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Cerebral Palsy and Nutrition—A Global Perspective

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (28 June 2019) | Viewed by 19556

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Dr. Gulam Khandaker

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Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
Interests: childhood disability; infectious disease; early childhood development; child survival; maternal and childhood undernutrition; poverty dynamics
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Dear Colleagues,

“Cerebral palsy and nutrition—A Global perspective,” is aimed to look into the issues and initiatives around undernutrition among children with Cerebral Palsy (CP) in both high and lower-middle income countries.

Nutritional status of children with CP is complex as disease severity often affects nutrition directly by minimizing their nutrient intake due to feeding difficulties. Children with oral motor impairments are more likely to take modified food e.g. fluid based, less chewable foods, and might lead to inadequate nutrient intake due to low energy and nutrient density of these modified food. In addition, socio demographic factors including educational level of the caregivers and socio-economic status of the families have an influential role in poor nutritional outcome among children with CP, particularly in low and middle-income countries (LMICs).

As Ban Ki-moon, United Nations 8th Secretary General said, “Nutrition is both a maker and a marker of development. Improved nutrition is the platform for progress in health, education, employment, empowerment of women and the reduction of poverty and inequality, and can lay the foundation for peaceful, secure and stable societies.”

Unfortunately, nutritional status of children with CP is still an under researched area. There is a lack of population based observational and experimental studies from LMICs. Moreover, there is a need for translational research to tackle the burden of undernutrition among children with CP Globally.

Assoc. Prof. Gulam Khandaker
Guest Editor

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Keywords

Cerebral palsy
Under nutrition
Malnutrition
Nutritional status
Growth
Anthropometry
Oromotor dysfunction
Enteral nutrition
Nutritional support

Published Papers (4 papers)

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Research

21 pages, 817 KiB

Open AccessArticle

Childhood Disability and Nutrition: Findings from a Population-Based Case Control Study in Rural Bangladesh

by Israt Jahan, Tasneem Karim, Mahmudul Hassan Al Imam, Manik Chandra Das, Khaled Mohammad Ali, Mohammad Muhit and Gulam Khandaker

Nutrients 2019, 11(11), 2728; https://doi.org/10.3390/nu11112728 - 11 Nov 2019

Cited by 10 | Viewed by 4702

Abstract

Background: Evidence regarding the complex relationship between childhood disability and malnutrition is limited in low and middle income countries. We aimed to measure the association between childhood disability and malnutrition in rural Bangladesh. Method: We conducted a population-based case control study among children aged <18 years in a rural sub-district (i.e., Shahjadpur) in Bangladesh. Children with permanent disability (i.e., Cases) and their age/sex-matched peers (i.e., Controls) were identified from the local community utilizing the key informant method. Socioeconomic, anthropometric, and educational information was collected using a pre-tested questionnaire. Only Cases underwent detailed medical assessment for clinical and rehabilitation information. Descriptive and bivariate analyses were performed. Results: Between October 2017 and February 2018, 1274 Cases and 1303 Controls were assessed. Cases had 6.6 times and 11.8 times higher odds of being severely underweight and severely stunted respectively than Controls. Although epileptic children had the highest overall prevalence of malnutrition, the age/sex-adjusted odds of malnutrition were significantly higher among children with physical impairments. Underweight and/or stunting among children with disability was significantly associated with parental educational qualification, socioeconomic status and mainstream school attendance. Conclusion: The significantly high proportion of severe malnutrition among children with disability calls for urgent action and implementation of inclusive nutrition intervention programs in rural Bangladesh. Full article

(This article belongs to the Special Issue Cerebral Palsy and Nutrition—A Global Perspective)

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15 pages, 266 KiB

Open AccessArticle

Nutritional Status of Children with Cerebral Palsy—Findings from Prospective Hospital-Based Surveillance in Vietnam Indicate a Need for Action

by Tasneem Karim, Israt Jahan, Rachael Dossetor, Nguyen Thi Huong Giang, Nguyen Thi Van Anh, Trinh Quang Dung, Cao Minh Chau, Nguyen Van Bang, Nadia Badawi, Gulam Khandaker and Elizabeth Elliott

Nutrients 2019, 11(9), 2132; https://doi.org/10.3390/nu11092132 - 06 Sep 2019

Cited by 21 | Viewed by 4785

Abstract

Background: Lack of evidence on the burden and risk factors for malnutrition among children with cerebral palsy (CP) in Vietnam limits evidence-based interventions. We aimed to define the nutritional status of children with CP in Vietnam. Materials and Methods: The study utilized data from active prospective hospital-based surveillance modelled on the Pediatric Active Enhanced Disease Surveillance system. Children (0–18 years) with CP attending the National Children’s Hospital Hanoi, Vietnam between June–November 2017 were included. Data on demographic, clinical and rehabilitation status were collected following detailed neurodevelopmental assessment. Anthropometric measurements were taken. Nutritional status was determined using the World Health Organization guideline. Results: Of 765 children (the mean (SD) age was 2.6 (2.5) years; 35.8% were female), 28.9% (n = 213) were underweight and 29.0% (n = 214) stunted. The odds of underweight were significantly higher among children aged >5 years and/or having a monthly family income of <50 USD. Underweight and/or stunting was high among children with quadriplegia (81%, n = 60 and 84.5%, n = 87) and/or Gross Motor Functional Classification System (GMFCS) level IV–V (62.5%, n = 45 and 67.0%, n = 67). Nearly one-third of intellectually impaired and more than half of hearing-impaired children were underweight and/or stunted. Conclusions: Poor economic status and increased motor severity increased vulnerability to malnutrition. Our findings will inform nutritional rehabilitation programs among these vulnerable children. Full article

