Nutritional status in neurologically impaired children and its relation with bone mineralization

Objectives and study: Malnutrition and low bone mineral density (BMD) are common in neurologically impaired (NI) children, in particular in children with cerebral palsy (CP). The two conditions are related, as it is known that poor nutritional status can negatively impact on bone mineralization. The aim of our study was to assess nutritional status, bone health and the relation between the two conditions in our population of NI children. Methods: A total of 26 NI subjects (mean age 9,9 + 3,7 years, M:F ratio 11:15, all Caucasian except for one Hispanic), were enrolled between November 2014 and March 2015. Diagnoses were: cerebral palsy (CP) 42.3% (n=11), epilepsy of various etiology associated with mild or no motor impairment (epilepsy without CP) 57.7% (n=15). Patients receiving vitamin D supplementation were excluded. All subjects underwent: 1) Nutritional assessment including feeding history, anthropometric evaluation of weight, height, body mass index (BMI) and triceps skinfold thickness (TST); 2) Biochemical analyses for bone metabolism and serum markers of bone turnover including parathormone (PTH), 25-hydroxy-vitamin D (25OHvitD), bone alkaline phosphatase (BAP) and carboxy-terminal collagen (CTX); 3) BMD measurement at lumbar spine (L1-L4) with Dual Energy X-ray Absorptiometry (DEXA). Results: Feeding difficulties were encountered in 42.3% of total patients, in 90,9% of children with CP. Nutrient intakes were compared to recommended dietary intakes for Italian population (LARN 2014), insufficient intake of energy, protein and calcium were found in 26,9%, 3.8%, 69,2% of total patients. A poor nutritional status (BMI< 10th c.le and/or TST< 10thc.le) was found in 38,5% of total patients, in 72,7% of children with CP. Vitamin D insufficiency (25OHvitD < 20 ng/dl) was found in 65,4% of total subjects, in 81,8% of children with CP. Values of CTX and BAP were significantly higher in epileptic children without CP compared to children with CP (p=0,0396 and 0,048 respectively). Results of nutritional status and bone metabolism are shown in table 1. A poor bone mineralization (BMD z-score < 2) was found in the lumbar spine of 38% of the total and in 73% of children with CP. Correlation analyses found positive correlation between BMD z-score and the anthropometric parameters BMI z-score and TST (r=0.8205; p< 0,0001 and r=0.7374; p< 0,0001 respectively). Negative correlation was also found between BMD z-score and severity of motor impairment measured by Gross Motor Function Classification Scale- GMFCS (r= -0,7216 p< 0,05). Conclusion: Our data confirm a high prevalence of malnutrition, vitamin D insufficiency and poor bone mineralization in NI children, particularly in those with CP. We also confirm that nutritional status and motor impairment are factors that negatively impact on bone mineralization. Disclosure of interest: None declared.