Nutrition Interventions for Children with Cerebral Palsy in Low- and Middle-Income Countries: A Scoping Review.

Israt Jahan,Sarah Mcintyre,Gulam Khandaker,Mohammad Muhit,Manik Chandra Das,Hayley Smithers-Sheedy,Tasneem Karim,Risad Sultana,Nadia Badawi,Mahmudul Hassan Al Imam,Delwar Akbar

doi:10.3390/nu14061211

Abstract

Background: Malnutrition is substantially higher among children with cerebral palsy (CP) in low- and middle-income countries (LMICs) when compared with the general population. Access to appropriate interventions is crucial for better management of malnutrition and nutritional outcomes of those children. We aimed to review the existing evidence on nutrition interventions for children with CP in LMICs. Methods: Online databases, i.e., PubMed and Scopus, and Google Scholar were searched up to 10 January 2022, to identify peer-reviewed publications/evidence on LMIC focused nutritional management guidelines/interventions. Following title screening and abstract review, full articles that met the inclusion/exclusion criteria were retained for data charting. Information about the study characteristics, nutrition interventions, and their effectiveness were extracted. Descriptive data were reported. Results: Eight articles published between 2008 and 2019 were included with data from a total of n = 252 children with CP (age range: 1 y 0 m–18 y 7 m, 42% female). Five studies followed experimental design; n = 6 were conducted in hospital/clinic/center-based settings. Four studies focused on parental/caregiver training; n = 2 studies had surgical interventions (i.e., gastrostomy) and n = 1 provided neurodevelopmental therapy feeding intervention. Dietary modification as an intervention (or component) was reported in n = 5 studies and had better effect on the nutritional outcomes of children with CP compared to interventions focused on feeding skills or other behavioral modifications. Surgical interventions improved nutritional outcomes in both studies; however, none documented any adverse consequences of the surgical interventions. Conclusion: There is a substantial knowledge gap on nutrition interventions for children with CP in LMICs. This hinders the development of best practice guidelines for the nutritional management of children with CP in those settings. Findings suggest interventions directly related to growth/feeding of children had a better outcome than behavioral interventions. This should be considered in planning of nutrition-focused intervention or comprehensive services for children with CP in LMICs.

Highlights

Undernutrition is a major global public health challenge, and children with disability, such as cerebral palsy (CP), often suffer from undernutrition, especially in low- and middleincome countries (LMICs)
A total of n = 25 full articles met the inclusion criteria. Of those n = 13 were conducted in high-income settings, n = 1 did not report information for children with CP separately, the outcome could not be differentiated from other study participants, and n = 3 were conducted in high-income countries (HICs) and did not report data on CP separately
In this review we provide a summary of the available evidence on different nutrition interventions for children with CP in low- and middle-income countries (LMICs)

Summary

Introduction

Undernutrition is a major global public health challenge, and children with disability, such as cerebral palsy (CP), often suffer from undernutrition, especially in low- and middleincome countries (LMICs). Ensuring availability and accessibility to evidence-based nutrition interventions is essential to avert adverse outcomes of malnutrition among those vulnerable children [6]. While a few factors have been identified as common predictors of malnutrition (e.g., gross motor and oromotor function limitations) [1,8,9], the conceptual framework of malnutrition in children with CP is not yet clearly understood, especially in LMICs. To date, several clinical nutrition guidelines based on current evidence on surgical and non-surgical intervention outcomes have been published [6,10]. Several clinical nutrition guidelines based on current evidence on surgical and non-surgical intervention outcomes have been published [6,10] Most of those studies were conducted in high-income countries (HICs) [6], whereas 85% of children with disabilities live in LMICs and the majority have no or limited access to any rehabilitation services [11,12]. In absence of optimal management, these children are at high risk of malnutrition, which can in turn impact their functional outcomes, quality of life, and survival [14–16]

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