Sang Ho Chun, MD, Ki Hyuk Sung, MD PhD, Gyeong Hee Cho, PT PhD, Chin Youb Chung, MD PhD, Kyoung Min...
Transcript of Sang Ho Chun, MD, Ki Hyuk Sung, MD PhD, Gyeong Hee Cho, PT PhD, Chin Youb Chung, MD PhD, Kyoung Min...
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/m2) 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/m2) 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/m2) 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/m2) 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/m2) 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/m2) 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 (cm2) 28.7±24.0 26.1±25.1 32.3±22.1 46.3±29.2
VFA index (cm2/m2) 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/m2) 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/m2) .017 −0.0 to 0.0 .010 .101
GMFCS level (I/II/III/IV/V) −.221 −0.3 to −0.2 .031 <.001