Features of component body composition in children with infantile cerebral palsy

Relevance

Cerebral Palsy (CP) is a socially significant disease, ranking second in the structure of childhood disability [1]. It is also a serious pediatric problem due to its high prevalence, early onset of disability, and significant deterioration in patients' quality of life [2]. In addition to motor impairments characteristic of the core disease, these children often suffer from musculoskeletal, digestive, and endocrine system issues, which collectively contribute to the development of nutritional deficiencies. The presence of these deficiencies, in turn, reduces the effectiveness of rehabilitation, which typically focuses precisely on motor skills.

The prevalence of nutritional disorders in this patient group varies widely and, according to literature, can reach up to 70% [3, 4, 5]. The high frequency of nutritional disorders is largely due to the severity of the neurological deficit, significant motor limitations [6], and the presence of dysphagia [7].

In children with CP, nutritional insufficiency develops under the influence of multiple factors, including difficulty eating, impaired chewing and swallowing, gastrointestinal manifestations (such as gastroesophageal reflux and constipation), and metabolic disturbances associated with altered metabolism. All this leads to deficiencies in macro- and micronutrients, reduced muscle mass, and delayed physical development, which, in turn, exacerbates the underlying disease and worsens the patients' quality of life. Timely diagnosis and correction of the nutritional status in children with CP play a key role in improving their overall condition, enhancing the effectiveness of ongoing rehabilitation, and helping to prevent complications [8].

Objective

To study the characteristics of the body composition in children with CP using bioimpedance analysis.

Materials and Methods

The study of body composition was conducted in children diagnosed with CP receiving treatment at the Yaroslavl Regional Children's Clinical Hospital. The mean age of the children was 8.7 ± 3.3 years (n=100), of whom 38% (n=38) were male and 62% (n=62) were female. A brief characteristic of the group is presented in Table 1.
Assessment of anthropometric indicators was performed using specialized standards for children with CP (Life Expectancy Project, 2011) [9]. The severity of CP was determined using the GMFCS (Gross Motor Function Classification System) [10].

Table 1. Characteristics of the Studied Group of Children with Cerebral Palsy (n=100)

The body composition study was performed on children over 5 years old using the bioimpedance analysis method [11] with the determination of the following absolute and relative indicators: Fat Mass (FM) and Fat-Free Mass (FFM), Active Cell Mass (ACM), fluid content (total and extracellular), Phase Angle (PA), and Basal Metabolic Rate (BMR).
Statistical processing was performed using the Jamovi 2.6.26 application, employing standard descriptive methods (Me, Q1, Q3), calculation of Pearson's Chi-squared (χ²) for comparing qualitative variables, and the Mann-Whitney U test for quantitative features with a distribution different from normal, considering significance at p < 0.05. Spearman's correlation method was used to assess the strength and direction of the relationship between variables.

Results

The conducted analysis revealed significant differences in body composition among children with cerebral palsy depending on the presence of nutritional insufficiency according to somatometry data. In patients with signs of malnutrition, a decrease in Fat Mass (40%) was significantly more frequent (χ²=4.762; df=1; p < 0.05) – this indicator reflects the degree of development of all adipose tissue, including the visceral component. The Fat Mass Index (FMI) was below normal in 54% of children. Furthermore, even among patients with normal physical development indicators (36%), a decrease in FM (14%) and ACM (18%) was observed, which may indicate hidden trophic status impairments. Increased Fat Mass was found in children without nutritional deficiency and was associated with normal and high anthropometric indicators (p=0.022).
In children with body weight deficit according to physical development assessment, a significant decrease in ACM (p=0.0481) and PA (p=0.0067) was noted. Active Cell Mass reflects the sufficiency of the body's protein pool, and the Phase Angle correlates with the content of metabolically active tissues, allowing their use for assessing nutritional status [12]. Patients in the "red zone" of the table based on body weight had critically low PA (p=0.012), ACM (p=0.013), and iACM (p=0.00228) values. Data analysis established that a decrease in ACM (below -1 SDS) increases the likelihood of protein-energy malnutrition by 1.5 times (95% CI: 0.98-2.47).
Of particular clinical concern is the identification of deviations in body composition in 28.6% of patients with normal anthropometric indicators. Despite the absence of obvious signs of nutritional insufficiency based on physical development assessment, these children showed a decrease in FM (17.9%), FFM (24.6%), ACM (21.4%), and BMR (16%).
In children with severe motor impairments (GMFCS III–V), a decrease in Fat Mass (FM), Fat Mass percentage (FM%), Active Cell Mass (ACM), Skeletal Muscle Mass (SMM), and Fat-Free Mass (FFM) was observed significantly more often (Table 2).

Table 2. Differences in Body Composition in Patients Depending on the Severity of Motor Disorders

Dysphagia, leading to impaired nutrient intake, which negatively affects physical development and body composition, can be considered one of the causes of nutritional insufficiency development. According to the study results, children with signs of dysphagia (36% according to the EDACS scale) had significantly lower body composition indicators, including Fat Mass (FM), Fat Mass percentage (FM%), Active Cell Mass (ACM), Fat-Free Mass (FFM), and Phase Angle (PA). Furthermore, the severity of dysphagia demonstrated a direct correlation with the degree of motor limitations on the GMFCS scale (rs=0.82; p < 0.05).
The greatest deviations in body composition indicators (PA, ACM, ACM%) were noted in double hemiplegia (p < 0.05) when compared with spastic diplegia. In the atonic-astatic form of CP, the median values of Phase Angle, Fat Mass, and Active Cell Mass significantly exceeded the corresponding indicators in spastic diplegia.
According to the correlation analysis, direct relationships were determined between PA and FFM (rs=0.226, p < 0.05), ACM (rs=0.331, p < 0.05), SMM (rs=0.218, p < 0.05), and BMR (rs=0.331, p < 0.05). Correlations were found between ACM and body weight (rs=0.950, p < 0.05), height (rs=0.923, p < 0.05), waist circumference (rs=0.822, p < 0.05), and hip circumference (rs=0.914, p < 0.05).
Upon repeated assessment of body composition after 12 [8; 15] months of observation, a significant decrease in Active Cell Mass (ACM), Fat-Free Mass (FFM), and Skeletal Muscle Mass (SMM) indicators was revealed compared to the initial values (see Fig.). These changes correlate with the negative dynamics of physical development [13], manifested by an increase in the proportion of children with signs of malnutrition during the observation period.

Fig. 1. Dynamics of Body Composition Indicators in Children with Cerebral Palsy

Conclusions

Characteristic changes in body composition indicating nutritional insufficiency were identified in patients with cerebral palsy: a decrease in Active Cell Mass, Fat Mass, and Phase Angle. It should be noted that deviations in body composition are recorded even in children with normal anthropometric indicators. The conducted analysis demonstrated an interrelationship between the severity of motor impairments, the presence of dysphagia, the form of CP, and body composition parameters. A progressive decrease in these indicators over time was noted. The obtained results justify the necessity for regular monitoring of body composition in children with CP as part of comprehensive rehabilitation. This approach ensures the early detection of nutritional disorders and an objective assessment of the effectiveness of the nutritional support provided.