Algorithm of formula selection for nutritional support and enteral nutrition in children with cerebral palsy

Abstract

Objective. To develop an algorithm for selecting a nutritional support / enteral nutrition product in children with cerebral palsy based on nutritional status indicators and the nature of concomitant pathology. Patients and methods. This study included 261 children aged 2 to 17 years (159 (61%) boys) diagnosed with spastic cerebral palsy. All children were divided into different groups according to the Gross Motor Function Measure (GMFM) level and feeding method (per os / gastrostomy). Nutritional status and characteristics of gastrointestinal symptoms were investigated, and actual nutrition was assessed. Body composition was evaluated by measuring triceps skinfold thickness and mid-upper arm circumference. Dietary adjustments were made considering the identified disorders of nutritional status and gastrointestinal function. Follow-up examination was performed after 6–9 months to assess the efficacy of diet therapy. Results. An underweight condition was detected in 40–79% of cases and was most frequently observed in groups IV, V, VTF of GMFCS levels: 14 (21.9%), 33 (40.7%) and 18 (39.1%) children, respectively (pVTF–V–IV < 0,001). Stunting was recorded in groups IV, V, and VTF. The most common gastrointestinal disorder was constipation (47.1%). Energy deficiency was registered in 213 (81.6%) children and amounted to 12.3–61.8% from the norm. The rate of macronutrient deficiency: protein – 11.4–60.0%, fats – 10.9–61.6%, carbohydrates – 20.3–72.6% from the individual norm / recommended dietary intake. In the follow-up period, statistically significant positive dynamics of weight and height indicators, an increase in fat mass and skeletal muscle mass, and relief of gastrointestinal manifestations were observed against the background of diet therapy. Analysis of findings allowed us to develop an algorithm for selecting a nutritional support / enteral nutrition product for children with cerebral palsy. Conclusion. Evaluation of nutritional status and correction of its disorders requires a comprehensive approach in patients with cerebral palsy. In the absence of positive dynamics after 1–3 months, it is necessary to revise a dietary regimen. Key words: diet therapy algorithm, cerebral palsy, motor activity level, underweight, nutritional support