Malnutrition is common in children with cerebral palsy in Saudi Arabia - a cross-sectional clinical observational study

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.

Assessment of Iron Metabolism and Inflammation in Children with Cerebral Palsy

Background/Objectives: Cerebral palsy (CP) is a motor disorder resulting from brain damage that is common in childhood. Iron is vital for the body's basic functions. Iron metabolism disorders and inflammation contribute to the neurological complications seen in CP. The purpose of this research was to ascertain the association and correlation between markers of inflammation and iron metabolism in children with CP. Methods: A total of 181 children diagnosed with CP and 111 typically developing children were retrospectively included in the study. Demographic data, blood parameters, C-reactive protein, iron, total iron binding capacity, and inflammation markers were evaluated. Results: C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and systemic immuno-inflammatory index (SII) levels of CP children were found to be statistically significantly higher than those of control group children (p < 0.05). Iron (Fe) and ferritin levels were lower in the CP group, while total iron binding capacity (TIBC) was higher. Spearman correlation analysis showed significant correlations between iron, ferritin and TIBC and SII. Conclusions: Iron deficiency and chronic inflammation are associated with the pathophysiology of CP in patients with CP, and therefore it is important to monitor markers of iron metabolism and inflammation in these patients.

Nutritional status of children with cerebral palsy in Ghana

Background

Limited knowledge on nutritional epidemiology in Ghanaian children with Cerebral Palsy (CP) necessitates a comprehensive investigation for an improved understanding of malnutrition in this population.

Objectives

We aimed to describe the epidemiology of malnutrition among children with CP in Ghana.

Methods

The study used data collected as part of the Ghana CP Register (GCPR). The GCPR is an institution-based surveillance of children with CP aged < 18 years in Ghana. Between October 2018 and April 2020, N = 455 children with CP were registered. Data were collected on (i) weight, length or height, mid-upper-arm-circumference of children with CP; (ii) socio-demographic characteristics; (iii) motor type and topography, gross motor function classification system level (GMFCS); (iv) associated impairments; (v) educational and rehabilitation status for each child. Descriptive and bivariate analyses were performed.

Results

Mean and standard deviation age of the registered children at assessment was 5.9 ± 4.1 years, and 42.1% were female. Two-thirds of the children had ≥ one form of undernutrition (underweight or severely underweight: 38.9%, stunted or severely stunted: 51.2%, thin or severely thin: 23.8%). In the adjusted analysis, low maternal education, GMFCS-IV, speech impairment and epilepsy significantly increased the odds of undernutrition among participating children (aOR: 2.6 [95% CI:1.3-5.4]; 2.2 [95% CI:1.0-4.8]; 2.0 [95% CI:1.1-3.6]; 2.9 [95% CI:1.1-7.5] respectively).

Conclusions

The high malnutrition rate indicates an urgent need for nutrition interventions and translational research to improve nutritional status and prevent adverse outcomes among children with CP in Ghana.

Contribution

Our study contributes important data and a framework to develop guidelines and evidence-based interventions for children with CP in Ghana.

Clinical profile and associated comorbidities of cerebral palsy in children visiting Orotta National Referral Hospital, Eritrea: a cross-sectional study

BACKGROUND

Cerebral Palsy (CP) is one of the most common physical disabilities in children. This study aimed to explore the clinical spectrum of CP at Orotta National Referral and Teaching Hospital, including CP subtypes, gross motor function, patterns of associated comorbidities, and possible risk factors in children aged 2 to 12 years.

METHODS

A hospital-based cross-sectional study was conducted from January to April 2022 in 153 children with suspected motor symptoms. The Surveillance of CP in Europe (SCPE) decision tree was used as an inclusion criteria guideline and the evaluation of the participants was done using a standardized questionnaire and clinical examination. Descriptive statistics, chi-square test, and logistic regression were employed to statistically analyze the data.

