Sang Ho Chun, MD, Ki Hyuk Sung, MD PhD, Gyeong Hee Cho, PT PhD, Chin Youb Chung, MD PhD, Kyoung Min Lee, MD PhD,

Sangyeop Shin, MD, Hyun Choi, MD, Moon Seok Park, MD PhD Department of orthopaedic surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea

Objectives

To assess differences in body composition according to gross motor

function in children with CP compared with healthy controls using

bioelectrical impedance analysis (BIA)

To determine the factors that significantly affect body composition

measurements

Methods

Inclusion criteria

• Consecutive patients with CP admitted for orthopedic surgery who

underwent BIA

Exclusion criteria

• History of a genetic, metabolic, neurodegenerative disease

• Children with medical conditions that affect growth

Control group

• Typically developing children (TDC) who were not taking any medications

Anthropometric measurement

• Performed immediately before BIA

• Height, weight and BMI

Body composition measurement using BIA

• Skeletal muscle mass (SMM, soft lean mass (SLM), fat-free mass (FFM),

body fat, body cell mass (BCM), bone mineral content (BMC), waist-hip

ration, visceral fat area (VFA), basal metabolic rate (BMR)

• SLM index, FFM index, SMM index, BCM index, BMC index, and VFA index

to account for the effect of height

Results

Lower height, weight, and BMI in children with CP with GMFCS levels IV

and V than those with GMFCS levels I, II, and III

No significant differences in age and sex between the children with CP

and the TDC

Lower height, weight, and BMI in children with CP than TDC

Lower SLM, SLM index, FFM , FFM index, SMM, SMM index, BCM, BCM

index, BMC, BMC index, and BMR in children with CP with GMFCS

levels IV and V than those with GMFVS level I to III and TDC

No significant differences in body composition measures between the

children with CP with GMFCS levels I to III and the TDC, except in terms

of waist-hip ratio and VFA

SLM - positive correlation with BCM, BMC, BMR

- negative correlation with percent body fat, body fat

BMC - positive correlation with BCM, BMR

- negative correlation with percent body fat

BMR - negative correlation with body fat, percent body fat

Table 2. Body composition measures for children with CP according to GMFCS level and TDC

Age, Sex, BMI and GMFCS level were significant factors that

contributed to SLM

Age and GMFCS level were significant factors that contributed to BMC

Conclusions

Body composition analysis using BIA showed that non-ambulatory

children with CP had significantly lower FFM, SLM, SMM, BCM, and

BMC than ambulatory children with CP and TDC

GMFCS level was a significant contributing factor to SLM and BMC

Further study is required to allow the use of BIA as a valid nutritional

assessment tool in patients with CP

This study has been published in archives of Physical Medicine and Rehabilitation.

2017 Apr 30

Presenter: Moon Seok Park, MD, E-mail: pmsmed@gmail.com

Table 4. Multiple regression analysis to identify significantly contributing factors to SLM

Table 1. Patient demographics

Characteristic All Children

with CP (n=100)

GMFCS I, II,

and III (n=57)

GMFCS IV

and V (n=43) TDC (n=46)

Age (y) 11.5±4.2 11.6±4.5 11.4±3.9 12.8±4.5

Sex (M/F) 64/36 39/18 25/18 24/22

Anatomic type

(hemiplegia/diplegia

/quadriplegia)

13/46/41 13/36/8 0/10/33 NA

Height (cm) 133.2±21.0 139.1±20.6 125.4±18.9 149.3±19.0

Weight (kg) 32.8±16.0 38.2±17.2 25.5±10.6 45.6±18.2

BMI (kg/m2) 17.5±4.5 18.0±4.3 15.9±4.3 19.5±3.9

Table 3. Partial correlation between body composition measures after adjusting age, sex,

BMI, and GMFCS level

Measure All Children

with CP (n=100)

GMFCS I, II,

and III (n=57)

GMFCS IV

and V (n=43) TDC (n=46)

Body fat (kg) 6.9±6.4 7.6±6.9 5.9±5.6 11.3±7.2

Percent body fat 18.8±12.9 18.0±11.0 19.9±15.1 23.2±10.1

SLM (kg) 24.5±11.2 29.1±11.8 18.4±6.8 31.8±12.5

SLM index (kg/m2) 13.1±2.6 14.3±2.4 11.4±1.9 13.7±2.5

FFM (kg) 25.9±11.9 30.6±12.6 19.7±7.2 34.4±13.8

FFM index (kg/m2) 13.8±2.6 15.0±2.4 12.2±1.9 14.7±2.7

SMM (kg) 13.5±7.2 16.4±7.6 9.6±4.3 18.4±8.3

SMM index (kg/m2) 7.0±1.9 7.9±1.7 5.9±1.3 7.8±1.8

BCM (kg) 17.0±7.9 20.2±8.3 12.8±4.7 22.4±9.1

BCM index (kg/m2) 9.1±1.8 9.9±1.6 7.9±1.4 9.6±1.8

BMC (kg) 1.5±0.8 1.8±0.8 1.1±0.5 2.0±0.8

BMC index (kg/m2) 0.8±0.2 0.9±0.2 0.6±0.2 0.9±0.2

Waist-hip ratio 0.8±0.1 0.7±0.1 0.8±0.1 0.8±0.1

VFA (cm2) 28.7±24.0 26.1±25.1 32.3±22.1 46.3±29.2

VFA index (cm2/m2) 15.5±11.2 12.7±10.5 19.4±11.2 19.7±10.2

BMR (kcal) 929.7±257.4 1030.6±273.2 796.0±156.6 1112.7±297.9

Measure Body Fat SLM FFM SMM PBF BCM BMC WHR VFA

SLM r −.304

P .003

FFM r −.273 .952

P .007 <.001

SMM r −.323 .947 .984

P .001 <.001 <.001

PBF r .662 −.660 −.648 −.694

P <.001 <.001 <.001 <.001

BCM r −.322 .947 .983 1.000 −.693

P .001 <.001 <.001 <.001 <.001

BMC r −.090 .717 .796 .768 −.403 .768

P .384 <.001 <.001 <.001 <.001 <.001

WHR r .482 .102 .125 .033 .046 .031 .013

P <.001 .325 .225 .750 .655 .764 .899

VFA r .837 −.114 −.087 −.182 .442 −.182 .047 .777

P <.001 .267 .399 .076 <.001 .076 .651 <.001

BMR r −.271 .952 .999 .982 −.646 .982 .796 .129 −.083

P .008 <.001 <.001 .001 <.001 <.001 <.001 .209 .420

Abbreviations: PBF, percent body fat; r, correlation coefficient; WHR, waist-hip ratio.

Table 5. Multiple regression analysis to identify significantly contributing factors to BMC

Variable β Coefficient 95% CI SE P

Coefficient 10.102 3.2 to 17.1 3.484 .005

Age (y) 1.757 1.5 to 2.0 0.139 <.001

Sex (M/F) −2.881 −3.0 to 0.3 0.821 .012

BMI (kg/m2) 0.427 0.1 to 0.7 0.142 .003

GMFCS level (I/II/III/IV/V) −3.032 −3.9 to −2.2 0.424 <.001

Variable β Coefficient 95% CI SE P

Coefficient .644 0.1 to 1.1 .252 .012

Age (y) .124 0.1 to 0.1 .010 <.001

Sex (M/F) −.153 −0.3 to 0.0 .081 .063

BMI (kg/m2) .017 −0.0 to 0.0 .010 .101

GMFCS level (I/II/III/IV/V) −.221 −0.3 to −0.2 .031 <.001