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The Pediatric Subjective Global Nutrition Assessment Classifies More Children With Cerebral Palsy as Malnourished Compared With Anthropometry

      Abstract

      Background

      Nutrition assessment is multidimensional; however, much of the literature examining the nutritional status of children with cerebral palsy (CP) focuses on a single dimension.

      Objective

      The aim of the study was to evaluate nutritional status in children and adolescents with CP by comparing results from the Pediatric Subjective Global Nutrition Assessment (SGNA) with results from traditional anthropometric measures.

      Design

      This study was a cross-sectional observational study.

      Participants/setting

      This study was conducted in a tertiary hospital outpatient setting in Brisbane, Australia, from February 2017 to March 2018. A total of 89 children (63 boys) with CP aged between 2 and 18 years of age were included. All Gross Motor Function Classification System levels were observed. The majority of children were in Gross Motor Function Classification System I and II (57, 64%) compared with Gross Motor Function Classification System III to V (32, 36%). Children with feeding tubes and those acutely unwell or hospitalized were excluded.

      Main outcome measures

      Children were classified as well nourished, moderately malnourished, or severely malnourished by dietitians using the SGNA. Weight, height, body mass index (BMI), triceps skinfold thickness, subscapular skinfold thickness, and mid upper arm circumference were measured and converted to z scores to account for age and sex differences. Moderate malnutrition was defined by z scores −2.00 to −2.99 and severe malnutrition as ≤−3.00 z scores.

      Statistical analysis performed

      Multinomial logistic analyses were used to compare results from the SGNA and each single measurement. Continuous outcomes were transformed into z scores. Agreement was assessed with 2 categories: not malnourished and malnourished. Comparison statistics included percent agreement, sensitivity, and specificity.

      Results

      More children were classified as moderately or severely malnourished by SGNA than any of the anthropometric z score cutoffs. The majority of children were well nourished (n = 63) with 20 (22%) moderately malnourished and 6 (7%) severely malnourished by SGNA. The SGNA classified 11 children as malnourished that were not classified as malnourished by BMI. Children with moderate or severe malnutrition by SGNA had lower weight (P < .001, P < .001), BMI (P < .001, P < .001), mid upper arm circumference (P < .001, P < .001), triceps skinfold thickness (P = .01, P = .007), and subscapular skinfold thickness (P = .005, P = .02) z scores than well-nourished children.

      Conclusion

      The SGNA identified more potentially malnourished children including children classified as well nourished by the single measurements such as BMI, height, and weight. The SGNA provided a clinically useful multidimensional approach to nutrition assessment for children with CP.

      Keywords

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      Biography

      K. L. Bell is an accredited practicing dietitian and acting dietitian consultant, Dietetics and Food Services, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia; and an honorary senior lecturer, Child Health Research Centre, The University of Queensland, Brisbane, Australia.

      Biography

      K. A. Benfer is a postdoctoral research fellow, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia.

      Biography

      R. N. Boyd is scientific director, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia.

      Biography

      J. J. Garvey is a registered dietitian and associate lecturer, Child Health Research Centre, The University of Queensland, Brisbane, Australia.

      Biography

      R. Haddow is accredited practicing dietitian and Body Composition Laboratory manager, Child Health Research Centre, The University of Queensland, Brisbane, Australia.

      Biography

      P. S. W. Davies is professor, Child Health Research Centre, The University of Queensland, Brisbane, Australia.

      Biography

      R. S. Ware is professor of biostatistics, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.

      Biography

      T. A. Patrao is statistician, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.

      Biography

      J. C. Arvedson is a clinical professor, Children’s Hospital of Wisconsin-Milwaukee, Medical College of Wisconsin-Milwaukee.

      Biography

      K. Weir is principle research fellow, School of Allied Health Sciences, Griffith University, Gold Coast, Australia; and principle research fellow, Gold Coast University Hospital, Gold Coast Health, Southport, Australia.