Insufficient energy and nutrient intake in children with motor disability

Intake levels and main sources of nutrients for Japanese children with motor or intellectual disabilities

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.

Nutritional status and dietary intake of children and adolescents with cerebral palsy

OBJECTIVE

To analyze the association between energy and nutrient intake, nutritional status and motor compromise in children and adolescents aged 2-19 years with cerebral palsy (CP) attending rehabilitation centers in the Province of Cordoba, Argentina.

METHODS

Cross sectional study. Data from 105 children and adolescents of both sexes aged 2-19 years with CP (67 boys [63.8% 53.84-72.95]) were collected. Motor compromise was assessed with GMFCS. 24 h records were collected and analyzed. The results were compared with the recommended by FAO/UNU/WHO for age and sex. Normal data were presented with mean and SD, while those of non-normal distribution were described as medians with their ranges. The relationship between variables was analyzed using Fisher, t, or Mann-Whitney tests, with a p value < 0.05.

RESULTS

The mean age was 11 years 6 months (SD 4 years 4 months). Fifteen [14.3% 8.23-22.48] children failed to meet at least 80% of the recommended energy. Children with GMFCS IV-V consume fewer daily calories and carbohydrate calories than their peers (I-III). The median protein intake of children GMFCS IV-V group was significantly lower than that of their peers (47.37 g vs. 71.56 g, p = 0.0057). Those who did not reach 80% of the recommended energy intake had lower intakes of macro and micronutrients.

CONCLUSION

The greater the motor compromise in children with CP, the greater the compromise in the adequacy of nutrient intake. The intake of macro and micronutrients was different according to whether or not they were able to cover at least 80% of the recommended energy for their age.

Pre-operative nutrition assessments do not improve outcomes in cerebral palsy patients undergoing varus derotational osteotomy

Pre-operative nutritional assessments have been used as a "cornerstone" to help optimize nutritional status and weight in children with cerebral palsy (CP) to lower the risk of postoperative complications. However, the potential value of nutritional assessments on surgical outcomes in patients with CP undergoing major orthopedic surgery remains unproven.Do pre-operative nutritional assessments reduce complication rates of varus derotational osteotomy surgery in children with CP? Are complication rates higher in patients with a gastrostomy tube (G-tube) and can they be decreased by pre-operative nutritional assessment?One-hundred fifty-five patients with CP who underwent varus derotational osteotomy from January 1, 2012 through December 31, 2017 at a tertiary pediatric hospital with minimum 6 months follow-up were retrospectively identified. One-hundred-ten (71%) were categorized as "non-ambulatory" (Gross Motor Function Classification System [GMFCS] IV-V), and 45 (29%) as "ambulatory" (GMFCS I-III). Variables assessed included age, GMFCS level, G-tube, body mass index (BMI) percentile, complications, and if patients underwent pre-operative nutritional assessment.One-hundred-eleven patients (71.6%) underwent pre-operative nutritional assessment. Sixty-two of 155 patients (40.0%) had G-tubes. In non-ambulatory patients with G-tubes, BMI percentile changes were not significantly different between patients with a pre-operative nutritional assessment compared to those without at 1 (P = .58), 3 (P = .61), 6 (P = .28), and 12 months (P = .21) postoperatively. In non-ambulatory patients who underwent pre-operative nutritional assessment, BMI percentile changes were not significantly different between those with and without G-tubes at 1 (P = .61), 3 (P = .71), 6 (P = .19), and 12 months (P = .10). Pulmonary complication rates were significantly higher in non-ambulatory patients with G-tubes than in non-ambulatory patients without G-tubes (20% vs 4%, P = .03). Pre-operative nutritional assessments did not influence postoperative complication rates for non-ambulatory patients with or without a G-tube (P = .12 and P = .16, respectively). No differences were found in postoperative complications between ambulatory patients with and without G-tubes (P = .45) or between ambulatory patients with or without nutritional assessments (P = .99).Nutritional assessments, which may improve long term patient nutrition, should not delay hip surgery in patients with CP and progressive lower extremity deformity. Patients and their families are unlikely to derive any short-term nutritional improvement using routine pre-operative evaluation and surgical outcomes are unlikely to be improved.Level of Evidence: III, retrospective comparative.

