Anthropometric measurements to identify undernutrition in children with cerebral palsy

Abstract

AIM To evaluate the diagnostic performance of anthropometric indicators to identify undernutrition in children with cerebral palsy (CP). METHODThe present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation program. Undernutrition was defined as a z-score for dual-energy X-ray absorptiometry (DXA) determined body fat percentage less or equal to À2.0. The cut-off values for body mass index (BMI) of the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), and the cut-off values for BMI and height for age of the Robert Koch Institut (RKI) were evaluated. RESULTSIn total, 329 children with CP (181 males, 148 females, Gross Motor Function Classification System levels I-V) were eligible for analysis. The mean age was 12 years 4 months (SD 2y 9mo). The BMI cut-off values showed the following sensitivities and specificities: WHO, sensitivity of 0.474 (95% confidence interval [CI] 0.244-0.711), specificity of 0.897 (95% CI: 0.857-0.928); CDC, sensitivity of 0.632 (95% CI: 0.384-0.837), specificity of 0.819 (95% CI: 0.772-0.861); RKI, sensitivity of 0.789 (95% CI: 0.544-0.939), specificity of 0.732 (95% CI: 0.679-0.781); and for height for age, sensitivity of 0.263 (95% CI: 0.091-0.512), specificity of 0.668 (95% CI: 0.612-0.720).INTERPRETATION BMI had a high specificity but very low sensitivity in identifying undernutrition in children with CP. Z-scores for height for age had even lower specificity and sensitivity and seemed not to be appropriate for predicting undernutrition in children with CP.

Degree of Accuracy of the BMI Z-Score to Determine Excess Fat Mass Using DXA in Children and Adolescents

“…There are also several clinical conditions or disorders in which it has been shown that the correlation between DXA and BMI Z-score is not satisfactory, such as in patients with Down syndrome [13] in whom the BMI underestimates the alteration of the fat percentage in up to 57% of cases. Likewise, the study by Duran et al [15], in children with cerebral palsy, showed that the BMI Z-score overestimated the prevalence of underweight. In addition, a study on the accuracy of the BMI Z-score for detecting changes in fat percentage after a therapeutic intervention showed that this parameter had low specificity and, therefore, was not a solid predictor of adiposity change [12].…”

“…However, some studies state that the BMI Z-score has low sensitivity for the detection of excess adiposity in children [11][12][13][14][15]. It may not be an ideal tool in some situations involving altered body composition [12].…”

“…Likewise, it also appears to underestimate overweight and obesity status in children with infantile cerebral palsy, who have lower fat-free mass compared to typically developing children [14]. Furthermore, the sensitivity of the BMI Z-score for the identification of malnutrition status is low (47.4%) [15].…”

“…Moreover, the same BMI percentile could be different according to age, sex or race-ethnic groups [16,17]. Thus, children who are not obese may be classified as obese and vice versa, with the risk that a percentage of the pediatric population is not being included in health programs for childhood obesity [11][12][13][14][15]. However, there are few previous studies that evaluate the precision of the BMI z-score in terms of predicting the percentage of body fat in children.…”

Efforts targeted malnutrition among children with cerebral palsy in care homes and hospitals: A qualitative exploration study

“…Despite the great risk of malnutrition, there are no recommended methods for assessing nutritional risks in children with CP in Denmark. Several studies outside of Denmark have examined, validated and evaluated the ability of screening tools, anthropometric measurements, growth curves and questionnaires to identify malnutrition among this target group of children (11)(12)(13)(14)(15)(16)(17)(18) . In 2017, The European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) determined the evidence from the literature, combined it with recommendations from experts, and developed 31 recommendations and suggestions for professionals working with children with physical and mental disabilities, including CP (9) .…”