Assessment of features of the nutritional status and nutrient requirements in children with cerebral palsy
- Authors: Makarova S.G. 1,2,3, Pak L.A. 1, Fisenko A.P. 1, Kuzenkova L.M. 1,4, Pronina I.Y. 1
- Affiliations:
- National Medical Research Center for Children’s Health
- N.I. Pirogov Russian National Research Medical University
- Lomonosov Moscow State University
- N.F. Filatov Clinical Institute of Children's Health, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University)
- Issue: Vol 1, No 2 (2020)
- Pages: 122-131
- Section: Reviews
- URL: https://journals.eco-vector.com/2686-8997/article/view/34196
- Cite item
Abstract
The energy and nutrient requirements of children with cerebral palsy (СP) have always been discussed among domestic and foreign scientists. A wide range of physical characteristics such as state of muscle tone, dysphagia, pseudobulbar syndrome, hyperkinesia or the lack of physical activity determine individual features of the patients’ nutritional needs. Whereas, underestimation of these needs along with comorbid pathologies (frequent pneumonia, bronchitis, etc.), characterizing this group of patients, can easily lead to the emergence and rapid progression of protein-energy deficiency. In addition, there are also difficulties with the interpretation of indices of a patients’ physical development. In this regard, both special scales for physical development assessment and formulas for individual nutrient and energy requirements calculation have been developed for this category of patients. However, according to recent data, the use of these scales and formulas can lead to underestimation of the nutritional needs of CP children. This, in its turn, can cause protein-energy deficiency, frequently (in 29–66% of cases) found in these patients. Therefore, some principles of diet and nutritional support for CP children are being reviewed now. At the same time, the organization of adequate nutritional support based on modern clinical recommendations and a personalized approach is the key component of the comprehensive treatment of this complex patients’ category. This review contains the description of the current situation, as well as a broad discussion of different approaches based on the international, domestic guidelines and relevant recommendations of the European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists — ESPGHAN, 2017).
Keywords
Full Text

About the authors
S. G. Makarova
National Medical Research Center for Children’s Health; N.I. Pirogov Russian National Research Medical University; Lomonosov Moscow State University
Author for correspondence.
Email: sm27@yandex.ru
ORCID iD: 0000-0002-3056-403X
Russian Federation, Moscow
MD
L. A. Pak
National Medical Research Center for Children’s Health
Email: sm27@yandex.ru
Russian Federation, Moscow
MD, Ph.D., DSc.
A. P. Fisenko
National Medical Research Center for Children’s Health
Email: sm27@yandex.ru
ORCID iD: 0000-0002-7893-1863
Russian Federation, Moscow
MD, Ph.D., DSc., Prof.
L. M. Kuzenkova
National Medical Research Center for Children’s Health; N.F. Filatov Clinical Institute of Children's Health, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University)
Email: sm27@yandex.ru
ORCID iD: 0000-0002-9562-3774
Russian Federation, Moscow
MD, Ph.D., DSc., Prof.
Irina Yu. Pronina
National Medical Research Center for Children’s Health
Email: sm27@yandex.ru
ORCID iD: 0000-0003-3306-6869
Russian Federation, Moscow, 119991, Moscow, Russian Federation
References
- ЛИТЕРАТУРА
- Студеникин В.М., ред. Нейродиетология детского возраста. М.: Династия; 2012.
- Sullivan P.B., Juszczak E., Lambert B.R., Rose M., Ford-Adams M.E., Johnson A. Impact of feeding problems on nutritional intake and growth: Oxford feeding study II. Dev. Med. Child Neurol. 2002; 44(7): 461-7. DOI: http://doi.org/10.1017/s0012162201002365
- Mergler S., Evenhuis H.M., Boot A.M., De Man S.A., Bindels-De Heus K.G., Huijbers W.A., et al. Epidemiology of low bone mineral density and fracture in children with cerebral palsy: a systematic review. Dev. Med. Child Neurol. 2009; 51(10): 773-8. DOI: http://doi.org/10.1111/j.1469-8749.2009.03384.x
- Пак Л.А., Макарова С.Г., Чумбадзе Т.Р., Фисенко А.П. Нарушения нутритивного статуса и их коррекция у детей с детским церебральным параличом. Российский педиатрический журнал. 2019; 22(1): 23-7. DOI: http://doi.org/10.18821/1560-9561-2019-22-1-23-27
- Детский церебральный паралич (ДЦП). Глава 16. В кн.: Студеникин В.М., ред. Нейродиетология детского возраста. М.: Династия; 2012: 242-51.
