Prospective cohort study of relationship between growth and diet, physical activity and time spent sedentary in preschool aged children with cerebral palsy

Abstract

Background: Children with cerebral palsy (CP), particularly those with severe motor impairment, grow differently than children with typical development. The effect of energy intake, habitual physical activity (HPA) and sedentary time (ST) on growth is not known. Aim: To investigate the longitudinal relationship between height Z-score (HZ), growth velocity Z-score (GvZ), energy intake, HPA and ST across all Gross Motor Function Classification System groups (GMFCS I-V) in young children with CP. Method: Children with CP (n=175; 109 boys; recruitment age: 2.8±0.9 years; GMFCS I:n=83; II: n=21, III: n=28; IV n=19; V: n=25) were assessed on 440 occasions between ages 1.5 and 5 years. Height or length was measured or estimated using kneeheight. Age-and sex-based standards were used to calculate HZ and GvZ. Feeding method and gestational age at birth (GA) was collected from parents. Three-day ActiGraph® and food diary data was used to measure HPA/ST and energy intake respectively. A speech therapist scored a Dysphagia Disorder Survey (DDS) assessment. Analysis was by mixed effects linear regression. Results: for children classified as GMFCS I, HZ (mean difference (MD)= -0.22, 95% CI=-0.77 to 0.03) and GvZ (MD=0.18 95% CI=-0.25 to 0.62) did not differ from growth standards developed for children with typical development, while groups II-V were significantly shorter (MD=-1.04 to - 0.34; 95% CI=-1.45 to -0.11), and groups III-V grow significantly slower (MD=-1.15 to -0.73; 95% CI=-1.6 to -0.72), than group I. Height Z-score and GA were positively associated in all groups (MD=0.25; 95% CI= 0.11 to 0.39). Energy intake, HPA, ST and DDS-score or feeding method did not contribute to either model once GMFCS level was controlled for. Conclusion: GMFCS level and GA should be taken into consideration when assessing the growth of a child with CP.L6129302912016-11-02 <br />