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Assessment of body composition in children with cerebral palsy: a cross-sectional study in Norway
Ane-Kristine Finbråten1,2, Catia Martins3, Guro Lillemoen Andersen1,4
1Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
Insights
Children with cerebral palsy (CP) often show stunted growth but may have normal or high body fat. Clinical assessments using modified equations are more accurate than BMI for body composition in CP.
Area of Science:
- Pediatrics
- Body Composition Analysis
- Clinical Assessment
Background:
- Assessing growth and body composition in children with cerebral palsy (CP) presents unique challenges.
- Dual-energy X-ray absorptiometry (DXA) is a precise method for body composition analysis.
Purpose of the Study:
- To compare clinical body composition assessments with DXA measurements in children with CP.
- To evaluate the accuracy of standard and modified skinfold thickness (SFT) equations for estimating body fat in this population.
Main Methods:
- Measurements included knee height, weight, and SFT in 47 children with CP (aged 8-18 years).
- Body mass index (BMI) was calculated, and body fat percentage was estimated using standard ('Slaughter') and CP-modified ('Gurka') equations.
- Results were compared with DXA measurements.
Main Results:
- Children with severe motor impairments (GMFCS levels III-IV) showed stunted growth but higher fat percentages and lower lean mass compared to those with milder impairments (GMFCS levels I-II).
- BMI underestimated body fat in some children with CP; 10 children classified as 'thin' by BMI had normal or high body fat by DXA.
- The CP-modified 'Gurka' equations demonstrated excellent precision for body fat estimation, while standard 'Slaughter' equations significantly underestimated it.
Conclusions:
- Children with CP and severe motor impairments exhibit stunted growth but are not necessarily undernourished.
- Relying solely on BMI can be misleading for assessing body composition in children with CP.
- Clinicians should utilize SFT measurements and CP-modified equations for accurate body fat assessment in this population.
Aim:
The assessment of growth and body composition is challenging in children with cerebral palsy (CP). The aim of this study was to compare clinical assessments of body composition with measurements obtained using dual-energy X-ray absorptiometry (DXA) in this population.
Method:
Knee height, weight, and triceps and subscapular skinfold thickness (SFT) were measured in 47 children with CP (age range 8-18y; 18 females, 29 males). Height was estimated from knee height, and used to calculate body mass index (BMI). Using SFT measurements, body fat percentage was calculated by standard ('Slaughter') and CP-modified ('Gurka') equations and compared with results obtained using DXA.
Results:
Children with severe gross motor function impairments (Gross Motor Function Classification System [GMFCS] level III or IV) exhibited stunted growth and had higher fat percentages and lower lean body mass than children classified in GMFCS level I or II. In 10 children classified as 'thin' according to their BMI (five of whom were assigned thinness grade of 2 or lower), percentage of body fat, as determined by DXA, was normal or high. The Slaughter equations significantly underestimated body fat percentages, whereas the precision of the CP-modified Gurka equations was excellent.
Interpretation:
In this study, children with CP and severe motor impairments displayed stunted growth, but were not undernourished. Relying solely upon BMIs may be misleading in children with CP. Therefore, clinicians should be encouraged to measure SFT and to calculate body fat percentages using the CP-modified version of the Slaughter equation.
