Gurka vs Slaughter equations to estimate the fat percentage in children with cerebral palsy from all subtypes and levels of the Gross Motor Function Classification System.

BACKGROUND: Body composition assessment in children with cerebral palsy (CP) is a challenge, specially the fat percentage. There are different methods that can be used to estimate the fat percentage in this population, such as anthropometric equations, but there is still a need to determine which is the best and most accurate. The purpose of the study was to determine the method that best estimates the fat percentage in children from all CP subtypes and levels of the Gross Motor Function Classification System (GMFCS). METHODS: Analytical cross-sectional study in which 108 children with CP diagnosed by a pediatric neurologist were included with any type of dysfunction and from all levels of the GFMCS. Slaughter equation, Gurka equation and Bioelectrical impedance analysis (BIA) as reference method, were used. Groups were stratified by sex, CP subtypes, GMFCS level and Tanner stage. Median differences, Kruskal-Wallis, Mann-Whitney U test, Spearman's correlation coefficients and simple regressions were used, also multivariate models were performed. RESULTS: The Slaughter equation differed from the other methods in the total population and when it was compared by sex, CP subtypes, gross motor function and Tanner stage. The Gurka equation showed significant differences by sex and gross motor function. Gurka equation correlated positively and significantly with BIA to estimate the fat percentage in all the CP subtypes and levels of the GMFCS. Tricipital skinfold (TSF), arm fat area (AFA) and weight for age index (W/A) showed the highest variability with respect to fat percentage. CONCLUSION: Gurka equation is more appropriate and accurate than Slaughter equation to estimate the fat percentage in children with CP from all subtypes and levels of the GMFCS.

Lactobacillus reuteri DSM 17938 and Agave Inulin in Children with Cerebral Palsy and Chronic Constipation: A Double-Blind Randomized Placebo Controlled Clinical Trial.

The main objective was to assess the efficacy of a probiotic (Lactobacillus reuteri DSM 17938), a prebiotic (agave inulin), and a synbiotic on the stool characteristics in children with cerebral palsy and chronic constipation. Thirty-seven children with cerebral palsy and chronic constipation were included. The probiotic group received 1 × 108 colony forming unit (cfu) of L. reuteri DSM 17938 plus placebo, the prebiotic group received 4 g of agave inulin plus placebo, the synbiotic group received L. reuteri DSM 17938 plus agave inulin, and the placebo group received two placebos for 28 days. The probiotic group showed a significant decrease in stool pH (p = 0.014). Stool consistency improved in the prebiotic group (p = 0.008). The probiotic, prebiotic, and synbiotic groups showed a significant improvement in the history of excessive stool retention, the presence of fecal mass in the rectum, and the history of painful defecation. L. reuteri concentration in feces was higher in the probiotic group than in the placebo group (p = 0.001) and showed an inverse correlation with stool pH in the probiotic group (r = -0.762, p = 0.028). This study showed that the use of L. reuteri DSM 17938 and/or agave inulin improved the stool characteristics such as the history of painful defecation and the presence of fecal mass in the rectum against placebo in children with cerebral palsy and chronic constipation.

Factors associated with the stool characteristics of children with cerebral palsy and chronic constipation.

BACKGROUND: chronic constipation is a common gastrointestinal problem in children with cerebral palsy and several factors can influence the stool frequency, consistency and pH in these cases. AIM: to identify the association of dietary factors, use of anticonvulsants and family history of constipation with the stool characteristics of children with cerebral palsy and chronic constipation. METHODS: an analytical cross-sectional study was performed of 45 children with cerebral palsy and chronic constipation that included 19 females and 26 males, aged 37 ± 13 months. Dietary factors, the use of anticonvulsants and family history were analyzed. Stool frequency, consistency (Bristol Stool Form Scale) and pH (using a pH-meter) were also determined. RESULTS: there was a positive correlation between stool frequency and the consumption of oilseeds (r = 0.339, p = 0.023). There was a negative correlation between hard stools and fluid intake (r = -0.336, p = 0.042) and between stool pH and the consumption of cereals rich in insoluble fiber, high soluble fiber vegetables, carrots and potatoes (r = -0.339, p = 0.030; r = -0.308, p = 0.044; r = -0.336, p = 0.027; r = -0.307, p = 0.045, respectively). An association was also identified between the use of anticonvulsant polytherapy and hard stools (OR = 14.2 [95% CI 1.16-174], p = 0.038). There was no association between family history and constipation. CONCLUSIONS: rich-fiber food consumption, fluids intake and anticonvulsant polytherapy were associated with the stool characteristics of children with cerebral palsy and chronic constipation.

