Nutritional Issues in Children with Dysphagia
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
Limitations and Future Directions for Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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n (%) | ||
---|---|---|
Gender (Males) | 54 (54.5) | |
Age years (median, IQR) | 2.71 (1.43:4.83) | |
Disease group | ||
Congenital brain damage | 53 (53.5) | |
Acquired brain damage | 13 (13.1) | |
Neurodegenerative disease | 3 (3) | |
Neurodevelopmental disorder | 6 (6.1) | |
Craniofacial anomaly | 11 (11.1) | |
Cardiorespiratory pathology | 2 (2) | |
Functional/Maturational | 11 (11.1) | |
GMFCS | ||
I | 44 (44.4) | |
II | 11 (11.1) | |
III | 10 (10.1) | |
IV | 13 (13.1) | |
V | 20 (20.2) | |
PedCOM complexity level | ||
No complexity | 41 (41.4) | |
Low complexity | 29 (29.3) | |
Moderate complexity | 22 (22.2) | |
High complexity | 3 (3) | |
Recurrent respiratory processes | 30 (30.3) | |
Aspiration pneumonia | 1 (1) | |
Digestive comorbidity | 46 (46.4) | |
GERD | 24 (24.2) | |
Constipation | 7 (7) | |
GERD and constipation | 15 (15.1) | |
Presence of external feeding device (Y/N) | 29 (29.3) | |
NGT/NYT | 23 (23.2) | |
Gastrostomy | 6 (6) | |
Referral | ||
Primary care | 6 (6.1) | |
Hospitalized care | 93 (93.9) | |
Neuropediatric | 30 (30.3) | |
Palliative care/Complex Chronic | 13 (13.1) | |
Gastroenterology | 19 (19.1) | |
Neonatology | 8 (8) | |
Pneumologist | 5 (5) | |
Others | 18 (18.2) | |
Reason for referral | ||
Evaluate swallowing safety | 29 (293) | |
Cough with intake | 12 (12.1) | |
Difficulty expanding oral diet | 37 (37.3) | |
SDR incoordination | 14 (14.1) | |
Suspicion of chronic aspirative syndrome | 2 (2) | |
Others | 5 (5.1) | |
Anthropometry t0 (mean ± SD) | ||
z-score Weight | −1.54 ± 1.75 | |
z-score Height | −1.62 ± 1.92 | |
z-score BMI | −0.91 ± 1.86 |
Intake | Mean (SD) | Range | p | |
---|---|---|---|---|
Energy (kcal/day) | 1109.42 (413.72) | [848.19–1.314.6] | ||
<1 year | 627.04 (195) | [437.1–751.5] | <0.001 | |
1–7 years | 1.174 (342.57) | [967.45–1321.465] | <0.001 | |
>7 years | 1457.95 (338.48) | [1.258–1.612.78] | <0.005 | |
Proteins (g/day) | 39.15 (19.98) | [28.03–50.85] | ||
<1 year | 17.57 (7.23) | [12.57–24.29] | <0.001 | |
1–7 years | 41.41 (11.74) | [32.64–50.79] | <0.001 | |
>7 years | 53.65 (10.02) | [47.35–60.09] | <0.005 | |
Proteins (%TCI) | 17.33 (13.83) | [11.77–16.19] | ||
<1 year | 10.9 (2.45) | [8.66–13.08] | <0.001 | |
1–7 years | 14.39 (3.38) | [11.90–16.67] | <0.001 | |
>7 years | 14.9 (1.9) | [13.21–16.84] | 0.005 | |
Fat (g/day) | 42.72 (19.48) | [31.55–50.09] | ||
<1 year | 25.93 (8.97) | [19.48–34.21] | 0.004 | |
1–7 years | 43.76 (8.33) | [34.18–50.74] | <0.005 | |
>7 years | 58 (20.14) | [42.28–73.24] | <0.005 | |
Fat (%TCI) | 42.26 (77.43) | [29.02–39.58] | ||
<1 year | 38.51 (11.65) | [26.41–48.39] | <0.05 | |
1–7 years | 33.07 (7.31) | [28.87–38.01] | <0.005 | |