Phenotype assessment in neurologically impaired paediatric patients: Impact of a nutrition intervention protocol

BACKGROUND

Deficits in nutritional status and functional feeding disorders are common in Neurologically Impaired Paediatric Patients (NIPP). Interventions addressing these problems could offer better overall health status and quality of life in this group of patients, but the extent of their effectiveness is yet to be determined. Recent guidelines concerning the nutritional care of NIPP have been published from ESPGHAN but compliance to them has not been assessed.

AIM

The study aimed to assess the phenotypic profile of a group of NIPP attending the outpatient clinic of a pediatric department, and to implement, for the first time to our knowledge, an individualized nutritional intervention protocol following ESPGHAN guidelines 2017 as well as to assess the impact on phenotypic parameters and nutritional status.

PATIENTS AND METHODS

68NIPP and their caregivers aged 1m-17 years (83.8% suffering from cerebral palsy (CP) were invited to assess their phenotypic parameters and to implement in a nutrition intervention protocol in order to improve their dietary intake and nutritional status. Anthropometry (weight, height, triceps skinfold thickness, mid upper arm circumference) was expressed as z-scores for age and sex using WHO Anthro software and classified following the WHO criteria. Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Dysphagia Disorder Survey (DDS), Saliva Severity Scale (SSS), gastrointestinal complications, energy and nutrient intake were assessed at the beginning (zero point), after 6 (point 1) and 12 (point 2) months period. Intake to Requirement ratio (I/R) was derived. At zero point, following the baseline evaluation, caregivers were advised and educated on nutrition protocol and customized nutrition plans were handed out. The impact of the nutritional intervention on the phenotypic parameters was recorded on follow up visits (points 1, 2).The primary outcomes analyzed were anthropometric parameters (Waz), as indicators of nutritional status. GMFCS, MACS, DDS, SSS, FA were evaluated as possible predictors of this outcome. Secondary outcomes included the impact of the intervention protocol on the phenotypic parameters during the study period.

RESULTS

Based on weight for age z-score (Waz ≤ -2) (WHO) 17 patients (32.1%) were undernourished, 5/68 (10, 4%) were with triceps skinfold thickness z-score (TSTz) <-2 and 3/68 (7%) with mid upper arm circumference z-score (MUACz) <-2. Z-scores (WHO) for weight (p₁ = 0, 036) (p₂ = 0, 003), body mass index (BMI) (p₂ = 0,000), MUAC (p₁ = 0, 029) and TST (p₁ = 0, 021) (p₃ = 0, 044) were significantly improved in follow-up evaluations compared to the baseline. Less NIPP were found to be underweight according to Waz from point 1 to point 2 (p₃ = 0, 006), as well as stunding according to height for age z-score (Haz) from point 1 to point 2 (p ≤ 0,001). Patients with higher levels of GMFCS (p₁ = 0,040), MACS (p₁ = 0,028) DDS (p₁ = 0,001) and SSS (p₁ = 0,005) had significantly lower Haz. Patients with higher levels of SSS (p₁ = 0,002) had significantly lower TSTz scores. There were no significant changes in the classification of NIPP according to DDS or the patients' feeding ability. The energy (kcals) intake/kg of body weight (bw) was significantly higher at point 2 compared to point zero (p₃ = 0,028), protein intake/kg of body weight was significantly higher at points 1 and 2 compared to point zero (p₁ = 0,026, p₃ = 0,003), and fat intake/kg of body weight (bw) was significantly higher at point 2 compared to point zero (p₃ = 0,012). Intake of energy (kcals)/bw (p₁ = 0,026), (p₂ = 0,046), (p₃ = 0,048) carbs/bw (p₁ = 0,014) (p₂ = 0,042), I/R of pro (p₁ = 0,032), (p₃ = 0,013), and fat/kg (p₂ = 0, 033) (p₃ = 0,037) were found to be significantly lower in higher GMFCS levels. DQI did not improve during the study period nor correlated to any of the anthropometric parameters. Gastrointestinal complications correlated with Waz (r = -, 285 p₁ = 0, 011). Feeding Ability (FA) was found to be the only strong predictor for Waz at baseline evaluation (p = 0,012) when a multiple regression was run along with DDS.

