BODY MASS INDEX VALUES FOR AMBULATORY CHILDREN WITH CEREBRAL PALSY

INTRODUCTION: Historically it was thought that children with cerebral palsy (CP) are underweight due to increased metabolic demands from spastic muscles and energy expenditure in performing daily tasks. Malnutrition has also been associated in the more severely involved, nonambulatory group of children with CP. The purpose of this study was to determine how body mass index (BMI) values for ambulatory children with CP compared to the Center for Disease Center (CDC) norms and to determine if BMI values were different among gender, type of CP, or severity level as defined by the Gross Motor Function Classification System (GMFCS) levels I, II and III. CLINCAL SIGNIFICANCE: Ambulatory children and adolescents with CP have Body Mass Index values that indicate that they are not underweight and have equal rates of obesity as their able-bodied peers. Rates of overweight do not vary by GMFCS level. Clinicians working with ambulatory children and adolescents with CP need to consider nutritional status and interventions for those who are at risk or overweight. METHODS: As part of a larger multi-center study, BMI values were calculated from height and weight measurements of 560 ambulatory children with CP (339 Male, 221 Female; mean age 11.1 3.5 years). GMFCS level was recorded. Mean BMI values were calculated for the entire study population and by GMFCS level, CP type and gender. Individual BMI values were compared to age- and gender-matched CDC values and classified in one of the four CDC categories of underweight (<5% norm), normal (5-85% norm), at risk for overweight (>85% and <95% norm), and overweight (>95% norm). The percentage of the study population that fell within each category were calculated and compared across GFMCS level and gender using Chi Square comparisons. RESULTS: The mean BMI value for all participants was 19.4 5.4 (N=560). Mean BMI values by GMFCS Level were: Level I = 19.4 5.3 (N=241), Level II = 19.3 5.4 (N=196), Level III = 19.7 5.6 (N=123). These means fall in the normal range for BMI values. There was no significant difference between GMFCS levels, gender or type of CP(hemiplegia, diplegia) When the individual BMI values for the children with CP were compared to age- and gendermatched CDC norms, 10% were underweight, 62% normal, 10% were at risk for overweight and 18% overweight. These findings are consistent with data reported in JAMA 2006 by National Health And Nutrition Examination Survey (NHANES)1 for children without CP, where 18% were found to be overweight. There were no differences found for the percentages of individuals within each CDC category when comparing among GMFCS levels. These data

are shown in the graph below. No differences were found between genders overall or between genders within GMFCS levels.
100% 90% 80% % in CDC category 70% 60% 50% 40% 30% 20% 10% 0%
Underweight (<5% Norm) At Risk Overweight (>85% and <95% Norm Normal (5-85% Norm Overweight >95% Norm

18 10

17 10

18 9

19 10

62

64

60

63

10
OVERALL

9
GMFCS I

13
GMFCS II

6
GMFCS III

DISCUSSION: The study results suggest that ambulatory children with CP are not underweight and have similar risks for overweight as children without CP. Twenty-eight percent (28%) of the studied ambulatory children with CP were at risk for or overweight, while only 10% were underweight. Clinicians working with ambulatory children with CP need to consider nutritional status and interventions for those who are at risk or overweight. The findings from this study contradict the findings reported by Feeley et al. 20072 that found differences between children with CP and without CP, types of CP and GMFCS levels. The larger sample size, prospectively collected data and comparison to CDC norms (not a local control group) could be factors that contribute to these differences. The link between BMI values and function is important to establish and is currently being assessed. REFERENCES 1. Ogden, C., et al. (2006). Journal of the American Medical Association 295(13): 1549-55. 2. Feeley, B., et al. (2007). Journal Pediatric Orthopedics B 16(3): 165-9. ACKNOWLEDGEMENTS Funding provided by