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.
- SourceAvailable from: ajcn.org[show abstract] [hide abstract]
ABSTRACT: The ratio of resting metabolic rate (RMR) to fat-free mass (FFM) is often used to compare individuals of different body sizes. Because RMR has not been well described over the full range of FFM, a literature review was conducted among groups with a wide range of FFM. It included 31 data sets comprising a total of 1111 subjects: 118 infants and preschoolers, 323 adolescents, and 670 adults; FFM ranged from 2.8 to 106 kg. The relationship of RMR to FFM was found to be nonlinear and average slopes of the regression equations of the three groups differed significantly (P less than 0.0001). For only the youngest group did the intercept approach zero. The lower slopes of RMR on FFM, at higher measures of FFM, corresponded to relatively greater proportions of less metabolically active muscle mass and to lesser proportions of more metabolically active nonmuscle organ mass. Because the contribution of FFM to RMR is not constant, an arithmetic error is introduced when the ratio of RMR to FFM is used. Hence, alternative methods should be used to compare individuals with markedly different FFM.American Journal of Clinical Nutrition 05/1992; 55(4):790-4. · 6.50 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: We measured body composition, resting metabolic rate (RMR), and total energy expenditure (TEE) in a group of adolescents with cerebral palsy (CP) and myelodysplasia (M) aged 13- to 20-y-old using indirect calorimetry and the doubly labeled water method. Fat-free mass (FFM), RMR, and TEE were significantly lower in both the CP and M groups than comparable measurements in a control group of normal adolescent males and females. The ratio of TEE to RMR did not differ between controls and ambulatory M and CP subjects. However, TEE/RMR was significantly lower in the nonambulatory M and CP subjects than in controls (p less than 0.01). Our data indicate that energy requirements are reduced in both populations because both FFM and activity are decreased. Although energy requirements were decreased in both groups, the relationships between FFM and body weight differed. FFM and body weight were significantly correlated with RMR only in the M group. These data suggest that the type of paralysis in a handicapped population may affect resting energy expenditure.Pediatric Research 02/1991; 29(1):70-7. · 2.67 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: We measured resting metabolic rate (RMR) in 12 persons (aged 10 to 30 years) with severe impairment of the central nervous system requiring gastrostomy feedings, and compared our findings with the RMR predicted from standardized equations. The RMR was 70.6% +/- 15.7% of that predicted from the Mayo Clinic nomogram, 63.7% +/- 18% of that predicted from the Food and Agriculture Organization/World Health Organization/United Nations University equation, and 75.4% +/- 17.3% of that predicted from the Robertson and Reid equation. Energy intake was 756 +/- 225 kcal/day and RMR was 708 +/- 231 kcal/day; RMR adjusted for changes in body energy stores was 729 +/- 231 kcal/day. No significant differences were found between energy intake and RMR, or between energy intake and the sum of RMR and changes in body energy stores. These findings demonstrate that standardized equations overestimate energy needs of individuals with severe CNS impairment. Measures of energy intake adjusted for weight changes represent a valid method to determine energy requirements in a group of individuals with severe CNS impairment. Length was found to be significantly correlated with RMR (r = 0.79; p < 0.01). When the regression equation was tested on another group of subjects from the same residential facility, the equation predicted energy needs reasonably well for those individuals with similar energy intakes but not for all patients with CNS disorders.Journal of Pediatrics 06/1995; 126(5 Pt 1):828-32. · 4.04 Impact Factor