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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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Expósito D, Morales-Suarez MM, Soriano JM, Soler C. Tools for Nutrition Assessment of Adults with Cerebral Palsy: Development of a Gold Standard. Curr Nutr Rep 2023; 12:545-553. [PMID: 37486592 DOI: 10.1007/s13668-023-00485-w] [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] [Accepted: 06/16/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW Cerebral palsy (CP) is a group of disorders caused by non-stabilized cerebral lesions. Individuals with this disorder are at a higher risk of suffering from malnutrition and other related detrimental effects to their quality of life. For this reason, accurate methods of nutritional assessment are vital for people suffering from this condition. While assessment of nutritional status in children with CP has been extensively studied, very few studies have been carried out on adults. These limitations are due to the great anatomical-functional variability characteristic of this syndrome. Difficulties that derive from this variability in adult patients with CP mean that there remains an urgent need for certain standards of nutritional assessment for this population. The objective of this review is to compile the latest trends in nutritional assessment in adults with CP to guide the development of a conceptual framework for future research. RECENT FINDINGS With this aim, relevant studies have been identified. The most commonly used technique to evaluate nutritional status is the BMI because of its ease-of-use. However, its well-known limitations fail to adequately estimate the nutritional status in this population, with measurements of patients with CP yielding results that are much less accurate than those that already exist in the general population. Although more studies are needed, kinanthropometry is considered one of the most reliable techniques; nevertheless, the anatomical limitation characteristic of CP plays a limiting factor.
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Affiliation(s)
- D Expósito
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain.
- Department of Basic Medical Sciences, Universidad Católica de Valencia, 46001, Valencia, Spain.
- Department of Nutrition, Universidad Católica de Valencia, 46001, Valencia, Spain.
| | - M M Morales-Suarez
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100, Burjassot, Valencia, Spain
- CIBER Epidemiologia Y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - J M Soriano
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain
- Joint Research Unit On Endocrinology, Nutrition and Clinical Dietetics, UV-IIS La Fe, 46012, Valencia, Spain
| | - C Soler
- Food & Health Lab. Instituto de Ciencias de los Materiales, Universitat de València, C/ Catedrático José Beltrán 2, 46980, Paterna, Valencia, Spain
- Joint Research Unit On Endocrinology, Nutrition and Clinical Dietetics, UV-IIS La Fe, 46012, Valencia, Spain
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Sattoe JNT, Hilberink SR. Impairments and comorbidities in adults with cerebral palsy and spina bifida: a meta-analysis. Front Neurol 2023; 14:1122061. [PMID: 37533474 PMCID: PMC10390785 DOI: 10.3389/fneur.2023.1122061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Aging with a childhood-onset disability, such as cerebral palsy (CP), spina bifida (SB), and muscular diseases (MD), comes along with significant impairments and comorbidities. Despite the increasing evidence an overall picture is lacking. This study aimed to review the literature about adults with CP/SB/MD and impairments and comorbidities to perform a meta-analysis. Materials and methods Embase, PubMed, Cinahl, and Google Scholar were searched (2000-2020). Search terms included adults with one of the aforementioned disabilities combined with impairments and comorbidities. If specific impairments or comorbidities were reported by at least four studies, these were included in the study. Pooled prevalence (95% Confidence Interval) of impairments/comorbidities were calculated. Results The search yielded 7,054 studies of which 95 were included in the meta-analysis (64 CP, 31 SB, 0 MD). In total estimates were calculated for 26 (CP) and 11 (SB) outcomes. In adults with CP, pain [56.4% (95%CI 48.8-63.8)], deformities [44.2% (95%CI 12.9-78.4)], intellectual disability [37.2% (95%CI 26.7-48.3)], and fatigue [36.9% (95%CI 24.6-50.1)] were most prevalent; renal disease [3.0% (95%CI 2.1-4.2)] and stroke/rheumatic diseases {4.8% (95%CI 3.4-6.5; 4.8% (95%CI 1.5-9.9)] respectively} were least prevalent. For adults with SB, bladder incontinence [60.0% (95%CI 50.5-69.2)], bowel incontinence [49.2% (95%CI 34.5-64.0)], pain [44.1% (95%CI 27.4-61.5)], and sleeping problems [30.3% (95%CI 4.7-65.8)] were most prevalent; diabetes [4.8% (95%CI 2.8-7.3)] and renal disease [8.7% (95%CI 2.0-19.9)] were least prevalent. The included studies showed large heterogeneity. Conclusions More research is needed to study health issues in adults with MD. Adults with CP or SB deal with a variety of health issues. More attention for the mental health of these adults is needed. There also is a need for accessible and adequate screening, preventive measures and clinical follow-up.
