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Sapkota KP, Shibanuma A, Ong KIC, Kiriya J, Jimba M. Accommodation and disability-specific differences in nutritional status of children with disabilities in Kathmandu, Nepal: A cross-sectional study. BMC Public Health 2023; 23:315. [PMID: 36782145 PMCID: PMC9926754 DOI: 10.1186/s12889-023-14999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/05/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Worldwide, more than 150 million children < 18 years live with disabilities. These children are more vulnerable to malnutrition regardless of institutional care that they receive, such as daycare or residential care. In Nepal, little is known about the status of malnutrition and factors associated with malnutrition among children with disabilities. This study was conducted to investigate the factors associated with malnutrition based on the types of disability and accommodation. METHODS This institution-based, cross-sectional study was conducted in 22 institutions in the Kathmandu Valley, Nepal. From these institutions, parents/guardians of all children with disabilities were recruited who were present there on the day of data collection. They were interviewed using a structured questionnaire. The questionnaire included questions on demographic characteristics, disability type and severity, accommodation place, feeding practices, and dietary patterns. The outcome variables, stunting, underweight, and obesity were measured using height-for-age, weight-for-age, and body mass index-for-age, respectively. A generalized linear model was used to investigate the factors associated with stunting and underweight, and multinomial logistic regression was used to identify the factors associated with overweight and obesity. RESULTS Among the 345 children with disabilities, 45% were stunted, 33% were underweight, 19% were thin, and 12% were overweight. Children with physical disabilities (relative risk ratio = 1.88, 95% confidence interval [CI] = 1.26-2.81) were more likely to be stunted than those with sensory disabilities. Children with autism (adjusted odds ratio [aOR] = 5.56, 95% CI: 1.23-25.23) and intellectual disabilities (aOR = 5.84, 95% CI: 1.59-21.51) were more likely to be overweight and obese than those with sensory disabilities. No evidence was found regarding an association between accommodation type and malnutrition. CONCLUSION Children with disabilities are vulnerable to malnutrition in several ways. Different types of disabilities are associated with different forms of malnutrition. Considering the types of disabilities, tailor-made approaches should be adopted to improve malnutrition status.
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Affiliation(s)
- Krishna Prasad Sapkota
- grid.26999.3d0000 0001 2151 536XDepartment of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Ken Ing Cherng Ong
- grid.26999.3d0000 0001 2151 536XDepartment of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Kiriya
- grid.26999.3d0000 0001 2151 536XDepartment of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masamine Jimba
- grid.26999.3d0000 0001 2151 536XDepartment of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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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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Ruiz Brunner MDLM, Cieri ME, Rodriguez Marco MP, Schroeder AS, Cuestas E. Nutritional status of children with cerebral palsy attending rehabilitation centers. Dev Med Child Neurol 2020; 62:1383-1388. [PMID: 32893359 DOI: 10.1111/dmcn.14667] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 01/01/2023]
Abstract
AIM To describe the nutritional status of children with cerebral palsy (CP) from rehabilitation and therapeutic centers in Argentina, and to analyze their risk of undernutrition based on their Gross Motor Function Classification System (GMFCS) level. METHOD This was a cross-sectional study with data collected from 321 children (196 males, 125 females) with CP age 2 to 19 years (mean age 9y 3mo, SD 4y 5mo) from 17 rehabilitation and therapeutic centers in five Argentine provinces. Nutritional status was defined by height, weight, and body mass index for age z-scores using World Health Organization growth charts. Odds ratios were used to evaluate the association between GMFCS level and nutritional status. RESULTS Of the children with CP studied, 52.4% were in GMFCS levels IV and V. Regarding the nutritional status, 41.7% were normal, 19.0% had moderate undernutrition, 33.9% severe undernutrition, 2.5% overweight, and 2.8% obese. When compared to those in GMFCS levels I to III, the odds of children in GMFCS levels IV and V having moderate undernutrition are four times greater and the odds of having severe undernutrition are 14 times greater. INTERPRETATION There is a high prevalence of undernutrition associated with CP (GMFCS levels IV and V) among children in rehabilitation and therapeutic centers in Argentina. Risk of severe undernutrition increases with increased motor compromises.