Densidad mineral ósea e indicadores bioquímicos y hormonales en niños con parálisis cerebral cuadripléjica.

INTRODUCTION: Introduction: children with cerebral palsy (CP) have multiple risk factors for low bone mineral density or osteoporosis. Objective: to explore the association between bone mineral density (BMD) and biochemical and hormonal indicators of bone metabolism in children with quadriplegic cerebral palsy (CP). Methods: a cross-sectional analytical study included 59 participants from six to 18 years of age with quadriplegic CP. Serum concentrations of calcium, phosphorus, 25OHD metabolite, parathyroid hormone (PTH), alkaline phosphatase, and thyroid hormones were determined using standardized methods. The BMD measurement was obtained from the lumbar spine expressed in g/cm2 and Z-score. Unpaired Student's t-test, Chi-square test, odds ratio and Pearson's correlation were performed. Results: participants with CP and malnutrition had lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Those who had low BMD showed lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Most participants with low and normal BMD had vitamin D deficiency (27.1% and 10%) and insufficiency (35.4% and 30%), respectively. There was a significant correlation between BMD and serum concentrations of calcium, phosphorus, alkaline phosphatase, vitamin D and thyroid-stimulating hormone (TSH). There were no differences in the biochemical and hormonal indicators by level of gross motor function, use of anticonvulsants and oral versus enteral feeding method. Conclusion: malnutrition and alteration of vitamin D nutritional status were associated with low BMD and alterations of biochemical indicators of bone metabolism in pediatric patients with quadriplegic CP. The relationship between BMD and biochemical indicators of bone metabolism in children with quadriplegic CP was also demonstrated.

INTRODUCCIÓN: Introducción: los niños con parálisis cerebral (PC) presentan múltiples factores de riesgo de densidad mineral ósea baja u osteoporosis. Objetivo: explorar la asociación entre la baja densidad mineral ósea (DMO) e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica. Métodos: un estudio transversal analítico incluyó a 59 participantes de entre seis y 18 años de edad con PC cuadripléjica. Las concentraciones séricas de calcio, fósforo, metabolito 25OHD, hormona paratiroidea (PTH), fosfatasa alcalina y hormonas tiroideas se determinaron utilizando métodos estandarizados. La medición de DMO se obtuvo de la columna lumbar expresada en g/cm2 y puntaje Z. Se realizaron pruebas t de Student no pareada, Chi-cuadrado, razón de momios y correlación de Pearson. Resultados: los participantes con PC y desnutrición tenían concentraciones séricas más bajas de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja tuvieron menor concentración sérica de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja y normal tenían deficiencia de vitamina D (27.1% y 10%) e insuficiencia (35.4% y 30%), respectivamente. Hubo una correlación significativa entre DMO y las concentraciones séricas de calcio, fósforo, fosfatasa alcalina, vitamina D y hormona estimulante de la tiroides. Conclusión: la desnutrición y la alteración del estado nutricio de la vitamina D se asociaron con DMO baja y alteraciones de los indicadores bioquímicos del metabolismo óseo. Se demostró una asociación entre DMO e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica.

Energy expenditure is associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy.