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Ryan JM, Albairami F, Hamilton T, Cope N, Amirmudin NA, Manikandan M, Kilbride C, Stevenson VL, Livingstone E, Fortune J. Prevalence and incidence of chronic conditions among adults with cerebral palsy: A systematic review and meta-analysis. Dev Med Child Neurol 2023. [PMID: 36807150 DOI: 10.1111/dmcn.15526] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 02/22/2023]
Abstract
AIM To assess the prevalence and incidence of chronic conditions among adults with cerebral palsy (CP) and compare them to the prevalence and incidence among adults without CP. METHOD We searched MEDLINE and Embase for studies reporting the prevalence or incidence of one or more chronic conditions among adults with CP. Two independent reviewers screened titles, abstracts, and full-text articles. Two independent reviewers extracted data relating to prevalence and incidence and appraised study quality. We performed random-effects meta-analyses to pool prevalence and incidence. RESULTS We identified 69 studies; 65 reported the prevalence of 53 conditions and 13 reported the incidence of 21 conditions. At least 20% of adults had the following conditions: depression (21%); anxiety (21%); mood affective disorders (23%); asthma (24%); hypertension (26%); epilepsy (28%); urinary incontinence (32%); malnutrition (38%); and scoliosis (46%). Adults with CP were more likely to have type 2 diabetes, anxiety, bipolar disorder, depression, schizophrenia, hypertension, ischaemic heart disease, stroke, cerebrovascular disease, asthma, liver disease, osteoarthritis, osteoporosis, underweight, and chronic kidney disease than adults without CP. INTERPRETATION These data from 18 countries, which provide an international perspective, may be used to promote awareness, identify targets for intervention, and inform the development of appropriate supports for adults with CP.
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Affiliation(s)
- Jennifer M Ryan
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fatemah Albairami
- Department of Physical Therapy, Ahmadi Hospital, Kuwait Oil Company, Kuwait.,College of Health, Medicine and Life Sciences, Brunel University, London, UK
| | - Thomas Hamilton
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nigel Cope
- Physiotherapy Department, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | | | - Manjula Manikandan
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cherry Kilbride
- College of Health, Medicine and Life Sciences, Brunel University, London, UK
| | - Valerie L Stevenson
- The National Hospital for Neurology and Neurosurgery, UCLH Foundation Trust, London, UK
| | | | - Jennifer Fortune
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Alenazi KA. Vitamin D deficiency in children with cerebral palsy: A narrative review of epidemiology, contributing factors, clinical consequences and interventions. Saudi J Biol Sci 2022; 29:2007-2013. [PMID: 35531196 PMCID: PMC9072905 DOI: 10.1016/j.sjbs.2021.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/16/2021] [Accepted: 12/12/2021] [Indexed: 11/02/2022] Open
Abstract
Sufficient vitamin D levels are necessary, not only for mineralization, normal growth and development of bones, but also for the prevention of fatal chronic diseases like diabetes mellitus, metabolic syndrome and cancer. This is of particular importance in children with neuro- and musculoskeletal disorders, especially cerebral palsy (CP). CP is a heterogeneous group of childhood developmental disability disorders described by uncharacteristic posture, balance, and movement. Patients with CP are at an increased risk of vitamin D deficiency and as a result reduced bone mineral density, bone fragility, osteopenia, and rickets. The present review aims to combine and summarize available evidence, regarding the epidemiology, underlying contributing factors, clinical consequences, and treatment interventions of vitamin D deficiency in children with CP.
