Nutrition-Focused Physical Exam in assessing nutritional status of children with neurological impairment

Background: Accurate and reliable anthropometric measurements in children with neurological impairments who are not able or not suitable for conventional anthropometric measuring techniques can be challenging and potentially leading to misinterpretation of their nutritional status. Nutrition-Focused Physical Exam (NFPE) is proven useful in providing supportive evidence to malnutrition. This study investigated the use of NFPE to identify malnutrition among children with Down syndrome (DS) and cerebral palsy (CP), in comparison to AND/ASPEN Pediatric Malnutrition Identification Criteria as the reference method. Methods: A cross-sectional study was conducted to recruit 31 children with DS and 20 children with CP aged between 4 and 15 years old. Nutrition-focused physical findings (fat loss, muscle wasting, abnormality observations on hair, eyes, oral cavity, skin, and nails), weight, height, mid upper arm circumference, and dietary intake were collected. The malnutrition status of children was determined using NFPE and AND/ASPEN criteria, respectively. Weighted Kappa agreement and diagnostic values were analyzed between these two criteria. Chi-square test examined the association between oral cavity abnormalities and the nutritional status identified by the AND/ASPEN criteria and NFPE. A p-value of <0.05 was considered statistically significant. Results: Findings reported a significant and fair agreement between the two criterions for children with DS (k = 0.367, p = 0.018). NFPE offers a sensitivity of 81.3 % and a specificity of 60.0 % for children with DS when compared with the AND/ASPEN criteria as the reference method. Similarly, for children with CP, NFPE recorded a significant and moderate agreement (k = 0.503, p < 0.001) with AND/ASPEN criteria where NFPE offers a sensitivity of 90.9 % and a specificity of 22.2 %. Children with oral cavity abnormality were significantly associated with malnutrition defined by NFPE. Conclusions: NFPE serves as a supplementary assessment method to identify malnutrition in children with DS with altered body composition and CP with neuromuscular impairment.

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