(This article belongs to the Special Issue Cerebral Palsy and Nutrition—A Global Perspective)

8 pages, 509 KiB

Open AccessArticle

Gastrostomy Placement and Management in Children: A Single-Center Experience

by Grazia Di Leo, Paola Pascolo, Kamar Hamadeh, Andrea Trombetta, Sergio Ghirardo, Jurgen Schleef, Egidio Barbi and Daniela Codrich

Nutrients 2019, 11(7), 1555; https://doi.org/10.3390/nu11071555 - 10 Jul 2019

Cited by 22 | Viewed by 4319

Abstract

BACKGROUND: To prevent malnutrition and food aspiration in children with chronic neuromuscular problems, enteral nutrition provided by gastrostomy is recommended. Long-term follow-up data about surgical and medical complications of PEG are available, but few papers have addressed all of the issues in the same series. METHODS: This retrospective study enrolled patients under 18 years who had a gastrostomy tube placed at our institution between 2003 and 2017. The aim is to evaluate outcomes after gastrostomy placement, focusing both on surgical complications (early and late), and its effect on their nutritional status, on the prevention of pulmonary infections, and their parents’ opinion. RESULTS: Eighty-four gastrostomies were placed in total (35 F; 49 M). Seventy-seven patients had a severe neurocognitive impairment (GMFCS 5). The principal indication for gastrostomy was severe dysphagia (53.3%). No gastrostomy-related death was observed. Early surgical complications were observed in five of 84 (5,9%) patients; late complications were observed in 15 of 84 (17.8%) patients. Twenty-two patients were diagnosed with subsequent gastroesophageal reflux; five patients developed dumping syndrome (6%). Complete medical follow-up data were available for 45 patients. A progressive improvement of nutritional status was observed in 29 patients, and 11 maintained the same percentile; the occurrence of respiratory infections and need for hospitalization decreased. In 90% of cases, parents were fully satisfied with the g-tube. CONCLUSION: This study confirms the positive nutritional outcomes of gastrostomy-tube with an associated small risk of surgical complications and a reduction in the number of respiratory infections, with most parents scoring their experience as positive. Full article

(This article belongs to the Special Issue Cerebral Palsy and Nutrition—A Global Perspective)

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16 pages, 1049 KiB

Open AccessArticle

Suboptimal Nutrition and Low Physical Activity Are Observed Together with Reduced Plasma Brain-Derived Neurotrophic Factor (BDNF) Concentration in Children with Severe Cerebral Palsy (CP)

by Solvejg L. Hansen, Jakob Lorentzen, Lin T. Pedersen, Frederikke L. Hendrich, Martin Jorsal, Jessica Pingel, Jens B. Nielsen and Bente Kiens

Nutrients 2019, 11(3), 620; https://doi.org/10.3390/nu11030620 - 14 Mar 2019

Cited by 13 | Viewed by 4885

Abstract

Brain-derived neurotrophic factor (BDNF) is a mediator of exercise and nutrition-induced neural plasticity. In children with cerebral palsy (CP), neuromuscular deficits and mobility impairment have a negative impact on their physical activity level and nutritional status, but whether these children have reduced BDNF concentrations is unknown. Therefore, the aim of the present study was to investigate the plasma BDNF concentration, nutritional status, and physical activity level in children with mild to severe CP. Blood sampling, dietary registration, and questionnaires were completed for children with mild CP (gross motor function classification system (GMFCS) I–II, n = 31, age 10.6 ± 0.6 years), severe CP (GMFCS IV–V, n = 14, age 10.9 ± 1.1 years) and typically developed (TD) children (n = 22, age 10.9 ± 0.6 years). Children with severe CP had ~40% lower plasma BDNF concentration than TD children (p < 0.05). Furthermore, children with severe CP had lower daily physical activity level than TD children (p < 0.01), and a daily intake of energy, n-3 fatty acids, and dietary fibers that was only ~50% of TD (p > 0.001). Reduced plasma BDNF concentrations were observed in children with severe CP. This may be of significance for optimal neural growth and plasticity. This was observed together with low physical activity levels and a suboptimal intake of energy, n-3 fatty acids, and dietary fibers. Full article

(This article belongs to the Special Issue Cerebral Palsy and Nutrition—A Global Perspective)

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