Energy expenditure and body composition in children with spastic quadriplegic cerebral palsy.
ABSTRACT To determine the relationship between resting energy expenditure and body cell mass in a group of children with spastic quadriplegic cerebral palsy (SQCP) in comparison with a group of healthy volunteers.
Children with SQCP (n = 13) and healthy control subjects (n = 21) participated in the study. Resting energy expenditure (REE) by indirect calorimetry, as well as body composition measurements were obtained. Those included skinfold measurements, isotope dilution methods for total body water and extracellular water (2H2O or H2(18)O and NaBr, respectively), and bioelectrical impedance analysis. Intracellular water was calculated as total body water minus extracellular water.
Overall REE in children with SQCP was significantly less than in control subjects or from predicted World Health Organization equations. There was a poor correlation between REE and weight or height for children with SQCP and those for control subjects. Children with SQCP showed a higher variance and small improvement in the correlation between REE and lean body mass or intracellular water in comparison with control subjects. Nine of the thirteen children with SQCP had significantly reduced REE per unit of lean tissue or intracellular water. Furthermore, bioelectrical impedance analysis was validated against dilution methods as a suitable technique for measuring total body water (r2 = 0.90, r = 0.95) and extracellular water (r2 = 0.84, r = 0.92) in children with SQCP.
REE in children with SQCP is poorly correlated with body cell mass. We postulate that the central nervous system plays a crucial role in energy regulation. In children with SQCP, individual energy expenditure should be measured so that optimal nutritional status can be achieved. Bioelectrical impedance analysis can be used in this population to measure body water spaces.
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ABSTRACT: Children with severe cerebral palsy and particularly those with oropharyngeal dysfunction are at risk of poor nutritional status. Determining the need and the mode of nutritional intervention is multifactorial and requires multiple methodologies. First-line treatment typically involves oral nutritional support for those children who are safe to consume an oral diet. Enteral tube feeding may need to be considered in children with undernutrition where poor weight gain continues despite oral nutritional support, or in those with oropharyngeal dysphagia and an unsafe swallow. Estimates for energy and protein requirements provide a starting point only, and ongoing assessment and monitoring is essential to ensure nutritional needs are being met, that complications are adequately managed and to avoid over or under feeding.European Journal of Clinical Nutrition 12/2013; · 2.76 Impact Factor
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ABSTRACT: Objective: To compare Dixon-based MRI techniques for intramuscular fat quantification at 3 T with MR spectroscopy (MRS) in vitro and in vivo. Methods: In vitro, two- three- and four-point mDixon (Philips Medical Systems, Best, Netherlands) sequences with 10°, 20° and 30° flip angles were acquired from seven test phantoms with sunflower oil-water percentages of 0-60% sunflower oil and calculated fat-water ratios compared with MRS. In vivo, two- three- and four-point mDixon sequences with 10° flip angle were acquired and compared with MRS in the vastus medialis of nine healthy volunteers (aged 30.6 ± 5.3 years; body mass index 22.2 ± 2.6). Results: In vitro, all mDixon sequences correlated significantly with MRS (r > 0.97, p < 0.002). The measured phantom percentage fat depended significantly on the flip angle (p ≤ 0.001) and mDixon sequence (p = 0.005). Flip angle was the dominant factor influencing agreement with MRS. Increasing the flip angle significantly increased the overestimation of the mDixon sequences compared with MRS. In vivo, a significant difference was observed between sequences (p < 0.001), with all mDixon sequences overestimating the intramuscular fat content of the vastus medialis muscle compared with MRS. Two-point mDixon agreed best with MRS and had comparable variability with the other mDixon sequences. Conclusion: This study demonstrates that mDixon techniques have good linearity and low variability for use in intramuscular fat quantification. To avoid significant fat overestimation with short repetition time, a low flip angle should be used to reduce T1 effects. Advances in knowledge: This is the first study investigating the optimal mDixon parameters for intramuscular fat quantification compared with MRS in vivo and in vitro.The British journal of radiology 02/2014; · 2.11 Impact Factor
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ABSTRACT: It is not possible to measure the height of a patient with contractures in the normal way. On occasions, health professionals need to measure the height directly of patients with contractures because: (i) the patient is unable to report his/her height as a result of a lack of mental capacity and (ii) there is no-one available to report the height or the reported height is obviously inaccurate. Height derived from ulna length is an option but, in some individuals, it can be conspicuously inaccurate. Therefore, we have attempted to develop and validate a simple bedside method using a tape measure. Twenty-four normal healthy adult volunteers were recruited into the study. They were positioned on a hospital bed in three different standardised positions simulating patients with typical contractures. They were measured in each position by four measurers using blanked out tape measures. The participants were then measured standing giving a 'true' height. Ulna length was also measured. The mean of the tape-measured heights was 2.3 cm taller than the 'true' height (95% confidence interval = 4.6-9.3). The measurement in all three positions gave an over-estimate of the height, whereas the ulna-derived height gave an under-estimate (2.2 cm). The estimated reliability between measurers (intraclass correlation coefficient) was 0.94 with a 95% confidence interval (0.91-0.96). This new method is giving an acceptable estimate of the height of contracted patients with a good inter-rater reliability. It comprises a useful additional tool for measuring the height of people with contractures.Journal of Human Nutrition and Dietetics 07/2013; · 1.97 Impact Factor