RESULTS

Eighty-four children who fulfilled the clinical criteria were included in the study. The median age was 5-years [IQR: 3.8] with an equal distribution of males and females. Quadriplegic CP was the most common subtype (51.2%) followed by unilateral (hemiplegic) CP (22.6%), and dyskinetic CP (14.3%). Most children had severe gross motor impairment GMFCS level IV-V and females were almost three times more likely to have GMFCS level IV/V than males (AOR: 2.70; CI: 1.08-6.72; p-value = 0.033.) More than half (52.4%) of the neonates either did not cry within five minutes and/or needed breathing resuscitation, 55.3% had to be admitted to the NICU with a median of 5 days' hospital stay. Between the first week of birth and the first year of life, 28.6% had trouble feeding, 26.2% had an infection, 10.7% had difficulty breathing, 20.2% had seizures and 6% had jaundice. Feeding problems (64.3%), speech problems of some sort (91.7%), and epilepsy (46.4%) were the most commonly associated comorbidities with CP.

CONCLUSIONS

The clinical profile of the CP patients was found to be dominated by the spastic subtype and moderate to severe disability. Since perinatal risk factors were found to be dominant, strengthening maternal and child healthcare systems is recommended to minimize incidents of preventable risk factors and the burden of the disability.

Nutritional Status and Dietary Behaviors of Children with Intellectual or Developmental Disabilities in Saudi Arabia: A Systematic Review

Children with intellectual or developmental disabilities are susceptible to malnutrition. This systematic review was conducted to assess the nutritional status and dietary behaviors of children with intellectual or developmental disabilities in Saudi Arabia. The target population was children from Saudi Arabia aged 18 years or younger and diagnosed with intellectual or developmental disabilities. Appropriate research studies that were published from inception up to December 2023 were obtained and reviewed. The outcomes of interest, including anthropometric data, laboratory data, dietary intake data, and dietary behaviors data, were collected and organized in relevant tables. The methodological quality and bias risk for the involved studies were evaluated. Out of 286 screened articles, 31 research articles were selected. The review results show that the rates of overweight and obesity were significantly higher among children with intellectual or developmental disabilities compared to typically developing children. The laboratory data revealed that they were more likely to have nutritional deficiencies. Low intake of energy, protein, and several micronutrients is frequently reported among them. Moreover, they are anticipated to have unhealthy dietary behavior. In conclusion, the findings suggested that children with intellectual or developmental disabilities were at higher risk of malnutrition including deploying obesity and nutritional deficiencies. Healthy and balanced nutrition that considers dietary requirements and food preferences is critical to maintaining the optimal development of these children. This review could invite researchers and policy-makers in Saudi Arabia to put more effort into integrating individuals with disability into the healthcare system and community. Further research is required to determine the types of intervention measures that can be taken to reduce the risk of malnutrition. Additional action is needed to monitor the implementation of national policies and programs that target this part of society.

Helicobacter pylori Infection in Children With Cerebral Palsy: A Cross-Sectional Study

BACKGROUND

Children with cerebral palsy (CP) frequently have associated disorders and complications, including gastrointestinal problems. Helicobacter pylori is a common infection worldwide, frequently associated with gastrointestinal manifestations.

METHODS

To estimate the prevalence of H. pylori infection in children with CP, a cross-sectional study over an eight-month period was performed in the pediatric neurology outpatient clinic of Tanta University Hospital. The study included 100 patients with CP aged two to 17 years. All patients were tested for H. pylori antigen in stool by enzyme-linked immunosorbent assay.

RESULTS

The mean age of studied children with CP was 7.03 ± 4.1 years; there were 57 males and 43 females. Spastic quadriplegic CP was the most common type of CP (34%). Forty-five children with CP were positive for H. pylori antigen in stool. Intellectual disability (ID), low sociodemographic scoring system, semisolid diet, and Eating and Drinking Ability Classification System (EDACS) levels 4 and 5 were significant predictors of H. pylori infection (odds ratio of 1.86, 2.63, 12, and 1.77, respectively, P < 0.05). Vomiting, abdominal pain, and gastrointestinal tract bleeding were significantly more frequent in H. pylori-infected children with CP than noninfected children with CP (P value < 0.05) CONCLUSION: H. pylori is a relatively common infection among children with CP. The main risk factors for H. pylori infection were low socioeconomic level, ID, semisolid diet, and EDACS levels 4 and 5.

