Growth of Severely Impaired Children: Neurological Versus Nutritional Factors

Shapiro, Bruce K.; Green, Pauline; Krick, Jackie; Allen, Darlene; Capute, Arnold J.

doi:10.1111/j.1469-8749.1986.tb03924.x

Cited by 144 publications

(72 citation statements)

References 4 publications

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“…Even in children with CP, a population previously described as having decreased growth, the diet slowed their increase in height. 20 Contrary to a previous report, growth did not seem to be adversely affected by higher levels of ketosis in our study. 11 These data suggest that 2 21 (3) 22 (4) Results are shown as mean (SD).…”

Section: Discussioncontrasting

confidence: 56%

Long‐term use of the ketogenic diet in the treatment of epilepsy

Groesbeck

Bluml

Kossoff

2006

Develop Med Child Neuro

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Long-term outcomes of the ketogenic diet in the treatment of epilepsy have not previously been reported. A retrospective chart review of children treated with the ketogenic diet for more than 6 years at the Johns Hopkins Hospital was performed. The response was documented at clinic visits and by telephone contacts; laboratory studies were obtained approximately every 6 to 12 months. Satisfaction and tolerability were assessed by means of a brief parental telephone questionnaire. In all, 28 patients (15 males, 13 females), currently aged 7 to 23 years, were identified. The median baseline seizure frequency per week at diet onset was 630 (range 1-1400). Diet duration ranged from 6 to 12 years; 19 remain on the diet currently. After 6 years or more, 24 children experienced a more than 90% decrease in seizures, and 22 parents reported satisfaction with the diet's efficacy. Ten children were at less than the 10th centile for height at diet initiation; this number increased to 23 at the most recent follow-up (p=0.001). Kidney stones occurred in seven children and skeletal fractures in six. After 6 years or more the mean cholesterol level was 201mg/dl, high-density lipoprotein was 54mg/dl, low-density lipoprotein was 129mg/dl, and triglycerides were 97mg/dl. Efficacy and overall tolerability for children are maintained after prolonged use of the ketogenic diet. However, side effects, such as slowed growth, kidney stones, and fractures, should be monitored closely.The ketogenic diet is a high-fat, low-carbohydrate, adequateprotein diet that was developed more than 80 years ago as a method of managing intractable epilepsy in children. 1 Previous studies have demonstrated that the efficacy of the diet in providing seizure control for children with difficult-to-manage seizures is at least equal to many of the newer anticonvulsant medications and often allows a decrease in medication. 2,3 Most epilepsy centers advocate use of the diet for 2 to 3 years if it controls seizures, followed by a gradual discontinuation in a manner similar to the withdrawal of anticonvulsants. Effects of the diet have been reported in patients who were on it for as long as 3 to 6 years' duration. 4 However, the ketogenic diet has been the only successful therapy for many children with epilepsy, and often these families continue the diet for longer periods.There are many questions regarding the long-term use of the ketogenic diet. Is it feasible for patients to remain on the diet for prolonged periods of time? Does the efficacy of the diet fluctuate over time? Does the diet become more tolerable over time, or do families eventually tire of the strict regimen of calculating ratios and weighing out foods? Established side effects of the ketogenic diet include kidney stones, dyslipidemia, changes in bone density, and slowed growth. [5][6][7][8][9][10][11][12][13] Most studies reporting on side effects have a follow-up period of less than 2 years, whereas a recent review examined diet complications after up to 4 years of treatment. 13 Are children on t...

