Evaluation of micronutrient levels in children with cerebral palsy

Çarman, Kürşat Bora; Aydın, Kürşad; Aydin, Betul Kilic; Cansu, Ali; Direk, Meltem Çobanoğulları; Durmus, Selver; Dündar, Nihal Olgaç; Gençpınar, Pınar; Güngör, Serdal; Gürkaş, Esra; Hur, Ozgen; Karadağ, Meral; Karademir, Cefa Nil; Kart, Pınar Özkan; Okuyaz, Çetin; Öz, Nefise Arıbaş; Pedük, Yakup; Per, Hüseyin; Serin, Mine; Tekgül, Hasan; Ünay, Bülent; Yarar, Çoşkun; Yıldırım, Gonca

doi:10.1111/ped.15005

Pediatrics International

2022

DOI: 10.1111/ped.15005

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Evaluation of micronutrient levels in children with cerebral palsy

Kürşat Bora Çarman

Kürşad Aydın

Betul Kilic Aydin

et al.

Abstract: Background Many studies evaluating the nutritional status of children with cerebral palsy (CP) have focused on energy requirements and protein intake. The present work aimed to assess nutritional status and micronutrient levels of children with (CP). Methods This multicenter, cross‐sectional and observational study was conducted in 10 different cities in Turkey. Data were available for 398 participants. Anthropometric measurements, feeding mode, nutritional status, and micronutrient levels were evaluated. Resu… Show more

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2023

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Cited by 3 publications

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Low skeletal muscle mass and liver fibrosis in children with cerebral palsy

Naume,

Jørgensen,

Høi-Hansen

et al. 2023

Eur J Pediatr

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The purpose of the study was to conduct a nutritional and metabolic assessment of children with cerebral palsy, including an investigation of liver status, body composition, and bone mineral density. In this cross-sectional study we included 22 children with cerebral palsy. By using ultrasound, transient elastography, dual x-ray absorptiometry (DXA) scan, blood samples, anthropometric measurements, and a three-day diet registration, the nutritional and metabolic status was evaluated. Liver fibrosis and steatosis were found in four patients (18.2%), all with severe motor impairments, low skeletal muscle mass, and epilepsy. All patients with liver involvement had normal liver-related blood samples. Decreased bone mineral density was found in 26.3%, and 91.0% had low skeletal muscle mass. Fat mass and muscle mass were significantly lower in the patients with severe motor impairments compared to the patients with less severe motor impairments. Within the children classified as ‘underweight’ or ‘normal’ according to body mass index, body fat determined by DXA scan was normal or high in 50% of these patients.Conclusions: This study is the first to report liver fibrosis and steatosis in children with cerebral palsy. Possible causes of liver fibrosis and/or steatosis are altered body composition with low skeletal muscle mass, decreased mobility and medical drug intake. Further investigations of liver involvement and risk factors are needed. What is Known:• Children and adolescents with cerebral palsy are at risk of malnutrition and altered body composition, both of which can lead to fatty liver disease.• It is unknown whether children with cerebral palsy are at increased risk of metabolic disturbances such as fatty liver disease. What is New:• Altered body composition and low skeletal muscle mass, regardless of ambulation is present in 91% of the children with cerebral palsy.• Liver fibrosis and/or steatosis were found in 18.2% of the patients. Possible causes are altered body composition, decreased mobility and medical drug intake.

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Low skeletal muscle mass and liver fibrosis in children with cerebral palsy

Naume,

Jørgensen,

Høi-Hansen

et al. 2023

Eur J Pediatr

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Association between Cu/Zn/Iron/Ca/Mg levels and cerebral palsy: a pooled-analysis