CONCLUSION

Underweight was detected in one third of the patients, some degree of dysphagia in 69% and gastrointestinal complications in 58.8% of the sample. Height for age z-score (Haz) was the anthropometric parameter most sensitive to the changes in ranking on motor and functional feeding scores. The implementation of a customized nutrition intervention protocol in line with ESPGHAN's guidelines had a beneficial effect on improving dietary intake and nutritional status of NIPP after a 12 months period. Better results could be expected if dysphagia and feeding ability were also addressed by appropriate intervention protocols. Patients' feeding ability is of importance for predicting Waz.

A comparison of nutritional status between children with and without disabilities: A community-based study

Background:

Children with disabilities are expected to have poor nutritional status in comparison to children without disabilities. However, limited data on nutritional status of children with and without disabilities in rural settings in India.

Objective:

To assess and compare the nutritional status of children with and without disability.

Methods:

A cross-sectional study among children aged 5–15 years was conducted in the rural practise area of a medical college in Karnataka. 290 children (145 with and 145 children without disability) of similar age and sex were studied. Age and sex-specific World Health Organization (WHO) BMI centiles, 24 h dietary calorie and protein intakes were assessed and compared. Median and interquartile ranges were calculated for quantitative variables. Mann–Whitney U test was used to assess the differences in quantitative variables among the two groups.

Results:

As per WHO BMI centiles, 33.1% with and 37.20% without disabilities were undernourished. The median calorie consumed by children with disabilities was 1169.0 (946.5–1586.0) significantly lower compared to that of children without disability, that is, 1362.0 (1167.0–1641.0). The median protein consumed by children with disabilities was 28.0 (22.5–38.0) significantly lower compared to that of children without disability, that is, 32.0 (28.0–40.0).

Conclusions:

Children with disabilities had similar rates of undernutrition as that of their non-disabled peers and their lesser dietary intake in terms of calories and proteins.

Anthropometric Assessment of Nepali Children Institutionalized in Orphanages

Nepal is among the world’s poorest countries, and it is the third-poorest country in the South Asian region. Asia has the largest number of orphans in the world; in Nepal there are around 13,281 orphan children. The objective of this study is to evaluate the growth status of institutionalized children in Nepal through the analyses of anthropometric measures. The sample was Nepalese children aged 4 to 17, obtained from two different orphanages: in the first one, children with physical and mental disabilities coexist with children without any conditions. In the second one, there were no subjects with disabilities. Significant evidence of an association between mental and physical disability in institutionalized children and undernutrition (wasting and stunting) was found in this study. There is also weak but significant evidence of a relationship between underweight and being male. The study could help reaching a better understanding of growth status of institutionalized children in Nepal.

Complex nutritional deficiencies in a large cohort of Italian patients with Cornelia de Lange syndrome spectrum

Cornelia de Lange syndrome Spectrum (CdLSp) is characterized by intellectual disability, facial dysmorphisms, and growth impairment. Although eating difficulties are a well-known feature of the disease, there is no data regarding the nutritional deficiencies of these patients. The food intake was tracked using a dietary transcription provided by the family/caregivers, biochemical nutritional parameters were measured with laboratory tests and through an accurate clinical evaluation of the incidence of qualitative and quantitative imbalances in a cohort of 73 patients with CdLSp ware determined. Of these 73, 62 (85%) subjects provided a complete and detailed dietary transcription. In the studied population, a quantitative caloric imbalance in 47/62 (76%) subjects was observed. The caloric intake was low in 27/62 (43%) subjects whereas excessive in 20/62 (33%). Only 15/62 (24%) had an optimum caloric intake. Regarding micronutrients, a calcium intake deficiency in 32% of the patients (20/62) was observed. Blood tests revealed a low iron level in 22/73 (30%) of the patients and 25(OH)D deficiency in 49/73 (67%). Serum hypocalcemia was not evidenced. Qualitative and quantitative imbalances resulted in more frequent than expected in CdLSp patients. A qualitative imbalance was more prevalent in younger patients while in older patients prevailed mainly a quantitative disproportion. We found no statistically meaningful correlation between dietary imbalances, genetic, or clinical parameters. Our findings highlight the need for further studies to evaluate the basal metabolic rate of CdLSp patients and find a correlation with their growth impairment.