- Клинические рекомендации. Детский церебральный паралич у детей. М.; 2016.
- Семенова Е.В., Клочкова Е.В., Коршикова-Морозова А.Е., Трухачева А.В., Заблоцкис Е.Ю. Реабилитация детей с ДЦП: обзор современных подходов в помощь реабилитационным центрам. М.: Лепта Книга; 2018.
- Benfer K.A., Weir K.A., Bell K.L., Ware R.S., Davies P.S., Boyd R.N. Longitudinal study of oropharyngeal dysphagia in preschool children with cerebral palsy. Arch. Phys. Med. Rehabil. 2016; 97(4): 552-560.e9. DOI: http://doi.org/10.1016/j.apmr.2015.11.016
- Benfer K.A., Weir K.A., Bell K.L., Ware R.S., Davies P.S., Boyd R.N. Food and fluid texture consumption in a population-based cohort of preschool children with cerebral palsy: relationship to dietary intake. Dev. Med. Child Neurol. 2015; 57(11): 1056-63. DOI: http://doi.org/10.1111/dmcn.12796
- Romano C., van Wynckel M., Hulst J., Broekaert I., Bronsky J., Dall’Oglio L., et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J. Pediatr. Gastroenterol. Nutr. 2017; 65(2): 242-64. DOI: http://doi.org/10.1097/MPG.0000000000001646
- Finbråten A.K., Martins C., Andersen G.L., Skranes J., Brannsether B., Júlíusson P.B., et al. Assessment of body composition in children with cerebral palsy: a cross-sectional study in Norway. Dev. Med. Child Neurol. 2015; 57(9): 858-64. DOI: http://doi.org/10.1111/dmcn.12752
- Kalra S., Aggarwal A., Chillar N., Faridi M.M. Comparison of micronutrient levels in children with cerebral palsy and neurologically normal controls. Indian J. Pediatr. 2015; 82(2): 140-4. DOI: http://doi.org/10.1007/s12098-014-1543-z
- Kuperminc M.N., Gottrand F., Samson-Fang L., Arvedson J., Bell K., Craig G.M., et al. Nutritional management of children with cerebral palsy: a practical guide. Eur. J. Clin. Nutr. 2013; 67(Suppl. 2): S21-3. DOI: http://doi.org/10.1038/ejcn.2013.227
- Sullivan P. Measurement of body composition should become routine in nutritional assessment of children with cerebral palsy. Dev. Med. Child Neurol. 2015; 57(9): 793-4. DOI: http://doi.org/10.1111/dmcn.12751
- Taş S.A., Çankaya T. An investigation of the relationship of drooling with nutrition and head control in individuals with quadriparetic cerebral palsy. J. Phys. Ther. Sci. 2015; 27(11): 3487-92. DOI: http://doi.org/10.1589/jpts.27.3487
- Walker J.L., Bell K.L., Boyd R.N., Davies P.S. Validation of a modified three-day weighed food record for measuring energy intake in preschool-aged children with cerebral palsy. Clin. Nutr. 2013; 32(3): 426-31. DOI: http://doi.org/10.1016/j.clnu.2012.09.005
- Samson-Fang L., Fung E., Stallings V.A., Conaway M., Worley G., Rosenbaum P., et al. Relationship of nutritional status to health and societal participation in children with cerebral palsy. J. Pediatr. 2002; 141(5): 637-43. DOI: http://doi.org/10.1067/mpd.2002.129888
- Wodarski LA. An interdisciplinary nutrition assessment and intervention protocol for children with disabilities. J. Am. Diet. Assoc. 1990; 90(11): 1563-8.
- Marchand V., Motil K.J. Nutrition support for neurologically impaired children: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J. Pediatr. Gastroenterol. Nutr. 2006; 43(1): 123-35. DOI: http://doi.org/10.1097/01.mpg.0000228124.93841.ea
- Dahlseng M.O., Finbråten A.K., Júlíusson P.B., Skranes J., Andersen G., Vik T. Feeding problems, growth and nutritional status in children with cerebral palsy. Acta Paediatr. 2012; 101(1): 92-8. DOI: http://doi.org/10.1111/j.1651-2227.2011.02412.x
- Mehta N.M., Corkins M.R., Lyman B., Malone A., Goday P.S., Carney L., et al. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN. J. Parenter. Enteral. Nutr. 2013; 37(4): 460-81. DOI: http://doi.org/10.1177/0148607113479972
- Боровик Т.Э., Ладодо К.С., ред. Клиническая диетология детского возраста: Руководство для врачей. М.: МИА; 2015.