Zhu,

Mao,

2023

Sci Rep

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It was well documented that macro/trace elements were associated with the neurodevelopment. We aimed to investigate the relationship between copper (Cu)/zinc (Zn)/iron/calcium (Ca)/magnesium (Mg) levels and cerebral palsy (CP) by performing a meta-analysis. We searched the PubMed, Embase, Cochrane and Chinese WanFang databases from January 1985 to June 2022 to yield studies that met our predefined criteria. Standard mean differences (SMDs) of Cu/Zn/Iron/Ca/Mg levels between CP cases and healthy controls were calculated using the fixed-effects model or the random-effects model, in the presence of heterogeneity. 95% confidence intervals (CI) were also computed. Sensitivity analysis was performed by omitting each study in turn. A total of 19 studies were involved in our investigation. CP cases showed markedly lower Cu, Zn, iron and Ca levels than those in controls among overall populations (SMD = − 2.156, 95% CI − 3.013 to − 1.299, P < 10−4; SMD = − 2.223, 95% CI − 2.966 to − 1.480, P < 10−4; SMD = − 1.092, 95% CI − 1.513 to − 0.672, P < 10−4; SMD = − 0.757, 95% CI − 1.475 to − 0.040, P = 0.038) and Asians (SMD = − 2.893, 95% CI − 3.977 to − 1.809, P < 10−4; SMD = − 2.559, 95% CI − 3.436 to − 1.683, P < 10−4; SMD = − 1.336, 95% CI − 1.807 to − 0.865, P < 10−4; SMD = − 1.000, 95% CI − 1.950 to − 0.051, P = 0.039). CP cases showed markedly lower Zn level than that in controls among Caucasians (SMD = − 0.462, 95% CI − 0.650 to − 0.274, P < 10−4). No significant differences of Cu, iron and Ca levels between CP cases and controls among Caucasians (SMD = − 0.188, 95% CI − 0.412 to 0.037, P = 0.101; SMD = − 0.004, 95% CI − 0.190 to 0.182, P = 0.968; SMD = 0.070, 95% CI − 0.116 to 0.257, P = 0.459) were observed. No marked difference of Mg level between CP cases and controls was noted among overall populations (SMD = − 0.139, 95% CI − 0.504 to 0.226, P = 0.455), Asians (SMD = − 0.131, 95% CI − 0.663 to 0.401, P = 0.629), and Caucasians (SMD = − 0.074, 95% CI − 0.361 to 0.213, P = 0.614). Sensitivity analysis did not change the overall results significantly for Cu, Zn, iron and Mg. CP cases demonstrated significantly lower levels of Cu/Zn/iron/Ca than those in healthy controls, particularly in Asians. Decreasing trend of Cu/Zn/iron/Ca levels merit attention, particularly in the population with high susceptibility to CP. Frequent monitoring and early intervention may be needed.

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Relationship Between Nutritional Status, Dysphagia, and Functional Eating Level in Adult Patients With Cerebral Palsy in Long Institutional Stays

OLIVEIRA,

MARQUITTI,

RAMOS

et al. 2023

Arq. Gastroenterol.

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Background: Diets with modified consistencies for patients with dysphagia in long term care health institutions may be associated with malnutrition. Objective : To assess the nutritional status of adult patients with cerebral palsy and dysphagia hospitalized in a health institution for more than 10 years. Methods : This prospective investigation was performed in 56 patients with cerebral palsy (ages 25 to 71 years, mean: 44±12 years) and no other neurological diagnosis in hospital stay for more than 10 years had their nutritional status, dysphagia, and food ingestion capacity assessed in two moments with a 12-month interval in between them, respectively using the body mass index, the dysphagia risk assessment protocol (PARD), and the functional oral ingestion scale (FOIS). Results : There were no differences between December 2015 and December 2016 in the patients’ weight, nutritional status, diet consistency classification, PARD, and FOIS. The limits of prescribed diet consistency (IDDSI-FDS) and the assessments of dysphagia and functional eating level influenced the nutritional status. More intense dysphagia and greater eating restrictions were associated with a worse nutritional status. Conclusion : The nutritional status of adult patients with cerebral palsy hospitalized in a health long term institution who had modified diets according to their swallowing and mastication capacity did not worsen between assessments with a 12-month interval in between them. The severity of dysphagia and diet restrictions interfere with the patients’ nutritional status: dysphagia and more intense eating restrictions are associated with a worse nutritional status.

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Evaluation of micronutrient levels in children with cerebral palsy

Cited by 3 publications

References 34 publications

Low skeletal muscle mass and liver fibrosis in children with cerebral palsy

Low skeletal muscle mass and liver fibrosis in children with cerebral palsy

Association between Cu/Zn/Iron/Ca/Mg levels and cerebral palsy: a pooled-analysis

Relationship Between Nutritional Status, Dysphagia, and Functional Eating Level in Adult Patients With Cerebral Palsy in Long Institutional Stays

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