INTRODUCTION: proper estimation of energy requirements in children with cerebral palsy (CP) is essential in ensuring that their energy needs are optimally met. OBJECTIVE: therefore, the purpose of this study was to demonstrate that resting energy expenditure (REE) and total energy expenditure (TEE) are associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy. METHODS: a cross-sectional study included 79 participants with spastic CP from 24 months to 16 years nine months. Weight and height (estimated by lower leg length) were obtained; body composition and energy expenditure were estimated by bioelectrical impedance analysis. ANOVA, post hoc tests, the Pearson correlation and determination coefficients (R2) were performed. RESULTS: significant gradual increases according to age in REE and TEE (both in kcal/d) were observed. There were highly significant positive correlations between REE and TEE (kcal/d, kcal/cm/d) with fat-free mass (FFM) and fat mass (FM), but negative correlations between REE (kcal/ kg/d) with body composition and energy indicators. FFM and total body water, and to a lesser extent FM, explained a high percentage of the direct variability of REE and TEE in kcal/d and the inverse in kcal/kg/d. CONCLUSIONS: as age increased, energy expenditure also increased. The estimated energy expenditure in kcal/cm/d did not differ with age and sex. The estimated energy expenditure, based on height, would be a practical and reliable method for estimating energy expenditure and ensuring adequate nutritional status.

Bone mineral density and nutritional status in children with quadriplegic cerebral palsy.

This study demonstrated the relationship of low bone mineral density (BMD) with the degree of motor impairment, method of feeding, anthropometric indicators, and malnutrition in children with quadriplegic cerebral palsy (CP). The control of these factors could optimize adequate bone mineralization, avoid the risk of osteoporosis, and would improve the quality of life. PURPOSE: The purpose of the study is to explore the relationship between low BMD and nutritional status in children with quadriplegic CP. METHODOLOGY: A cross-sectional analytical study included 59 participants aged 6 to 18 years with quadriplegic CP. Weight and height were obtained with alternative measurements, and weight/age, height/age, and BMI/age indexes were estimated. The BMD measurement obtained from the lumbar spine was expressed in grams per square centimeter and Z score (Z). Unpaired Student's t tests, chi-square tests, odds ratios, Pearson's correlations, and linear regressions were performed. RESULTS: The mean of BMD Z score was lower in adolescents than in school-aged children (p = 0.002). Patients with low BMD were at the most affected levels of the Gross Motor Function Classification System (GMFCS). Participants at level V of the GMFCS were more likely to have low BMD than levels III and IV [odds ratio (OR) = 5.8 (confidence interval [CI] 95% 1.4, 24.8), p = 0.010]. There was a higher probability of low BMD in tube-feeding patients [OR = 8.6 (CI 95% 1.0, 73.4), p = 0.023]. The probability of low BMD was higher in malnourished children with weight/age and BMI indices [OR = 11.4 (1.3, 94), p = 0.009] and [OR = 9.4 (CI 95% 1.1, 79.7), p = 0.017], respectively. CONCLUSION: There was a significant relationship between low BMD, degree of motor impairment, method of feeding, and malnutrition. Optimizing these factors could reduce the risk of osteopenia and osteoporosis and attain a significant improvement of quality of life in children with quadriplegic CP.

Assessment of anthropometric indicators in children with cerebral palsy according to the type of motor dysfunction and reference standard.

AIM: The study aimed to demonstrate that the assessment of the anthropomorphic measurements of children with cerebral palsy (CP) varies according to the type of motor dysfunction and references standard used for comparison. METHOD: In a cross-sectional design, 108 children 2 to 16 years were classified according to the type of motor dysfunction by gender and age group. Weight, mid-upper-arm-circumference (MUAC), and alternative measures for height were performed. Height/age and weight/age indexes and BMI were evaluated with percentiles and/or Z-scores with reference to a number of previously published references of growth, including those of the World Health Organization (WHO). RESULTS: Fifty-three (49.1%) were females and 55 (50.9%) males. Spastic type was predominant (73.1%) and 26.9% were other types of dysfunction. Most of the children were located on level IV (14.6%) and level V (73.1%) of the Gross Motor Function Classification System (GMFCS). Significant differences were found, suggesting that weight (p = 0.002), height (p = 0.001), and MUAC (p = 0.05) are higher in the spastic group than in other groups. CONCLUSIONS: The anthropometric indicators were significantly higher in the spastic group than in other groups. Upper-arm length (UAL) seemed less appropriate than knee height (KH) and lower-leg length (LLL) for measuring height. The WHO reference standard was not useful to evaluate the majority of anthropometric indexes in children with CP, other references as the growth charts of Day and Brooks have been more suitable.

