Serum Prealbumin and Albumin Concentrations do not Reflect Nutritional State in Children with Cerebral Palsy

doi:10.1016/j.jpeds.2005.05.029

The Journal of Pediatrics

Volume 147, Issue 5, November 2005, Pages 695-697

https://doi.org/10.1016/j.jpeds.2005.05.029 Get rights and content

Serum prealbumin concentration (PALB) and albumin concentration (ALB) were evaluated as markers of undernutrition in 107 children with cerebral palsy (CP) age 2 to 18 years. PALB and ALB were rarely below the normal reference ranges and showed little to no correlation with anthropometric measures (eg, skinfolds, midarm fat area), growth (height), severity of CP (eg, feeding dysfunction, motor impairment), or general health.

Section snippets

Methods

Children age 2 to 18 years with moderate to severe CP were recruited to participate in a multicenter study of growth and nutrition. This was a convenience sample that included patients followed at our tertiary care centers. However, the recruitment process also included newspaper notices, pediatric physical therapists, handicap equipment vendors, special education teachers, and regional United Cerebral Palsy newsletters, in an attempt to obtain a broad-based sample. The study was approved by

Results

The study group consisted of 107 subjects, 78 enrolled at the North Carolina site and 29 enrolled at the Salt Lake City site. The mean age was 10.8 years (range, 2 to 18 years); 68 (64%) were male, 73 (68%) were white, and 20 (19%) were black. Nine subjects (8%) were GMFCS level 3, 26 (24%) were GMFCS level 4, and 72 (67%) were GMFCS level 5. Feeding dysfunction was common in this group, with 30 subjects in the severe category (38%), including 19 subjects (18%) requiring a feeding tube.

Discussion

The reliability of ALB and PALB as nutritional markers in children varies in different pathological states. ALB and PALB have been shown to be useful markers of nutritional status in acutely ill children and for monitoring short-term refeeding in these children.¹⁴ However, children with kwashiorkor (low protein intake) and marasmus (low calorie intake) have been found to have low ALB and PALB even years after their disease has resolved.¹⁵ In contrast, malnourished adolescents with anorexia

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Cited by (27)

