ENERGY-EXPENDITURE AND BODY-COMPOSITION IN CHILDREN WITH SPASTIC QUADRIPLEGIC CEREBRAL-PALSY

Objective: To determine the relationship between resting energy expend iture and body cell mass in a group of children with spastic quadriple gic cerebral palsy (SQCP) in comparison with a group of healthy volunt eers. Subjects and methods: Children with SQCP (n = 13) and healthy co ntrol subjects (n = 21) participated in the study. Resting energy expe nditure (REE) by indirect calorimetry, as well as body composition mea surements were obtained. Those included skinfold measurements, isotope dilution methods far total body water and extracellular water ((H2O)- H-2 or (H2O)-O-18 and NaBr, respectively), and bioelectrical impedance analysis. Intracellular water was calculated as total body water minu s extracellular water. Results: Overall REE in children with SQCP was significantly less than in control subjects or from predicted World He alth Organization equations. There was a poor correlation between REE and weight or height for children with SQCP and those for control subj ects. Children with SQCP skewed a higher variance and small improvemen t in the correlation between REE and lean body mass or intracellular w ater in comparison with control subjects. Nine of the thirteen childre n with SQCP had significantly seduced REE per unit of lean tissue or i ntracellular water. Furthermore, bioelectrical impedance analysis was validated against dilution methods as a suitable technique for measuri ng total body water (r(2) = 0.90, r = 0.95) and extracellular water (r (2) = 0.84, r = 0.92) in children with SQCP. Conclusion: REE in childr en with SQCP is poorly correlated with body cell mass. We postulate th at the central nervous system plays a crucial role in energy regulatio n. In children with SQCP, individual energy expenditure should be meas ured so that optimal nutritional status can be achieved. Bioelectrical impedance analysis can be used in this population to measure body wat er spaces.