Malnutrition Highly Prevalent in Kids with Cerebral Palsy, Better Measures Needed, Study Shows

Malnutrition affects a majority of children with cerebral palsy, mainly due to severe motor disability. Better tools are needed to assess their nutritional status and to design improved rehabilitation plans for these young patients, researchers in Turkey suggest.

Their study, “A multicenter cross-sectional study to evaluate the clinical characteristics and nutritional status of children with cerebral palsy,” was published in the journal Clinical Nutrition ESPEN.

A total of 1,108 patients (59.3% males) ages 1-18 (61% were younger than 8) diagnosed with cerebral palsy were analyzed in a non-interventional multicenter single-visit study conducted between October 2015 and July 2016 at 20 centers across Turkey.

The most common causes of cerebral palsy in this study group were asphyxia (62.5%), low birth weight (45.6%), and premature birth (44.5%).

The most prevalent form of the disease was spastic cerebral palsy (87.5%) — the most common form of the disease worldwide, which mainly affects the muscle groups.

Most spastic cerebral palsy patients had the quadriplegic form of the disease (54.0%) — the most severe type, marked by dysfunction in the legs, arms, and body — and nearly half were classified with the highest disability score in gross motor function (45.4%).

Intellectual disability, speech difficulties, epilepsy, and gastrointestinal problems (including constipation, lack of appetite, and difficulty in swallowing) were the most frequent concomitant disorders.

The high incidence of gastrointestinal problems suggested the presence of feeding difficulties, risk of aspiration (inhaling material such as blood, mucus, or vomit), prolonged feeding times, and reduced nutrient intake, which ultimately may lead to malnutrition.

Researchers found that malnutrition was highly prevalent among children and teens with cerebral palsy and varied greatly depending on the assessment method used.

Based on physicians’ clinical judgment, 57.2% of the children were considered malnourishe. But assessments based on standard child growth charts — according to weight for age (Gomez classification) or height for age (Waterlow classification) — identified over 90% of children with malnutrition, and severe malnutrition in more than 80%.

The discrepancy between physicians’ clinical judgment and growth measures to evaluate malnutrition is probably linked to growth impairments observed in cerebral palsy children, which affect the scores based on healthy children’s measures.

As a result, researchers called attention to the risk of overestimating malnutrition when assessments are based on standard growth charts, and the need to use tools that are better adapted to the characteristics of children with cerebral palsy.

Curiously, researchers considered parents’ lack of knowledge and lack of attention to diet instead of physicians’ lack of awareness and knowledge to be the main barriers to good nutrition in kids with cerebral palsy.

“This large-scale survey provided valuable data regarding nutritional assessment practice and malnutrition prevalence among children with [cerebral palsy] in Turkey, which may be utilized for future proactive strategies in the prevention and treatment of malnutrition in this population,” researchers wrote.