Assessment of body composition in children with cerebral palsy: a cross‐sectional study inNorway

Abstract

Aim The assessment of growth and body composition is challenging in children with cerebral palsy (CP). The aim of this study was to compare clinical assessments of body composition with measurements obtained using dual‐energy X‐ray absorptiometry (DXA) in this population. Method Knee height, weight, and triceps and subscapular skinfold thickness (SFT) were measured in 47 children with CP (age range 8–18y; 18 females, 29 males). Height was estimated from knee height, and used to calculate body mass index (BMI). Using SFT measurements, body fat percentage was calculated by standard (‘Slaughter’) and CP‐modified (‘Gurka’) equations and compared with results obtained using DXA. Results Children with severe gross motor function impairments (Gross Motor Function Classification System [GMFCS] level III or IV) exhibited stunted growth and had higher fat percentages and lower lean body mass than children classified in GMFCS level I or II. In 10 children classified as ‘thin’ according to their BMI (five of whom were assigned thinness grade of 2 or lower), percentage of body fat, as determined by DXA, was normal or high. The Slaughter equations significantly underestimated body fat percentages, whereas the precision of the CP‐modified Gurka equations was excellent. Interpretation In this study, children with CP and severe motor impairments displayed stunted growth, but were not undernourished. Relying solely upon BMIs may be misleading in children with CP. Therefore, clinicians should be encouraged to measure SFT and to calculate body fat percentages using the CP‐modified version of the Slaughter equation.

Anthropometric measurements to identify undernutrition in children with cerebral palsy

“…These results were comparable to the results of Oeffinger et al and Finbr aten et al 13,33 As reported by other authors, the mean body fat percentage in children in GMFCS levels III to V in this study was significantly higher than in children in GMFCS levels I and II. These results were comparable to the results of Oeffinger et al and Finbr aten et al 13,33 As reported by other authors, the mean body fat percentage in children in GMFCS levels III to V in this study was significantly higher than in children in GMFCS levels I and II.…”

“…33,35 Children in GMFCS levels I and II were more likely to have low body fat percentage than children in GMFCS levels III to V (14.3% vs 1.79%, Table III). 33,35 Therefore, with the same fat mass, a child with lower lean body mass would have a higher body fat percentage. Another explanation could be a methodological bias: in concordance with other studies, children in GMFCS levels III to V in this study had less lean body mass by DXA (which is a surrogate for muscle mass and a main component of body weight) than children in GMFCS levels I and II (Table II).…”

“…According to the WHO recommendations for cut-offs of anthropometric indicators (Table I), we used the cut-off value less or equal to À2.0 for body fat percentage z-scores to define undernutrition. Finbr aten et al 33 analysed the body fat percentage by DXA in 47 Norwegian children with CP (GMFCS levels I-V, mean age 13y 1mo). Finbr aten et al 33 analysed the body fat percentage by DXA in 47 Norwegian children with CP (GMFCS levels I-V, mean age 13y 1mo).…”

Pressure Injuries in Medically Complex Children: A Review

“…Comorbidities in the medically complex population also impact body composition. Among children with cerebral palsy, those with greater functional impairment (Gross Motor Function Classification System Level III or IV) have higher fat percentages and lower lean body mass than children with less functional impairment (Gross Motor Function Classification System Level I or II) [11]. …”

Greater Adipose Tissue Distribution and Diminished Spinal Musculoskeletal Density in Adults With Cerebral Palsy

“…Due to substantial deficits in overall lean tissue , 7-10 normal BMIs in CP may disguise excess adiposity in visceral or other ectopic adipose depots (e.g., liver, muscle, bone marrow, etc.). 11 There is some evidence to suggest greater general adiposity in children with CP; 12 however, this has yet to be well-studied in the adult CP population.…”