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Nutrition
ASSESS NUTRITIONAL STATUS

3

Anthropometric assessment

Anthropometric assessment icon
  • Weight
  • Height / Length
  • Length segments
  • Mid upper arm circumference (MUAC)
  • Subcutaneous folds

From the determinations of weight and height/length, the corresponding z-scores and percentiles will be calculated.

These measurements will be useful to calculate the body mass index (BMI) and its corresponding z-score and percentile.

It is necessary to carry out a prospective and individualized minimum follow-up every 6 months although frequency can be increased in infants. Specific growth indicators are available for children with CP but the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) does not recommend the use of these to detect malnutrition or risk of malnutrition, but the ones of children with normal growth (WHO).6,7 However, the same patterns should be always used in order to evaluate progression.6

Malnutrition Risk Criteria

  • BMI z score >-2 and <-1 (percentile >p2 and <p10)
  • AMUAC z score <-1 (percentile <p10)
  • Subcutaneous folds percentile <p108

Malnutrition Criteria

  • BMI z score <-2 (percentile <p2)
  • MUAC z score <-2 (percentile <p2)
  • Subcutaneous folds percentile <p28
Child with CP

Formulas to estimate stature from segmental measures6

Equations for estimation of stature from segmental measures

Segmental measure Ecuation to estimate stature (S) (cm) SE of estimate (cm)
Children with CP (age: birth – 12 years)
Upper arm length, UAL S = (4.35 x UAL) + 21.8 1.7
Tibial length, TL S = (3.26 x TL) + 30.8 1.4
Knee height, KH S = (2.69 x KH) + 24.2 1.1
SE = standard error

Estimation of stature (S) from knee height (KH) in children aged 6-18 years

Race and gender Ecuation to estimate stature (cm) SE of estimate (cm)
Derived in typically developing children, validity demonstrated in a small group of children with CP
White males S = (2.22 x KH) + 40.54 4.21
Black males S = (2.18 x KH) + 39.6 4.58
White females S = (2.15 x KH) + 43.21 3.90
Black females S = (2.02 x KH) + 46.59 4.39
SE = standard error

Estimation of height (H) from ulna length (UL)

Gender Ecuation to estimate height (cm) Root Mean-Square Error
Derived in typically developing children aged 5-19 years. Not validated in children with CP. Performed better in typically developing children than prior ulnar equations, which had shown validity in CP (construct validity)
Males H = 4.605 UL + 1.308 A + 28.003 3.896
Females H = 4.459 UL + 1.315 A + 31.485 3.896
A = age
Estimation of stature

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4 Supplementary
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1 Patient
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References

  1. Samson-Fang L, Bell KL. Assessmentof growth and nutrition in children with cerebral palsy. Eur J Clin Nutr. 2013; 67: S5-S8.
  2. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for- age, weight-for-age, weight-for-length, weight-for- height and body mass index-for-age: Methods and development. Geneva: World Health Organization, 2006.
  3. Romano C, van Wynckel M, Hulst J et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children with Neurological Impairment. J Pediatr Gastroenterol Nutr. 2017; 65(2): 242-64.