Bone health in pediatric patients with neurological disorders

Patients with neurological disorders are at high risk of developing osteoporosis, as they possess multiple risk factors leading to low bone mineral density. Such factors include inactivity, decreased exposure to sunlight, poor nutrition, and the use of medication or treatment that can cause lower bone mineral density such as antiepileptic drugs, ketogenic diet, and glucocorticoids. In this article, mechanisms involved in altered bone health in children with neurological disorders and management for patients with epilepsy, cerebral palsy, and Duchenne muscular dystrophy regarding bone health are reviewed.

Nutritional status of neurologically impaired children: Impact on comorbidity

BACKGROUND AND AIMS

Malnutrition is common in neurologically impaired (NI) children. It is, however, ill-defined and under-diagnosed. If not recognized and treated, it increases the burden of comorbidities and affects the quality of life of these children. The aim of this study was to characterize the nutritional status of a cohort of children followed up at a reference center for cerebral palsy (CP) in Brussels, Belgium, and to investigate possible links with the occurrence of comorbidities.

MATERIAL AND METHODS

We conducted a single-center retrospective study including all the children followed up at the Inter-university Reference Center for Cerebral Palsy ULB-VUB-ULg. The data were obtained by reviewing medical files. Anthropometric measurements as well as the etiology of neurological impairment, comorbidities, feeding patterns, and laboratory test results were collected. The children were assigned a nutritional diagnosis according to the World Health Organization and Waterlow definitions.

RESULTS

A total of 260 children with cerebral palsy were included, 148 males and 112 females. Their mean age was 10.9±4.3 years. The gross motor function classification system (GMFCS) level was I for 79 children, II for 63 children, III for 35 children, IV for 33 children, and V for 50 children. Of the children, 54% had a normal nutritional status, 34% showed malnutrition, and 8% were obese; 38% had oropharyngeal dysphagia. The sensitivity of mean upper arm circumference of<p10 to detect severe malnutrition was 95%. Specific growth charts for CP were neither sensitive nor specific for predicting the risk of comorbidities. Malnutrition was associated with an increased risk of comorbidities (relative risk of 2.4 [1.7; 3.4]). It was also associated with the occurrence of pneumonia, pressure ulcers, and pathological bone fracture.

DISCUSSION AND CONCLUSION

Children who are NI should be systematically and thoroughly screened for malnutrition, in the hope of offering early nutritional support and reduce comorbidities.

Oral health and nutritional status of children with cerebral palsy in northeastern peninsular Malaysia

AIMS

To investigate the oral health and nutritional status of children with cerebral palsy (CP).

METHODS AND RESULTS

Oral health assessment included dental caries and dental plaque maturity scores (DPMS) while the nutritional assessment included children's height-for-age Z-score (HAZ), body mass index-for-age Z-score (BAZ), mid-upper-arm circumference (MUAC), nutrient intake, cariogenic food frequency (CFF) and daily sugar exposure (DSE). Ninety-three CP children were recruited. The prevalence of caries was 81.7% (95% CI: 72.7%-88.3%). The median (IQR) of the DMFT and dft scores were 0.5(4.0) and 3.0(8.0), respectively. Most of the participants had acid-producing plaque (90.3%), severely stunted (81.4%), and 45% were severely thin with acute malnutrition. Intakes of calcium, iron, zinc, vitamin A, vitamin D and total fat were below 77% of the Recommended Nutrient Intakes for Malaysian children (RNI 2017). Nine types of cariogenic foods/drinks were consumed moderately, and DSE indicated that 45% of the children were at moderate risk of dental caries.

