becher JG, Harlaar J, Jaspers RT. Gastrocnemius Medialis Muscle Geometry and Extensibility in Typically Developing Children and Children With Spastic Paresis Aged 6-13 Years. Front Physiol 2020; 11:528522. [PMID: 33329011 PMCID: PMC7719761 DOI: 10.3389/fphys.2020.528522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022] Open
Abstract
Gait of children with spastic paresis (SP) is frequently characterized by a reduced ankle range of motion, presumably due to reduced extensibility of the triceps surae (TS) muscle. Little is known about how morphological muscle characteristics in SP children are affected. The aim of this study was to compare gastrocnemius medialis (GM) muscle geometry and extensibility in children with SP with those of typically developing (TD) children and assess how GM morphology is related to its extensibility. Thirteen children with SP, of which 10 with a diagnosis of spastic cerebral palsy and three with SP of unknown etiology (mean age 9.7 ± 2.1 years; GMFCS: I-III), and 14 TD children (mean age 9.3 ± 1.7 years) took part in this study. GM geometry was assessed using 3D ultrasound imaging at 0 and 4 Nm externally imposed dorsal flexion ankle moments. GM extensibility was defined as its absolute length change between the externally applied 0 and 4 Nm moments. Anthropometric variables and GM extensibility did not differ between the SP and TD groups. While in both groups, GM muscle volume correlated with body mass, the slope of the regression line in TD was substantially higher than that in SP (TD = 3.3 ml/kg; SP = 1.3 ml/kg, p < 0.01). In TD, GM fascicle length increased with age, lower leg length and body mass, whereas in SP children, fascicle length did not correlate with any of these variables. However, the increase in GM physiological cross-sectional area as a function of body mass did not differ between SP and TD children. Increases in lengths of tendinous structures in children with SP exceeded those observed in TD children (TD = 0.85 cm/cm; SP = 1.16 cm/cm, p < 0.01) and even exceeded lower-leg length increases. In addition, only for children with SP, body mass (r = -0.61), height (r = -0.66), muscle volume (r = - 0.66), physiological cross-sectional area (r = - 0.59), and tendon length (r = -0.68) showed a negative association with GM extensibility. Such negative associations were not found for TD children. In conclusion, physiological cross-sectional area and length of the tendinous structures are positively associated with age and negatively associated with extensibility in children with SP.
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Affiliation(s)
- Guido Weide
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Peter A. Huijing
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lynn Bar-On
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lizeth Sloot
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Annemieke I. Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jules G. Becher
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Richard T. Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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11
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Hasegawa M, Tomiwa K, Higashiyama Y, Kawaguchi C, Kin H, Kubota M, Shima M, Nogami K. Risk factors of malnutrition in children with severe motor and intellectual disabilities. Brain Dev 2020; 42:738-746. [PMID: 32624241 DOI: 10.1016/j.braindev.2020.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/30/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Children with severe motor and intellectual disabilities (SMID) are at a high risk of malnutrition and often require tube feeding to maintain their nutritional status. However, determining their energy requirements is difficult since inadequate dietary intake, severe neurological impairment, respiratory assistance, and cognitive impairment are all factors that affect malnutrition in SMID. AIM This study investigated the factors affecting malnutrition and identified problems affecting the nutritional status of children with SMID. METHODS Forty-two children with SMID with oral motor dysfunction who were receiving home medical care at one of four hospitals were enrolled. Their nutritional status was assessed using a 3-day dietary record, anthropometric measurements, and laboratory tests. The clinical findings associated with malnutrition were compared, and a body mass index (BMI) z-score less than -2SD was defined as malnutrition. The relationship between BMI z-score and other potential predictors was also investigated. RESULTS Thirty-three (79%) children received tube feeding, and 20 (48%) experienced malnutrition. The median age of the malnourished children was older than that of non-malnourished children. Respiratory assistance was significantly correlated with higher BMI z-score, independent of other potential confounders such as nutrition method, muscle tonus, and energy intake. Cholesterol levels were significantly higher in children receiving a standard infant formula beyond 3 years of age than in those who switched to enteral formula before 3 years of age. CONCLUSIONS Malnutrition in children with SMID was mainly associated with age or respiratory condition. Energy requirements should be regularly re-evaluated with considering these factors.
