中低收入国家脑瘫儿童营养不良的流行病学：来自全球中低收入国家脑瘫登记处的研究结果。
Epidemiology of Malnutrition among Children with Cerebral Palsy in Low- and Middle-Income Countries: Findings from the Global LMIC CP Register.
机构信息
CSF Global, Dhaka 1213, Bangladesh.
Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka 1212, Bangladesh.
出版信息
Nutrients. 2021 Oct 20;13(11):3676. doi: 10.3390/nu13113676.
BACKGROUND
This study aimed to describe the epidemiology of malnutrition among children with cerebral palsy (CP) in low- and middle-income countries (LMICs).
METHODS
Data from children with confirmed CP aged <18 years registered into the Global LMIC CP Register (GLM CPR) from Bangladesh, Indonesia, Nepal, and Ghana were included. Anthropometric measurements were collected, and nutritional status was determined following the WHO guidelines. Descriptive statistics and adjusted logistic regression were used to describe the nutritional status and identify predictors of malnutrition.
RESULTS
Between January 2015 and December 2020, 3619 children with CP were registered into the GLM CPR (median age at assessment: 7.0 years, 39% female). Overall, 72-98% of children from Bangladesh, Indonesia, Nepal, and Ghana had at least one form of undernutrition. The adjusted analysis showed, older age, low maternal education, spastic tri/quadriplegia, and Gross Motor Functional Classification System (GMFCS) levels III-V were significant predictors of underweight and stunting among children with CP in Bangladesh. In Nepal, female children, GMFCS III-V had higher odds of underweight and stunting. In Ghana, low maternal education was significantly associated with underweight, whereas older age and the presence of associated impairments were the significant predictors of stunting among children with CP. Having a GMFCS of III-V increased the odds of being underweight among children in Indonesia; however, no predictors were identified for stunting, as nearly all children with CP registered from Indonesia were stunted.
CONCLUSION
Most children with CP in GLM CPR had undernutrition. Maternal education and moderate-to-severe motor impairment (GMFCS III-V) were significant predictors. Practical nutrition education to mothers/caregivers and management guidelines according to the motor severity using local resources could improve the nutritional outcome of children with CP in LMICs.
背景
本研究旨在描述中低收入国家（LMICs）脑瘫（CP）患儿的营养不良流行病学。
方法
纳入了在孟加拉国、印度尼西亚、尼泊尔和加纳登记的年龄<18 岁的确诊脑瘫患儿的全球 LMIC CP 登记处（GLM CPR）数据。按照世界卫生组织（WHO）指南进行了人体测量学测量，并确定了营养状况。采用描述性统计和调整后的逻辑回归描述营养状况并确定营养不良的预测因素。
结果
2015 年 1 月至 2020 年 12 月期间，GLM CPR 共登记了 3619 名脑瘫患儿（评估时的中位年龄：7.0 岁，39%为女性）。来自孟加拉国、印度尼西亚、尼泊尔和加纳的患儿中，72%-98%至少有一种形式的营养不良。调整后的分析表明，年龄较大、母亲受教育程度较低、痉挛型四肢瘫或截瘫、粗大运动功能分类系统（GMFCS）水平 III-V 是孟加拉国脑瘫患儿消瘦和发育迟缓的显著预测因素。在尼泊尔，女性患儿、GMFCS III-V 与消瘦和发育迟缓的几率较高。在加纳，母亲受教育程度较低与消瘦显著相关，而年龄较大和存在相关障碍是脑瘫患儿发育迟缓的显著预测因素。GMFCS 水平为 III-V 会增加印尼脑瘫患儿消瘦的几率；然而，对于发育迟缓，没有发现预测因素，因为在印尼登记的几乎所有脑瘫患儿都有发育迟缓。
结论
GLM CPR 中大多数脑瘫患儿都存在营养不良。母亲教育和中重度运动障碍（GMFCS III-V）是显著的预测因素。根据当地资源，为母亲/照顾者提供实用的营养教育，并根据运动严重程度制定管理指南，可能会改善 LMICs 脑瘫患儿的营养状况。
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