BACKGROUND Nutrition assessment is multidimensional; however, much of the literature examining the nutritional status of children with cerebral palsy (CP) focuses on a single dimension. OBJECTIVE The aim of the study was to evaluate nutritional status in children and adolescents with CP by comparing results from the Pediatric Subjective Global Nutrition Assessment (SGNA) with results from traditional anthropometric measures. DESIGN This study was a cross-sectional observational study. PARTICIPANTS/SETTING This study was conducted in a tertiary hospital outpatient setting in Brisbane, Australia, from February 2017 to March 2018. A total of 89 children (63 boys) with CP aged between 2 and 18 years of age were included. All Gross Motor Function Classification System levels were observed. The majority of children were in Gross Motor Function Classification System I and II (57, 64%) compared with Gross Motor Function Classification System III to V (32, 36%). Children with feeding tubes and those acutely unwell or hospitalized were excluded. MAIN OUTCOME MEASURES Children were classified as well nourished, moderately malnourished, or severely malnourished by dietitians using the SGNA. Weight, height, body mass index (BMI), triceps skinfold thickness, subscapular skinfold thickness, and mid upper arm circumference were measured and converted to z scores to account for age and sex differences. Moderate malnutrition was defined by z scores -2.00 to -2.99 and severe malnutrition as ≤-3.00 z scores. STATISTICAL ANALYSIS PERFORMED Multinomial logistic analyses were used to compare results from the SGNA and each single measurement. Continuous outcomes were transformed into z scores. Agreement was assessed with 2 categories: not malnourished and malnourished. Comparison statistics included percent agreement, sensitivity, and specificity. RESULTS More children were classified as moderately or severely malnourished by SGNA than any of the anthropometric z score cutoffs. The majority of children were well nourished (n = 63) with 20 (22%) moderately malnourished and 6 (7%) severely malnourished by SGNA. The SGNA classified 11 children as malnourished that were not classified as malnourished by BMI. Children with moderate or severe malnutrition by SGNA had lower weight (P < .001, P < .001), BMI (P < .001, P < .001), mid upper arm circumference (P < .001, P < .001), triceps skinfold thickness (P = .01, P = .007), and subscapular skinfold thickness (P = .005, P = .02) z scores than well-nourished children. CONCLUSION The SGNA identified more potentially malnourished children including children classified as well nourished by the single measurements such as BMI, height, and weight. The SGNA provided a clinically useful multidimensional approach to nutrition assessment for children with CP.

中文翻译：

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与人体测量学相比，儿科主观全球营养评估将更多脑瘫儿童归类为营养不良

背景 营养评估是多维度的；然而，许多研究脑瘫 (CP) 儿童营养状况的文献都集中在一个维度上。目的 本研究的目的是通过将儿科主观全球营养评估 (SGNA) 的结果与传统人体测量测量的结果进行比较来评估患有 CP 的儿童和青少年的营养状况。设计 本研究是一项横断面观察性研究。参与者/地点 本研究于 2017 年 2 月至 2018 年 3 月在澳大利亚布里斯班的一家三级医院门诊进行。共纳入 89 名 2 至 18 岁的 CP 儿童（63 名男孩）。观察到所有粗大运动功能分类系统水平。与大运动功能分类系统 III 至 V (32, 36%) 相比，大多数儿童属于粗大运动功能分类系统 I 和 II (57, 64%)。有喂食管的儿童和严重不适或住院的儿童被排除在外。主要结局指标 营养师使用 SGNA 将儿童分类为营养良好、中度营养不良或严重营养不良。测量体重、身高、体重指数 (BMI)、肱三头肌皮褶厚度、肩胛下皮褶厚度和上臂中部周长，并将其转换为 z 分数以解释年龄和性别差异。中度营养不良定义为 z 分数 -2.00 至 -2.99，严重营养不良定义为 z 分数≤-3.00。执行的统计分析 多项逻辑分析用于比较 SGNA 和每个单一测量的结果。连续结果转化为 z 分数。一致性被评估为 2 个类别：未营养不良和营养不良。比较统计包括一致性百分比、敏感性和特异性。结果 SGNA 将更多儿童归类为中度或重度营养不良，而不是任何人体测量 z 评分截止值。大多数儿童营养良好 (n = 63)，SGNA 显示 20 (22%) 名中度营养不良和 6 (7%) 名严重营养不良。SGNA 将 11 名没有被 BMI 归类为营养不良的儿童归类为营养不良。SGNA 中度或重度营养不良的儿童体重较低 (P < .001, P < .001)、BMI (P < .001, P < .001)、上臂中围 (P < .001, P < .001) )、三头肌皮褶厚度 (P = .01, P = .007) 和肩胛下皮褶厚度 (P = .005, P = . 02) z 分数高于营养良好的儿童。结论 SGNA 确定了更多潜在营养不良的儿童，包括根据 BMI、身高和体重等单一测量值归类为营养良好的儿童。SGNA 为 CP 儿童的营养评估提供了一种临床上有用的多维方法。