Prevalence, severity, and predictors of malnutrition in Indian children with cerebral palsy and their impact on health-related quality of life

Although several studies have shown that undernutrition is frequent in children with cerebral palsy (CP), studies determining predictors of undernutrition and its impact on health-related quality of life (HRQoL) are scarce. This study aimed to assess the prevalence, severity, and predictors of malnutrition in children with CP and its impact on quality of life. This prospective study was performed between August 2019 and December 2021 in children with a clinical diagnosis of CP aged 2-18 years. We also intended to determine the socio-demographic and clinical predictors of undernutrition in these children and its impact on HRQoL, measured by the cerebral palsy quality of life (CPQoL)-Primary Caregiver reported version. Out of 569 (5.4 ± 2.8 years of age, 74% boys) children with CP, 71%, 44%, and 72% children were underweight, wasted, and stunted respectively, whereas 22%, 11%, and 21% were severely underweight, wasted and stunted respectively. Lower socioeconomic status, higher Gross Motor Function Classification System, and Manual Ability Classification System level were found to be significantly associated with the severity of stunting and underweight (p < 0.05), but not with wasting. CPQoL score in children with CP aged > 4 years was lower in patients with severe wasting, stunting, and underweight, as compared to their rest of the counterparts when adjusted for socio-demographic and other clinical variables (p < 0.05).  Conclusion: Chronic undernutrition is more common than severe acute malnutrition in children with CP. The severity of undernutrition is an important predictor of impaired HRQoL in children with CP. What is Known: • Several studies have shown that undernutrition is frequent in children with cerebral palsy; however, studies determining predictors of undernutrition and its impact on health-related quality of life are scarce. What is New: • Our study identifies that lower socioeconomic status, higher Gross Motor Function Classification System, and Manual Ability Classification System level are significantly associated with the severity of stunting and being underweight. • Chronic undernutrition is more common than severe acute malnutrition in children with cerebral palsy. Its severity is an important predictor of impaired health-related quality of life in children with cerebral palsy.

Hematological and biochemical profiles in children with cerebral palsy: A cross-sectional study

PURPOSE

Cerebral palsy is a common pediatric neurological problem that has multiple comorbidities, including nutritional issues. Hematological and biochemical parameters significantly affect the health status of patients with cerebral palsy, and till now very few studies have analyzed these parameters. This study aimed to describe the hematological and biochemical parameters of children diagnosed with cerebral palsy.

METHODS

This four-year observational study included children with cerebral palsy who were admitted to the Department of Pediatrics of a medical college teaching hospital.Hemoglobin, platelet count, white blood count (WBC), red blood cells (RBCs), packed cell volume, RBC indices, and biochemical parameters (urea, creatinine, total bilirubin, total protein, albumin, globulin, aspartate transaminase, alanine transaminase, electrolytes, calcium and alkaline phosphatase) were noted and values (mean, standard deviation, and interquartile range) presented. Age and gender-based analyses were performed.

RESULTS

The average hemoglobin level was 11.48 mg/dl, platelet count was 301.24×109/L, and WBC count was 11.13 109/L. Anemia was observed more commonly in males younger than nine years of age. Of 282 patients, 14 (4.96%) had a platelet count of less than 150×109/L. Abnormal alkaline phosphatase levels were observed more commonly in patients who were younger than nine years of age and in females more than males, and the difference was statistically significant. Protein levels and calcium levels were similar between both age groups.