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Section: Discussioncontrasting

confidence: 56%

Long‐term use of the ketogenic diet in the treatment of epilepsy

Groesbeck

Bluml

Kossoff

2006

Develop Med Child Neuro

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“…Growth retardation is more important in spastic quadriplegic CP (4,8) , but it has been also reported in children with diplegia and hemiplegia (2) , even when there is not malnutrition. In children with CP, approximately 35 to 40% have spastic hemiplegia, with one side of their body being more severely affected than the other (9,10) .…”

Section: Introductionmentioning

confidence: 99%

“…Children with CP are usually affected by growth impairment, having lower weight and height than healthy children at the same age (2) . Rotta (3) emphasized that these children, in addition to showing lower height and weight, are also less resistant against infections, highlighting the importance of having a normal brain so that normal physical development can be achieved.…”

Section: Introductionmentioning

confidence: 99%

“…The moment when the lesion leading to CP occurred (6) , the type of movement disorder (2) , the severity of CP, mainly regarding self-feeding and walking capacity (7) , and the level of physical activity limitation (4) have been described as factors that can have an influence on growth disorders.…”

Section: Introductionmentioning

confidence: 99%

“…Growth retardation in children with chronic diseases, such as CP, has a multifactorial etiology (4) , and it can even be associated with non-nutritional factors resulting from brain malformation or lesions responsible for the child's disability (2,5) . The moment when the lesion leading to CP occurred (6) , the type of movement disorder (2) , the severity of CP, mainly regarding self-feeding and walking capacity (7) , and the level of physical activity limitation (4) have been described as factors that can have an influence on growth disorders.…”

Section: Introductionmentioning

confidence: 99%

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Crescimento e antropometria em pacientes com paralisia cerebral hemiplégica

Zonta¹,

Agert²,

Muzzolon³

et al. 2009

Rev. paul. pediatr.

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Objective: To analyze the linear growth, the head circumference and the anthropometric differences between involved and non-involved sides of 24 children with hemiplegic cerebral palsy, comparing them to standard values for age.Methods: This cross-sectional study enrolled 24 consecutive children with cerebral palsy clinically classified as spastic hemiplegia. The anthropometric measures included: weight, lenght, head circumference, total upper limb length, hand length, palm width, total lower limb length, foot length, and limb circumference of upper-arm, thigh and calf. The anthropometric differences between both sides were calculated in centimeters and a comparison of the involved and non-involved sides was made. Two different reference values were used to compare the measures of hand and foot length: growth charts and the software ABase ® (a PalmOS-based software). The Spearman's correlation coefficient was estimated for the association between quantitative variables and the Wilcoxon non-parametric test was used for age comparisons between involved and noninvolved sides. Results:The mean values of weight, length and head circumference were within the normal range for age and 21% of the children presented microcephaly. Discrepancy was noted between both sides in all cases, being the largest discrepancy in hand length and width. There was a positive correlation between the discrepancy observed in superior and inferior affected limbs (r=0.48), and discrepancy increases with age (r=0.44). Conclusion: Growth impairment in children with hemiplegic cerebral palsy was observed on the affected limbs and in smaller proportion in head circumference. Key-words:anthropometry; cerebral palsy; hemiplegia; growth; child. RESUMO Objetivo:Analisar o crescimento linear, o perímetro cefálico e as diferenças antropométricas entre o lado envolvido e o não-envolvido de 24 crianças com paralisia cerebral (PC) hemiplégica, comparados à média para a idade.Métodos: Estudo transversal com amostragem consecutiva de crianças com PC, classificadas clinicamente como hemiplegia espástica. As medidas antropométricas incluíram: peso, estatura, perímetro cefálico, comprimento total de membro superior, comprimento da mão, largura da palma da mão, comprimento total do membro inferior, comprimento do pé e a circunferência dos membros (braço, coxa e panturrilha). As diferenças antropométricas entre os dimídios foram calculadas em centímetros e como porcentagem de encurtamento, comparando o lado envolvido com o não-envolvido. Dois referenciais populacionais, tabelas de crescimento e o software ABase ® , desenvolvido para sistema PalmOS, foram comparados na classificação das medidas do comprimento da mão e do pé. A análise estatística utilizou o coeficiente de correlação de Spearman para avaliar a associação entre variáveis quantitativas e o teste não-paramétrico de Wilcoxon para comparar as medidas do lado envolvido e não-envolvido.Rev Paul Pediatr 2009;27(4):416-23. Original ArticleResultados: As médias de peso, estatura e perímetro cefá-lic...

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