Department of Paediatrics, University of Oxford, Oxford, UK.
Dev Med Child Neurol. 2010 Dec;52(12):1099-105. doi: 10.1111/j.1469-8749.2010.03789.x. Epub 2010 Oct 21.
gastrostomy feeding children with spastic quadriplegic cerebral palsy (SQCP) improves weight gain but may cause excess deposition of body fat. This study was designed to investigate whether weight gain could be achieved without an adverse effect on body composition by using a low-energy feed in gastrostomy-fed children with SQCP.
ourteen children (seven male; seven female; median age 2y; range 10mo-11y) with SQCP were studied, 13 of whom were classified as Gross Motor Function Classification Score (GMFCS) level V and one as GMFCS level IV. Children were eligible for the study if they weighed between 8 and 30kg with a diagnosis of severe SQCP and significant feeding difficulties in whom a clinical decision had been made to insert a gastrostomy feeding tube. The feed used in the study had an energy concentration of 0.75kcal/mL (Nutrini Low Energy Multi Fibre). Assessments were performed before gastrostomy insertion (baseline) and after 6months, and included body composition, growth, nutritional intake, and gastrointestinal symptoms.
there was a significant increase in weight (median difference 1.9kg; 95% confidence interval [CI] 0.85-3.03kg; p=0.012), mid-upper arm circumference (median difference 1.45cm; 95% CI -0.36cm to 3.47cm; p=0.043), and lower leg length (median difference 1.62cm; 95% CI 0.44-3.95cm; p=0.012) over the 6 months. There was no significant increase in fat mass index (median diff 1.21, 95% CI -1.15 to 2.94, p=0.345) or fat free mass index (median diff -1.43, 95% CI -1.15 to 2.94, p=0.249). Micronutrient levels remained within reference ranges with the exception of elevated chromium. The median percentage intake of the estimated average requirements for energy (kcal) was 43% at the beginning of the study and 48.8% after 6 months on the low-energy feed.
children with SQCP who are fed a low-energy, micronutrient-complete, high-fibre feed continue to grow even with energy intakes below 75% of the estimated average requirements. This was not associated with a disproportionate rise in fat mass or fat percentage, and the majority of micronutrient levels remained within the reference range.
胃造口喂养痉挛性四肢瘫痪脑瘫（SQCP）患儿可增加体重，但可能导致体脂肪过度沉积。本研究旨在探讨通过使用低能量喂养管喂养胃造口喂养的 SQCP 患儿，是否可以在不影响身体成分的情况下实现体重增加。
我们研究了 14 名儿童（7 名男性；7 名女性；中位年龄 2 岁；范围 10 个月至 11 岁），其中 13 名被归类为总体运动功能分类评分（GMFCS）水平 V，1 名 GMFCS 水平 IV。如果患儿体重在 8 至 30kg 之间，患有严重的 SQCP 和严重的喂养困难，且临床决定插入胃造口喂养管，则患儿有资格参加研究。研究中使用的饲料能量浓度为 0.75kcal/mL（Nutrini Low Energy Multi Fibre）。在胃造口插入前（基线）和 6 个月后进行评估，包括身体成分、生长、营养摄入和胃肠道症状。
体重（中位数差异 1.9kg；95%置信区间[CI]0.85-3.03kg；p=0.012）、中上臂围（中位数差异 1.45cm；95%CI-0.36cm 至 3.47cm；p=0.043）和小腿长度（中位数差异 1.62cm；95%CI0.44-3.95cm；p=0.012）在 6 个月内均有显著增加。脂肪量指数（中位数差异 1.21，95%CI-1.15 至 2.94，p=0.345）或无脂肪量指数（中位数差异-1.43，95%CI-1.15 至 2.94，p=0.249）无显著增加。除铬升高外，微量营养素水平仍在参考范围内。研究开始时，能量（千卡）估计平均需求量的中位数摄入量为 43%，6 个月后，低能量喂养的摄入量为 48.8%。
接受低能量、微量营养素完整、高纤维喂养的 SQCP 患儿即使能量摄入低于估计平均需求量的 75%，仍继续生长。这与体脂肪或体脂百分比的不成比例增加无关，大多数微量营养素水平仍在参考范围内。