CONCLUSION

Anemia was more common in younger patients and males with cerebral palsy. Abnormal bone turnover markers (alkaline phosphatase) were more common in young patients and females with cerebral palsy. Understanding the differential effect of age and gender on various investigational parameters will help improve care of children with cerebral palsy by initiating appropriate and timely clinical interventions, thereby providing a better quality of life.

Nutrition Situation Analysis in the UAE: A Review Study

This review study aimed to assess the nutrition situation in the UAE using published data from 2010 to 2022. It highlights the gaps and challenges that prevail in addressing the nutrition-related problems in the UAE and the opportunities that have been overlooked. The available literature indicates that the UAE is burdened with more than one form of nutrition-related problems, including being underweight, being overweight, obesity, micronutrient deficiencies, and nutrition-related chronic diseases. It is clear that data on micronutrient deficiencies, protein-energy malnutrition, obesity, diabetes, and other nutrition-related diseases among the UAE population are extremely scarce. The UAE has a high prevalence of obesity and diabetes; however, limited studies have been conducted to document this nutritional phenomenon. Few examples of published data are available assessing the burden of stunting, wasting, and being underweight among children under five years of age. Despite the importance of protein-energy malnutrition, no recent publications analyze its prevalence within the UAE population. Therefore, future studies must be conducted, focusing on malnutrition. Based on the literature, and bearing in mind the magnitude of the health issues due to the UAE population's nutrition negligence, there is an urgent need to assess the population's nutrient behaviors, to aid policy decision-makers in developing and implementing effective health policies and strategies.

Influence of malnutrition and body composition on the gross motor function of children with cerebral palsy in Kano, Nigeria: a cross-sectional study

Background

Malnutrition is common among children with cerebral palsy (CWCP); however, its impact on gross motor function (GMF) is not adequately reported. The study evaluated the influence of malnutrition and body composition on GMF.

Methods

In the cross-sectional survey, CWCP were recruited using purposive sampling from three selected secondary and tertiary hospitals in Kano, Nigeria. Sociodemographic variables were recorded on a data capture form. Anthropometric variables were measured using standard procedures. Percent (%) body fat, malnutrition, and GMF were assessed using skinfold thickness, screening tool for the assessment of malnutrition in pediatrics, and GMF classification system (GMFCS), respectively. The data was analyzed with one-way ANOVA, chi-square, and logistic regression using SPSS version 20 at p < 0.05.

Results

The 146 CWCP have mean age of 4.70 ± 2.46 years. About 95 (65.1%) are malnourished. Those with GMFCS V had lower %body fat and higher malnutrition than children with GMFCS II and I, respectively (p < 0.05). Malnutrition has no significant influence on GMF (B = 0.984, OR = 2.676; 95% CI = 0.965–7.423, p > 0.05). %body fat (B = −0.192, OR = 0.826; 95% CI = 0.687–0.992, p < 0.05), type of CP (OR = 12.106; 95% CI = 3.771–38.866, p < 0.005), child’s position in the family (OR = 1.639; 95% CI = 1.162–2.312, p < 0.05), and mothers’ education (B = −2.815, OR = 0.060; 95% CI = 0.012–0.309, p < 0.005) all predicted GMF.

Conclusions

Majority of the CWCP in this study are malnourished. But malnutrition did not however significantly predict GMF, meaning that though malnutrition could impair children’s physical growth and motor development, it however did not have significant influence on their motor function. Hence, CWCP undergoing rehabilitation may not likely experience significant decrease in their motor function due to inadequate nutrition. Decrease in body fat, type of CP, low level of mothers’ education, and child occupying 4th or more position in the family have negative influence on GMF. It was recommended that physiotherapists should routinely assess for malnutrition in CWCP. Prompt nutritional intervention may prevent considerable lose of body fat and augment the gains of physical rehabilitation by providing appropriate nutrition to support muscle growth and the supply of adequate energy for participation in physical exercise. Adequate caregiver education is important for ensuring satisfactory nutrition for CWCP.

