Food Intake, Nutritional Status and Gastrointestinal Symptoms in Children With Cerebral Palsy

Abstract

BACKGROUND: Cerebral palsy may be associated with comorbidities such as undernutrition, impaired growth and gastrointestinal symptoms. Children with cerebral palsy exhibit eating problems due to the effect on the anatomical and functional structures involved in the eating function resulting in malnutrition. OBJECTIVE: The aim of this study was to investigate the association between food intake, nutritional status and gastrointestinal symptoms in children with cerebral palsy. METHODS: Cross-sectional study that included 40 children with cerebral palsy (35 with spastic tetraparetic form and 5 with non-spastic choreoathetoid form of cerebral palsy, all requiring wheelchairs or bedridden) aged from 4 to 10 years. The dietary assessment with the parents was performed using the usual household food intake inquiry. Anthropometric data were collected. Gastrointestinal symptoms associated with deglutition disorders, gastroesophageal reflux and chronic constipation were also recorded. RESULTS: The median of height-for-age Z-score (-4.05) was lower (P<0.05) than the median of weight-for-age (-3.29) and weight-for-height (-0.94). There was no statistical difference between weight-for-age and weight-for-height Z-scores. Three patients with cerebral palsy (7.5%) exhibited mild anemia, with normal ferritin levels in two. Symptoms of dysphagia, gastroesophageal reflux, and constipation were found in 82.5% (n=33), 40.0% (n=16), and 60.0% (n=24) of the sample, respectively. The patients with symptoms of dysphagia exhibited lower daily energy (1280.2±454.8 Kcal vs 1890.3±847.1 Kcal, P=0.009), carbohydrate (median: 170.9 g vs 234.5 g, P=0.023) and fluid intake (483.1±294.9 mL vs 992.9±292.2 mL, P=0.001). The patients with symptoms of gastrointestinal reflux exhibited greater daily fluid intake (720.0±362.9 mL) than the patients without symptoms of gastroesophageal reflux (483.7±320.0 mL, P=0.042) and a greater height-for-age deficit (Z-score: -4.9±1.7 vs 3.7±1.5, P=0.033). The patients with symptoms of constipation exhibited lower daily dietary fiber (9.2±4.3 g vs 12.3±4.3 g, P=0.031) and fluid (456.5±283.1 mL vs 741.1±379.2 mL, P=0.013) intake. CONCLUSION: Children with cerebral palsy exhibited wide variability in food intake which may partially account for their severe impaired growth and malnutrition. Symptoms of dysphagia, gastroesophageal reflux, and constipation are associated with different food intake patterns. Therefore, nutritional intervention should be tailored considering the gastrointestinal symptoms and nutritional status.

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

“…In a previous study involving children with CP and chronic constipation [ 38 ], researchers found a low dietary intake for fiber (10 g) and fluid (945 mL), which were similar to the findings in this study, and both were below the optimal dietary requirements. Furthermore, our results are similar to the findings of Caramico-Favero et al [ 39 ] in children with CP and constipation with a dietary fiber intake of 9.2 ± 4.3 g; however, the fluid intake of 457 ± 283 mL is lower compared to our finding.…”

The effect of different dietary structure on gastrointestinal dysfunction in children with cerebral palsy and epilepsy based on gut microbiota

“…Constipation is the most common symptom of GI dysfunction in children with CP and epilepsy. Previous studies indicated that constipation in children with CP associated with many factors, which included feeding difficulties, insufficient dietary fiber, liquid intake and gut microbiota [8,13,14]. Dietary fiber was able to disrupt occurrence and development of constipation by stimulating intestinal movement, absorbing water, and lubricating intestinal tract [15].…”

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

“…The proportion of students fed by gastrostomy in our study (31.3%, 25% exclusively and 6.3% mixed) was greater than that obtained by other authors. Caramico et al noted 17.5% (12.5% exclusively and 5% mixed) after assessing 40 children with CP [ 83 ], and Dahlseng described gastrostomies at 11% [ 34 ]. However, when Dahlseng stratified the CP patients according to GMFCS (Level IV–V), the prevalence was 32%, which coincides with the numbers in our study.…”

“…Studies have also reported that the intake of energy and nutrients in this group is considerably lower than the recommended daily allowances [ 26 , 97 ]. Caramico et al found that patients with CP and OD received lower daily energy [ 83 ]. However, another study based on preschool children with CP found that energy requirements in ambulant children were similar to healthy children [ 13 ].…”