Energy expenditure and body composition in children with spastic quadriplegic cerebral palsy

Azcue, Maria P.; Zello, Gordon A.; Levy, Liran; Pencharz, Paul B.

doi:10.1016/s0022-3476(96)70031-8

Cited by 94 publications

(88 citation statements)

References 20 publications

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“…It is likely, for theoretical reasons, that BIA will better estimate lean than fat mass, as it is fat-free mass that is estimated directly in BIA, whereas all the residual variation in weight is assumed to be due to fat mass. This is in keeping with studies that have found much tighter inter-correlation between BIA and other methods for estimates of lean than for fat mass (Stallings et al, 1995;Azcue et al, 1996;Liu et al, 2005).…”

Section: Discussionsupporting

confidence: 89%

“…Sullivan recently described very similar findings to ours using stable isotopes in a comparable patient group (Sullivan et al, 2006), but this is not a method that can be used in routine clinical practice. In contrast, BIA has been shown to be practical and feasible in this and another study (Azcue et al, 1996).…”

Section: Discussionmentioning

confidence: 65%

“…It is known that children with CP are at high risk for undernutrition (Fung et al, 2002), but the growing trend to artificial feeding introduces the new challenge of establishing what their true nutrient requirements are and recognizing when these have been met. It has been shown that such children have greatly reduced energy requirements (Azcue et al, 1996) and have low fat-free mass (Stallings et al, 1995;Chad et al, 2000), but height, which is the main determinant of fat-free mass, tends to be low in CP. Our data suggest that such children also have low fat-free mass per unit height and, despite low normal BMI, tend to have a relatively high fat mass.…”

Section: Discussionmentioning

confidence: 99%

“…Both methods produce similar results, as most of the variance is contributed by the limbs and there is usually high correlation between the composition of upper and lower limbs (Foster and Lukaski, 1996;Jebb et al, 2000). The limited work that has been done in children suggests that BIA itself is reasonably precise and repeatable (Schaefer et al, 1994) and studies in children with cerebral palsy (CP) have found high correlations with more accurate methods for fat-free mass, but weaker correlations for fat mass (Stallings et al, 1995;Azcue et al, 1996;Liu et al, 2005). However the resulting estimates of fat and fat-free mass actually agree poorly with more accurate methods, tending to be both biased and imprecise (Reilly et al, 1996;Parker et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

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Development of bioelectrical impedance-derived indices of fat and fat-free mass for assessment of nutritional status in childhood

Cm¹,

Sherriff²,

Ward³

et al. 2007

Eur J Clin Nutr

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Objectives: (1) To develop a method of manipulating bioelectrical impedance (BIA) that gives indices of lean and fat adjusted for body size, using a large normative cohort of children. (2) To assess the discriminant validity of the method in a group of children likely to have abnormal body composition. Design: Two prospective cohort studies. Setting: Normative data: Avon Longitudinal Study of Parents and Children (ALSPAC), population based cohort; proof of concept study: tertiary feeding clinic and special needs schools. Subjects: Normative data: 7576 children measured aged between 7.25 and 8.25 (mean 7.5) (s.d. ¼ 0.2) years; proof of concept study: 29 children with either major neurodisability or receiving artificial feeding, or both, mean age 7.6 (s.d. ¼ 2) years. Measures: Leg-to-leg (Z T ) and arm-to-leg (Z B ) BIA, weight and height. Total body water (TBW) was estimated from the resistance index (RI ¼ height 2 /Z), and fat-free mass was linearly related to TBW. Fat mass was obtained by subtracting fat-free mass from total weight. Fat-free mass was log-transformed and the reciprocal transform was taken for fat mass to satisfy parametric model assumptions. Lean and fat mass were then adjusted for height and age using multiple linear regression models. The resulting standardized residuals gave the lean index and fat index, respectively. Results: In the normative cohort, the lean index was higher and fat index lower in boys. The lean index rose steeply to the middle of the normal range of body mass index (BMI) and then slowly for higher BMI values, whereas the fat index rose linearly through and above the normal range. In the proof of concept study, the children as a group had low lean indices (mean (s.d.) À1.5 (1.7)) with average fat indices ( þ 0.21 (2.0)) despite relatively low BMI standard deviation scores (À0.60 (2.3)), but for any given BMI, individual children had extremely wide ranges of fat indices. The lean index proved more stable and repeatable than BMI. Conclusions: This clinical method of handling BIA reveals important variations in nutritional status that would not be detected using anthropometry alone. BIA used in this way would allow more accurate assessment of energy sufficiency in children with neurodisability and may provide a more valid identification of children at risk of underweight or obesity in field and clinical settings.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Development of bioelectrical impedance-derived indices of fat and fat-free mass for assessment of nutritional status in childhood

Cm¹,

Sherriff²,

Ward³

et al. 2007

Eur J Clin Nutr

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“…Various methods have been proposed all of which are limited by the numerous assumptions. [7][8][9][10] Accurate estimations are difficult because of variations in energy requirements related to the heterogeneity of the group, altered body composition and reduced physical activity levels. There is currently no commonly accepted method for estimating the energy needs of children and adolescents with CP.…”

Section: Estimating Nutritional Requirementsmentioning

confidence: 99%

Nutritional management of children with cerebral palsy

Bell

Samson‐Fang

2013

Eur J Clin Nutr

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Children with severe cerebral palsy and particularly those with oropharyngeal dysfunction are at risk of poor nutritional status. Determining the need and the mode of nutritional intervention is multifactorial and requires multiple methodologies. First-line treatment typically involves oral nutritional support for those children who are safe to consume an oral diet. Enteral tube feeding may need to be considered in children with undernutrition where poor weight gain continues despite oral nutritional support, or in those with oropharyngeal dysphagia and an unsafe swallow. Estimates for energy and protein requirements provide a starting point only, and ongoing assessment and monitoring is essential to ensure nutritional needs are being met, that complications are adequately managed and to avoid over or under feeding.

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Growth in children with Cerebral Palsy

Cronk

Stallings

1997

Ment. Retard. Dev. Disabil. Res. Rev.

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Energy expenditure and body composition in children with spastic quadriplegic cerebral palsy

Cited by 94 publications

References 20 publications

Development of bioelectrical impedance-derived indices of fat and fat-free mass for assessment of nutritional status in childhood

Development of bioelectrical impedance-derived indices of fat and fat-free mass for assessment of nutritional status in childhood

Nutritional management of children with cerebral palsy

Growth in children with Cerebral Palsy

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