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Shin HI, Jung SH. Body Fat Distribution and Associated Risk of Cardiovascular Disease in Adults With Cerebral Palsy. Front Neurol 2021; 12:733294. [PMID: 34956040 PMCID: PMC8692887 DOI: 10.3389/fneur.2021.733294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Fat distribution has increasingly been acknowledged as a more significant health parameter than general obesity, in terms of the risk of cardiovascular disease (CVD). We aimed to investigate the regional fat distribution pattern and general body fat characteristics of adults with cerebral palsy (CP), and we explored the risk of CVD in this population. Methods: People aged ≥20 years who were diagnosed with CP were recruited between February 2014 and November 2014. The subjects underwent a structured interview, laboratory studies, and physical examination. The amount and distribution of fat were determined directly by dual-energy X-ray absorptiometry. Laboratory analysis was performed to measure total cholesterol and triglyceride, high-density lipoprotein (HDL), low-density lipoprotein, and fasting plasma glucose levels. The Framingham risk score (FRS) was used to present the 10-year risk for having CVD, and predictors such as sex, age, total cholesterol, HDL, systolic blood pressure, treatment for hypertension, and smoking status were used to calculate the FRS. Results: Ninety-nine adults (58 men, mean age 41.77 ± 8.95 years) with CP were included. The participants consisted of all five levels of the Gross Motor Function Classification System. The mean body mass index (BMI) was 22.52 ± 4.58 kg/m2. According to BMI criteria, 54.9% were overweight and 27.3% were obese. The fat mass index criteria revealed 10.1% excess fat and 7.6% obesity. In univariable regression analysis, age, the timing of physical function deterioration, and android fat percentage were associated with the FRS (p <0.001, p <0.001, and p = 0.007, respectively). In multiple regression analysis, the FRS was associated with age and android fat percentage, based on the following formula: " FRS= - 18 . 549 + 0 . 410 ∗ Age + 0 . 577 ∗ Android percent fat ( % ) ( R 2 =0 . 528 ) ' ' ( p < 0.001 ) . Conclusions: Body fat distribution in the android area is significantly associated with future CVD risk in adults with CP.
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Affiliation(s)
- Hyun Iee Shin
- Department of Rehabilitation Medicine, Chung Ang University Hospital, Seoul, South Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Epidemiology of Cerebral Palsy in Adulthood: A Systematic Review and Meta-analysis of the Most Frequently Studied Outcomes. Arch Phys Med Rehabil 2020; 101:1041-1052. [PMID: 32059945 DOI: 10.1016/j.apmr.2020.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/13/2019] [Accepted: 01/08/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the epidemiology of health status, impairments, activities and participation in adults with cerebral palsy (CP). DATA SOURCES Embase, MEDLINE, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane, and Google Scholar were searched for 3 themes ("cerebral palsy," "adult," and "outcome assessment") in literature published between January 2000 and December 2018. STUDY SELECTION Full-article peer-reviewed English journal articles on descriptive, observational, or experimental studies describing the most studied outcomes in adults with CP (n≥25, age≥18y) were included. Studies were included in the analyses if frequently studied outcomes were described in at least 3 studies using similar methods of assessment. DATA EXTRACTION Data were extracted independently by 2 authors from 65 articles (total N=28,429) using a standardized score sheet. DATA SYNTHESIS Meta-analyses revealed that overall, on average 65.1% (95% confidence interval [CI], 55.1-74.5) of adults with CP experienced pain, 57.9% (95% CI, 51.1-64.6) were ambulant, 65.5% (95% CI, 61.2-69.7) had little or no limitation in manual ability, 18.2% (95% CI, 10.6-27.2) had tertiary education, 39.2% (95% CI, 31.5;47.1) were employed, and 29.3% (95% CI, 9.0-55.3) lived independently. In adults without intellectual disability, proportions of individuals who were ambulant (72.6% [95% CI, 58.8-84.5]) and lived independently (90.0% [95% CI, 83.8-94.9]) were higher (P=.014 and P<.01, respectively). The Fatigue Severity Scale score was 4.1 (95% CI, 3.8-4.4). Epilepsy (28.8% [95% CI, 20.1-38.4]) and asthma (28.3% [95% CI, 18.7-38.9]) were especially prevalent comorbidities. CONCLUSIONS The present systematic review and meta-analysis on the epidemiology of adults with CP provided state-of-the-art knowledge on the most frequently studied outcomes. On average, adults with CP are fatigued, and a majority experience pain, are ambulant, and have little or no difficulty with manual ability. On average, 40% are employed and 30% live independently. More uniformity in assessment and reports is advised to improve knowledge on epidemiology and gain insight in more outcomes.