CONCLUSION

Untreated dental caries, severe stunting and thinness were prevalent, and cariogenic foods/drinks were consumed moderately suggesting a moderate risk of caries. Therefore, controlling cariogenic food intake is crucial, but monitoring daily nutrient intake is needed for the optimum growth of children with CP.

Nutritional Outcome in Home Gastrostomy-Fed Children with Chronic Diseases

The aim of the study was to assess the anthropometric outcomes after gastrostomy tube (GT) placement in children with chronic diseases and the influence of primary diagnosis, age, and nutritional support. A longitudinal, multicenter, and prospective study was performed evaluating 65 children with GT feeding and chronic diseases (61.5% with neurological disease). Each child was evaluated three times (at baseline and at 6 and 12 months after GT placement) and the following data was collected: primary diagnosis, age at GT placement, anthropometry, and feeding regime. Repeated measures ANOVA were used to analyze the main effects (intra and intergroup) and the interactions effects on weight gain and linear growth at 6 and 12 months after GT placement. All patients significantly improved their body mass index (BMI)-for-age z-score (p < 0.001) and height-for-age z-score (p < 0.05) after 6 and 12-month of follow-up. BMI gain increased significantly the first 6 months, followed by a plateau, while height followed a linear trend. Children with GT placement before 18 months old experienced an accelerated growth rate during the first 6 months post-GT. This technique showed the effectiveness of GT placement improving nutritional status and growth catch up regardless of their primary diagnosis and the type of nutritional support.

Dose, timing, and source of protein intake of young people with spastic cerebral palsy

Purpose: Since the dose, timing and source of dietary protein intake are important for muscle growth and development, the aim of this study was to examine the dose, timing and source of protein intake of young people with cerebral palsy.Materials and methods: Dietary intake was assessed in 19 children with spastic cerebral palsy (Gross Motor Function Classification System levels I-V; Eating and Drinking Classification System levels I-V; 10 males, 9 females; mean [SD] age 11 years 2 months [3 years 3 months]) using a 3-day food diary. The data were analyzed for three age categories (4-8, 9-13, and 14-17 years).Results: Average 3-day protein intake (62.1 g [27.9 g]) was within the recommended boundaries with a minimum of 1.0 g/kg body weight/day and a maximum of 4.1 g/kg body weight/day. However, dinner was the only mealtime that provided at least 25 g of protein, which is needed for optimal muscle maintenance. The main food groups that contributed to protein intake were 'milk and milk products', 'meat, meat products and poultry', and 'bread'.Conclusions: These observations suggest timing of protein intake can be improved with higher intakes during breakfast and lunch to better support skeletal muscle growth and development.IMPLICATIONS FOR REHABILITATIONRecent studies have shown that smaller muscles and early atrophy are already present at young age in individuals with cerebral palsy.Besides physical training, adequate protein intake (with optimal dose, timing and source of protein) may be a key factor in the prevention and treatment of loss of muscle mass in children with cerebral palsy.In a relatively small sample this study shows that overall protein intake (dose) was in line with recommendations and also that the source of the protein seemed sufficient to contain all essential amino acids.Improvement of the timing of protein intake throughout the day, with higher intakes during breakfast and lunch, seems important to better support skeletal muscle growth and development.

Basics of bone metabolism and osteoporosis in common pediatric neuromuscular disabilities

Bone modeling is a process that starts with fetal life and continues during adolescence. Complex factors such as hormones, nutritional and environmental factors affect this process. In addition to these factors, physical conditioning and medications that have toxic effects on bony tissue should be carefully considered in patient follow-up. Osteoporosis is a significant problem in pediatric population because of ongoing growth and development of skeletal system. Two types of osteoporosis are primary and secondary types and children with neuromuscular disabilities constitute a major group with secondary osteoporosis. Low bone mass in patients with cerebral palsy, spina bifida, and Duchenne muscular dystrophy cause increased bone fragility in even slight traumas. Maximizing peak bone mass and prevention of bone loss are very important to reduce the fracture risk in neuromuscular diseases. This article aims to review the determinants of bone physiology and bone loss in children with cerebral palsy, spina bifida, and Duchenne muscular dystrophy.

