Characteristics of dietary intake assessment in children with neurological disorders

Children with severe neurological disorders frequently experience gastrointestinal problems, including dysphagia, constipation, and gastroesophageal reflux disease, which often lead to protein-energy undernutrition (PEU). Effective management of nutritional disorders is not possible without assessment of actual dietary intake. The available literature provides limited data on dietary intake in children with neurological disorders, particularly in those with cerebral palsy (CP). Objective. To perform a comprehensive assessment of actual dietary intake among children with CP according to the severity of motor impairment, disease type, and physical development. Patients and methods. This cross-sectional analytical study included 175 children aged 1–18 years with spastic forms of CP and all levels of motor impairment according to the Gross Motor Function Classification System (GMFCS). Physical development was evaluated, and dietary intake was analyzed using a questionnaire survey and a 3-day dietary record. Results. The analysis of dietary intake revealed a monotonous diet in 41% of children with CP, inadequate intake of fresh vegetables and greens in 39%, low fiber intake in 32%, and a significantly low red meat intake in 16%. Meal duration exceeding 30 minutes was observed in 31% of children. The average daily energy intake was comparable to the total energy expenditure (TEE) calculated using the Krick formula but differed significantly from age-specific requirements (p < 0.001). Overall, 81% of children had energy intake below age-specific requirements; carbohydrate intake was inadequate in 89% of cases, fat intake in 66%, and protein intake in 60%. Regarding TEE, children assigned to GMFCS levels I–II had excess energy intake (>100%) compared to those with GMFCS levels III–V (81–90% of TEE). Children with hemiparetic CP had a more optimal dietary intake than those with spastic tetraparesis (p = 0.001 for protein and carbohydrate; p = 0.012 for fat). In children with GMFCS level V, macronutrient intake was lower than in children with GMFCS levels I and II for protein (pV–I = 0.045; pV–II = 0.029) and carbohydrates (pV–I = 0.015; pV–II = 0.09). Fat intake in children with GMFCS level V was lower than in those with GMFCS level II (p < 0.001) and level III (p = 0.041). Conclusion. Most children with CP exhibited inadequate intake of energy, carbohydrates, fat, and protein. Children with spastic/ hyperkinetic CP, spastic tetraparesis, and severe motor impairments (GMFCS level V) represent a high-risk group for developing PEU. In contrast, children with hemiparetic CP and/or preserved motor function (GMFCS levels I–II) are at risk of overweight and obesity. Key words: children, cerebral palsy, energy intake, nutritional status, dietary intake, physical development