Aydin Kursad
Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey.
Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey.
Clin Nutr ESPEN. 2018 Aug;26:27-34. doi: 10.1016/j.clnesp.2018.05.002. Epub 2018 May 31.
BACKGROUND & AIMS: This study was designed to assess clinical characteristics and nutritional status of pediatric outpatients with cerebral palsy (CP) and to determine prevalence of malnutrition based on physicians' clinical judgment and on anthropometric data in relation to percentile reference values.
A total of 1108 pediatric neurology outpatients (mean ± SEM age: 7.2 ± 0.1 years, 59.3% were males) diagnosed with CP were included in this cross-sectional, non-interventional multicenter single-visit study conducted between October 2015 and July 2016 at 20 centers across Turkey. Data on patient and CP characteristics, concomitant nonneuromotor impairments and gastrointestinal disorders as well as anthropometrics, outcome of nutritional status assessment (via physicians' clinical judgment and Gomez classification and Waterlow classification of anthropometric data) and physician's view on nutritional care in CP patients were collected at a single visit.
The most common CP etiology was asphyxia (62.5%). The most common clinical category was spastic CP (87.5%) with quadriplegic (54.0%) topography and level V gross motor dysfunction (45.4%) in most of patients. The prevalence of malnutrition was considered to be 57.2% based on physicians' clinical judgment, while shown to be 94.3% (3rd degree in 86.7%) according to Gomez classification of Neyzi weight for age (WFA) percentiles and to be 91.3% (severe in 88.3%) according to Waterlow classification of Neyzi height for age (HFA) percentiles.
In conclusion, our findings revealed high prevalence of malnutrition, while also emphasize the likelihood of overestimation of malnutrition in children with CP when anthropometric assessment was based on use of growth charts for general pediatric population. This large-scale survey provided valuable data regarding nutritional assessment practice and malnutrition prevalence among children with CP in Turkey, which may be utilized for future proactive strategies in the prevention and treatment of malnutrition in this population.
本研究旨在评估小儿脑性瘫痪（CP）门诊患者的临床特征和营养状况，并根据医生的临床判断以及与百分位数参考值相关的人体测量数据来确定营养不良的患病率。
本横断面、非干预性多中心单次就诊研究于2015年10月至2016年7月在土耳其的20个中心进行，共纳入1108名被诊断为CP的小儿神经科门诊患者（平均年龄±标准误：7.2±0.1岁，59.3%为男性）。在单次就诊时收集患者及CP特征、伴随的非神经运动障碍和胃肠道疾病以及人体测量数据、营养状况评估结果（通过医生的临床判断、戈麦斯分类法以及人体测量数据的沃特洛分类法）和医生对CP患者营养护理的看法。
最常见的CP病因是窒息（62.5%）。最常见的临床类型是痉挛型CP（87.5%），大多数患者为四肢瘫（54.0%）且粗大运动功能为V级（45.4%）。基于医生的临床判断，营养不良的患病率被认为是57.2%，而根据内齐年龄别体重（WFA）百分位数的戈麦斯分类法显示为94.3%（86.7%为Ⅲ度），根据内齐年龄别身高（HFA）百分位数的沃特洛分类法显示为91.3%（88.3%为重度）。
总之，我们的研究结果显示营养不良的患病率很高，同时也强调了在根据一般儿科人群生长图表进行人体测量评估时，CP患儿营养不良可能被高估。这项大规模调查提供了有关土耳其CP患儿营养评估实践和营养不良患病率的宝贵数据，可用于该人群未来预防和治疗营养不良的积极策略。
