Original research
Differences in Body Composition According to Gross Motor Function in Children With Cerebral Palsy

https://doi.org/10.1016/j.apmr.2017.04.005Get rights and content

Abstract

Objective

To assess differences in body composition according to gross motor function in children with cerebral palsy (CP) compared with healthy controls.

Design

Retrospective case-control study.

Setting

Tertiary referral center for CP.

Participants

Participants (N=146) comprised consecutive patients with CP (n=100; mean age, 11.5±4.2y) who were admitted for orthopedic surgery between May 2014 and March 2016 and typically developing children (TDC, n=46; control group).

Interventions

Not applicable.

Main Outcome Measures

Bioelectrical impedance analysis (BIA) was used to assess body composition, including body fat, soft lean mass (SLM), fat-free mass (FFM), skeletal muscle mass (SMM), body cell mass (BCM), bone mineral content (BMC), and basal metabolic rate. Body composition measures were compared according to Gross Motor Function Classification System (GMFCS) level, as well as between children with CP and TDC.

Results

Children with CP with GMFCS levels IV and V had a lower height, weight, and body mass index than those with GMFCS levels I to III. Children with CP with GMFCS levels IV and V had a significantly lower SLM, SLM index, FFM, FFM index, SMM, SMM index, BCM, BCM index, BMC, and BMC index than those with GMFCS levels I to III and TDC. GMFCS level significantly affected SLM and BMC.

Conclusions

Body composition analysis using BIA showed that nonambulatory children with CP had significantly lower FFM, SLM, SMM, BCM, and BMC than ambulatory children with CP and TDC. However, further study is required to allow the use of BIA as a valid nutritional assessment tool in patients with CP.

Section snippets

Methods

This retrospective study was approved by the institutional review board at our hospital, which is a tertiary referral center for CP. The informed consent was waived because of the study's retrospective design.

Results

One hundred patients with CP (64.0% boys) were included in this study. Their mean age ± SD was 11.5±4.2 years. Most patients had diplegia (46 patients) based on the anatomic classification. The distribution of GMFCS levels was as follows: I, 20 patients; II, 13; III, 24; IV, 23; and V, 20. Among the 20 patients with GMFCS level V, 9 received anticonvulsants and 4 were fed via a gastrostomy tube. The control group consisted of 46 TDC with a mean age of 12.8 years. Children with CP with GMFCS

Discussion

Our body composition analysis using the BIA method showed that children with CP, especially nonambulatory children (GMFCS levels IV and V), had a lower muscle mass, BCM, and BMC than TDC, which was consistent with findings from previous studies using DXA and the isotope dilution procedure. In addition, GMFCS level was an independent factor that affected SLM and BMC. However, body composition in ambulatory children with CP was not significantly different from that of TDC.

Previous studies9, 16, 17

Conclusions

Our body composition analysis using the BIA method showed that nonambulatory children with CP had significantly lower FFM, SLM, SMM, BCM, and BMC than ambulatory children with CP and TDC. In addition, GMFCS level was a significant contributing factor to SLM and BMC. However, further study is required before the BIA method can be used as a valid nutritional assessment tool in patients with CP.

Suppliers

  • a.

    Kiker plus; G-Tech International Co, Ltd.

  • b.

    Scale-Tronix 2001 Sling Scale; Scale-Tronix, Inc.

  • c.

    InBody S10; InBody, Co, Ltd.

  • d.

    SPSS software for Windows (version 22.0); IBM Corp.

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  • Cited by (29)

    • The utility of bioelectrical impedance analysis to assess nutritional status of patients with severe motor and intellectual disabilities

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      The BIA data that significantly correlated with Alb were SMI (r = 0.369), SMR (r = 0.393), ECW/TBW (r = −0.354), BCM (r = 0.334), and BCM index (r = 0.420) (Table 4). The present study was conducted in subjects with GMFCS levels IV and V. Previous studies have shown that GMFCS levels contribute to body composition, and that the results of body composition are different between ambulatory and non-ambulatory subjects [11]. Therefore, it is necessary to consider subjects’ levels of motor function when assessing body composition.

    • Body Fat Distribution in Children and Adolescents With Cerebral Palsy

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      Also, epilepsy and musculoskeletal problems can occur (5). Until today, there are only few investigations about the body composition in children with CP (9), (11–18). One of those is a study by Whitney et al from 2018.

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

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      There was a predominance of cross-sectional cohort studies (68.65%; n = 46).1,3,6–9,14–17,19,20,22–24,26,36,39–41,44–47,52–61,63,65,67–70,76–79 Regarding the methodological quality, for the studies with a cross-sectional design, it was verified that 78.26% (n = 36) of the publications1–3,6,7,9,15–17,20,22,24,26,35,36,39,40,44,46,52,54,55,58–61,63,65,67,69,74–79 clearly presented the criteria for inclusion in the sample. No study was excluded because of its methodological quality.

    • Criterion validity of assessment methods to estimate body composition in children with cerebral palsy: A systematic review

      2021, Annals of Physical and Rehabilitation Medicine
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      There is some evidence that improving nutritional intake may correct anthropometric deviations: in one study, children with gross impairment who received a reliable intake of energy and nutrients via tube feeding had a higher average weight, muscle mass and fat stores than children with similar disabilities without tube feeding [9]. Other consequences of poor nutritional status include decreased bone health [11] and a limitation in daily activities [6,7,12]. Because of the diversity of impairments in these children, both over- and underweight are highly prevalent [1,5,12].

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    Supported by Projects for Research and Development of Police Science and Technology under the Center for Research and Development of Police Science and Technology and Korean National Police Agency, funded by the Ministry of Science, ICT and Future Planning (grant no. PA-C000001-2015-202) by Small and Medium Business Administration (grant no. S2409723), and by the National Research Foundation of Korea (grant no. 2017R1A2B4007412).

    Disclosures: none.

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