Longitudinal association between nutritional status and gross motor function in children with cerebral palsy

Abstract

Introduction: Growth is the primary measure of nutritional status. Children with cerebral palsy (CP) frequently grow poorly compared to reference norms. This study examined the association between nutritional status and gross motor function in children with CP. Patients and methods: A longitudinal cohort of children with CP (n = 186, 60.7% boys) were assessed up to five times for a total of 494 assessments between the ages of 1.5 and 12 years (3.3 ± 2.4 years at recruitment, Gross Motor Function Classification System [GMFCS] I = 87, II = 23, III = 29, IV = 21, V = 26). Physiotherapists administered the Gross Motor Function Measure (GMFM-66). Weight and length/ height/knee-height were measured, and Body Mass Index (BMI) was calculated. Anthropometric data were converted to Z-scores using standard age and gender specific reference data. The longitudinal association between growth Z-scores and GMFM-66 was determined using mixed-effects linear regression models. Results: Height (B = 1.58, 95% CI: 0.45,2.72) for children classified as GMFCS I and II, but not those classified as GMFCS III-V, was positively and significantly associated with gross motor function in children. Weight and BMI Z-score were not associated with GMFM-66 score. Conclusion: Greater height-for- age was associated with greater gross motor function attainment in children classified as GMFCS I-II. The difference in GMFM-66 associated with one standard deviation difference in height was greater than the minimal clinical important difference in GMFM-66 for children classified as GMFCS II (1.5 units). Regular monitoring of growth and timely dietetic involvement, if necessary, is recommended in children with CP to optimize growth and gross motor outcomes..