BACKGROUND Children with severe motor and intellectual disabilities (SMID) are at a high risk of malnutrition and often require tube feeding to maintain their nutritional status. However, determining their energy requirements is difficult since inadequate dietary intake, severe neurological impairment, respiratory assistance, and cognitive impairment are all factors that affect malnutrition in SMID. AIM This study investigated the factors affecting malnutrition and identified problems affecting the nutritional status of children with SMID. METHODS Forty-two children with SMID with oral motor dysfunction who were receiving home medical care at one of four hospitals were enrolled. Their nutritional status was assessed using a 3-day dietary record, anthropometric measurements, and laboratory tests. The clinical findings associated with malnutrition were compared, and a body mass index (BMI) z-score less than -2SD was defined as malnutrition. The relationship between BMI z-score and other potential predictors was also investigated. RESULTS Thirty-three (79%) children received tube feeding, and 20 (48%) experienced malnutrition. The median age of the malnourished children was older than that of non-malnourished children. Respiratory assistance was significantly correlated with higher BMI z-score, independent of other potential confounders such as nutrition method, muscle tonus, and energy intake. Cholesterol levels were significantly higher in children receiving a standard infant formula beyond 3 years of age than in those who switched to enteral formula before 3 years of age. CONCLUSIONS Malnutrition in children with SMID was mainly associated with age or respiratory condition. Energy requirements should be regularly re-evaluated with considering these factors.

中文翻译：

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严重运动和智力障碍儿童营养不良的危险因素

背景 患有严重运动和智力障碍 (SMID) 的儿童处于营养不良的高风险中，并且经常需要管饲以维持他们的营养状况。然而，很难确定他们的能量需求，因为饮食摄入不足、严重的神经功能障碍、呼吸辅助和认知障碍都是影响 SMID 营养不良的因素。目的 本研究调查了影响营养不良的因素，并确定了影响 SMID 儿童营养状况的问题。方法 42 名患有口腔运动功能障碍的 SMID 儿童，他们在四家医院之一接受家庭医疗。他们的营养状况是通过 3 天的饮食记录、人体测量和实验室测试来评估的。比较了与营养不良相关的临床发现，体重指数 (BMI) z 分数小于 -2SD 被定义为营养不良。还研究了 BMI z 分数与其他潜在预测因素之间的关系。结果 33 (79%) 名儿童接受管饲，20 (48%) 名儿童营养不良。营养不良儿童的中位年龄大于非营养不良儿童。呼吸辅助与较高的 BMI z 分数显着相关，独立于其他潜在混杂因素，如营养方法、肌肉紧张和能量摄入。3 岁以上接受标准婴儿配方奶粉的儿童的胆固醇水平显着高于 3 岁前改用肠内配方奶粉的儿童。结论 SMID 儿童营养不良主要与年龄或呼吸系统疾病有关。应定期重新评估能源需求并考虑这些因素。