Eating and drinking ability and nutritional status in adults with cerebral palsy

Abstract

Aim: To describe eating and drinking ability in adults with cerebral palsy (CP) relative to sex, age, subtype, and severity of gross motor and hand function and nutritional status.Method: This was a cross-sectional study based on data of 2035 adults with CP, median age 26 years (range 18-78 years). The Eating and Drinking Ability Classification System (EDACS), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification System (MACS) were used in addition to subtype, body weight, height, body mass index (BMI), skin fold thickness, and gastrostomy. Linear regression models were used to estimate associations between body weight and the other variables.Results: More than half of the adults (52.5%) eat and drink safely and 32.4% have dysphagia with limitations to eating and drinking safety. Weight, height, and BMI decreased with increasing EDACS levels. In EDACS level V, 86% had a gastrostomy, 23.4% in EDACS levels III to V were underweight, whereas 42.3% in EDACS levels I to II had a BMI over 25, indicating overweight or obesity. Increasing EDACS levels and need of support during meals were associated with lower body weight.Interpretation: Adults with CP should be routinely screened and treated for dysphagia to avoid nutritional complications. Being dependent on others during mealtimes is a risk factor for low body weight.

Editorial: Adults with childhood onset disabilities: A lifespan approach

“…This requires access to person-centered rehabilitation, social services and in many cases access to personal assistance ( Pettersson and Rodby-Bousquet ; van Heijningen et al ). Adults with CODs may experience higher risk for developing secondary conditions such as musculoskeletal morbidity ( Dayanidhi ; Won and Jung ), pain ( Jersak and Noritz ; Jonsson et al ; Jacobson et al ), cardiometabolic diseases ( Shin and Jung ; Whitney et al ), kidney diesase ( Whitney and Oliverio ), dysphagia [ Jonsson et al ; ( 1 )], and mental health outcomes such as depression and anxiety ( Jonsson et al ; Cohen et al ; Nguyen et al ) that may develop or be influenced by the disability, the presence of impairment, and/or the possibly accelerated process of aging. Consequently, there is a need for approaching health care delivery for adults with COD within the context of a life course health development model.…”

Intervention for swallowing problems in adults with cerebral palsy

“…The Eating and Drinking Ability Classification System (EDACS) is a reliable and valid tool in both children and adults with CP that is used to assess the ability to chew, swallow, manage food or fluid textures, changes in breathing associated with swallowing, symptoms of choking, and the level of assistance required to get food or liquids into the mouth 2, 3 . Analyzing data collected from the Cerebral Palsy Follow‐up Program (CPUP), McAllister et al suggested that adults with CP classified in EDACS levels III to V should be regularly screened and treated for dysphagia to avoid nutritional complications based on their high risk of becoming underweight 4 . A swallowing disorder not only results in poor ability to swallow food and drink safely, but also reduces the ability to eat appropriate amounts to maintain a healthy body weight and composition.…”

“…In the study by McAllister et al, approximately two‐thirds of adults with CP were in EDACS level I or II 4 . However, there is a possibility that highlighting potentially detrimental features such as silent aspiration or increased residue may require a videofluoroscopic swallowing study or more detailed imaging in individuals in EDACS levels I or II.…”