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Affiliation(s)
- Mari Hasegawa
- Department of Pediatrics, Nara Medical University, Japan
| | - Kiyotaka Tomiwa
- Department of Pediatrics, Todaiji Ryoiku Hospital for Children, Japan
| | - Yukie Higashiyama
- Division of Human Life and Environment, Nara Women's University, Japan; Division of Health and Nutritional Sciences, Aichi Shukutoku University, Japan
| | - Chiharu Kawaguchi
- Department of Pediatrics, Todaiji Ryoiku Hospital for Children, Japan; Department of Pediatrics, Yamato Takada Municipal Hospital, Japan
| | - Hajime Kin
- Department of Pediatrics, Todaiji Ryoiku Hospital for Children, Japan
| | - Masaru Kubota
- Division of Human Life and Environment, Nara Women's University, Japan
| | - Midori Shima
- Department of Pediatrics, Nara Medical University, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Japan.
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12
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Almuneef AR, Almajwal A, Alam I, Abulmeaty M, Bader BA, Badr MF, Almuammar M, Razak S. Malnutrition is common in children with cerebral palsy in Saudi Arabia - a cross-sectional clinical observational study. BMC Neurol 2019; 19:317. [PMID: 31823743 PMCID: PMC6905047 DOI: 10.1186/s12883-019-1553-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is considered as the main cause of severe physical impairment and malnutrition in children. This cross-sectional study intended to survey the nutritional status of children cerebral palsy in Riyadh, Saudi Arabia. METHODS We examined 74 children (age: 1-10 yrs) with CP, who attended Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh Saudi Arabia. Data on age, general demographics, nutritional status, and dietary intake were collected. A child was considered underweight, wasted, stunted or thin if the standard deviation scores for his/her weight for age, weight for height, height for age and body mass index for age were ≤ -2.0 standard deviation (SD) using WHO growth standards. Multivariable logistic regression identified the factors associated with nutritional indicators. RESULTS More than half (56.4%) of the children with cerebral palsy were malnourished as they had z-score below <-2 SD in at least one of the four indicators. Thinness (50%) was the most common form of malnutrition, followed by underweight, stunting, and wasting. Arm anthropometrics gave similar results on the percent number of malnourished children. Factors that were independently associated with malnutrition with an adjusted OR (aOR) were as follow: age ≤ 5 yrs. (aOR: 4.29); presence of cognitive impairment (aOR: 4.13); presence of anemia (aOR: 3.41) and inadequate energy intake (aOR: 4.86) (p, for all trends <0.05). CONCLUSION Children with cerebral palsy of the current study have impaired growth and nutritional status as assessed by all four common nutritional status indicators. Further large-scale community-based studies for in-depth evaluation of nutritional status and growth patterns in children with CP are needed.
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Affiliation(s)
- Abdul Rahman Almuneef
- Sultan Bin Abdulaziz Humanitarian City, P.O. Box: 10219, Riyadh, KSA, 11433, Saudi Arabia.,Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
| | - Ali Almajwal
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia.
| | - Iftikhar Alam
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud Abulmeaty
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
| | - Bader Al Bader
- Sultan Bin Abdulaziz Humanitarian City, P.O. Box: 10219, Riyadh, KSA, 11433, Saudi Arabia
| | - Mohamed Farouq Badr
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
| | - May Almuammar
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
| | - Suhail Razak
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
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13
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Sundelin HEK, Stephansson O, Johansson S, Ludvigsson JF. Pregnancy outcome in women with cerebral palsy: A nationwide population-based cohort study. Acta Obstet Gynecol Scand 2019; 99:518-524. [PMID: 31738455 DOI: 10.1111/aogs.13773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is a lifelong disorder with a high rate of comorbidities and complications. We hypothesized that women with CP are at increased risk of adverse pregnancy outcome. MATERIAL AND METHODS In this nationwide population-based cohort study 1997-2011, we examined the outcome of 770 births in women with CP vs 1 247 408 births in women without a CP diagnosis using the Swedish Medical Birth Register. We used unconditional logistic regression, adjusting for maternal age, smoking, parity, year of birth and epilepsy, to calculate adjusted odds ratios for adverse pregnancy outcome. Main adverse outcome was preterm birth. Secondary outcomes were cesarean section, induction of labor, low 5-min Apgar score, small for gestational age, large for gestational age, and stillbirth. RESULTS After adjusting for potential confounders, maternal CP was associated with increased risk of preterm birth (12.9% vs 4.9%; adjusted odds ratio [aOR] 2.8, 95% CI 2.3-3.5), cesarean delivery (aOR 1.9, 95% CI 1.6-2.2), induced delivery (aOR 1.4, 95% CI 1.1-1.6), low 5-min Apgar score (aOR 1.8, 95% CI 1.1-2.9) and small of gestational age birth (aOR 1.6, 95% CI 1.2-2.3). We found no increased risk of large for gestational age or stillbirth. CONCLUSIONS Women with CP are at increased risk of preterm birth and other adverse pregnancy outcomes, suggesting that they deserve extra surveillance during antenatal care. Further studies, with information on type of CP and gross motor function, are warranted to better understand the association between CP and pregnancy outcome.