The utility of bioelectrical impedance analysis to assess nutritional status of patients with severe motor and intellectual disabilities
2022, Clinical Nutrition ESPEN
Citation Excerpt :
Hgb was measured at the same time as TLC was measured, thus increasing the number of subjects whose nutritional scores can be measured, and therefore enabling the nutritional status of a larger number of subjects to be evaluated. In addition, previous studies have reported that albumin concentration does not necessarily reflect the nutritional status of patients with SMID [15]. In the present study, PhA showed a significant correlation with the nutrition score, but only a weak correlation with albumin concentration.
We aimed to evaluate the usefulness of the bioelectrical impedance analysis method in the nutritional assessment of patients with severe motor and intellectual disabilities.
Eighty patients with severe motor and intellectual disabilities were included in the study, and the samples collected were biochemical and body composition data were obtained from regular blood samples and using the bioelectrical impedance analysis method. Nutritional status was scored from the biochemical data, and the subjects were divided into three groups: well-nourished, mildly malnourished, and moderately malnourished.
The data that changed significantly with worsening nutritional status were serum albumin, total lymphocyte count, skeletal muscle ratio, phase angle, edema index, and body cell mass normalized by height. There were no significant differences in total lymphocyte count and body cell mass normalized by height between the groups.
phase angle and edema index, which have been reported to be useful in nutritional assessment, responded sensitively to this nutritional score. Skeletal muscle ratio, which has been reported less frequently, has also been suggested to be useful in the nutritional assessment of severe motor and intellectual disabilities.
Low skeletal muscle ratio, low phase angle, and high edema index were significantly suggestive of malnutrition in patients with severe motor and intellectual disabilities, and correlated significantly with biochemical data, a conventional nutritional index. Therefore, bioelectrical impedance analysis is a useful method for nutritional assessment in patients with severe motor and intellectual disabilities.
Malnutrition and nutritional deficiencies in children with cerebral palsy: a systematic review and meta-analysis
2022, Public Health
Citation Excerpt :
Studies published between 1986 and 2019 were included, but most were published between 2008 and 2019 (74.62%).2,3,5–9,14,16–18,22,24–26,35–39,41–43,45,46,48–54,57–63,65–68,72,76–80 There was a predominance of cross-sectional cohort studies (68.65%; n = 46).1,3,6–9,14–17,19,20,22–24,26,36,39–41,44–47,52–61,63,65,67–70,76–79 Regarding the methodological quality, for the studies with a cross-sectional design, it was verified that 78.26% (n = 36) of the publications1–3,6,7,9,15–17,20,22,24,26,35,36,39,40,44,46,52,54,55,58–61,63,65,67,69,74–79 clearly presented the criteria for inclusion in the sample.
This systematic review study and meta-analysis sought to estimate the prevalence of malnutrition and nutritional deficiencies in children with cerebral palsy (CP).
This is a systematic review and meta-analysis.
The systematic review was conducted according to the PRISMA guidelines. The articles were chosen using the PubMed, Embase, Scopus, Web of Science, Cochrane Library, SciELO, and Lilacs databases and the bibliographical reference lists of the articles. No limitations were placed on the time of publication, but the articles had to include children from 0 to 18 years old with CP who presented the prevalence of malnutrition and nutritional deficiencies. The methodological quality of the articles was assessed using the verification list for analytical cross-sectional studies, the Newcastle–Ottawa scale, and the Cochrane Collaboration tool for randomized studies. The meta-analysis of proportions was conducted based on the prevalence data for malnutrition or nutritional deficiencies. The study is registered in PROSPERO under CRD number 42020175068.
Sixty-seven articles (N = 453,804) published between 1986 and 2019 were included. Most of the articles presented a low risk of bias and no publication was excluded for quality reasons. The most widely used anthropometric index for diagnosing nutritional status was weight-to-age and the estimated prevalence of malnutrition was 40% (95% CI = 28.0–53.0). Nutrient deficiency was investigated by nine publications, with hypocalcemia and reduced serum concentrations of zinc, copper, and vitamin D being reported the most.
We found a high rate of malnutrition in the population in this review, moreover, we suggest that some nutritional deficiencies are associated with food deficit and that the socio-economic and age factors of these children may relate with the poor nutritional outcome. This makes monitoring and personalized nutritional management necessary, in accordance with the characteristics and particularities of children with CP.
Vitamin D and iron deficiencies in children and adolescents with cerebral palsy
2021, Neurologia