>7 years | 35.28 (5.66) | [29.31–40.79] | 0.47 | |
Carbohydrates (g/day) | 145.62 (54.08) | [108.41–179.67] | ||
<1 year | 80.41 (32.97) | [62.18–102.62] | <0.001 | |
1–7 years | 154.14 (48.86) | [123.62–182.61] | <0.001 | |
>7 years | 180.32 (5.65) | [161.22–189.73] | 0.08 | |
Carbohydrates (%TCI) | 67.33 (149.45) | [46.17–56.74] | ||
<1 year | 50.35 (9.53) | [43.01–59.66] | 0.73 | |
1–7 years | 52.66 (8.33) | [46.89–56.82] | 1 | |
>7 years | 49.82 (5.09) | [46.05–54.81] | 1 | |
Fiber (g/day) | 6.54 (6.75) | [2.39–7.37] | ||
<1 year | 2.09 (2.13) | [0–3.51] | <0.05 | |
1–7 years | 5.55 (7.14) | [3.28–9.62] | 1 | |
>7 years | 6.53 (6.37) | [2.02–9.41] | 0.3 |
Age | Coverage ≥80% RDI | Coverage <80% RDI | |
---|---|---|---|
n (%) | n (%) | p | |
<1 year | 13 (17.3%) | 4 (12.5) | 0.01 |
1–7 years | 57 (76%) | 19 (59.4) | |
>7 years | 5 (21.6%) | 9 (28.1) | |
GMFCS | n (%) | p | |
I–III | 50 (70.4%) | 23 (74.2) | 0.698 |
IV–V | 21 (29.6%) | 8 (25.8) | |
PedCom® | n (%) | n (%) | p |
No complexity | 38 (55.1) | 13 (43.3) | 0.14 |
Low complexity | 20 (29) | 6 (20) | |
Moderate complexity | 5 (7.2) | 4 (13.3) | |
High complexity | 6 (8.7) | 7 (23.3) | |
EDACS | n (%) | n (%) | p |
Levels 1–3 | 61 (88.4) | 26 (86.7) | 0.81 |
Levels 4–5 | 8 (11.6) | 4 (13.3) | |
External feeding device | n (%) | n (%) | p |
None | 54 (74) | 23 (74.2) | 0.98 |
NGT/Gastrostomy | 19 (26) | 8 (25.8) | |
Macronutrients | Median [IQR] | p | |
Proteins (%, g/day) | 13.81; 41.84 [30.48–51.44] | 14.25; 34.24 [22.94–47.4] | 0.014 |
Carbohydrates (%, g/day) | 52.59; 160.19 [130.61–190.63] | 50.95; 117.55 [86.48–145.1] | <0.001 |
Fat (%, g/day) | 33.65; 45.65 [34.25–53.03] | 34.79; 35.47 [23.6–45.74 | 0.004 |
Micronutrients | Median [IQR] | ||
Calcium (mg/day) | 716.33 [465.84–934.63] | 591.35 [392.39–747.03] | 0.133 |
Phosphorus (mg/day) | 486.95 [326.89–585.64] | 361.27 [170.71–488.88] | 0.009 |
Magnesium (mg/day) | 120.12 [72.25–154.95] | 95.87 [52.76–134.32] | 0.054 |
Iron (mg/day) | 8.26 [4.80–10.25] | 5.96 [3.27–7.53] | 0.029 |
Vitamin D (mcg/day) | 8.05 [1.93–10.87] | 4.99 [0.97–7.03] | 0.13 |
Non-Enteral Nutrition Support (n = 17) | Enteral Nutrition Support (n = 28) | p | |
---|---|---|---|
Age, median (IQR) | 3.4 (2.1–6.4) | 2.8 (1.3–4.2) | 0.223 |
Sex (females), n % | 8 (47.1) | 10 (35.7) | 0.329 |
Weight (z score) | −2.2 (−2.7–−1.6) | −2.4 (−3.3–−1.9) | 0.157 |
Height/Length (z score) | −2.3 (−3.9–−1.7) | −2.1 (−2.9–−1.3) | 0.482 |
TEE (kcal), median [IQR] | 1070 [774–1159] | 977 [671–1149] | 0.287 |
DER, median [IQR] | 1252 [1252–1573] | 1252 [1000–1333] | 0.112 |
Total daily energy, median [IQR] | 1102 [915–1161] | 1100 [844–1355] | 0.607 |
DER Covered (%), median [IQR] | 78 [62–86] | 90 [75–106] | 0.037 |
% Energy from TEE, median [IQR] | 101 [85–120] | 117 [92–155] | 0.083 |
Energy/kg BW, median [IQR] | 83 [61–101] | 95 [75–127] | 0.042 |
