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Prevalence, severity, and predictors of malnutrition in Indian children with cerebral palsy and their impact on health-related quality of life

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Abstract

Although several studies have shown that undernutrition is frequent in children with cerebral palsy (CP), studies determining predictors of undernutrition and its impact on health-related quality of life (HRQoL) are scarce. This study aimed to assess the prevalence, severity, and predictors of malnutrition in children with CP and its impact on quality of life. This prospective study was performed between August 2019 and December 2021 in children with a clinical diagnosis of CP aged 2–18 years. We also intended to determine the socio-demographic and clinical predictors of undernutrition in these children and its impact on HRQoL, measured by the cerebral palsy quality of life (CPQoL)-Primary Caregiver reported version. Out of 569 (5.4 ± 2.8 years of age, 74% boys) children with CP, 71%, 44%, and 72% children were underweight, wasted, and stunted respectively, whereas 22%, 11%, and 21% were severely underweight, wasted and stunted respectively. Lower socioeconomic status, higher Gross Motor Function Classification System, and Manual Ability Classification System level were found to be significantly associated with the severity of stunting and underweight (p < 0.05), but not with wasting. CPQoL score in children with CP aged > 4 years was lower in patients with severe wasting, stunting, and underweight, as compared to their rest of the counterparts when adjusted for socio-demographic and other clinical variables (p < 0.05).

  Conclusion: Chronic undernutrition is more common than severe acute malnutrition in children with CP. The severity of undernutrition is an important predictor of impaired HRQoL in children with CP.

What is Known:

• Several studies have shown that undernutrition is frequent in children with cerebral palsy; however, studies determining predictors of undernutrition and its impact on health-related quality of life are scarce.

What is New:

• Our study identifies that lower socioeconomic status, higher Gross Motor Function Classification System, and Manual Ability Classification System level are significantly associated with the severity of stunting and being underweight.

• Chronic undernutrition is more common than severe acute malnutrition in children with cerebral palsy. Its severity is an important predictor of impaired health-related quality of life in children with cerebral palsy.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

References

  1. Murarkar S, Gothankar J, Doke P, Pore P, Lalwani S, Dhumale G et al (2020) Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study. BMC Public Health 20:1559

    Article  PubMed  PubMed Central  Google Scholar 

  2. Müller O, Krawinkel M (2005) Malnutrition and health in developing countries. CMAJ Can Med Assoc J J Assoc Medicale Can 173:279–286

    Article  Google Scholar 

  3. Almuneef AR, Almajwal A, Alam I, Abulmeaty M, Bader BA, Badr MF et al (2019) Malnutrition is common in children with cerebral palsy in Saudi Arabia – a cross-sectional clinical observational study. BMC Neurol 19:317

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sharawat IK, Sitaraman S (2016) Skeletal Maturation and Mineralisation of Children with Moderate to Severe Spastic Quadriplegia. J Clin Diagn Res 10:SC01–5

  5. Chauhan A, Singh M, Jaiswal N, Agarwal A, Sahu JK, Singh M (2019) Prevalence of cerebral palsy in Indian children: a systematic review and meta-analysis. Indian J Pediatr 86:1124–1130

    Article  PubMed  Google Scholar 

  6. Jain R, Juneja M, Sairam S (2013) Children with developmental disabilities in India: age of initial concern and referral for rehabilitation services, and reasons for delay in referral. J Child Neurol 28:455–460

    Article  PubMed  Google Scholar 

  7. Wang F, Cai Q, Shi W, Jiang H, Li N, Ma D et al (2016) A cross-sectional survey of growth and nutritional status in children with cerebral palsy in West China. Pediatr Neurol 58:90–97

    Article  PubMed  Google Scholar 

  8. Sahu SK, Kumar SG, Bhat BV, Premarajan KC, Sarkar S, Roy G et al (2015) Malnutrition among under-five children in India and strategies for control. J Nat Sci Biol Med 6:18–23

    Article  PubMed  PubMed Central  Google Scholar 

  9. Rahman MA, Halder HR, Rahman MS, Parvez M (2021) Poverty and childhood malnutrition: evidence-based on a nationally representative survey of Bangladesh. PLoS ONE 16:e0256235

