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      Food pattern and nutritional status of children with cerebral palsy Translated title: Estándar alimentar y estado nutricional de niños con parálisis cerebral

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          Abstract

          OBJECTIVES

          To assess the food intake pattern and the nutritional status of children with cerebral palsy.

          METHODS

          Cross-sectional study with 90 children from two to 12.8 years with cerebral palsy in the following forms: hemiplegia, diplegia, and tetraplegia. Nutritional status was assessed by weight, height, and age data. Food intake was verified by the 24-hour recall and food frequency questionnaire. The ability to chew and/or swallowing, intestinal habits, and physical activity were also evaluated.

          RESULTS

          For 2-3 year-old age group, the mean energy intake followed the recommended range; in 4-6 year-old age group with hemiplegia and tetraplegia, energy intake was below the recommended limits. All children presented low intake of carbohydrates, adequate intake of proteins and high intake of lipids. The tetraplegia group had a higher prevalence of chewing (41%) and swallowing (12.8%) difficulties compared to 14.5 and 6.6% of children with hemiplegia, respectively. Most children of all groups had a daily intestinal habit. All children presented mild physical activity, while moderate activity was not practiced by any child of the tetraplegia group, which had a significantly lower height/age Z score than those with hemiplegia (-2.14 versus -1.05; p=0.003).

          CONCLUSIONS

          The children with cerebral palsy presented inadequate dietary pattern and impaired nutritional status, with special compromise of height. Tetraplegia imposes difficulties regarding chewing/swallowing and moderate physical activity practice.

          Translated abstract

          OBJETIVO

          Evaluar el estándar alimentar y estado nutricional de niños con parálisis cerebral.

          MÉTODOS

          Estudio transversal con 90 niños de 2 a 12,8 años de edad, con parálisis cerebral de tipo hemiplejía, diplejía y tetraplejía. Se evaluaron el estado nutricional por medio de los datos de peso, altura y edad, el consumo alimentar por el Recordatorio de 24 horas y por el Cuestionario de Frecuencia Alimentar, la capacidad de masticar y/o deglutir, el hábito intestinal y la práctica de actividad física.

          RESULTADOS

          En el grupo de 2 a 3 años, el promedio de ingestión energética estaba conforme a la recomendación; en la franja de 4 a 6 años, los grupos con hemiplejía y con tetraplejía presentaban promedios inferiores al límite inferior de recomendación. El grupo como un todo presentó estándar dietético bajo en carbohidratos, adecuado en proteínas y alto en lípidos. El grupo con tetraplejía presentó mayor prevalencia de dificultad para masticación (41%) y deglución (12,8%), versus, respectivamente, 14,5 y 6,6% de los niños con hemiplejía. Se observó que la mayoría de los niños con cada tipo de parálisis cerebral presentaba hábito intestinal diario. Todos los niños estudiados tenían actividad física liviana, mientras que la actividad moderada no era practicada por ningún niño del grupo tetraplejía, que también presentó escore Z de -2,14 de la relación estatura/edad, significantemente menor respecto al grupo con hemiplejía (escore Z de -1,05; p=0,003).

          CONCLUSIONES

          Los niños presentaron estándar alimentar inadecuado, estado nutricional comprometido, principalmente la estatura. La tetraplejía impone dificultades de masticación/deglución y práctica de actividad física moderada.

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          Most cited references34

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          Use of segmental measures to estimate stature in children with cerebral palsy.

          The assessment of stature in children with cerebral palsy is difficult. This study tested the clinical utility of the segmental measures of upper-arm length, tibial length, and knee height as proxies for stature in children with cerebral palsy. The study included 211 sets of measurements made in 172 children with cerebral palsy attending an outpatient clinic at a pediatric rehabilitation center during a 2-year period. Forty-three percent were female, 20% black, 31% diplegic or hemiplegic, and 52% nonambulatory. An observer measured weight, head circumference, recumbent length or standing height, upper-arm length, tibial length, knee height, midarm circumference, triceps skinfold, and subscapular skinfold. The correlation coefficients were as follows: upper-arm length and stature, .97 (95% confidence interval, .95 to .98) (R2 = .94); tibial length and stature, .97 (95% confidence interval, .96 to .98) (R2 = .94); and knee height and stature, .98 (95% confidence interval, .98 to .99) (R2 = .97). The linear regression equations were used to develop formulas for the estimation of stature from a segmental measure. Upper-arm length, tibial length, and knee height are all reliable and valid proxies for stature in children with cerebral palsy up to 12 years of age. We recommend that either knee height or tibial length be measured in the routine anthropometry of children with cerebral palsy who cannot be measured by standard techniques. Estimates of stature can then be calculated and plotted on standard growth charts.
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            Feeding problems, growth and nutritional status in children with cerebral palsy.

