Food group energy intake of pre-school aged children with cerebral palsy in relation to gross motor function and oropharyngeal dysphagia

Abstract

Objective: To examine energy intake from food groups in relation to feeding difficulties and gross motor function in preschool aged children with cerebral palsy (CP). Design: Prospective population based cohort study. Method: One hundred and eighteen children with CP (81 male), mean (SD) age 2.7 years (0.9) were recruited from the community. GMFCS levels: I=48, II=17, III=18, IV=12, V=23. Sixty six children had no, 24 mild, and 28 moderate/ severe oropharyngeal dysphagia (OPD). Sixteen children were partially/completely tube-fed. Food groups were manually categorised according to the Australian Dietary Guidelines. Dietary energy intake (KJ) and food group intake were determined using a parent completed validated 3-day weighed-foodrecord, and analysed by Foodworks™. Severity of OPD was determined by parent-reported questionnaire. Data analysis utilised ANOVA and Welch's tests (SPSS). Significance was set at p<0.05. Data are mean difference (95% confidence interval). Results: The greatest contribution to overall daily energy intake (excluding tube feeds) for children in GMFCS V and those with moderate/severe OPD was from dairy, and from 'extras' (non-core foods) in children GMFCS I-IV. Children in GMFCS V had lower energy intakes from all food groups (dairy: -817(-1333 to -237), meat: -228(-406 to -49), fruits: -342(-474 to -211); 'extras': -1243(-1647 to -840), cereals: -590(-821 to -358)) except vegetables, than GMFCS I. Children in GMFCS V had lower overall energy intakes from meats (-264(-489 to -39)); and from fruit and 'extras' than those in GMFCS II (fruits: -226(-430 to -22); 'extras': -1234(-2065 to -403)) and III (fruits: -270(-451 to -90); 'extras': -1135(-1902 to -368)) and cereals than GMFCS II (-771(-1266 to -277)), III (-562(-922 to -202)) and IV (-425(-847 to -202)). For children with no/ mild OPD, 'extras' contributed the greatest overall energy intake (excluding tube feeds). Children with moderate/severe OPD had lower energy intakes from all food groups except vegetables than those with no OPD (meat: -180(-327 to -34); dairy: -617(-1060 to -175); cereals: -500(-760 to -239); fruits: -281(-381 to 182); 'extras': -1148(-1553 to -742)). Children with moderate/severe OPD had lower intakes of cereals, fruits and 'extras' than those with mild OPD (cereal: -409(-725 to -92); fruits: -306(-490 to 123); 'extras': -924(-1417 to -431)). Conclusion: Dairy provided the greatest energy for children in GMFCS V and those with severe OPD; these children had lower intakes from all food groups. Intakes of vegetables were low across all groups. The greatest daily energy intake from 'extras' for children in GMFCS 1-IV may reflect the intentional use of these foods to increase the energy intakes of children with CP. These results highlight that recommendations for food group intakes may not be relevant in the CP population due to altered energy requirements.L6148361072017-03-21 <br />