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Sellier E, McIntyre S, Smithers-Sheedy H, Platt MJ (2020) SCPE and ACPR Groups. European and Australian cerebral palsy surveillance networks working together for collaborative research. Neuropediatrics 51:105–12

  11. Hogan SE (2004) Energy requirements of children with cerebral palsy. Can J Diet Pract Res 65:124–130

    Article  PubMed  Google Scholar 

  12. Kuperminc MN, Gottrand F, Samson-Fang L, Arvedson J, Bell K, Craig GM et al (2013) Nutritional management of children with cerebral palsy: a practical guide. Eur J Clin Nutr 67:S21–S23

    Article  PubMed  Google Scholar 

  13. Wright CM, Reynolds L, Ingram E, Cole TJ, Brooks J (2017) Validation of US cerebral palsy growth charts using a UK cohort. Dev Med Child Neurol 59:933–938

    Article  PubMed  Google Scholar 

  14. Silva DBR, Pfeifer LI, Funayama CAR (2013) Gross Motor Function Classification System Expanded & Revised (GMFCS E & R): reliability between therapists and parents in Brazil. Braz J Phys Ther 17:458–463

    Article  PubMed  Google Scholar 

  15. Eliasson AC, Ullenhag A, Wahlström U, Krumlinde-Sundholm L (2017) Mini-MACS: development of the Manual Ability Classification System for children younger than 4 years of age with signs of cerebral palsy. Dev Med Child Neurol 59:72–78

    Article  PubMed  Google Scholar 

  16. Hyun SE, Yi YG, Shin HI (2020) Reliability and validity of the eating and drinking ability classification system in adults with cerebral palsy. Dysphagia

  17. Hidecker MJC, Paneth N, Rosenbaum PL, Kent RD, Lillie J, Eulenberg JB et al (2011) Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol 53:704–710

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bilukha O, Couture A, McCain K, Leidman E (2020) Comparison of anthropometric data quality in children aged 6–23 and 24–59 months: lessons from population-representative surveys from humanitarian settings. BMC Nutr 6:60

    Article  PubMed  PubMed Central  Google Scholar 

  19. Forman MR, Zhu Y, Hernandez LM, Himes JH, Dong Y, Danish RK et al (2014) Arm span and ulnar length are reliable and accurate estimates of recumbent length and height in a multiethnic population of infants and children under 6 years of age. J Nutr 144:1480–1487

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Shinsugi C, Gunasekara D, Takimoto H (2020) Use of mid-upper arm circumference (MUAC) to predict malnutrition among Sri Lankan schoolchildren. Nutrients 12:E168

    Article  Google Scholar 

  21. Maier M, Stoltenburg C, Sarpong-Bengelsdorf A, Lebek S (2021) Validity and reliability of the German version of the CP QOL-Child and CP QOL-Teen Questionnaire. Neuropediatrics. https://doi.org/10.1055/s-0041-1740377

  22. Das S, Aggarwal A, Roy S, Kumar P (2017) Quality of life in Indian children with cerebral palsy using Cerebral Palsy-quality of Life Questionnaire. J Pediatr Neurosci 12:251–254

    Article  PubMed  PubMed Central  Google Scholar 

  23. Dandona R, Pandey A, Dandona L (2016) A review of national health surveys in India. Bull World Health Organ 94:286-296A

    Article  PubMed  PubMed Central  Google Scholar 

  24. Saleem S, Jan S (2021) Modified Kuppuswamy socioeconomic scale updated for the year 2021. Indian J Forensic Community Med 8:1–3

    Article  Google Scholar 

  25. Jahan I, Muhit M, Karim T, Smithers-Sheedy H, Novak I, Jones C et al (2019) What makes children with cerebral palsy vulnerable to malnutrition? Findings from the Bangladesh cerebral palsy register (BCPR). Disabil Rehabil 41:2247–2254

    Article  PubMed  Google Scholar 

  26. Mushta SM, Jahan I, Sultana R, McIntyre S, Badahdah AM, Almasri NA et al (2021) Burden of malnutrition among children and adolescents with cerebral palsy in Arabic-speaking countries: a systematic review and meta-analysis. Nutrients 13:3199

