Day-to-day variation in energy intake of preschool-aged children with cerebral palsy: Relationship to gross motor function and oropharyngeal dysphagia

Abstract

Objective: To determine day-to-day variation in energy intake for preschool-aged children with cerebral palsy (CP) related to gross motor functional severity and oropharyngeal dysphagia (OPD), in comparison to children with typical development (CTD). Design: Prospective population based cohort study. Method: 135 children with CP (91 male), mean (SD) age 2.9 years (0.9) and 17 CTD (11 male) age 3.7 years (0.5) were recruited from the community. GMFCS levels: I=64, II=17, III=18, IV=13, V=23. Dietary energy intake was determined using a parent completed validated 3-day weighed-foodrecord, and analysed using FoodworksTM. Coefficients of variation (CV) for daily energy intake were calculated for each child. Severity of OPD and feeding method were determined by parented reported questionnaire. Ambulatory children (GMFCS I-II) were compared to partial ambulators (GMFCS III) and wheelchair dependent children (GMFCS IV-V). Data analysis utilised ANOVA, and independent t-tests (SPSS). Significance was set at p<0.05. Data are mean difference (95% confidence interval). Results: hundred and thirty children with CP reported method of feeding: total oral intake=87, total oral intake with modifications= 27, partially tube feed=11 and total tube fed=5; OPD were: no problems=75, mild=29, moderate=14 and severe OPD=12. Mean energy intake for CP=4.8MJ/day and CTD=5.2MJ/day. Mean CV (±SD) in energy intake was greater for CP (18.1 (11.2)%) than for CTD (15.7 (11.4)%) though this difference was not statistically significant (p=0.469). Children classified as GMFCS I-II had greater dayto- day variation in energy intake compared to GMFCS IV-V (MD 5.58 (95%CI -0.36 to 10.80), p=0.033). Children with no OPD (MD 11.9 (95%CI 3.3-20.5), p=0.003) or mild OPD (MD 13.5 (95%CI 4-23), p=0.002) had greater day-to-day variation in energy intake than those with severe OPD. Children with a greater dependence on tube feeds had a lower variation in energy intake (full oral intakes compared to: partially tube-fed (MD 17.6 (95%CI 4.92-30.28), p=0.002); totally tube fed (MD 13.7 (95%CI 0.2-27.1), p=0.045). Conclusion: Children who are ambulatory, have no or mild OPD, and have a total/predominant oral intake had greater variation in daily energy intakes. This maybe reflective of access to a wider range of foods and less dependence on others for feeding. Minimal variation for children who were tube fed and/or had severe OPD suggests that fewer days of dietary recording may be required to establish estimates of energy intake. The levels of day-to-day variation in energy intake identified should be considered to increase reliability of nutrition assessments and develop suitable interventions.L6148363042017-03-21 <br />