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Mcphee PG, Claridge EA, Noorduyn SG, Gorter JW. Cardiovascular disease and related risk factors in adults with cerebral palsy: a systematic review. Dev Med Child Neurol 2019; 61:915-923. [PMID: 30221763 DOI: 10.1111/dmcn.14028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2018] [Indexed: 01/23/2023]
Abstract
AIM To summarize the literature on the prevalence of cardiovascular disease (CVD), risk factors of CVD, and CVD-related mortality in adults with cerebral palsy (CP). METHOD A systematic review was conducted by searching the PubMed, Embase, MEDLINE (Ovid), Cochrane, and CINAHL databases. Selection criteria included adults with CP aged 18 years or over. Methodological quality was assessed using the Newcastle-Ottawa scale for observational studies. Data were reported descriptively. RESULTS Nineteen studies met the inclusion criteria. Only one study reported directly on the presence of CVD in adults with CP, which found adults with CP reported greater CVD conditions than adults without CP (15.1 vs 9.1%, p<0.001). The most commonly reported risk factor of CVD in adults with CP was overweight/obesity. Five studies included data on CVD-related mortality in persons with CP, where CVD-related and circulatory system-related deaths were elevated and more common at a younger age in adults with CP than in the general population. INTERPRETATION The prevalence of CVD and the risk of death because of CVD in this population seems increased, though the knowledge base is fragmented by studies that are small in size and geographically isolated. Further research is required to understand prevalence of risk factors among adults with CP, in particular overweight/obesity. WHAT THIS PAPER ADDS Overweight and obesity are risk factors of cardiovascular disease (CVD) that are commonly reported in adults with cerebral palsy (CP). CVD-related and circulatory system-related deaths are elevated in individuals with CP compared to the general population.
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Affiliation(s)
- Patrick G Mcphee
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Everett A Claridge
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stephen G Noorduyn
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Yi YG, Jung SH, Bang MS. Emerging Issues in Cerebral Palsy Associated With Aging: A Physiatrist Perspective. Ann Rehabil Med 2019; 43:241-249. [PMID: 31311245 PMCID: PMC6637058 DOI: 10.5535/arm.2019.43.3.241] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/17/2018] [Indexed: 11/16/2022] Open
Abstract
The population of adults diagnosed with cerebral palsy (CP) is increasing along with the survival rate of children born with the disability. Adults with CP need health services for the continued monitoring and management of their condition. Moreover, the development of additional health problems in adulthood increases the need for ongoing access to health services. Adults with CP manifest a higher rate of chronic health conditions and eventual decline in strength and functional reserve, deterioration in physical activity, increased risk of musculoskeletal complications, and gradual changes in swallowing ability. They are also reported to exhibit difficulty engaging socially and have a low health-related quality of life (QOL). However, there are a large number of adults with CP who cannot access medical services adequately and are therefore not effectively treated. To overcome these apparent challenges, we need to fully comprehend the healthcare needs of adults with CP to develop adult-focused health services. Further research is needed regarding the impact of physical activity, nutrition, sarcopenia, myeloradiculopathy, and swallowing function on QOL.