Serebral Palsili Çocuklarda Beslenme Alışkanlıkları ve Sorunları: Kesitsel Bir Çalışma

Amaç: Serebral Palsi’li (SP) çocuklarda beslenme sorunları yetersiz ve dengesiz beslenmeye neden olmanın yanı sıra günlük yaşamı ve psikososyal gelişimi de olumsuz etkileyebilmektedir. Bu çalışmanın amacı; özel bir kliniğe başvuran SP tanısı almış 6-14 yaş aralığındaki çocukların beslenme alışkanlıklarını değerlendirmek ve yaşadıkları beslenme sorunlarını saptamaktır.Yöntem: Çalışma, literatür taranarak hazırlanan anket formu kullanılarak 50 SP tanılı çocuk ile gerçekleştirilmiştir. Anket formunda tanımlayıcı bilgilerin yanı sıra çocuğun beslenmesine ayrılan süre (dk), tüketilen ara öğün ve ana öğün sayısı, tüketilen su miktarı gibi beslenme alışkanlıklarına yönelik sorular yer almaktadır. Ayrıca çocuklar Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS)’ne göre değerlendirilmiştir. Besin tüketim sıklığı formu ile hangi besinin ne sıklıkla tüketildiği saptanmıştır. Verilerin analizinde SPSS 22.0 Programı kullanılmıştır ve p değeri 0,05 olarak kabul edilmiştir.Bulgular: Hastaların tamamına yakınının SP’ye ek bir hastalığı bulunmakta olup en sık görülen hastalık gastroözofageal reflü (%84,0) olarak saptanmıştır. Oral yoldan normal diyetle beslenen hastaların oranı %18,0; en sık görülen beslenme sorunu yutma güçlüğüdür (%76,0). Çocukların yarısına yakını haftanın 5-6 günü süt ve süt ürünleri (%50,0), yumurta (%46,0) ve sebze (%40,0) tüketmektedir. Çalışmaya katılan SP tanılı çocukların beslenme şekilleri; cinsiyet, yaş grubu ve babanın eğitim durumu ile ilişkili bulunmazken (p&gt;0,05), annenin eğitim durumu ve kaba motor fonksiyon sınıflandırma sistemi ile aralarında anlamlı ilişki saptanmıştır (p&lt;0,05).Sonuç: Serebral palsili çocuklar beslenme yetersizliği açısından risk altında olmaları nedeniyle diyetisyeni de içeren multidisipliner bir ekip tarafından takip edilmeli, beslenme durumları izlenmeli ve aileleri bilgilendirilmelidir. 

Epidemiology of Cerebral Palsy among Children and Adolescents in Arabic-Speaking Countries: A Systematic Review and Meta-Analysis

BACKGROUND

Studies on cerebral palsy among children and adolescents in Arabic-speaking countries are scarce. In this systematic review, we aimed to describe the epidemiology of cerebral palsy among children and adolescents in Arabic-speaking countries in terms of prevalence, risk factors, motor types, and rehabilitation.

METHODS

Six key bibliographic databases were searched for relevant literature published to 17 July 2021. Titles and abstracts were screened for potential inclusion and two independent reviewers screened the full texts of potential articles following pre-defined inclusion/exclusion criteria. The included studies were evaluated independently by three reviewers. The risk of bias was assessed, and data were extracted and analysed.

RESULTS

A total of 32 studies from 7 countries met our inclusion criteria. The prevalence of cerebral palsy in Arabic-speaking countries was 1.8/1000 live births (95% CI: 1.2-2.5). Spastic cerebral palsy was the most common motor type, representing 59.8% (95% CI: 46.2-72.7) of pooled estimates. This included children with spastic quadriplegia, diplegia, and hemiplegia; 25.1% (95% CI: 18.2-32.8), 16.2% (95% CI: 11.4-23.3), and 10.4% (95% CI: 7.3-13.8), respectively. Consanguinity was high and represented 37.7% (95% CI: 29.3-46.6). Only one included study reported the types of rehabilitation received (e.g., physiotherapy and assistance devices).

