Title

Fat‐free soft tissue deficit in children with CP is more pronounced in the appendicular than in the non‐appendicular regions

Document Type

Contribution to Book

Publication Date

2019

Publication Title

Developmental Medicine & Childhood Neurology

DOI

10.1111/dmcn.14354

ISSN

1469-8749

Abstract

Background and Objective(s)

Cerebral palsy (CP) is a neurological disorder characterized by skeletal muscle deficit. However, whether there is a regional‐specific skeletal muscle deficit in children with CP is unknown. The purpose of this study was to determine whether fat‐free soft tissue mass (FFST) ‐ a commonly used surrogate for skeletal muscle mass ‐ is more compromised at the appendages than at the trunk in children with CP, and whether we can use physical characteristics data to accurately estimate appendicular FFST and its derived indexes that account for height differences.

Study Design

Cross‐sectional.

Study Participants and Settings

Forty two children with CP (4–13y) were recruited from local pediatric hospitals. Forty‐two typically developing children matched to children with CP for sex, age and race were also recruited via word of mouth and flyers.

Materials and Methods

Whole body FFST (FFSTwhole), appendicular FFST and non‐appendicular FFST were estimated from a dual‐energy X‐ray absorptiometry whole body scan. Appendicular FFST index 1 (appendicular FFSTI1) and 2 (appendicular FFSTI2) were estimated by dividing appendicular FFST by height and height squared, respectively. Statistical models were developed to estimate appendicular FFST, appendicular FFSTI1 and appendicular FFSTI2 in both groups.

Results

When compared to typically developing children, children with CP had 21% lower FFSTwhole, 30% lower appendicular FFST, 14% lower non‐appendicular FFST, 23% lower appendicular FFSTI1, 19% lower appendicular FFSTI2 and 9% lower appendicular FFST/FFSTwhole (all p<0.05). Statistical models developed using physical characteristics data from typically developing children overestimated appendicular FFST, appendicular FFSTI1 and appendicular FFSTI2 by 35%, 30% and 21% (all p<0.05), respectively, in children with CP. Separate models developed using physical characteristics data from children with CP more accurately estimated appendicular FFST and FFST indexes. Specifically, the estimates were highly correlated (r=0.95, 0.92 and 0.80, respectively; all p<0.001) and not different from measured appendicular FFST, appendicular FFSTI1 and appendicular FFSTI2 (all p>0.99). However, when the difference in estimated values and measured values of appendicular FFST, FFSTI1 and FFSTI2 were plotted against measured values, there was an inverse relationship (r=−0.382, −0.479 and −0.603, respectively, all p<0.05). This indicated a trend for an overestimation of appendicular FFST, FFSTI1 and FFSTI2 for children with CP with lower values and an underestimation for children with higher values.

Conclusions or Significance

Children with CP have a remarkable deficit in FFST that is more pronounced in appendicular than the non‐appendicular regions. Preliminary models developed using data from children with CP can provide reasonable estimates of appendicular FFST and indexes, but further development of the models is needed.

Link to Work:https://doi.org/10.1111/dmcn.14354

Comments

Copyright and Open Access: https://v2.sherpa.ac.uk/id/publication/7644

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