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Affiliation(s)
- María de Las Mercedes Ruiz Brunner
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina.,Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina.,Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University Hospital of Munich (LMU), Hauner Children's Hospital, Munich, Germany
| | - Maria E Cieri
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina.,Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Maria P Rodriguez Marco
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - A Sebastian Schroeder
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University Hospital of Munich (LMU), Hauner Children's Hospital, Munich, Germany
| | - Eduardo Cuestas
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina.,Cátedra de Clínica Pediátrica, Hospital Nuestra Señora de la Misericordia, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
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Ruiz Brunner MDLM, Cieri ME, Rodriguez Marco MP, Schroeder AS, Cuestas E. Estado nutricional de niños y niñas con parálisis cerebral que asisten a centros de rehabilitación. Dev Med Child Neurol 2020; 62. [PMID: 33017056 DOI: 10.1111/dmcn.14680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/28/2022]
Abstract
ObjetivoDescribir el estado nutricional de niños con parálisis cerebral (PC) en centros de rehabilitación y terapéuticos de Argentina, y analizar el riesgo de desnutrición en relación su nivel según el sistema de la clasificación de la función motora gruesa (GMFCS).MétodoEste fue un estudio transversal con datos recolectados de 321 niños (196 varones, 125 mujeres) con PC de 2 a 19 años (edad media 9 años 3 meses, DE 4 años) de 17 centros de rehabilitación y terapéuticos en cinco provincias argentinas. El estado nutricional se definió con puntajes z según peso, talla e índice de masa corporal para la edad utilizando patrones de crecimiento de la Organización Mundial de la Salud. Se utilizó Odds ratio para evaluar la asociación entre el nivel GMFCS y el estado nutricional.ResultadosDe los niños con PC estudiados, 52.4% tenían nivel IV y V de GMFCS. En cuanto al estado nutricional, 41,7% eran normales, 19,0% tenían desnutrición moderada, 33,9% desnutrición severa, 2,5 % sobrepeso, y 2,8% obesidad. En comparación con los niños con niveles I–III de GMFCS, los niños con niveles IV y V de GMFCS presentaron 4 veces más probabilidades de presentar desnutrición moderada y 14 veces más probabilidades de tener desnutrición severa.InterpretaciónExiste una alta prevalencia de desnutrición asociada a la PC (niveles IV y V de GMFCS) entre niños de centros de rehabilitación y terapéuticos en Argentina. El riesgo de desnutrición severa aumenta cuando aumenta el compromiso motor.
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Affiliation(s)
- María de Las Mercedes Ruiz Brunner
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- Departamento de Neurología Pediátrica, Medicina y Pediatría del Desarrollo Social, Hospital de la Universidad de Munich (LMU), Hospital de niños Hauner, Munich, Alemania
| | - Maria E Cieri
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Maria P Rodriguez Marco
- Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Andreas Sebastian Schroeder
- Departamento de Neurología Pediátrica, Medicina y Pediatría del Desarrollo Social, Hospital de la Universidad de Munich (LMU), Hospital de niños Hauner, Munich, Alemania
| | - Eduardo Cuestas
- Instituto de Investigación en Ciencias de la Salud, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad Nacional de Córdoba, Cordoba, Argentina
- Cátedra de Clínica Pediátrica, Facultad de Ciencias Médicas, Hospital Nuestra Señora de la Misericordia, Universidad Nacional de Córdoba, Córdoba, Argentina
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Jaafar NH, Othman A, Majid NA, Harith S, Zabidi-Hussin Z. Parent-report instruments for assessing feeding difficulties in children with neurological impairments: a systematic review. Dev Med Child Neurol 2019; 61:135-144. [PMID: 30079517 DOI: 10.1111/dmcn.13986] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 12/01/2022]
Abstract
AIM This study aimed to review the psychometric properties and clinical application of parent-report instruments that assess feeding difficulties in children with neurological impairments. METHOD Papers were identified through five electronic databases based on 15 keywords and were included if they met the following criteria: published in English, described the implementation of parent-report instruments, and included children with neurological impairments (either in the report or a related study population). RESULTS In total, 1220 relevant abstracts were screened and 22 full-text articles were evaluated. The following six parent-report instruments met the inclusion criteria: (1) Screening Tool of Feeding Problems applied to children, (2) Paediatric Eating Assessment Tool, (3) Paediatric Assessment Scale for Severe Feeding Problems, (4) Montreal Children's Hospital Feeding Scale, (5) Children's Eating Behaviour Inventory, and (6) Behavioural Paediatric Feeding Assessment Scale (BPFAS). Based on comprehensive psychometric testing and consistently good results, the BPFAS was considered the most valid and reliable instrument. The BPFAS also showed good clinical applicability because it was readily available, required a short administration time, and used a simple scoring system. INTERPRETATION We reviewed the available parent-report instruments for assessing feeding difficulties in children with neurological impairments. The BPFAS had the best psychometric properties and clinical applicability. WHAT THIS PAPER ADDS Six parent-report instruments were suitable for assessing feeding in children with neurological impairments. The Behavioural Paediatric Feeding Assessment Scale (BPFAS) has the strongest psychometric properties. The BPFAS also has good clinical applicability.