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Affiliation(s)
- Heléne E K Sundelin
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Stefan Johansson
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, University Hospital, Örebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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14
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Viñals-Labañino CP, Velazquez-Bustamante AE, Vargas-Santiago SI, Arenas-Sordo ML. Usefulness of Cerebral Palsy Curves in Mexican Patients: A Cross-Sectional Study. J Child Neurol 2019; 34:332-338. [PMID: 30854918 DOI: 10.1177/0883073819830560] [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] [Indexed: 11/16/2022]
Abstract
Cerebral palsy describes a group of movement and posture disorders that cause activity limitation, and are attributable to nonprogressive disorders that occur in the fetal or infant brain. The growth of these children should not be compared with those of the healthy population. We studied 452 children, 186 female and 266 male. We compared the results in 2 growth charts, Centers for Disease Control and Prevention (CDC) and cerebral palsy, and the results were statistically significant ( P = .00001). With the CDC charts, 40.71% of the patients were below the 5th percentile and only 5.5% of them when we used the charts for cerebral palsy patients. The Mexican cerebral palsy patients were similar to US cerebral palsy patients when we compared height ( P = .4075) and body mass index (BMI) ( P = .4075). Only the weight was found to be different ( P = .00001). All the correlation indexes were negative: Eating and Drinking Ability Classification System (EDACS)-BMI (rho = -0.4798) ( P = .00001), Communication Function Classification System (CFCS)-BMI (rho = -0.4353) ( P = .00001), and Gross Motor Function Classification System (GMFCS)-BMI (rho = -0.3584) ( P = .00001). The growth charts of the healthy pediatric population tend to overestimate the underweight. We propose to use cerebral palsy charts as a reference in our patients. It is possible to determine a functional profile (communication, gross motor function and safety, and feed efficiency) for the cerebral palsy population based on their BMI.
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Affiliation(s)
- Carlos P Viñals-Labañino
- 1 Pediatric Rehabilitation Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
| | - Ana E Velazquez-Bustamante
- 1 Pediatric Rehabilitation Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
| | - Silvia I Vargas-Santiago
- 1 Pediatric Rehabilitation Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
| | - Maria L Arenas-Sordo
- 2 Genetics Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarrra, Tlalpan, Mexico City, Mexico
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15
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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] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
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16
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Diamanti A, Cereda E, Capriati T, Giorgio D, Brusco C, Liguori A, Raponi M. Prevalence and outcome of malnutrition in pediatric patients with chronic diseases: Focus on the settings of care. Clin Nutr 2018; 38:1877-1882. [PMID: 30097363 DOI: 10.1016/j.clnu.2018.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/22/2018] [Accepted: 07/07/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Information on disease-related malnutrition and related outcomes in pediatric patients with chronic diseases in different settings of care is not available. METHODS Consecutive eligible patients attending the out-patient clinic (n = 177) or admitted to the day-hospital clinic (n = 163) or to hospital (n = 201) were screened for the presence of malnutrition (BMI and/or height/length for age z-scores < -2). We recorded data on emergency care admissions to hospital that occurred during the 3 years before screening and related total days of stay, as well as data on emergency care admissions to hospital occurring within 6 months after screening. RESULTS Prevalence of malnutrition was 2-fold higher (P < 0.001) in in-patients (56.7% [95% CI, 49.6-63.7]) than in patients assessed at the out-patient (33.3% [95% CI, 26.4-40.8]) and day-hospital (28.3% [95% CI, 21.5-35.8]) clinics. Estimates were heterogeneous across diagnostic groups with higher rates in patients with neurologic (61%) and cardiac (56%) diseases. Stunting was more frequent among in-patients, who also had more evident nutritional derangements. Multivariate logistic regression (covariates: age, gender, healthcare setting and disease group), showed that malnutrition (OR = 1.86 [95% CI, 1.21-2.88]; P = 0.005) was significantly associated with prolonged hospitalization (≥15 days) in the 3 years before screening. In-patients were also more likely to have been hospitalized ≥15 days (using out-patients as reference category, OR = 2.24 [95% CI, 1.39-3.63], P = 0.001), but we did not find any modifying effect (interaction) of the setting of care on the association between malnutrition and prolonged hospitalization. DISCUSSION The rates of malnutrition in children with chronic diseases are very high and increase hospital care needs, especially when they are admitted to hospital. Nutritional care in this patient population is recommended.
