Prevalence of overweight and obesity in Irish ambulant children with cerebral palsy

The nutritional status according to anthropometric indexes and growth patterns in children and adolescents with cerebral palsy: A scoping review of the literature

BACKGROUND

Determining the nutritional status of children with cerebral palsy (CP) presents numerous challenges. Accurate nutritional assessment is crucial in this population to ensure the provision of appropriate and effective nutritional interventions.

AIM

This scoping review aimed to analyze the most frequently used anthropometric indexes and growth patterns to determine the nutritional status of children and adolescents with CP.

METHODS

The literature search was performed in six databases Scopus, Cochrane Library, Web of Science, SciELO, Medline and PubMed. It was conducted on studies that included children aged 0 to 18 years. Sixty-three publications met the inclusion criteria.

RESULTS

The prevalence of undernutrition was higher when WHO growth standards and CDC growth charts were used (93.3% and 56.8%, respectively), whereas the prevalence of normal nutritional status was higher when US CP growth charts were used (92.5%). The prevalence of stunting was higher with the WHO growth standards (97.7%) and lowest with the US CP growth charts (4.3%). The WHO growth standards were the most frequently used (50.8%), followed by the CDC growth charts (22.2%) and the US CP growth charts (12.7%).

CONCLUSION

The index with more relevance in this scoping review was BMI since it was addressed in 77.8% of the studies. When assessing the nutritional status with typically developed children's patterns, there was a higher prevalence of undernutrition and stunting. When using US CP growth charts, more children were included in the normal range. More studies are needed to determine which growth pattern is a better indicator of health.

The evolution of nutrition management in children with severe neurological impairment with a focus on cerebral palsy

Nutritional management of children with severe neurological impairment (SNI) is highly complex, and the profile of this population is changing. The aim of this narrative review was to give the reader a broad description of evolution of the nutritional management of children with SNI in a high resource setting. In the last decade, there has been an emphasis on using multiple anthropometric measures to monitor nutritional status in children with SNI, and several attempts at standardising the approach have been made. Tools such as the Feeding and Nutrition Screening Tool, the Subjective Global Nutrition Assessment, the Eating and Drinking Ability Classification System and the Focus on Early Eating and Drinking Swallowing (FEEDS) toolkit have become available. There has been an increased understanding of how the gut microbiome influences gastrointestinal symptoms common in children with SNI, and the use of fibre in the management of these has received attention. A new diagnosis, 'gastrointestinal dystonia', has been defined. The increased use and acceptance of blended food tube feeds has been a major development in the nutritional management of children with SNI, with reported benefits in managing gastrointestinal symptoms. New interventions to support eating and drinking skill development in children with SNI show promise. In conclusion, as the life expectancy of people with SNI increases due to advances in medical and nutrition care, our approach necessitates a view to long-term health and quality of life. This involves balancing adequate nutrition to support growth, development and well-being while avoiding overnutrition and its associated detrimental long-term effects.

The effects of weight gain over time on gait in children with cerebral palsy: Comparison to a matched healthy weight cerebral palsy control group

BACKGROUND

Children with cerebral palsy (CP) have demonstrated higher rates of overweight and obesity than their typically developed peers. Limited studies have assessed how being overweight or obese affect lower limb kinematics during gait in these children.

RESEARCH QUESTION

How are lower limb kinematics during gait affected in children with CP who progress from a healthy weight to being overweight or obese compared to a well-matched healthy weight CP control group?

METHODS

A retrospective analysis of the movement analysis laboratory database was conducted.Children with CP were included if they were aged between 4 and 17 years at baseline,had a follow-up assessment with a minimum of 12 months between assessments, and had no orthopaedic interventions between assessments. A matched control group of children with CP with the same inclusion criteria, except for a requirement of healthy BMI at follow-up, was included. Temporal-spatial and full 3-dimensional lower limb kinematic data were examined.

RESULTS

Normalized speed and step length reduced from baseline to follow-up for both groups,with no difference in the amount of change between groups. Children with increased BMI demonstrated increased external hip rotation during stance at follow-up not evident in the control group.

SIGNIFICANCE

Results demonstrated similar changes over time between groups. Increased external hip rotation in children with increased BMI was considered small and within the threshold of error associated with transverse plane kinematics. Our results suggest that being overweight or obese does not result in a meaningful change in lower limb kinematics in children with CP.

Obesity in ambulatory children with cerebral palsy in Turkey: A cross-sectional study

PURPOSE

Obesity prevalence and the relationship between obesity and motor function in children with ambulatory cerebral palsy (CP) were investigated.

METHODS

This was a cross-sectional study. The obesity profile of 75 children aged 2-18 years with ambulatory CP was investigated. GMFCS levels were recorded, and BMI was calculated using height and weight data and converted into Z-scores. Age- and gender-specific growth charts were used for children and adolescents.

RESULTS

The mean BMI of the participants was 17.78, with an obesity rate of 18.67% and an overweight rate of 16%. Gross motor function was found to be associated with height, weight, and BMI (p <  0.05). No relationship was found between obesity +overweight and gender and CP subtype (p >  0.05).

CONCLUSION

Turkish children with CP had a higher rate of obesity compared to typically developing peers and also their counterparts in other countries. There is a need for studies to identify the causes of obesity and to develop effective intervention programs for prevention of it in children with CP.

The progression of BMI status over time in Irish ambulant children with cerebral palsy

BACKGROUND

An increasing prevalence of overweight and obesity in children has been reported globally. Most studies examining the trajectory of BMI in children over time have tended to focus on children with typical development. Our group previously reported static prevalence rates in children with cerebral palsy. However, concern remains within our multi-disciplinary team that progression into higher BMI categories is apparent as children with cerebral palsy age.

AIMS

To examine the progression of BMI status as children with cerebral palsy age and determine the severity of obesity.

METHODS

A retrospective analysis was conducted of the National Movement Laboratory database yielding 574 participants that met inclusion criteria. BMI was calculated retrospectively, and age adjusted BMI centiles were used for analysis. A chi-square test for homogeneity was used to compare differences in proportions. Differences in age, weight and height between assessments were assessed using a Wilcoxon signed rank test. Statistical significance was set at p < 0.05.

RESULTS

No statistically significant differences were present in proportions for any BMI classifications between first and repeat assessments. Small increases were evident in both the obesity (7.8 to 11.5%) and overweight (10.8 to 12.4%) categories. Eighty percent of children remained in a normal BMI category between assessments while 56% remained either overweight or moved into a category of obesity.

CONCLUSION

The majority of children with cerebral palsy who presented with a normal BMI at first assessment maintained this BMI classification at follow-up. The results of this study highlight the importance of maintaining a healthy BMI status.