- Pawellek I., Dokoupil K., Koletzko B. Prevalence of malnutrition in paediatric hospital patients. Clin. Nutr. 2008; 27(1): 72-6. DOI: http://doi.org/10.1016/j.clnu.2007.11.001
- Sermet-Gaudelus I., Poisson-Salomon A., Colomb V., Brusset M.C., Mosser F., Berrier F., et al. Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am. J. Clin. Nutr. 2000; 72(1): 64-70. DOI: http://doi.org/10.1093/ajcn/72.1.64
- Пырьева Е.А., Сорвачева Т.Н., Максимычева Т.Ю., Айвазян С.О. Диетологические подходы в комплексном лечении детей с неврологической патологией: учебное пособие. М.; 2017.
- Студеникин В.М., Букш А.А. Нарушения нутритивного статуса у детей с церебральным параличом (часть 1). Лечащий врач. 2016; (9): 56-9.
- Студеникин В.М., Букш А.А. Нарушения нутритивного статуса у детей с церебральным параличом (часть 2). Лечащий врач. 2016; (11): 68-71.
- Студеникин В.М., Турсунхужаева С.Ш. ДЦП и нейродиетология. Жизнь с ДЦП. Проблемы и решения. 2010; (4): 28-30.
- Pencharz P.B. Assessment of protein nutritional status in children. Pediatr. Blood Cancer. 2008; 50(2 Suppl.): 445-6. DOI: http://doi.org/10.1002/pbc.21415
- Forse R.A., Shizgal H.M. Serum albumin and nutritional status. JPEN. J. Parenter. Enteral. Nutr. 1980; 4(5): 450-4. DOI: http://doi.org/10.1177/014860718000400503
- Hartman C., Shamir R. Basic clinical assessment of pediatric malnutrition. Ann. Nestlé. 2009; 67(2): 55-63. DOI: http://doi.org/10.1159/000226613
- Tomoum H.Y., Badawy N.B., Hassan N.E., Alian K.M. Anthropometry and body composition analysis in children with cerebral palsy. Clin. Nutr. 2010; 29(4): 477-81. DOI: http://doi.org/10.1016/j.clnu.2009.10.009
- Sánchez-Lastres J., Eirís-Puñal J., Otero-Cepeda J.L., Pavón-Belinchón P., Castro-Gago M. Nutritional status of mentally retarded children in northwest Spain: II. Biochemical indicators. Acta Paediatr. 2003; 92(8): 928-34.
- Hillesund E., Skranes J., Trygg K.U., Bøhmer T. Micronutrient status in children with cerebral palsy. Acta Paediatr. 2007; 96(8): 1195-8. DOI: http://doi.org/10.1111/j.1651-2227.2007.00354.x
- Takeda Y., Kubota M., Sato H., Nagai A., Higashiyama Y., Kin H., et al. Carnitine in severely disabled patients: relation to anthropometric, biochemical variables, and nutritional intake. Brain Dev. 2015; 37(1): 94-100. DOI: http://doi.org/10.1016/j.braindev.2014.03.012
- Руднев С.Г., Соболева Н.П., Стерликов С.А., Николаев Д.В., Старунова О.А., Черных С.П. и др. Биоимпедансное исследование состава тела населения России. М.; 2014.
- Aydin K., Turkish Cerebral Palsy Study Group. A multicenter cross-sectional study to evaluate the clinical characteristics and nutritional status of children with cerebral palsy. Clin. Nutr. ESPEN. 2018; 26: 27-34. DOI: http://doi.org/10.1016/j.clnesp.2018.05.002
- Скурихин И.М., Тутельян В.А. Химический состав российских пищевых продуктов. М.: ДеЛи принт; 2002.