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Affiliation(s)
- Antonella Diamanti
- Artificial Nutrition Unit, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy.
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Teresa Capriati
- Artificial Nutrition Unit, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
| | - Daniela Giorgio
- Medical Direction, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
| | - Carla Brusco
- Medical Direction, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
| | - Alessandra Liguori
- Artificial Nutrition Unit, Pediatric Hospital "Bambino Gesù", IRCCS, Rome, Italy
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17
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Jahan I, Muhit M, Karim T, Smithers-Sheedy H, Novak I, Jones C, Badawi N, Khandaker G. What makes children with cerebral palsy vulnerable to malnutrition? Findings from the Bangladesh cerebral palsy register (BCPR). Disabil Rehabil 2018; 41:2247-2254. [PMID: 29658318 DOI: 10.1080/09638288.2018.1461260] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: To assess the nutritional status and underlying risk factors for malnutrition among children with cerebral palsy in rural Bangladesh. Materials and methods: We used data from the Bangladesh Cerebral Palsy Register; a prospective population based surveillance of children with cerebral palsy aged 0-18 years in a rural subdistrict of Bangladesh (i.e., Shahjadpur). Socio-demographic, clinical and anthropometric measurements were collected using Bangladesh Cerebral Palsy Register record form. Z scores were calculated using World Health Organization Anthro and World Health Organization AnthroPlus software. Results: A total of 726 children with cerebral palsy were registered into the Bangladesh Cerebral Palsy Register (mean age 7.6 years, standard deviation 4.5, 38.1% female) between January 2015 and December 2016. More than two-third of children were underweight (70.0%) and stunted (73.1%). Mean z score for weight for age, height for age and weight for height were -2.8 (standard deviation 1.8), -3.1 (standard deviation 2.2) and -1.2 (standard deviation 2.3) respectively. Moderate to severe undernutrition (i.e., both underweight and stunting) were significantly associated with age, monthly family income, gross motor functional classification system and neurological type of cerebral palsy. Conclusions: The burden of undernutrition is high among children with cerebral palsy in rural Bangladesh which is augmented by both poverty and clinical severity. Enhancing clinical nutritional services for children with cerebral palsy should be a public health priority in Bangladesh. Implications for Rehabilitation Population-based surveillance data on nutritional status of children with cerebral palsy in Bangladesh indicates substantially high burden of malnutrition among children with CP in rural Bangladesh. Children with severe form of cerebral palsy, for example, higher Gross Motor Function Classification System (GMFCS) level, tri/quadriplegic cerebral palsy presents the highest proportion of severe malnutrition; hence, these vulnerable groups should be focused in designing nutrition intervention and rehabilitation programs. Disability inclusive and focused nutrition intervention programme need to be kept as priority in national nutrition policies and nutrition action plans specially in low- and middle-income countries. Community-based management of malnutrition has the potential to overcome this poor nutritional scenario of children with disability (i.e., cerebral palsy). The global leaders such as World Health Organization, national and international organizations should take this in account and conduct further research to develop nutritional guidelines for this vulnerable group of population.
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Affiliation(s)
- Israt Jahan
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh
| | - Mohammad Muhit
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh
| | - Tasneem Karim
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh
| | - Hayley Smithers-Sheedy
- c Cerebral Palsy Alliance Research Institute , University of Sydney , Sydney , Australia.,d Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , Australia
| | - Iona Novak
- c Cerebral Palsy Alliance Research Institute , University of Sydney , Sydney , Australia
| | - Cheryl Jones
- e Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI) , University of Sydney , Sydney , Australia.,f Department of Paediatrics , The University of Melbourne , Parkville , Australia
| | - Nadia Badawi
- c Cerebral Palsy Alliance Research Institute , University of Sydney , Sydney , Australia.,d Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , Australia
| | - Gulam Khandaker
- a CSF Global , Dhaka , Bangladesh.,b Asian Institute of Disability and Development (AIDD) , University of South Asia , Dhaka , Bangladesh.,d Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , Australia
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