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Affiliation(s)
- Nurul Hazirah Jaafar
- Paediatrics Department, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Azizah Othman
- Paediatrics Department, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Noorizan A Majid
- Paediatrics Department, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Sakinah Harith
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Zamh Zabidi-Hussin
- Department of Paediatrics and Chancellery, Perdana University, Selangor, Malaysia
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SILVA BNS, BRANDT KG, CABRAL PC, MOTA VVDL, CAMARA MMA, ANTUNES MMDC. Malnutrition frequency among cerebral palsy children: Differences in onset of nutritional intervention before or after the age of five years. REV NUTR 2017. [DOI: 10.1590/1678-98652017000600004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To evaluate the frequency of malnutrition and food consumption of children with cerebral palsy according to the age at the beginning of speech and hearing rehabilitation treatment. Methods Two to eleven-year-old children diagnosed with cerebral palsy who had up to three months of speech-language and nutritional rehabilitation were included in two reference centers in Recife, Pernambuco, Brazil. The following measurement of the children were taken: weight, knee height, arm circumference and triceps skinfold. Weight, estimated height and body mass index were classified into Z-scores according to the World Health Organization curves. Brachial circumference, triceps skinfold and arm circumference were classified according to Frisancho. The 24-hour recall was used to calculate intake of calories, proteins, calcium, iron, vitamin A, and zinc using the NutriWin software. Results A total of 68 patients were evaluated. Children older than five had a higher frequency of malnutrition when weight (.=0.02) and arm circumference (.<0.001) were considered, although there was less triceps malnutrition (.=0.002). These also had lower calorie consumption per kg/day, protein/kg/day and calcium than the younger children. Conclusion The greatest nutritional impairment after the age of five suggests that nutritional and speech therapy interventions could have a greater effect if they were performed before that age.
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McDonald ML, Huang A, Proudfoot JA, Le JT, Chiang GJ, Bush RA. Association of Obesity, BMI, and Hispanic Ethnicity on Ambulatory Status in Children with Spinal Dysraphism followed near the California-Mexico Border. J Health Care Poor Underserved 2016; 27:1956-1969. [PMID: 27818449 PMCID: PMC5147503 DOI: 10.1353/hpu.2016.0173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Evaluate the relationship between body mass index (BMI), overweight status (OW), or obesity (OB) and ambulatory status in a predominantly Hispanic population of children with spinal dysraphism (SD). METHODS Retrospective data were extracted from records of 272 children and youth aged 0-24 years with a diagnosis of SD. Body mass index (BMI) and OW / OB rates were calculated for children 0-3 years, 4-11 years, and adolescents older than 11. RESULTS Ethnicity was predominantly Hispanic (65.4%). No difference in mean BMI or OW / OB rate was found between ambulation groups (p = .20; p = .72). Mean BMI and OW / OB rate increased with increasing age in all groups (p < .001; p = .02). Forty-four percent of patients were OW / OB, which was greater among Hispanics (48.2%) compared with non-Hispanics [(35.2%), p = .03]. Female gender was a risk factor for increased BMI among Hispanics (p = .00). CONCLUSION Despite no difference in ambulatory status, increasing BMI and OW / OB are associated with Hispanic ethnicity and increasing age.