            The aim was to estimate the prevalence of feeding and nutritional problems in children with cerebral palsy (CP) in Norway. Data were abstracted from the Norwegian CP Register for 661 (368 boys) children born 1996-2003 (mean age 6 years 7 months; SD: 1.5). For children born from 1999 to 2003, weight and height were available. Body mass index (BMI) (kg/m(2)) was used to assess nutritional status. One hundred and thirty-two (21%) children with CP were completely dependent on assistance during feeding. The prevalence of gastrostomy tube feeding was 14%. Longer duration of gastrostomy tube feeding was associated with higher weight and BMI, but not with height. Only 63% of the children with CP had normal BMI, 7% had grade 3 thinness, while the prevalence of overweight and obesity in our study was 16%. In all, 20% of the children had mean z-scores for weight and/or height below - 2 SD. Feeding problems in children with CP were common and associated with poor linear growth. A high proportion of the children were undernourished. Moreover, our results suggest that gastrostomy tube feeding may have been introduced too late in some children. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.
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              The prevalence of constipation in institutionalized people with intellectual disability.

              Constipation is a common problem in people with intellectual disability (ID). Laxatives are frequently prescribed with disappointing results. The prevalence of constipation was investigated in a random population of 215 people with ID (IQ < 50) and constipation was correlated with clinical symptoms. All subjects were scored for bowel habits. Constipation was defined as having a bowel movement less than three times a week or the necessity of using laxatives more than three times a week. Further possible accompanying factors were evaluated. The control subjects were defined as individuals who did not use laxatives. Subjects with constipation were defined as patients and were compared to subjects without constipation (controls). One hundred and forty-nine out of 215 cases (69.3%) showed constipation. Constipation was significantly correlated with non-ambulancy, cerebral palsy, the use of anticonvulsive medication or benzodiazepines, H2-receptor antagonists or proton pump inhibitors, food refusal, and an IQ < 35. Fifty-eight per cent of the patients used bisacodyl or magnesium oxide, 39% lactulose, 13% sodiumlaurylsulphoacetate/sodium citrate/sorbitol and only 10% were given sodium phosphate enemas. Faecal soiling was found in 15% of subjects, while manual evacuation of faeces was performed in nearly 7% of cases. Constipation was randomly demonstrated in almost 70% of the population with ID. Subjects with the above-mentioned accompanying factors are especially at risk for constipation. Contrary to the general population, constipation in people with ID is associated with little use of phosphate enemas, microlax, a low incidence of faecal soiling and manual evacuation of faeces, suggesting an aetiology without distal faecal impaction. The regimen and effect of therapy has to be studied to define adequate treatment schedules.
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                Author and article information

                Journal
                Rev Paul Pediatr
                Rev Paul Pediatr
                Revista Paulista de Pediatria
                Sociedade de Pediatria de São Paulo
                0103-0582
                1984-0462
                September 2013
                September 2013
                : 31
                : 3
                : 344-349
                Affiliations
                [1 ]Mestre em Ciências pelo Departamento de Pediatria da Escola Paulista de Medicina da Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
                [2 ]Professora-Associada livre-docente do Departamento de Pediatria da Escola Paulista de Medicina da Unifesp, São Paulo, SP, Brasil
                [3 ]Doutora em Medicina pela Escola Paulista de Medicina da Unifesp; Médica do Departamento de Pediatria da Escola Paulista de Medicina da Unifesp, São Paulo, SP, Brasil
                [4 ]Doutora em Medicina pela Escola Paulista de Medicina da Unifesp; Professora-Adjunta do Departamento de Pediatria da Escola Paulista de Medicina da Unifesp. São Paulo, SP, Brasil
                Author notes
                Endereço para correspondência: Olga Maria S. Amancio Rua Botucatu, 703 CEP 04023-062 - São Paulo/SP E-mail: omsamancio.dped@ 123456epm.br

                Conflito de interesse: nada a declarar

                Article
                10.1590/S0103-05822013000300011
                4182970
                24142317
                da180e23-c1dd-4320-99cb-4c455bf5ad6e

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 July 2012
                : 14 February 2013
                Page count
                Tables: 3, References: 35, Pages: 6
                Categories
                Original Article

                brain damage, chronic,cerebral palsy,nutritional status,child,dano encefálico crônico,paralisia cerebral,estado nutricional,criança

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