Consenso para las prácticas de alimentación complementaria en lactantes sanos / Guidelines for complementary feeding in healthy infants

Resumen: La nutrición adecuada durante los primeros dos años de vida es fundamental para el desarrollo pleno del potencial de cada ser humano; actualmente se reconoce que este periodo es una ventana crítica para la promoción de un crecimiento y desarrollo óptimos y un buen estado de salud. Por tanto, cumplir con una alimentación adecuada en esta etapa de la vida tiene impacto sobre la salud, estado de nutrición, crecimiento y desarrollo de los niños; no sólo en el corto plazo, sino en el mediano y largo plazo. El presente trabajo ofrece recomendaciones de alimentación complementaria (AC) que se presentan en forma de preguntas o enunciados que consideran temas importantes para quienes atienden niños durante esta etapa de la vida; por ejemplo: inicio de la alimentación complementaria a los 4 o 6 meses de edad; exposición a alimentos potencialmente alergénicos; introducción de bebidas azucaradas; uso de edulcorantes artificiales y productos light; secuencia de introducción de alimentos; modificaciones de consistencia de alimentos de acuerdo a la maduración neurológica; número de días para probar aceptación y tolerancia a los alimentos nuevos; cantidades por cada tiempo de comida; prácticas inadecuadas de alimentación complementaria; mitos y realidades de la alimentación complementaria; hitos del desarrollo; práctica del "Baby Led Weaning" y práctica de vegetarianismo.

Abstract: A proper nutrition during the first two years of life is critical to reach the full potential of every human being; now, this period is recognized as a critical window for promoting optimal growth, development, and good health. Therefore, adequate feeding at this stage of life has an impact on health, nutritional status, growth and development of children; not only in the short term, but in the medium and long term. This paper provides recommendations on complementary feeding (CF) presented as questions or statements that are important for those who take care for children during this stage of life. For example: When to start complementary feedings: 4 or 6 months of age?; Exposure to potentially allergenic foods; Introduction of sweetened beverages; Use of artificial sweeteners and light products; Food introduction sequence; Food consistency changes according to neurological maturation; Number of days to test acceptance and tolerance to new foods; Amounts for each meal; Inadequate complementary feeding practices; Myths and realities of complementary feeding; Developmental milestones; Practice of "Baby Led Weaning" and practice of vegetarianism.

[Guidelines for complementary feeding in healthy infants]. / Consenso para las prácticas de alimentación complementaria en lactantes sanos.

A proper nutrition during the first two years of life is critical to reach the full potential of every human being; now, this period is recognized as a critical window for promoting optimal growth, development, and good health. Therefore, adequate feeding at this stage of life has an impact on health, nutritional status, growth and development of children; not only in the short term, but in the medium and long term. This paper provides recommendations on complementary feeding (CF) presented as questions or statements that are important for those who take care for children during this stage of life. For example: When to start complementary feedings: 4 or 6 months of age?; Exposure to potentially allergenic foods; Introduction of sweetened beverages; Use of artificial sweeteners and light products; Food introduction sequence; Food consistency changes according to neurological maturation; Number of days to test acceptance and tolerance to new foods; Amounts for each meal; Inadequate complementary feeding practices; Myths and realities of complementary feeding; Developmental milestones; Practice of "Baby Led Weaning" and practice of vegetarianism.

Energy expenditure in children with cerebral palsy and moderate / severe malnutrition during nutritional recovery.

