Protein levels in enteral feeds: do these meet requirements in children with severe cerebral palsy?

Abstract

Children with cerebral palsy (CP) have been documented to have feeding difficulties, which increase in line with condition severity and result in lowered growth potential. Much nutrition literature surrounds energy intake and expenditure in these children, with less information available on other parameters such as protein and micronutrients, which are also important for growth and development. We examined differences in protein intake and a variety of protein metabolism indices in children with CP compared with controls. A total of twenty-four children aged 4 -12 years with marked CP fed orally (O, n 15) or enterally (E, n 9) were recruited, including age-matched typically developing children (C, n 24). Fasting blood samples were analysed for levels of albumin, creatinine, urea and urate. Parents collected an exact food replica for three consecutive days of their child's actual intake, which were directly analysed for protein content. Significant differences were found in protein intakes between the groups (mean percentage minimum requirements: E ¼ 178 (SD 47); O ¼ 208 (SD 95); C ¼ 311 (SD 119), P¼ 0·005). Despite all children consuming over recommended levels, children with CP had significantly reduced levels of the protein metabolic indices compared with controls. These include as z-scores: albumin mean C ¼ 0·71 (SD 1·04) and CP ¼ 20·17 (SD 1·60), P¼ 0·03; creatinine C ¼ 22·06 (SD 0·46) and CP ¼ 2 3·11 (SD 0·98), P,0·001; urate C ¼ 0·18 (SD 0·62) and CP ¼ 20·58 (SD 0·93), P¼0·002. Post hoc analysis, the present data show potentially greater protein metabolism issues in enterally fed children, compared with the other groups. This may also support recent literature that suggests shortfalls in current recommendations.

Micronutrient, Antioxidant, and Oxidative Stress Status in Children With Severe Cerebral Palsy

“…An abnormally low FAD effect may occur in a negative nitrogen balance state, as erythrocytes can take up riboflavin released during tissue breakdown. This would corroborate with findings published elsewhere, documenting potential protein inadequacy in this group of enterally fed children with severe CP 32 …”

Determinants of muscle preservation in individuals with cerebral palsy across the lifespan: a narrative review of the literature

“…Despite the feeding and swallowing difficulties in a great proportion of the children with CP, different studies showed no differences in protein intake between children with CP and their TD peers . However, to date, it remains unclear whether children with CP have similar protein requirements as TD children.…”

“…113 Despite the feeding and swallowing difficulties in a great proportion of the children with CP, different studies showed no differences in protein intake between children with CP and their TD peers. [115][116][117][118] However, to date, it remains unclear whether children with CP have similar protein requirements as TD children. Many people with CP participate in intensive (strengthening) exercise programmes, and because exercise causes muscle micro-damage, it is important to replace and rebuild this tissue to allow for hypertrophy and strength increases.…”

A Core Outcome Set for Children With Feeding Tubes and Neurologic Impairment: A Systematic Review

“…The majority of these articles (78%) were cohort studies, 5 23,44,53,65,71,74,80,81,83 systematic reviews (5%), 7,49,89,96,97 and controlled trials (5%). 22,28,48,55,91 The 5 systematic reviews performed analyses on 0 to 25 articles each. Years of publication were from 1969 to 2014, and the median total sample size among our included texts was 51 (range, 3-24 920 children).…”