Rogelio Troyo Sanromán

Energy expenditure is associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy

INTRODUCTION proper estimation of energy requirements in children with cerebral palsy (CP) is essential in ensuring that their energy needs are optimally met. OBJECTIVE therefore, the purpose of this study was to demonstrate that resting energy expenditure (REE) and total energy expenditure (TEE) are associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy. METHODS a cross-sectional study included 79 participants with spastic CP from 24 months to 16 years nine months. Weight and height (estimated by lower leg length) were obtained; body composition and energy expenditure were estimated by bioelectrical impedance analysis. ANOVA, post hoc tests, the Pearson correlation and determination coefficients (R2) were performed. RESULTS significant gradual increases according to age in REE and TEE (both in kcal/d) were observed. There were highly significant positive correlations between REE and TEE (kcal/d, kcal/cm/d) with fat-free mass (FFM) and fat mass (FM), but negative correlations between REE (kcal/ kg/d) with body composition and energy indicators. FFM and total body water, and to a lesser extent FM, explained a high percentage of the direct variability of REE and TEE in kcal/d and the inverse in kcal/kg/d. CONCLUSIONS as age increased, energy expenditure also increased. The estimated energy expenditure in kcal/cm/d did not differ with age and sex. The estimated energy expenditure, based on height, would be a practical and reliable method for estimating energy expenditure and ensuring adequate nutritional status.

Patient-Generated Subjective Global Assessment of nutritional status in pediatric patients with recent cancer diagnosis

BACKGROUND The subjective global assessment (SGA) is a simple, sensitive tool used to identify nutritional risk. It is widely used in the adult population, but there is little evidence on its effectiveness in children with cancer. OBJECTIVE This cross-sectional study was undertaken to demonstrate significant correlation between a simplified version of the Patient-Generated SGA (PG-SGA) and anthropometric assessment to identify nutritional status in children recently diagnosed with cancer. METHODS The nutritional status of 70 pediatric cancer patients was assessed with the PG-SGA and anthropometric measurements. The relation between the assessments was tested with ANOVA, independent samples t-test, Kappa statistic, and non-parametric Spearman and Kendall correlation coefficient. The PG-SGA divided the patients into four groups: well nourished, mildly, moderately and severely malnourished. RESULTS The prevalence of malnutrition according to the PG-SGA was 21.4%. The correlations (r ≥ 0.300, p < 0.001) and the concordance (k ≥ 0.327, p < 0.001) between the PG-SGA and anthropometric indicators were moderate and significant. CONCLUSIONS The results indicate that the PG-SGA is a valid tool for assessing nutritional status in hospitalized children recently diagnosed with cancer. It is important to emphasize that the subjective assessment does not detect growth retardation, overweight or obesity.

Height and Body Mass Index Estimated by Alternative Measures in Children with Spastic Quadriplegic Cerebral Palsy and Moderate/Severe Malnutrition

Objective : To demonstrate that alternative measures are reliable predictors of height in children with spastic quadriplegic cerebral palsy (CP) and moderate/severe malnutrition and in healthy children. Methods: In an intervention study, thirteen patients with CP (10 females and 3 males, with an average age of 9 y 11 m±2 y 3 m) with Gross Motor Function Classification System level V and moderate/severe malnutrition were included. They were compared with 57 healthy participants (31 Original Research Article García-Contreras et al.; BJMMR, 14(12): 1-10, 2016; Article no.BJMMR.25458 2 females and 26 males with an average age of 8 y 7 m±10 m). Weight, height and alternative measures to height were obtained. ANOVA, Student’s t test, the Mann-Whitney U test, the Wilcoxon test, and the Pearson correlation were used. Results: Significant differences were observed in weight, height and alternative measures between children with CP and healthy children (p < 0.001). In healthy children, knee height (KH) and lowerleg length (LLL) were similar to standing height. The correlation coefficients between height and alternative measures as well as correlations between the heights estimated by alternative measures were higher in children with CP than in healthy children. Conclusion: KH was the most appropriate measurement to estimate height in children with spastic quadriplegic CP and in healthy children. In the absence of a segmometer, height can be estimated by LLL in children with spastic quadriplegic CP and healthy children. The anthropometric indexes height/age and BMI were more appropriately obtained by the height estimated by KH or LLL.

The distribution of the indicator height for age of Mexican children and adolescents with Down syndrome according to different reference standards

OBJECTIVE To compare the indicator height for age in Mexican children with Down Syndrome (DS) with two different reference patterns of growth (American and Spanish) that might be suitable for the Mexican population. METHODS A cross-sectional study was performed including 235 Mexican children and adolescents of both sexes with DS aged 45 days to 16 years enrolled in two specialized schools in the metropolitan area of Guadalajara. The dependent variables were weight/age; height/age; weight/ height and BMI. The data expressed was percentiles and the chi-square test was used to compare the distribution of the height/age index with American and Spanish reference patterns. In addition, a chi-square test was performed for the goodness of fit of the height/age index, with breakpoints lower and greater than the 50th percentile. RESULTS The percentage of participants who were below the 50th percentile in the height/age index was significantly higher with the Spanish vs. the American reference pattern. The chi-square test for goodness of fit showed that the frequency of cases located below the 50th percentile in the height/age index was significantly higher with the American pattern in the age groups of 0 to 36 months (p = 0.022) and 37 to 72 months (p <0.001), but it was not significant (p = 0.225) in the older than 72 months age group. CONCLUSION The American reference pattern is a better fit for the growth of Mexican children with DS compared with the Spanish reference pattern, and the distribution profile obtained with the standard growth and WHO reference was not suitable for the assessment of children with Down syndrome.