Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Eur J Pediatr. 2023 Nov;182(11):5047-5055. doi: 10.1007/s00431-023-05177-9. Epub 2023 Sep 1.
The purpose of the study was to conduct a nutritional and metabolic assessment of children with cerebral palsy, including an investigation of liver status, body composition, and bone mineral density. In this cross-sectional study we included 22 children with cerebral palsy. By using ultrasound, transient elastography, dual x-ray absorptiometry (DXA) scan, blood samples, anthropometric measurements, and a three-day diet registration, the nutritional and metabolic status was evaluated. Liver fibrosis and steatosis were found in four patients (18.2%), all with severe motor impairments, low skeletal muscle mass, and epilepsy. All patients with liver involvement had normal liver-related blood samples. Decreased bone mineral density was found in 26.3%, and 91.0% had low skeletal muscle mass. Fat mass and muscle mass were significantly lower in the patients with severe motor impairments compared to the patients with less severe motor impairments. Within the children classified as 'underweight' or 'normal' according to body mass index, body fat determined by DXA scan was normal or high in 50% of these patients.
This study is the first to report liver fibrosis and steatosis in children with cerebral palsy. Possible causes of liver fibrosis and/or steatosis are altered body composition with low skeletal muscle mass, decreased mobility and medical drug intake. Further investigations of liver involvement and risk factors are needed.
• Children and adolescents with cerebral palsy are at risk of malnutrition and altered body composition, both of which can lead to fatty liver disease. • It is unknown whether children with cerebral palsy are at increased risk of metabolic disturbances such as fatty liver disease.
• Altered body composition and low skeletal muscle mass, regardless of ambulation is present in 91% of the children with cerebral palsy. • Liver fibrosis and/or steatosis were found in 18.2% of the patients. Possible causes are altered body composition, decreased mobility and medical drug intake.
对脑瘫儿童进行营养和代谢评估，包括肝脏状况、身体成分和骨密度调查。本横断面研究纳入 22 例脑瘫儿童。采用超声、瞬时弹性成像、双能 X 线吸收法（DXA）扫描、血液样本、人体测量和 3 天饮食记录评估营养和代谢状况。发现 4 例（18.2%）患儿存在肝纤维化和脂肪变性，均为重度运动障碍、骨骼肌量低和癫痫患儿。所有肝受累患者的肝相关血液样本均正常。发现骨密度降低 26.3%，91.0%患儿骨骼肌量低。与运动障碍较轻的患儿相比，运动障碍严重的患儿的脂肪量和肌肉量明显更低。根据 BMI 分类为“体重不足”或“正常”的患儿中，50%的患儿 DXA 扫描测定的体脂正常或偏高。
本研究首次报道脑瘫儿童存在肝纤维化和脂肪变性。肝纤维化和/或脂肪变性的可能原因是骨骼肌量低、活动度降低和药物摄入改变导致的身体成分改变。需要进一步调查肝脏受累和危险因素。
患有脑瘫的儿童存在营养不良和身体成分改变的风险，两者均可能导致脂肪肝疾病。脑瘫儿童是否存在代谢紊乱（如脂肪肝疾病）的风险尚不清楚。
91%的脑瘫儿童存在骨骼肌量低、活动度降低的改变身体成分情况。91%的患儿存在骨骼肌量低、活动度降低的改变身体成分情况。18.2%的患儿存在肝纤维化和/或脂肪变性。可能的原因是身体成分改变、活动度降低和药物摄入。
