Dietary approaches for atherosclerotic cardiovascular disease prevention in cerebral palsy

Abstract

Atherosclerotic cardiovascular disease (ASCVD) affects approximately 523 million individuals globally and the burden of ASCVD has nearly doubled since 1990. In addition to improving ASCVD prevention efforts in the general population, special consideration must also be directed towards vulnerable patient populations. Cerebral palsy (CP) is a heterogeneous class of disorders that involve nonprogressive central motor dysfunction that affect muscle tone, posture, and movement, yet may also be accompanied by widespread secondary effects on cognitive and psychological development, growth, and life expectancy. Adults with CP have a near two-fold higher risk of ASCVD compared to adults without CP. Given the mobility restrictions of the disease, the primary focus here has been the high burden of physical inactivity and sedentary time. In addition to adequate physical activity, the cornerstone of ASCVD prevention includes adherence to a plant-based diet rich in fruits, vegetables, whole grains, legumes, nuts, and seeds. However, promoting a healthy diet among individuals with CP poses unique challenges because of the obesity risk associated with physical inactivity, but also due to potential CP-associated feeding difficulties. Beginning from a young age, the burden of obesity and undernutrition risk among individuals with CP poses unique challenges to clinicians and public health professionals. Therefore, studies that assess the role of diet with cardiometabolic health outcomes can contribute to ASCVD prevention efforts in individuals with CP and broader vulnerable patient populations. Brown et al. assessed diet quality and its association with cardiometabolic outcomes among 45 adults with CP. Notably, all 45 individuals consumed food orally, though 13 reported a certain degree of decline in the efficiency and safety with eating. The authors found that individuals with CP do not satisfy United States Department of Agriculture dietary requirements and that a considerable percentage of individuals had obesity (11%), hypertension (49%), and pre-diabetes (20%). The burden of ASCVD risk factors was thus comparable and/or slightly smaller than that of the general US population, though the authors correctly note that dietary modification continues to be an underemphasized modality for ASCVD risk modification in a considerable proportion of adults, especially among individuals with neurological disorders (including CP). This exploratory study lays the groundwork for an understudied area that deserves further attention. How feasible are dietary modifications for ASCVD risk reduction among patient populations with neurological disorders, such as persons living with CP? The lifespan approach to promoting cardiometabolic health is certainly important to consider here, as the development of optimal dietary behaviors starting from a young age among individuals with CP can facilitate primordial ASCVD prevention efforts. For example, special dietary planning to incorporate plant-based meals that meet calorie requirements, but that are also soft/palatable (such as vegetable pureeing), can provide nutrition in the setting of oral-motor dysfunction. Furthermore, caretakers and families should be educated on the importance of dietary approaches for achieving cardiometabolic health; hands-on teaching programs in the kitchen for this group may be an important step towards improving diet quality among young people with CP. Overall, individuals with CP require close primary and preventive care. Careful childhood dietary assessment can contribute to regular ASCVD risk assessment and follow-up among patients with CP, which will help to ensure timely preventive care in this vulnerable patient population. Future studies that longitudinaly assess dietary behaviors and ASCVD risk factors with clinical outcomes will be important contributions to our understanding of preventive cardiology care in persons with CP and other neurological disorders.