Bone health in cerebral palsy and introduction of a novel therapy

Objective

To assess the bone health status of children with cerebral palsy and the therapeutic effect of denosumab in a subgroup of children with cerebral palsy and decreased bone mass.

Methods

Children with cerebral palsy were evaluated according to their motor disability score (classification system gross motor functions III to V), bone density and bone turnover markers. Dual X-ray energy absorption was used to measure the lumbar spine, and total body, except the head. Thereafter a group of children with cerebral palsy and osteoporosis was treated with denosumab, a fully human monoclonal antibody. Bone turnover markers were measured before and three months after treatment.

Results

Reduction in bone mineral density was observed, particularly in children with greater impairment evaluated by the motor score. Decreased bone turnover markers were found in a selected group of children three months after exposure to denosumab.

Conclusion

Bone loss was present in children with significant impairment of motor function, as well as decreased serum levels of bone resorption markers with new forms.

Dietary Intakes and Nutritional Issues in Neurologically Impaired Children

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.

[Effect of supplementation with a single dose of vitamin D in children with cerebral palsy. Preliminary randomised controlled study]

INTRODUCTION

Children with cerebral palsy (CP) have an increased risk of vitamin D (VD) deficiency. Although there are many studies on VD and CP, there is limited information about VD supplementation in these patients.

OBJECTIVE

To evaluate the effect of supplementation with a single dose of VD on the plasma concentrations of 25-hydroxy-vitamin-D (25OHD) in children with CP.

PATIENTS AND METHOD

Prospective-randomised-controlled-trial, including 30 Chilean children (19 males) with CP, median age 9.9 years (6.2-13.5). Clinical and biochemical variables including 25OHD, were recorded (time 0 and 8 weeks). Patients were allocated to the supplemented (S) group receiving 100,000 IU oral D3 at baseline, and compared with the placebo (P) group.

RESULTS

Among clinical features are highlighted: gastrostomy (60%), underweight (30%), bed-ridden (93.3%), antiepileptic drugs (70%), and 43.3% used VD metabolism inducing antiepileptics. Baseline biochemical measurements were normal. The 25OHD was insufficient in 4/30 and deficient in 6/30. 25OHD levels were not associated with the variables studied. Eight patients completed the study in the S group, and 10 in P group. The placebo and supplementation groups had no significant difference in baseline variables. Serum calcium, phosphate, and alkaline phosphatase levels at 8 weeks were normal in both groups, with no statistically significant differences. 25OHD in the P group was normal in 6/10, and insufficient+deficient in 4/10, and the S group was normal in all (8/8) (exact Fisher test P=.07).

CONCLUSIONS

A single dose of 100,000 IU VD could normalise the concentrations of 25OHD after 8 weeks of supplementation in Children with CP, but more studies are required to confirm these results.

Nutritional problems in children with neuromotor disabilities: an Italian case series

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.

Factors predicting distress among parents/caregivers of children with neurological disease and home enteral nutrition

BACKGROUND & AIMS

Caregivers of children with chronic diseases included in a home enteral nutrition (HEN) programme are at risk of experiencing a feeling of burden, high level of anxiety and psychological distress. The aims of this study were: first, to examine the prevalence of symptoms of anxiety-depression in caregivers of children with neurological diseases requiring HEN by gastrostomy tube (GT); second, to compare the characteristics of caregivers with high or low risk of exhibiting symptoms of anxiety-depression; and third, to investigate possible associations to child disease severity and nutrition support mode.

