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Published on: January 11, 2016
Energy requirements in preschool-age children with cerebral palsy
Jacqueline L Walker1, Kristie L Bell, Roslyn N Boyd
1Children's Nutrition Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. j.walker3@uq.edu.au
Insights
Energy requirements (ERs) for preschool children with cerebral palsy (CP) are lower than in typically developing children, decreasing with reduced mobility and increased limb involvement. Fat-free mass and ambulatory status are key predictors of these ERs.
Area of Science:
- Pediatric Nutrition
- Neurology
- Human Physiology
Background:
- Limited data exists on energy requirements (ERs) for preschool children with cerebral palsy (CP).
- Understanding ERs is crucial for effective early nutritional management in children with CP.
Purpose of the Study:
- To determine the ERs of preschool children with CP.
- To analyze ERs in relation to functional ability, motor type, and distribution.
- To compare ERs with typically developing children (TDC) and existing estimation equations.
Main Methods:
- Employed the doubly labeled water method to measure ERs in 32 children with CP and 16 TDC (aged 2.9-4.4 years).
- Utilized ANOVA, t tests, Bland and Altman analyses, correlations, and multivariable regressions for statistical analysis.
Main Results:
- Children with CP had significantly lower ERs than TDC.
- Marginally ambulant and nonambulant children showed approximately 18-31% lower ERs compared to ambulant children and TDC.
- Published equations underestimated ERs in nonambulant children by about 22%.
Conclusions:
- ERs in preschool children with CP decrease with declining ambulatory status and increasing limb involvement.
- Fat-free mass and ambulatory status were the strongest predictors of ERs.
- Further research is needed to expand the understanding of ERs in children with CP.
Background:
There is a paucity of data concerning the energy requirements (ERs) of preschool-age children with cerebral palsy (CP), the knowledge of which is essential for early nutritional management.
Objective:
We aimed to determine the ERs for preschool-age children with CP in relation to functional ability, motor type, and distribution and compared with typically developing children (TDC) and published estimation equations.
Design:
Thirty-two children with CP (63% male) of all functional abilities, motor types, and distributions and 16 TDC (63% male) aged 2.9-4.4 y participated in this study. The doubly labeled water method was used to determine ERs. Statistical analyses were conducted by 1-factor ANOVA and post hoc Tukey honestly significant difference tests, independent and paired t tests, Bland and Altman analyses, correlations, and multivariable regressions.
Results:
As a population, children with CP had significantly lower ERs than did TDC (P < 0.05). No significant difference in ERs was found between ambulant children and TDC. Marginally ambulant and nonambulant children had ERs that were ∼18% lower than those of ambulant children and 31% lower than those of TDC. A trend toward lower ERs with greater numbers of limbs involved was observed. The influence of motor type could not be determined statistically. Published equations substantially underestimated ERs in the nonambulant children by ∼22%.
Conclusions:
In preschool-age children with CP, ERs decreased as ambulatory status declined and more limbs were involved. The greatest predictor of ERs was fat-free mass, then ambulatory status. Future research should build on the information presented to expand the knowledge base regarding ERs in children with CP. This trial was registered with the Australian New Zealand Clinical Trials Registry as ACTRN 12612000686808.
