Undernutrition in children with cerebral palsy: comparison of anthropometric measures across gross motor function
Günce Başarır1,2, Sema Bozkaya Yilmaz1,3, Pınar Gençpınar4,5
1Department of Pediatric Neurology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkiye.
Insights
Nutritional assessment in children with cerebral palsy (CP) is challenging. Children with severe CP (GMFCS IV-V) show higher rates of undernutrition, indicating a need for tailored anthropometric approaches.
Area of Science:
- Pediatric Nutrition
- Cerebral Palsy Research
- Anthropometry
Background:
- Nutritional assessment in children with cerebral palsy (CP) is complex due to varying growth patterns and motor severity.
- Motor impairment significantly impacts body composition and the reliability of standard anthropometric measurements.
Purpose of the Study:
- To compare anthropometric indicators of undernutrition in children with CP.
- To analyze these indicators based on Gross Motor Function Classification System (GMFCS) levels.
Main Methods:
- An observational, cross-sectional study involving 43 children with CP (aged 2-18 years).
- Children were classified into GMFCS I-III and IV-V groups.
- Undernutrition assessed using z-scores for height, weight, BMI, MUAC, and TST against CDC charts, with sensitivity analysis using CP-specific Brooks references.
Main Results:
- Undernutrition prevalence varied by indicator: 33% (height-for-age), 49% (weight-for-age, BMI), 47% (MUAC), and 28% (TST).
- Children in GMFCS IV-V exhibited significantly lower height-for-age, weight-for-age, and MUAC z-scores compared to GMFCS I-III.
- Weight-for-age and MUAC z-scores were more sensitive for detecting undernutrition in GMFCS IV-V, while BMI was more frequent in GMFCS I-III.
Conclusions:
- Undernutrition is prevalent in children with CP, especially those with severe motor impairment.
- Nutritional risk assessment is dependent on the methods and references used.
- A multidimensional anthropometric approach is recommended for clinical practice in CP.
Objective:
Nutritional assessment in children with cerebral palsy (CP) remains challenging because growth patterns, body composition, and the feasibility of anthropometric measurements vary according to motor severity. This study aimed to compare anthropometric indicators of undernutrition in children with CP according to Gross Motor Function Classification System (GMFCS) levels.
Methods:
In this observational cross-sectional study, forty-three children with CP aged 2-18 years were evaluated. Patients were grouped as GMFCS I-II-III and IV-V. Anthropometric, demographic, and clinical data were analyzed. Undernutrition was defined using age-specific z-scores for height, weight, body mass index (BMI), mid-upper arm circumference (MUAC), and triceps skinfold thickness (TST) based on 'Centers for Disease Control and Prevention' growth charts. Weight-based undernutrition was also re-evaluated using CP-specific Brooks weight-for-age percentiles in a sensitivity analysis.
Results:
Undernutrition was identified in 33% of patients based on height-for-age z-scores, 49% based on weight-for-age and BMI z-scores, 47% based on MUAC z-scores, and 28% based on TST z-scores. Children in GMFCS IV-V had significantly lower height-for-age, weight-for-age, and MUAC z-scores than those in GMFCS I-II-III (p = 0.02, p < 0.001, p = 0.02, respectively). BMI z-score identified undernutrition more frequently in GMFCS I-II-III, whereas weight-for-age and MUAC z-scores were more informative in GMFCS IV-V. In sensitivity analysis, the higher rate of low weight in the GMFCS IV-V group was less marked with CP-specific Brooks references.
Discussion:
Undernutrition is frequent in children with CP, particularly in those with more severe motor impairment. Nutritional risk assessment appears to be method- and reference-dependent, supporting a multidimensional anthropometric approach in clinical practice.
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