Sullivan Peter B, Alder Nicola, Bachlet Allison M E, Grant Hugh, Juszczak Edmund, Henry Jeya, Vernon-Roberts Angharad, Warner Justin, Wells Jonathan
Department of Paediatrics, University of Oxford, Oxford, UK.
Dev Med Child Neurol. 2006 Nov;48(11):877-82. doi: 10.1017/S0012162206001927.
Gastrostomy tube (GT) feeding in children with cerebral palsy (CP) is associated with significant increases in weight gain and, potentially, with overfeeding. This study aimed to measure energy balance and body composition in children with CP who were fed either orally or by GT. Forty children (27 males, 13 females; median age 8y 6mo; range 1y 4mo-18y 11mo) with spastic quadriplegic CP, of whom 22 were gastrostomy-fed and 18 orally-fed, underwent anthropometry, indirect calorimetry, and total energy expenditure determination (doubly-labelled water method). Total body water content (estimated by the 18O dilution method) was used to determine body composition. The Gross Motor Function Classification System (GMFCS) was used to determine the degree of motor impairment. GMFCS levels ranged from I to V; in the gastrostomy group 19 out of 22 were Level V and two out of 22 were Level IV. Within the orally-fed group, 11 out of 18 were Level V and four out of 18 were Level IV. Resting metabolic rate and total energy expenditure of the gastrostomy-fed children were lower but they had a significantly larger triceps skinfold thickness (p=0.01) and fat mass index (p=0.02) than the orally-fed children. Both groups had consistently higher body-fat content and lower fat-free (i.e. muscle and bone) content than the reference population of age- and sex-matched children without disabilities. This study has demonstrated the relatively low energy expenditure and high body-fat content of children with severe CP and highlighted the potential risk of overfeeding with available enteral feeds administered via GT.
对于脑瘫（CP）患儿，胃造口管（GT）喂养与体重显著增加相关，甚至可能导致喂养过度。本研究旨在测量经口喂养或胃造口管喂养的脑瘫患儿的能量平衡和身体成分。40名痉挛性四肢瘫脑瘫患儿（27名男性，13名女性；中位年龄8岁6个月；范围1岁4个月 - 18岁11个月），其中22名接受胃造口管喂养，18名经口喂养，接受了人体测量、间接测热法和总能量消耗测定（双标水法）。用全身水含量（通过18O稀释法估算）来确定身体成分。采用粗大运动功能分类系统（GMFCS）来确定运动障碍程度。GMFCS水平从I到V；胃造口管喂养组中22名患儿有19名处于V级，22名中有2名处于IV级。经口喂养组中，18名患儿有11名处于V级，18名中有4名处于IV级。胃造口管喂养患儿的静息代谢率和总能量消耗较低，但他们的肱三头肌皮褶厚度（p = 0.01）和脂肪量指数（p = 0.02）显著高于经口喂养患儿。与年龄和性别匹配的无残疾儿童参考人群相比，两组患儿身体脂肪含量一直较高，而无脂肪（即肌肉和骨骼）含量较低。本研究表明，重度脑瘫患儿能量消耗相对较低且身体脂肪含量较高，并强调了通过胃造口管给予现有肠内营养时存在喂养过度的潜在风险。