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Affiliation(s)
- You Gyoung Yi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Korea
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Yamakawa T, Sakamoto R, Takahashi K, Suzuki J, Matuura‐Shinoda M, Takahashi M, Shigematsu E, Tanaka S, Kaneshiro M, Asakura T, Kawata T, Yamada Y, Osada UN, Isozaki T, Takahashi A, Kadonosono K, Terauchi Y. Dietary survey in Japanese patients with type 2 diabetes and the influence of dietary carbohydrate on glycated hemoglobin: The Sleep and Food Registry in Kanagawa study. J Diabetes Investig 2019; 10:309-317. [PMID: 30070047 PMCID: PMC6400148 DOI: 10.1111/jdi.12903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 12/26/2022] Open
Abstract
AIMS/INTRODUCTION The present study investigated the relationship between the macronutrient energy ratio, dietary carbohydrate and glycated hemoglobin levels in Japanese patients with type 2 diabetes, to generate a potential optimal dietary intake of macronutrients for such patients. MATERIALS AND METHODS In total, 3,032 patients participating in the Sleep and Food Registry in Kanagawa study were evaluated. Their diets were assessed for macronutrient content through a brief self-administered dietary history questionnaire. Relevant biochemical assays were carried out. RESULTS The mean energy intake (±standard deviation) was 1,711 ± 645 kcal/day. The proportion of energy supplied by protein, fat and carbohydrate were 16.3, 26.8 and 52.3%, respectively. Total fiber intake was 12.6 ± 5.7 g/day. The high glycated hemoglobin (HbA1c) group (HbA1c >8%) had significantly lower protein and higher carbohydrate intake than the low HbA1c group (HbA1c <6.5%). Higher HbA1c levels were positively correlated with unfavorable metabolic factors, including elevated body mass index and excess carbohydrate intake, and negatively correlated with age, protein intake and fiber intake. Multiple regression analysis showed a significant association between HbA1c and carbohydrate intake after adjusting for sex, age and body mass index (0.104, P < 0.0001). Additionally, patients within the uppermost tertile for the percentage of total energy intake from carbohydrate (>60%) were most likely to have high HbA1c levels. HbA1c was significantly correlated with carbohydrate (%E) in all age groups and in patients taking one or two antidiabetic drugs. CONCLUSIONS The dietary carbohydrate:energy ratio has a positive correlation with HbA1c, suggesting that avoiding excessive carbohydrate intake (>60%) might help foster glycemic control.
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Affiliation(s)
- Tadashi Yamakawa
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Rika Sakamoto
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Kenichiro Takahashi
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Jun Suzuki
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Minori Matuura‐Shinoda
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Mayumi Takahashi
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Erina Shigematsu
- Department of Endocrinology and MetabolismYokohama Medical CenterYokohamaJapan
| | | | | | | | | | - Yoshihiko Yamada
- International University of Health and Welfare, Atami HospitalAtamiJapan
| | | | | | | | - Kazuaki Kadonosono
- Department of OphthalmologyYokohama City University Medical CenterYokohamaJapan
| | - Yasuo Terauchi
- Department of Endocrinology and MetabolismYokohama City University School of MedicineYokohamaJapan
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Abstract
Obesity is a common problem in children and adolescents with neuromuscular disease. The available literature on obesity in cerebral palsy, spina bifida, and Duchenne muscular dystrophy as it relates to orthopedic treatment is reviewed, including the demographics and measurement of obesity as well as the mechanisms of obesity in these individuals. In addition, the effect of obesity on function, patient evaluation, and orthopedic treatment are reviewed.
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12
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Verschuren O, Smorenburg AR, Luiking Y, Bell K, Barber L, Peterson MD. Determinants of muscle preservation in individuals with cerebral palsy across the lifespan: a narrative review of the literature. J Cachexia Sarcopenia Muscle 2018; 9:453-464. [PMID: 29392922 PMCID: PMC5989853 DOI: 10.1002/jcsm.12287] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/23/2017] [Accepted: 01/07/2018] [Indexed: 12/16/2022] Open
Abstract
In individuals with cerebral palsy (CP), smaller muscle and atrophy are present at young age. Many people with CP also experience a decline in gross motor function as they age, which might be explained by the loss of muscle mass. The clinical observation of muscle wasting has prompted a comparison with sarcopenia in older adults, and the term accelerated musculoskeletal ageing is often used to describe the hallmark phenotype of CP through the lifespan. However, there has been very little research emphasis on the natural history of ageing with CP and even less with respect to the determinants or prevention of muscle loss with CP. Considering the burgeoning interest in the science of muscle preservation, this paper aims to (i) describe the characteristics of accelerated musculoskeletal ageing in people with CP, (ii) describe the pathophysiology of sarcopenia and parallels with CP, and (iii) discuss possible therapeutic approaches, based on established approaches for sarcopenia.