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Martinez EE, Smallwood CD, Bechard LJ, Graham RJ, Mehta NM. Metabolic assessment and individualized nutrition in children dependent on mechanical ventilation at home. J Pediatr 2015; 166:350-7. [PMID: 25444009 DOI: 10.1016/j.jpeds.2014.09.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/14/2014] [Accepted: 09/19/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the nutritional and metabolic status and body composition of children on long-term mechanical ventilation using a home-based model. STUDY DESIGN Children on home mechanical ventilation, for at least 12 hours a day, were eligible. We performed anthropometry, bioelectrical impedance analysis (BIA), actual energy intake (AEI), and indirect calorimetry in the subject's home. Agreement between measured energy expenditure (MEE) from indirect calorimetry, and estimated energy expenditure by the Schofield equation and a novel volumetric carbon dioxide production-based equation was examined. Agreement between fat mass estimates from anthropometry and BIA was examined and compared with population norms. RESULTS We enrolled 20 children, 11 (55%) male; mean age 8.4 years (SD 4.8). Mean weight for age z-score was -0.26 (SD 1.48); 9/20 had z-scores <-1 or >+1. Thirteen were underfed (AEI:MEE <90%) or overfed (AEI:MEE >110%); 11 of 19 had protein intake that was less than recommended by guidelines. Fifteen subjects were hypo- or hypermetabolic. Mean (SD) fat mass % was 33.6% (8.6) by anthropometry, which was significantly greater than matched population norms (mean 23.0%, SD 6.1, P < .001). The estimated energy expenditure by a volumetric carbon dioxide production-based equation was in stronger agreement with the MEE than the Schofield equation (mean bias 0.06%, limits -15.98% to 16.16% vs mean bias -1.31%, limits -74.3% to 72%, respectively). BIA and anthropometric fat mass values were not in agreement. CONCLUSION A majority of children on home ventilation are characterized by malnutrition, altered metabolic status, and suboptimal macronutrient intake, in particular low protein intake. A multidisciplinary home-based model facilitates individualized energy and protein delivery and may improve outcomes in this cohort.
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Affiliation(s)
- Enid E Martinez
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Lori J Bechard
- Center for Nutrition, Boston Children's Hospital, Boston, MA
| | - Robert J Graham
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Nilesh M Mehta
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Center for Nutrition, Boston Children's Hospital, Boston, MA.
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Araújo LA, Silva LR. Anthropometric assessment of patients with cerebral palsy: Which curves are more appropriate? JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2012.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Araújo LA, Silva LR. Anthropometric assessment of patients with cerebral palsy: which curves are more appropriate? J Pediatr (Rio J) 2013; 89:307-14. [PMID: 23664198 DOI: 10.1016/j.jped.2012.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 11/21/2012] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To describe the nutritional assessment of children with cerebral palsy, verifying the correlation of growth curves specific for cerebral palsy with general curves, in addition to assessing the presence of digestive manifestations associated with nutritional problems. METHODS This was a cross-sectional study of 187 individuals with cerebral palsy, evaluating anthropometric data in curves commonly used in pediatrics and specific curves for cerebral palsy, in addition to the description of presence of dysphagia, constipation, and respiratory infections. RESULTS 58% of patients were males, with a mean age of 5.6 ± 3.5 years. Anthropometric data of weight below the 10th percentile occurred in 10% of the sample considering the cerebral palsy scale, versus 51% when considering the reference from the Centers for Disease Control and Prevention (p < 0.01; Kappa 0.19). The weight of most individuals with dysphagia, recurrent respiratory infections, and constipation was below the 50th percentile, with respective percentages of 67%, 75%, and 72%. CONCLUSION The references commonly used in pediatrics tend to overestimate malnutrition in individuals with cerebral palsy, and their correlation with specific references for cerebral palsy is low. Digestive manifestations were mainly found in those individuals whose anthropometric measurements were below the 50th percentile.
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Affiliation(s)
- Liubiana A Araújo
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
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