CONCLUSIONS

This paper provides a summary of the epidemiology of cerebral palsy in Arabic-speaking countries and highlights areas for future research. There is still a substantial knowledge gap on the epidemiology of cerebral palsy in these regions. Countries in the Arab region should follow examples of countries that have successfully established cerebral palsy registries to generate evidence on epidemiology of cerebral palsy and opportunities for prevention.

Malnutrition and nutritional deficiencies in children with cerebral palsy: a systematic review and meta-analysis

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.

Effect of Moringa Oleifera fortified porridge consumption on protein and vitamin A status of children with cerebral palsy in Nairobi, Kenya: A randomized controlled trial

BACKGROUND

Malnutrition due to inadequate dietary intake is commonly reported in children with Cerebral palsy (CP). Poor dietary intakes are majorly caused by feeding dysfunctions secondary to oro-motor impairment characteristic of the condition. Strategies that improve nutrient densities in foods can help enhance nutrient intakes by these children.

OBJECTIVE

This study investigated the effect of consumption of fermented finger millet porridge fortified with Moringa oleifera leaf powder (MoLP) on the protein and vitamin A status of children with CP.

DESIGN

A randomized controlled trial was conducted among 113 children aged 5-11 years with CP. The study had two arms (intervention [N = 57] and control [N = 56]). The intervention group received a daily serving of fortified finger millet porridge for 3 months while the control group received non-fortified finger millet porridge servings. All children received the same amounts of porridge servings. The levels of serum albumin and retinol between the groups were compared at both baseline and end line. The BMI-for-age Z-scores (BMIAZ) and morbidity prevalence of the children were also assessed.

RESULTS

At baseline, the two study groups were similar in all demographic and socio-economic characteristics, nutrient intakes, serum levels of albumin and retinol, weight status and morbidity. At end line, the children from the intervention group had significantly higher intakes of vitamin A at 717.12±432.7 μg/d (p = 0.038) and protein at 44.367±17.2 g/d (p = 0.031) respectively. The serum nutrients levels increased significantly from baseline by 0.456±0.12 g/dL (p<0.001) for albumin and by 0.243±0.10 μmol/L (p<0.001) for retinol among children in the intervention group. Among the children in the control group, the changes in the levels of both serum albumin 0.012±0.07 g/dL (p = 0.868) and serum retinol [0.0021±0.02 μmol/L (p = 0.890)] were not significant. At endline, the BMI-for-age Z-scores results showed that 10.52% and 34.0% of children from intervention and control group respectively were undernourished [χ2 = 30.985; p = 0.037]. Among the children in the intervention, group there was a significant change in the weight status between baseline and endline (p = 0.036). The weight status among children in the control group was not significantly different between baseline and endline (p = 0.109). Significant difference in morbidity prevalence between the two groups was also observed at endline (p = 0.003) with the prevalence being 24.6% and 51.8% among children in the intervention and control group respectively.

CONCLUSION

Consumption of M. oleifera fortified porridge significantly improved the children's serum albumin and retinol levels, as well as BMIAZ.

REGISTRATION NUMBER AND NAME OF TRIAL REGISTRY

The trial is registered at Pan African Clinical Trials Registry, number PACTR202107669905145 URL link: https://pactr.samrc.ac.za/.

Evaluation of micronutrient levels in children with cerebral palsy

BACKGROUND

Many studies evaluating the nutritional status of children with cerebral palsy (CP) have focused on energy requirements and protein intake. The present work aimed to assess nutritional status and micronutrient levels of children with (CP).

METHODS

This multicenter, cross-sectional and observational study was conducted in 10 different cities in Turkey. Data were available for 398 participants. Anthropometric measurements, feeding mode, nutritional status, and micronutrient levels were evaluated.