- Livingstone M.B., Robson P.J. Measurement of dietary intake in children. Proc. Nutr. Soc. 2000; 59(2): 279-93. DOI: http://doi.org/10.1017/s0029665100000318
- Семёнова Е.В., Клочкова Е.В., Коршикова-Морозова А.Е., Трухачёва А.В., Заблоцкис Е.Ю. Реабилитация детей с ДЦП: обзор современных подходов в помощь реабилитационным центрам. М.: Лепта Книга; 2018.
- Scarpato E., Staiano A., Molteni M., Terrone G., Mazzocchi A., Agostoni C. Nutritional assessment and intervention in children with cerebral palsy: a practical approach. Int. J. Food Sci. Nutr. 2017; 68(6): 763-70. DOI: http://doi.org/10.1080/09637486.2017.1289502
- Bandini L.G., Schoeller D.A., Fukagawa N.K., Wykes L.J., Dietz W.H. Body composition and energy expenditure in adolescents with cerebral palsy or myelodysplasia. Pediatr. Res. 1991; 29(1): 70-7. DOI: http://doi.org/10.1203/00006450-199101000-00014
- Duffy C.M., Hill A.E., Cosgrove A.P., Corry I.S., Graham H.K. Energy consumption in children with spina bifida and cerebral palsy: a comparative study. Dev. Med. Child Neurol. 1996; 38(3): 238-43.
- Samson-Fang L., Bell K.L. Assessment of growth and nutrition in children with cerebral palsy. Eur. J. Clin. Nutr. 2013; 67(Suppl. 2): S5-8. DOI: http://doi.org/10.1038/ejcn.2013.223
- Andrew M.J., Parr J.R., Montague-Johnson C., Braddick O., Laler K., Williams N., et al. Optimising nutrition to improve growth and reduce neurodisabilities in neonates at risk of neurological impairment, and children with suspected or confirmed cerebral palsy. BMC Pediatr. 2015; 15: 22. DOI: http://doi.org/10.1186/s12887-015-0339-2
- Calis E.A., Veugelers R., Rieken R., Tibboel D., Evenhuis H.M., Penning C. Energy intake does not correlate with nutritional state in children with severe generalized cerebral palsy and intellectual disability. Clin. Nutr. 2010; 29(5): 617-21. DOI: http://doi.org/10.1016/j.clnu.2010.02.006
- Marchand V. Nutrition in neurologically impaired children. Paediatr. Child Health. 2009; 14(6): 395-401.
- Andrew M.J., Parr J.R., Sullivan P.B. Feeding difficulties in children with cerebral palsy. Arch. Dis. Child Educ. Pract. Ed. 2012; 97(6): 222-9. DOI: http://doi.org/10.1136/archdischild-2011-300914
- Walker J.L., Bell K.L., Stevenson R.D., Weir K.A., Boyd R.N., Davies P.S. Relationships between dietary intake and body composition according to gross motor functional ability in preschool-aged children with cerebral palsy. Ann. Nutr. Metab. 2012; 61(4): 349-57. DOI: http://doi.org/10.1159/000342557
- Bell K.L., Samson-Fang L. Nutritional management of children with cerebral palsy. Eur. J. Clin. Nutr. 2013; 67(Suppl. 2): S13-6. DOI: http://doi.org/10.1038/ejcn.2013.225
- Schoendorfer N., Tinggi U., Sharp N., Boyd R., Vitetta L., Davies P.S. Protein levels in enteral feeds: do these meet requirements in children with severe cerebral palsy? Br. J. Nutr. 2012; 107(10): 1476-81. DOI: http://doi.org/10.1017/S0007114511004533
- Schoendorfer N., Boyd R., Davies P.S.W. Micronutrient adequacy and morbidity: paucity of information in children with cerebral palsy. Nutr. Rev. 2010; 68(12): 739-48. DOI: http://doi.org/10.1111/j.1753-4887.2010.00342.x
- Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J. Pediatr. Gastroenterol. Nutr. 2010; 51(1): 110-22. DOI: http://doi.org/10.1097/MPG.0b013e3181d336d2
- Moeeni V., Walls T., Day A.S. The STRONGkids nutritional risk screening tool can be used by paediatric nurses to identify hospitalised children at risk. Acta Paediatr. 2014; 103(12): e528-31. DOI: http://doi.org/10.1111/apa.12768
- Пак Л.А. Мультидисциплинарное сопровождение детей с детским церебральным параличом: Автореф. дисс. … д-ра мед. наук. М.; 2019.
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