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Affiliation(s)
- Olaf Verschuren
- Brain Center Rudolf Magnus, Center of Excellence for Rehabilitation Medicine, De Hoogstraat RehabilitationUniversity Medical Center UtrechtRembrandtkade 10Utrecht3583TMThe Netherlands
| | | | - Yvette Luiking
- Nutricia ResearchAdvanced Medical NutritionUtrechtThe Netherlands
| | - Kristie Bell
- Child Health Research CentreThe University of QueenslandBrisbaneAustralia
- Lady Cilento Children's HospitalSouth BrisbaneQueenslandAustralia
| | - Lee Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of MedicineThe University of QueenslandBrisbaneAustralia
| | - Mark D. Peterson
- Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborMIUSA
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de la Torre-Olivares R, Moreno-Lorenzo C, Pérez-Mármol JM, Cabrera-Martos I, Villaverde-Gutierrez C, Sánchez AMC, Aguilar-Ferrándiz ME. Evaluation of Functional Status Associated With Overweight in Adults With Cerebral Palsy. Rehabil Nurs 2018. [DOI: 10.1002/rnj.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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TOOPCHIZADEH V, BARZEGAR M, MASOUMI S, JAHANJOO F. Prevalence of Vitamin D Deficiency and Associated Risk Factors in Cerebral Palsy A study in North-West of Iran. IRANIAN JOURNAL OF CHILD NEUROLOGY 2018; 12:25-32. [PMID: 29696043 PMCID: PMC5904735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 04/16/2017] [Accepted: 05/06/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study aimed to compare the prevalence of 25-hydroxyvitamin D deficiency in cerebral palsied (CP) with healthy control children and evaluate possible correlations between 25-hydroxyvitamin D and severity of CP and motor function. MATERIALS & METHODS In this case-control study, serum levels of 25-hydroxyvitamin D were evaluated in 65 children with CP and compared with 65 healthy children referred to Tabriz Pediatric Hospital, Tabriz, northwestern Iran in 2015. Blood samples were taken to measure levels of 25-hydroxyvitamin D, calcium, phosphorus and alkaline phosphatase. Regarding 25-hydroxyvitamin D levels, patients were classified as sufficient (≥30 ng/ml), insufficient (20-30 ng/ml) and deficient (<20 ng/ml). RESULTS Mean 25-hydroxyvitamin D levels were 28.03±24.2 ng/ml in patients and 30±1.94 ng/ml in control group. 25-hydroxyvitamin D deficiency was seen in 44.6% of CP and 18.5% of healthy children. There was no significant difference in 25-hydroxyvitamin D levels between boys and girls, CP types and use of antiepileptics in case group. There was significant negative correlation between age and 25-hydroxyvitamin D levels (P=0.007). The correlation between 25-hydroxyvitamin D and Gross Motor Function Classification System was not significant. CONCLUSION 25-hydroxyvitamin D deficiency is common in children with CP in comparison with healthy children. There was significant negative correlation between age and 25-hydroxyvitamin D levels. Routine measurement of 25-hydroxyvitamin D levels and its proper treatment is recommended to prevent its deficiency and subsequent consequences.
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Affiliation(s)
- Vahideh TOOPCHIZADEH
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad BARZEGAR
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahab MASOUMI
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh JAHANJOO
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Wright CS, Weinheimer-Haus EM, Fleet JC, Peacock M, Campbell WW. The Apparent Relation between Plasma 25-Hydroxyvitamin D and Insulin Resistance is Largely Attributable to Central Adiposity in Overweight and Obese Adults. J Nutr 2015; 145:2683-9. [PMID: 26446485 PMCID: PMC4656909 DOI: 10.3945/jn.115.220541] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/10/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Research indicates that plasma 25-hydroxyvitamin D [25(OH)D] is associated with insulin resistance, but whether regional adiposity confounds this association is unclear. OBJECTIVE This study assessed the potential influence of adiposity and its anatomical distribution on the relation between plasma 25(OH)D and insulin resistance. METHODS A secondary analysis of data from middle-aged overweight and obese healthy adults [n = 336: 213 women and 123 men; mean ± SD (range); age: 48 ± 8 y (35-65 y); body mass index (BMI; in kg/m2): 30.3 ± 2.7 (26-35)] from West Lafayette, Indiana (40.4 °N), were used for this cross-sectional analysis. Multiple linear regression analyses that controlled for multiple covariates were used as the primary statistical model. RESULTS Of all participants, 8.6% and 20.5% displayed moderate [20.1-37.5 nmol/L plasma 25(OH)D] to mild (37.6-49.9 nmol/L) vitamin D insufficiency, respectively. A regression analysis controlling for age, sex, race, plasma parathyroid hormone concentration, season of year, and supplement use showed that 25(OH)D was negatively associated with fasting insulin (P = 0.021). Additional regression analyses showed that total and central adiposity but not peripheral adiposity predicted low plasma 25(OH)D [total fat mass index (FMI): P = 0.018; android FMI: P = 0.052; gynoid FMI: P = 0.15; appendicular FMI: P = 0.07) and insulin resistance (homeostasis model assessment of insulin resistance: total and android FMI, P <0.0001; gynoid FMI, P = 0.94; appendicular FMI, P = 0.86). The associations of total and central adiposity with insulin resistance remained significant after adjusting for plasma 25(OH)D. However, adjusting for central adiposity but not other anatomical measures of fat distribution eliminated the association between plasma 25(OH)D and insulin resistance. CONCLUSION Central adiposity drives the association between plasma 25(OH)D and insulin resistance in overweight and obese adults. The trial was registered at clinicaltrials.gov as NCT00812409.
