Validation of skinfold measurements and bioelectrical impedance analysis in children with severe cerebral palsy: A review

Intellectual Disability Medicine, Department of General Practice, Erasmus MC, Rotterdam, the Netherlands.
Clinical nutrition (Edinburgh, Scotland) (Impact Factor: 4.48). 09/2009; 29(2):217-21. DOI: 10.1016/j.clnu.2009.07.009
Source: PubMed


Accurately measuring nutritional status in children with severe cerebral palsy (CP) is a challenge. This review seeks to assess the validity of skinfold measurements and bioelectrical impedance analysis (BIA) for measuring body composition in children with severe CP.
We executed a literature search on the validation of both methods in children with severe CP. To be eligible for inclusion, a study had to report on a statistical comparison between these two methods and any method of reference. The QUADAS tool was used for quality assessment.
The search strategy resulted in 1549 studies of which 5 studies eventually met the inclusion criteria. When comparing body composition outcomes of skinfold measurements to a reference method, correlation coefficients were found ranging from 0.406 to 0.988. Correlation coefficients between body composition data of BIA and a reference method ranged from 0.515 to 0.95.
Although a number of authors found favorable agreement between skinfold measurements and BIA in comparison with reference methods, the small numbers studied, the lack of methodological quality measured by QUADAS, and the use of inappropriate analytical methods hamper solid conclusions.

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    • "The Slaughter equation was initially developed to estimate fat percentage of healthy children aged 7-18 years old [10]. Studies tested its adaptation for children with CP and found correlations ranging from 0.406 to 0.690 for fat mass estimative [3] [8] [9]. These studies pointed to the need to developing specific equations for estimating body fat in children with CP, and also for children with CP in the age groups up to seven years old, since the specificity of a skinfold equation helps in reducing the error estimative and increases the reliability of the information obtained. "
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    ABSTRACT: Nutritional changes are commonly related to children with cerebral palsy (CP), since these are problems as: dysphagia, vomiting and gastrointestinal reflux. For nutrition-al monitoring, body composition has become an important tool and has been present in this population assessments routine. In this sense, the aim of this study was to develop an equation for body composition estimate for children with cerebral palsy, aged between 5 and 6 years, using skinfolds, from the results of body composition obtained by Dual Energy X-rays Absor-metry (DEXA). The study included 10 male children with cerebral palsy, aged between five and six-years-old, who parti-cipated in the physical therapy intensive program in Vitória research center, Curitiba, Brazil. Participants were assessed by: the Gross Motor Function Classification System; DEXA; and skinfold thickness. The skinfolds that showed better corre-lation with the total fat percentage and segmental fat percen-tage were: biceps and abdominal. The results of the regression analysis obtained equations to estimate the fat percentage by skinfold thickness with R 2 : 1.000 and 0.971, to seven and two skinfold thickness, respectively. In this sense, it is recommend-ed to use the equation that utilizes the biceps and abdominal skinfolds thickness to estimate fat percentage of children with cerebral palsy, as this presents good estimation indicators.
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    ABSTRACT: Cerebral palsy is often accompanied by abnormalities of growth and nutrition; children with severe motor impairments are most at risk. Nutrition, neurological, and endocrine factors all contribute to suboptimal growth. Poor growth and nutrition are associated with poor general health outcomes and reduced levels of participation, and therefore warrant careful evaluation and appropriate intervention. The lack of normative data combined with the complex interaction of nutrition and nonnutrition factors contributing to growth in this population present real difficulties in management. Particular care is needed to avoid overfeeding and the resultant increase in fat mass and associated morbidity.
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    ABSTRACT: Accurate prediction equations for estimating body composition and total energy expenditure (TEE) in children with severe neurologic impairment and intellectual disability are currently lacking. The objective was to develop group-specific equations to predict body composition by using skinfold-thickness measurements and bioelectrical impedance analysis (BIA) and to predict TEE by using data on mobility, epilepsy, and muscle tone. Measures of body composition with the use of skinfold-thickness measurements (percentage of body fat) and BIA (total body water) were compared with those from isotope dilution (reference method) by using intraclass correlation coefficients (ICCs) and Bland and Altman limits of agreement analyses. With the use of the same methods, the outcomes of cerebral palsy-specific TEE equations were compared with those of the doubly labeled water method (reference method). Group-specific regression equations were developed by using forward-stepwise-multiple-correlation-regression analyses. Sixty-one children with a mean (±SD) age of 10.1 ± 4.3 y (32 boys) were studied. A new equation based on the sum of 4 skinfold-thickness measurements did not improve agreement (n = 49; ICC = 0.61), whereas the newly developed BIA equation-which includes tibia length as an alternative for standing height-did improve agreement (n = 61; ICC = 0.96, SEE = 1.7 kg, R(2) = 0.92). The newly developed TEE equation, which uses body composition, performed better (n = 52; ICC = 0.87, SEE = 180 kcal, R(2) = 0.77) than did the equation of Schofield (n = 52; ICC = 0.82, SEE = 207 kcal, R(2) = 0.69). Current cerebral palsy-specific equations for measuring body composition and energy expenditure are inaccurate. BIA is more accurate at assessing nutritional status in this population than is the measurement of skinfold thickness. The newly developed TEE equation, which uses body composition, provides a reasonable estimate of energy expenditure in these children despite its variability.
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