Los niños y adolescentes con parálisis cerebral (PC) tienen mayor riesgo de desnutrición y deficiencias de micronutrientes. Dos de los que podemos estudiar y tratar son la vitamina D (VD) y el hierro. No disponemos de estudios que describan estas deficiencias en Chile.
Describir el estado de ambos micronutrientes y evaluar la asociación con algunos factores que favorecen su déficit.
Estudio descriptivo, corte transversal. Se estudiaron 69 sujetos, de entre 2 a 21 años de edad, de dos hospitales públicos. Se obtuvieron datos demográficos, función motora, uso de sonda de alimentación y fármacos en uso. Se realizó evaluación nutricional según patrones para PC, y se determinó 25-hidroxivitamina D (25OHD), ferritinemia y albuminemia.
Edad promedio 11,1 ± 4,9 años, 43 (62,3%) varones, 56 (81,2%) tenían PC moderada-severa. Utilizaban sonda nasogástrica y/o gastrostomía 35 (50,7%), el 15,4% estaban con peso bajo y el 73,8% eutróficos, todos con talla normal. Recibían suplementación de VD 20 (29%), y de hierro, 4 (6,1%). La albuminemia fue normal en todos. El promedio de 25OHD fue 24,3 ± 8,8 ng/ml, 33 (47,8%) presentaron insuficiencia y 21 (30,4%) deficiencia. Tuvieron ferritina baja 36 (52,2%). No se encontró asociación entre 25OHD y variables estudiadas. Se encontró asociación entre ferritina baja y mayor edad (p = 0,03), ser hombre (p = 0,006) y uso de sonda de alimentación (p = 0,006).
El grupo estudiado fue principalmente PC moderada-severa, con alta frecuencia de valores subóptimos de VD y baja ferritina plasmática, además de escasa suplementación de ambos. Sugerimos realizar seguimiento de 25OHD y ferritina, por su alta frecuencia de deficiencia y por contar con fármacos para su tratamiento en los hospitales públicos.
Children and adolescents with cerebral palsy (CP) are at a greater risk of malnutrition and micronutrient deficiencies. Two deficiencies that we can study and treat are vitamin D (VD) and iron deficiencies; however, no studies have described these deficiencies in Chile.
To describe the status of VD and iron in patients with CP and evaluate the relationship with certain factors associated with deficiencies of these micronutrients.
We performed a descriptive, cross-sectional study including 69 patients aged between 2 and 21 years, from two public hospitals. Data were obtained on demographic variables, motor function, use of feeding tube, and pharmacological treatment. We performed a nutritional assessment according to patterns of CP and determined 25-hydroxyvitamin D (25[OH]D) ferritin, and albumin levels.
Patients’ mean age was 11.1 ± 4.9 years; 43 (62.3%) were male; and 56 (81.2%) had moderate-to-severe CP. Thirty-five (50.7%) used a nasogastric tube and/or gastrostomy; 15.4% were underweight and 73.8% were eutrophic, all with normal height. Twenty (29%) and 4 patients (6.2%) received VD and iron supplementation, respectively. Albuminaemia was normal in all patients. Mean 25(OH)D level was 24.3 ± 8.8 ng/mL; 33 patients (47.8%) had insufficiency and 21 (30.4%) deficiency; 36 patients (52.2%) had low ferritin levels. There was no association between 25(OH)D level and the other variables studied. Low ferritin levels were found to be associated with older age (P = .03), being male (P = .006), and feeding tube use (P = .006).
The patients studied mainly had moderate-to-severe CP, with a high frequency of suboptimal VD values and low plasma ferritin; few patients received VD and/or iron supplementation. We suggest monitoring 25(OH)D and ferritin levels due to the high rate of deficiency of these nutrients; public hospitals should be equipped with drugs to treat these deficiencies.
Risk factors of malnutrition in children with severe motor and intellectual disabilities
2020, Brain and Development
Citation Excerpt :
In the present study population, however, the levels of these proteins were not low, even in the severely thin children. Thus, a nutritional assessment based only on laboratory markers is unlikely to be accurate [28]. An appropriate nutritional assessment should include other markers such as anthropometric measurements and their change rate in addition to the nutritional index.
Children with severe motor and intellectual disabilities (SMID) are at a high risk of malnutrition and often require tube feeding to maintain their nutritional status. However, determining their energy requirements is difficult since inadequate dietary intake, severe neurological impairment, respiratory assistance, and cognitive impairment are all factors that affect malnutrition in SMID.
This study investigated the factors affecting malnutrition and identified problems affecting the nutritional status of children with SMID.
Forty-two children with SMID with oral motor dysfunction who were receiving home medical care at one of four hospitals were enrolled. Their nutritional status was assessed using a 3-day dietary record, anthropometric measurements, and laboratory tests. The clinical findings associated with malnutrition were compared, and a body mass index (BMI) z-score less than −2SD was defined as malnutrition. The relationship between BMI z-score and other potential predictors was also investigated.