RESULTS

The study was conducted with 398 participants (303 patients and 95 healthy controls). Statistical analysis showed that according to the Gomez Classification, weight-for-age (WFA) revealed malnutrition in 92.6% of children with CP, based on Centers for Disease Control and Prevention percentiles. Measurements of micronutrient levels showed that zinc levels were low in patients, whereas vitamin A levels were low in controls. Phosphorous and manganese levels were significantly lower in malnourished children than in typical children. The results revealed that children consuming enteral nutrition solutions had higher selenium and lower zinc levels than non-consumers.

CONCLUSIONS

Malnutrition is not only a protein- or calorie-based problem; micronutrient deficiencies might cause severe health problems. Children with chronic neurological disabilities must be carefully evaluated for these issues. Therefore, nutritional interventions should be adapted to nutrition.

Oral Motor Treatment Efficacy: Feeding and Swallowing Skills in Children with Cerebral Palsy

This study is aimed at identifying the relationship between oral motor treatment and the improvement of abilities for feeding and swallowing in boys and girls with CP residing in the state of Yucatán. The sample consisted of 30 patients with a diagnosis of CP and the presence of ADT, with gross motor function levels from II to V, between 3 and 14 years old, of which 50% received oral motor treatment. The predominant diagnosis was spastic CP and tetraplegia. An interview was carried out with the tutor, the application of the gross motor skills scale, and an assessment of feeding skills. The feeding and swallowing skills that improved significantly with the oral motor treatment were mandibular mobility, tongue activity, abnormal reflexes, control of breathing, and general oral motor skills (p ≤ 0.05). Within the sample that did not receive oral motor treatment, 46% presented low or very low weight and 40% referred recurrent respiratory diseases. In the end, it was concluded that feeding skills improve significantly with oral motor treatment, regardless of the severity of gross motor involvement. Likewise, oral motor treatment was associated with a lower presence of respiratory diseases and nutritional compromise.

Burden of Malnutrition among Children and Adolescents with Cerebral Palsy in Arabic-Speaking Countries: A Systematic Review and Meta-Analysis

BACKGROUND

We aimed to estimate the burden and underlying risk factors of malnutrition among children and adolescents with cerebral palsy in Arabic-speaking countries.

METHODS

OVID Medline, OVID Embase, CINAHL via EBSCO, Cochrane Library, and SCOPUS databases were searched up to 3 July 2021. Publications were reviewed to identify relevant papers following pre-defined inclusion/exclusion criteria. Two reviewers independently assessed the studies for inclusion. Data extraction was independently completed by two reviewers. Descriptive and pooled analysis has been reported.

RESULTS

From a total of 79 records screened, nine full-text articles were assessed for eligibility, of which seven studies met the inclusion criteria. Study characteristics, anthropometric measurements used, and nutritional outcome reported varied between the studies. The included studies contained data of total 400 participants aged 1-18 years. Overall, (mean: 71.46%, 95% confidence interval: 55.52-85.04) of children with cerebral palsy had at least one form of malnutrition. Severe gross motor function limitation, feeding difficulties, cognitive impairment and inadequate energy intake were the commonly reported underlying risk factors for malnutrition among children with cerebral palsy.

CONCLUSIONS

The burden of malnutrition is high among children with cerebral palsy in Arabic-speaking countries. More research is needed for better understanding of this public health issue in these countries.

Multi-Organ Dysfunction in Cerebral Palsy

Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.

Assessment of Swallowing Disorders, Nutritional and Hydration Status, and Oral Hygiene in Students with Severe Neurological Disabilities Including Cerebral Palsy

BACKGROUND

Special needs schools (SNS) educate children and young people with major neurological disabilities who are at high risk of oropharyngeal dysphagia (OD) and malnutrition (MN). We aimed to assess the prevalence of OD, MN, dehydration (DH), and oral health (OH) in students at an SNS.

