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Reduced body protein in children with spastic quadriplegic cerebral palsy^1,2,3

¹ From the Department of Gastroenterology (FEA, HS, and EVO), the James Fairfax Institute of Paediatric Nutrition (JRA, KJG, and MAG), the University of Sydney (FEA and SLC), and the Department of Nuclear Medicine (JNB and RBH-G), The Children’s Hospital at Westmead, Westmead, Australia

Background: No studies have directly measured body protein or validated skinfold-thickness anthropometry and dual-energy X-ray absorptiometry (DXA) to assess body protein in children with spastic quadriplegic cerebral palsy (SQCP).

Objective: We aimed to measure and evaluate body protein and to determine whether skinfold-thickness anthropometry and DXA can predict body protein in children with SQCP.

Design: This was a cross-sectional study of 59 children (22 girls, 37 boys) aged 3.9–19.5 y with SQCP. The children underwent measurements of anthropometric indexes, lean tissue mass by DXA (LTM_DXA), and total body protein by neutron activation analysis (TBP_NAA). In addition, TBP was estimated from both skinfold-thickness anthropometry (TBP_SKIN) and DXA (TBP_DXA). The agreement of TBP_SKIN and TBP_DXA was tested against TBP_NAA by using Bland and Altman plot analysis.

Results: Height and weight SD scores ( ± SD: –3.1 ± 1.6 and –4.8 ± 5.3, respectively) were significantly lower than reference data in the children with SQCP (P < 0.001). TBP_NAA for age and height was low in the children with SQCP (P < 0.001): 56.1 ± 17.3% and 81.5 ± 15.7%, respectively, of the values predicted from control data. TBP_SKIN and TBP_DXA were both highly correlated with TBP_NAA: r = 0.90, P < 0.001, and r = 0.91, P < 0.001, respectively. Despite these significant correlations, agreement analyses showed wide variation of up to 33.3% of the mean for both methods.

Conclusions: Body protein in children with SQCP is significantly reduced for age and height. Skinfold anthropometry and DXA show wide variation in estimation of body protein compared with NAA in this group of children.

Key Words: Cerebral palsy • children • anthropometry • total body nitrogen • body protein • neutron activation analysis • dual-energy X-ray absorptiometry • lean tissue mass

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