Thirty-three (79%) children received tube feeding, and 20 (48%) experienced malnutrition. The median age of the malnourished children was older than that of non-malnourished children. Respiratory assistance was significantly correlated with higher BMI z-score, independent of other potential confounders such as nutrition method, muscle tonus, and energy intake. Cholesterol levels were significantly higher in children receiving a standard infant formula beyond 3 years of age than in those who switched to enteral formula before 3 years of age.
Malnutrition in children with SMID was mainly associated with age or respiratory condition. Energy requirements should be regularly re-evaluated with considering these factors.
Carnitine in severely disabled patients: Relation to anthropometric, biochemical variables, and nutritional intake
2015, Brain and Development
Citation Excerpt :
However, rapid turnover proteins (retinol-binding protein and transthyretin) did not show any correlation. Lark et al. demonstrated that serum prealbumin (transthyretin) and albumin were not effective markers for nutritional status in children with cerebral palsy [29]. Considering the half-life of these proteins, the association between albumin and carnitine in the present study may indicate the possibility that chronic undernutrition status affects the carnitine metabolism.
Background: Carnitine plays a pivotal role in a variety of cellular functions. Carnitine deficiency often occurs in severely disabled patients, especially under valproic acid administration. However, the possible causative factors underlying carnitine deficiency have not been fully identified. The present study aimed at clarifying the association of various anthropometric and biochemical variables, including dietary intake of carnitine, with carnitine levels in severely disabled patients. Methods: Twenty-six severely disabled patients (mean age: 14.1 years; s.d. 7.8) were enrolled. Plasma carnitine levels were evaluated by an enzyme cycling assay. Estimation of the dietary intake of carnitine was made based on dietary records over a 3-day period. Results: Plasma total and free carnitine levels in patients were significantly lower than those in controls obtained from the previous report. However, the ratios of free carnitine to total carnitine did not change significantly. Free carnitine levels were well correlated with a nutritional intake of carnitine. Administration of not only valproic acid but also other anti-epileptic drugs was found to cause a significant decrease of free carnitine levels after adjusting the nutritional intake of carnitine. Among various anthropometric or biochemical variables, albumin and uric acid showed a significant correlation with free carnitine levels. Conclusions: Physicians should be aware of the fact that severely disabled patients are at risk for carnitine deficiency even in the absence of valproic acid administration, and pay more attention to the nutritional intake of carnitine.
Common Medical Comorbidities Associated with Cerebral Palsy
2009, Physical Medicine and Rehabilitation Clinics of North America
Citation Excerpt :
Other indicators of nutrition frequently used in the general population, but found to be unreliable in children with CP, include serum prealbumin and albumin concentrations. There is little to no correlation of these values with anthropometric measures (eg, skinfolds, midarm fat area), growth (height), severity of CP, feeding dysfunction, or general health.72 Several measures of nutritional status, including weight-for-height percentiles, arm circumference, BMI, lean BMI, head circumference to arm circumference ratio, triceps and subscapular skinfold thickness, have been evaluated and triceps skinfold thickness less than 10% for age/sex has been identified as the best indicator of malnutrition in children with CP.73

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: Supported by the National Center for Medical Rehabilitation Research, National Institutes of Health (grant R01 HD35739); the General Clinical Research Centers program of the Division of Research Resources, National Institutes of Health (grant RR00046); a career award from the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (grant K24 AR02132); and the Genentech Foundation for Growth and Development.

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Clinical and Laboratory ObservationSerum Prealbumin and Albumin Concentrations do not Reflect Nutritional State in Children with Cerebral Palsy

Section snippets

Methods

Results

Discussion

J Am Diet Assoc

Nutrition

Nutrition

J Am Diet Assoc

Nutrition-related growth failure of children with quadriplegic cerebral palsy

Dev Med Child Neurol

Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy

Pediatrics

Secondary sexual characteristics in children with cerebral palsy and moderate to severe motor impairment: a cross-sectional survey

Pediatrics

Health status of children with moderate to severe cerebral palsy

Dev Med Child Neurol

Linear growth velocity in children with cerebral palsy

Dev Med Child Neurol

Clinical and Laboratory Observation
Serum Prealbumin and Albumin Concentrations do not Reflect Nutritional State in Children with Cerebral Palsy