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Affiliation(s)
- Christian S Wright
- Department of Nutrition Science, Purdue University, West Lafayette, IN; and
| | | | - James C Fleet
- Department of Nutrition Science, Purdue University, West Lafayette, IN; and
| | - Munro Peacock
- Department of Medicine, Indiana University, Indianapolis, IN
| | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN; and
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16
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Ryan JM, Hensey O, McLoughlin B, Lyons A, Gormley J. Associations of sedentary behaviour, physical activity, blood pressure and anthropometric measures with cardiorespiratory fitness in children with cerebral palsy. PLoS One 2015; 10:e0123267. [PMID: 25835955 PMCID: PMC4383550 DOI: 10.1371/journal.pone.0123267] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/25/2015] [Indexed: 12/22/2022] Open
Abstract
Background Children with cerebral palsy (CP) have poor cardiorespiratory fitness in comparison to their peers with typical development, which may be due to low levels of physical activity. Poor cardiorespiratory fitness may contribute to increased cardiometabolic risk. Purpose The aim of this study was to determine the association between sedentary behaviour, physical activity and cardiorespiratory fitness in children with CP. An objective was to determine the association between cardiorespiratory fitness, anthropometric measures and blood pressure in children with CP. Methods This study included 55 ambulatory children with CP [mean (SD) age 11.3 (0.2) yr, range 6-17 yr; Gross Motor Function Classification System (GMFCS) levels I and II]. Anthropometric measures (BMI, waist circumference and waist-height ratio) and blood pressure were taken. Cardiorespiratory fitness was measured using a 10 m shuttle run test. Children were classified as low, middle and high fitness according to level achieved on the test using reference curves. Physical activity was measured by accelerometry over 7 days. In addition to total activity, time in sedentary behaviour and light, moderate, vigorous, and sustained moderate-to-vigorous activity (≥10 min bouts) were calculated. Results Multiple regression analyses revealed that vigorous activity (β = 0.339, p<0.01), sustained moderate-to-vigorous activity (β = 0.250, p<0.05) and total activity (β = 0.238, p<0.05) were associated with level achieved on the shuttle run test after adjustment for age, sex and GMFCS level. Children with high fitness spent more time in vigorous activity than children with middle fitness (p<0.05). Shuttle run test level was negatively associated with BMI (r2 = -0.451, p<0.01), waist circumference (r2 = -0.560, p<0.001), waist-height ratio (r2 = -0.560, p<0.001) and systolic blood pressure (r2 = -0.306, p<0.05) after adjustment for age, sex and GMFCS level. Conclusions Participation in physical activity, particularly at a vigorous intensity, is associated with high cardiorespiratory fitness in children with CP. Low cardiorespiratory fitness is associated with increased cardiometabolic risk.
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Affiliation(s)
- Jennifer M. Ryan
- School of Medicine, Trinity College Dublin, Ireland
- Institute of Environment, Health and Societies, Brunel University London, United Kingdom
- * E-mail:
| | | | | | - Alan Lyons
- Department of Physiotherapy, Enable Ireland, Cork, Ireland
| | - John Gormley
- School of Medicine, Trinity College Dublin, Ireland
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