Macronutrients | Median [IQR] | Median [IQR] | p |
Proteins (%, g/day) | 15.1; 40.6 [29.8–51.1] | 13.6; 37.1 [22.9–48.9] | 0.574 0.198 |
Carbohydrates (%, g/day) | 47.1; 128.9 [116.1–143.5] | 50.1; 137.4 [85.6–178.5] | 0.233 0.292 |
Fat (%, g/day) | 37.1; 44.1 [28.0–50.1] | 35.4; 42.5 [30.4–51.4] | 0.870 0.963 |
Fiber (g/day) | 3.1 [1.6–6.9] | 4.9 [2.2–10.7] | 0.210 |
% RDI fiber covered | 24.9 [13.7–50.2] | 41.4 [22.8–106.7] | 0.204 |
Micronutrients | Median [IQR] | Median [IQR] | p |
Calcium (mg/day) | 697.9 [415.2–840.9] | 602 [466.1–965.2] | 0.640 |
% RDI calcium covered | 94.9 [59.2–127.5] | 102.9 [77.5–158.8] | 0.292 |
Phosphorus (mg/day) | 338.1 [180.5–509.1] | 486.8 [343.1–674.1] | 0.033 |
% RDI phosphorus covered | 61.5 [37.7–104.3] | 106.3 [74.8–130.9] | 0.004 |
Magnesium (mg/day) | 100.5 [70.2–130.5] | 123.2 [71.7–170.3] | 0.153 |
% RDI magnesium covered | 82.3 [51.4–105.6] | 121.3 [74.9–188.9] | 0.029 |
Iron (mg/day) | 3.7 [2.5–5.1] | 8.7 [5.3–11.0] | 0.0001 |
% RDI iron covered | 45.1 [29.6–63.5] | 110.9 [66.9–156.7] | 0.0001 |
Zinc (mg/day) | 2.3 [0.8–4.3] | 5.4 [4.2–8.8] | 0.002 |
% RDI zinc covered | 39.7 [16.2–71.8] | 115.9 [90.4–197.7] | 0.0001 |
Vitamin D (mcg/day) | 1.7 [0.4–4.4] | 7.7 [4.2–12.8] | 0.002 |
% RDI vitamin D covered | 26.2 [5.4–71.4] | 115.0 [61.0–167.3] | 0.002 |
Neurologic Disease | GMFCS | EDACS | External Feeding Device | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Strategies | Yes | No | p | I–III | IV–V | p | 1–3 | 4–5 | p | Yes | No | p |
Compensatory | 11 (13.9%) | 6 (30%) | 0.016 | 13 (20.3%) | 4 (11.8%) | <0.001 | 14 (16.5%) | 3 (21.4%) | 0.032 | 10 (14.3%) | 7 (24.1%) | 0.184 |
Direct Rehabilitation | 20 (25.3%) | 9 (45%) | 28 (43.8%) | 1 (2.9%) | 29 (34.1%) | 0 (0%) | 24 (34.3%) | 5 (17.2%) | ||||
Both | 48 (60.8%) | 5 (25%) | 23 (35.9%) | 29 (85.3%) | 42 (49.4%) | 11 (78.6%) | 36 (51.4%) | 17 (58.6%) |
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Ortiz Pérez, P.; Valero-Arredondo, I.; Torcuato-Rubio, E.; Herrador-López, M.; Martín-Masot, R.; Navas-López, V.M. Nutritional Issues in Children with Dysphagia. Nutrients 2024, 16, 1590. https://doi.org/10.3390/nu16111590
Ortiz Pérez P, Valero-Arredondo I, Torcuato-Rubio E, Herrador-López M, Martín-Masot R, Navas-López VM. Nutritional Issues in Children with Dysphagia. Nutrients. 2024; 16(11):1590. https://doi.org/10.3390/nu16111590
Chicago/Turabian StyleOrtiz Pérez, Pilar, Inés Valero-Arredondo, Encarnación Torcuato-Rubio, Marta Herrador-López, Rafael Martín-Masot, and Víctor Manuel Navas-López. 2024. "Nutritional Issues in Children with Dysphagia" Nutrients 16, no. 11: 1590. https://doi.org/10.3390/nu16111590
APA StyleOrtiz Pérez, P., Valero-Arredondo, I., Torcuato-Rubio, E., Herrador-López, M., Martín-Masot, R., & Navas-López, V. M. (2024). Nutritional Issues in Children with Dysphagia. Nutrients, 16(11), 1590. https://doi.org/10.3390/nu16111590