    Article  PubMed  PubMed Central  Google Scholar 

  27. Reyes FI, Salemi JL, Dongarwar D, Magazine CB, Salihu HM (2019) Prevalence, trends, and correlates of malnutrition among hospitalized children with cerebral palsy. Dev Med Child Neurol 61:1432–1438

    Article  PubMed  Google Scholar 

  28. Herrera-Anaya E, Angarita-Fonseca A, Herrera-Galindo VM, Martínez-Marín RDP, Rodríguez-Bayona CN (2016) Association between gross motor function and nutritional status in children with cerebral palsy: a cross-sectional study from Colombia. Dev Med Child Neurol 58:936–941

    Article  PubMed  Google Scholar 

  29. da Silva DCG, de Sá Barreto da Cunha M, de Oliveira Santana A, Dos Santos Alves AM, Pereira Santos M (2022) Malnutrition and nutritional deficiencies in children with cerebral palsy: a systematic review and meta-analysis. Public Health 205:192–201

  30. Sforza E, Onesimo R, Leoni C, Giorgio V, Proli F, Notaro F et al (2022) Drooling outcome measures in paediatric disability: a systematic review. Eur J Pediatr 181:2575–2592

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kuperminc MN, Stevenson RD (2008) Growth and nutrition disorders in children with cerebral palsy. Dev Disabil Res Rev 14:137–146

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sadowska M, Sarecka-Hujar B, Kopyta I (2020) Cerebral palsy: current opinions on definition, epidemiology, risk factors, classification and treatment options. Neuropsychiatr Dis Treat 16:1505–1518

    Article  PubMed  PubMed Central  Google Scholar 

  33. Jeffries L, Fiss A, McCoy SW, Bartlett DJ (2016) Description of primary and secondary impairments in young children with cerebral palsy. Pediatr Phys Ther Off Publ Sect Pediatr Am Phys Ther Assoc 28:7–14

    Google Scholar 

  34. Brinksma A, Sanderman R, Roodbol PF, Sulkers E, Burgerhof JGM, de Bont ESJM et al (2015) Malnutrition is associated with worse health-related quality of life in children with cancer. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 23:3043–3052

    Google Scholar 

  35. Sharawat IK, Panda PK (2022) Quality of life and its association with level of functioning in young children with cerebral palsy. Neuropediatrics 53:227–234

    Article  CAS  PubMed  Google Scholar 

  36. Trivić I, Hojsak I (2019) Evaluation and Treatment of malnutrition and associated gastrointestinal complications in children with cerebral palsy. Pediatr Gastroenterol Hepatol Nutr 22:122–131

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. Indar Kumar Sharawat, Aparna Ramachandran, and Prateek Kumar Panda contributed equally and share joint first authorship.

Authors and Affiliations

  1. Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India

    Indar Kumar Sharawat & Prateek Kumar Panda

  2. Department of Neurology, IQRAA International Hospital & Research Centre, Kozhikode, Kerala, 673009, India

    Aparna Ramachandran

  3. Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India

    Vinod Kumar & Nowneet Kumar Bhat

Authors
  1. Indar Kumar Sharawat
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  2. Aparna Ramachandran
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  3. Prateek Kumar Panda
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  4. Vinod Kumar
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  5. Nowneet Kumar Bhat
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Contributions

PKP, AR, IKS, VK, and NKB were involved in the conception, acquisition, analysis, and interpretation of data. PKP, AR, and IKS drafted the initial draft, and AR performed the statistical analysis and critically revised the manuscript. All the authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Prateek Kumar Panda.

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Ethical approval

The study was approved by the institutional review board and informed consent was taken from the caregivers.

Competing interest

The authors declare no competing interests.

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Communicated by Gregorio Milani.

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Sharawat, I.K., Ramachandran, A., Panda, P.K. et al. Prevalence, severity, and predictors of malnutrition in Indian children with cerebral palsy and their impact on health-related quality of life. Eur J Pediatr 182, 2433–2441 (2023). https://doi.org/10.1007/s00431-023-04930-4

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