1
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: [email protected] 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/m 2 ) 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/m 2 ) 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/m 2 ) 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/m 2 ) 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/m 2 ) 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/m 2 ) 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 (cm 2 ) 28.7±24.0 26.1±25.1 32.3±22.1 46.3±29.2 VFA index (cm 2 /m 2 ) 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/m 2 ) 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/m 2 ) .017 −0.0 to 0.0 .010 .101 GMFCS level (I/II/III/IV/V) −.221 −0.3 to −0.2 .031 <.001