METHODS

A cross-sectional observational study was performed in 58 caregivers of children (31 boys, aged 0.3-18 years) with neurological diseases and GT feeding. The characteristics of caregivers with high or low risk of presenting symptoms of anxiety-depression were compared regarding the following variables: socio-demographic characteristics, the primary caregiver's intrapsychic factors, anthropometric parameters of the child, length of HEN, type of nutrients delivered by GT and infusion regime.

RESULTS

All primary caregivers were mothers. Fifty-three per cent of them showed high risk of exhibiting symptoms of anxiety-depression. Mothers with high or low risk of presenting symptoms of anxiety-depression were comparable in age and family socio-economic status. They were also similar in terms of age, anthropometric conditions and length of HEN in their children.No differences were found between the two groups of mothers according to the level of the child's motor function impairment, type of nutrients delivered by GT and infusion regime. Higher levels of psychological distress and perception of burden overload were found in mothers with high risk of exhibiting symptoms of anxiety-depression.

CONCLUSIONS

This study found a high prevalence of symptoms of anxiety-depression, perception of burden overload and psychological distress in caregivers of children with HEN. Thus, greater practical and emotional support is required for these families.

An exploratory study of sodium, potassium, and fluid nutrition status of tube-fed nonambulatory children with severe cerebral palsy

Children with severe cerebral palsy (CP) often have lower mineral intakes than healthy children. It is unknown if their lower nutrient intakes are adequate to meet their needs. The objective of this study was to examine the sodium, potassium, phosphate, and fluid status of primarily tube-fed nonambulatory children with severe CP. The design consisted of a cross-sectional exploratory study and a clinical trial of sodium supplementation. Nutritional status was determined among primarily tube-fed children (aged 2 to 17 years) with CP based on blood and urine samples, anthropometry, and 3-day food records. Mineral and fluid status was evaluated by a nephrologist blind to nutrient intakes. Twenty children supplied food records, blood samples, and anthropometric measurements, and 16 supplied urine samples. Six (37.5%) of those who provided urine samples were considered possibly dehydrated, as urine osmolality was >600 mmol·kg(-1). Six (60%) of the 10 children with satisfactory fluid status (low urine osmolality) were considered to have a possible dietary sodium deficiency based on a very low urine sodium concentration (<20 mmol·L(-1)). Those considered to have a possible dietary sodium deficiency had a significantly lower sodium intake (48% ± 15% Adequate Intake (AI)) compared with those considered sodium sufficient (73% ± 20% AI) (p = 0.031). One child was considered possibly phosphorus deficient, but none was assessed as likely potassium deficient. The conclusion was that sodium deficiencies were likely prevalent among the children. The findings from this small observational study suggest that sodium intakes for tube-fed children with CP should be maintained near the AI for their age. Hydration status of children receiving hypercaloric formulas should be monitored.

Identification of feeding risk factors for impaired nutrition status in paediatric patients with cerebral palsy

AIM

To assess the nutrition status of children with CP, applying WHO growth standards, to indentify feeding risk factors and to evaluate their impact on the growth of children with CP.

METHODS

In 42 paediatric patients (mean age 8.00 ± 4.00 years), anthropometry and food intake records were assessed. z-scores were calculated using WHO Anthro software. Intake to requirements ratio (I/R) was calculated, and patients were classified according to their feeding ability (PFA). Overall diet quality was assessed using the Diet Quality Index International (DQI-I).

RESULTS

Based on WAz, 15 patients (38.1%) were undernourished. No association was found between I/R ratio and BMI z-score, while PFA and DQI-I displayed a significant correlation to both (p < 0.05). Diet Quality Index International was also correlated with macronutrient distribution (p < 0.05). Patients with CP were undernourished in a considerable proportion. Malnutrition in patients with CP is not associated with the intake of estimated energy requirements. Among the other feeding risk factors studied, PFA and DQI-I represented important parameters associated with malnutrition.

CONCLUSION

WHO z-scores represent accurate parameters for the assessment of malnutrition in patients with CP. Together with anthropometry and PFA evaluation, the use of the DQI-I would add prognostic value to both the initial growth assessment and the patients' growth monitoring.