METHODS

A cross-sectional observational study was conducted at SNS L'Arboç, Catalonia, Spain. We assessed (a) demographics, health status, comorbidities, and gross motor function classification system (GMFCS), (b) swallowing function, oral-motor evaluation, masticatory capacity, and EDACS classification for eating and drinking abilities, (c) nutritional and DH status (anthropometry, bioimpedance and dietary records), and (d) OH (Oral Hygiene Index Simplified).

RESULTS

A total of 33 students (mean age 13.3 years; 39.4% level V of GMFCS) were included. Main diagnosis was cerebral palsy at 57.6%. All students presented OD, 90.6% had impaired safety, 68.7% were at levels II-III of EDACS, and 31.3% required PEG; furthermore, 89.3% had chronic MN, 21.4% had acute MN, 70% presented intracellular DH, and 83.9% presented impaired OH.

CONCLUSION

MN, DH, OD, and poor OH are highly prevalent conditions in students with cerebral palsy and other neurological disabilities and must be specifically managed through nutritional and educational strategies. The multidisciplinary team at SNS should include healthcare professionals specifically trained in these conditions.

Development and Psychometric Properties of the Arabic Parent Nutritional Assessment Scale (A-PNAS) for Children with Developmental Disabilities

Aims: To describe the development of the Arabic-Parent Nutritional Assessment Scale (A-PNAS), and to examine construct and known-group discriminant validity, internal consistency, and test-retest reliability of the A-PNAS.Methods: A cross-sectional design was used. Participants were 130-children with CP (mean age = 4.26 ± 3.29 years) who were registered in the national CP registry of Jordan with a matching group of 130-children with typical development (mean age = 4.65 ± 3.54 years). Parents completed the developed A-PNAS through a structured phone interview. Parents of children with CP confirmed their child's level of gross motor function classification system.Results: Exploratory factor analysis identified three subscales in the A-PNAS: Food Intake Problems, Health Problems, and Behavioral Problems which explained 31.6% of the variance in nutritional problems of children with CP. Cronbach's alpha indicated acceptable internal consistency for Food Intake (α = 0.61) and Health Problems (α = 0.67)subscales. Parents of children with CP reported that their children had more food intake, health, and behavioral problems compared to children with typical development (p<.001). Test-retest reliability was excellent for the subscales of the A-PNAS (ICCs = 0.96, 0.98, 0.96).Conclusions: The findings provide support for the face validity, construct validity, internal consistency, Known-Groups discriminant validity, and test-retest reliability of the A-PNAS.

Risk factors of malnutrition in children with severe motor and intellectual disabilities

BACKGROUND

Children with severe motor and intellectual disabilities (SMID) are at a high risk of malnutrition and often require tube feeding to maintain their nutritional status. However, determining their energy requirements is difficult since inadequate dietary intake, severe neurological impairment, respiratory assistance, and cognitive impairment are all factors that affect malnutrition in SMID.

AIM

This study investigated the factors affecting malnutrition and identified problems affecting the nutritional status of children with SMID.

METHODS

Forty-two children with SMID with oral motor dysfunction who were receiving home medical care at one of four hospitals were enrolled. Their nutritional status was assessed using a 3-day dietary record, anthropometric measurements, and laboratory tests. The clinical findings associated with malnutrition were compared, and a body mass index (BMI) z-score less than -2SD was defined as malnutrition. The relationship between BMI z-score and other potential predictors was also investigated.

RESULTS

Thirty-three (79%) children received tube feeding, and 20 (48%) experienced malnutrition. The median age of the malnourished children was older than that of non-malnourished children. Respiratory assistance was significantly correlated with higher BMI z-score, independent of other potential confounders such as nutrition method, muscle tonus, and energy intake. Cholesterol levels were significantly higher in children receiving a standard infant formula beyond 3 years of age than in those who switched to enteral formula before 3 years of age.

CONCLUSIONS

Malnutrition in children with SMID was mainly associated with age or respiratory condition. Energy requirements should be regularly re-evaluated with considering these factors.