OBJECTIVE: To analyze the total energy expenditure (TEE) and resting energy expenditure (REE) in children with cerebral palsy (CP) and moderate or severe malnutrition during nutritional recovery. METHODS: In an intervention study, thirteen subjects with CP (10 females and 3 males with a mean age of 9y11m ± 2y3m), level V of the Gross Motor Function Classification System and moderate or severe malnutrition were included. Eight were fed by nasogastric tube and five by gastrostomy. They were compared with 57 healthy participants (31 females and 26 males with mean age of 8y7m ± 10m). Anthropometric measurements, body composition and energy expenditure by bioelectrical impedance analysis (BIA) and indirect calorimetry (IC) were performed in both groups. RESULTS: TEE and REE were higher in healthy children than in children with CP in kcal/d and kcal/cm/d but were lower in kcal/kg/d (p <0.001). Intensive nutritional support for four weeks in children with CP produced a significant increase in energy expenditure. CONCLUSION: TEE and REE, in children with CP, are lower than in healthy children. Estimating the REE in children with CP and malnutrition is better performed in kcal/kg/d than in kcal/cm/d. Fat-free mass (FFM) is a good predictor of the REE in healthy children and children with CP.

Objetivo: Analizar el gasto energético total (GET) y gasto energético basal (GEB) en niños con parálisis cerebral infantil (PCI) y desnutrición moderada o grave durante la recuperación nutricia. Métodos: En un estudio de intervención, se incluyeron trece sujetos con PCI (10 mujeres y 3 hombres, con una edad promedio de 9a11m±2a3m), pertenecían al nivel V del Sistema de Clasificación de la Función Motora Gruesa y desnutrición moderada o grave. Ocho fueron alimentados por sonda nasogástrica y cinco por gastrostomía. Se compararon con 57 participantes sanos (31 mujeres y 26 varones con una edad promedio de 8a7m±10m). Se realizaron mediciones antropométricas, de composición corporal y de gasto energético mediante el análisis de impedancia bio-eléctrica (IBE) y calorimetría indirecta (CI) en ambos grupos. Resultados: El GET y GEB fueron mayores en los niños sanos que en los niños con parálisis cerebral en kcal/d y kcal/cm/d, pero fueron menores en kcal/kg/día (p.

Intensive nutritional support improves the nutritional status and body composition in severely malnourished children with cerebral palsy.

OBJECTIVE: To demonstrate that a nutritional support intervention, via naso-enteral tube-feeding or gastrostomy, has a significant impact on the nutritional status and body composition in severely malnourished children with cerebral palsy spastic quadriplegia. METHODS: Thirteen patients with moderate/severe malnutrition and cerebral palsy spastic quadriplegia who were fed via naso-enteral tube-feeding or gastrostomy were included in a cohort study. Anthropometric measurements and estimated body composition by bioelectric impedance analysis were obtained. ANOVA and Wilcoxon tests were used. RESULTS: During the four weeks of nutritional recovery, an average weight increase of 2700 g was achieved. There were significant increases in anthropometric indicators, including BMI and weight/length (p < 0.01). The increase in arm fat area was significantly higher than the increase in arm muscle area (104.5 vs 17.5%). CONCLUSION: Intensive nutritional support for four weeks had a significant effect on the nutritional status and body composition of severe and moderately malnourished children with cerebral palsy spastic quadriplegia.

Objetivo: Demostrar que el apoyo nutricio intensivo por vía naso-enteral o gastrostomía tiene un impacto significativo en el estado nutricio y en la composición corporal en niños desnutridos graves con parálisis cerebral cuadriplejia espástica. Métodos: En un estudio de cohorte se incluyeron trece pacientes con desnutrición moderada/grave y parálisis cerebral cuadriplejia espástica, quienes fueron alimentados por vía naso-enteral o gastrostomía. Fueron obtenidos indicadores antropométricos y de composición corporal estimada por antropometría e impedancia bio-eléctrica. Se utilizó ANOVA y prueba de Wilcoxon para el análisis estadístico. Resultados: Hubo un aumento de 2700 g durante las cuatro semanas de recuperación nutricia y un incremento significativo en los indicadores antropométricos, índice de masa corporal y peso/talla (p < 0,01). El porcentaje de incremento del área grasa del brazo fue mayor que el área muscular del brazo (104,5 vs 17,5%). Conclusión: El apoyo nutricio intensivo tuvo un efecto significativo en el estado nutricio y en la composición corporal de niños con desnutrición moderada/grave con parálisis cerebral infantil.