title: The effect of gastrostomy tube feeding on body protein and bone mineralization in children with quadriplegic cerebral palsy.
abstract: OBJECTIVE
  The aim of this study was to investigate the effect of gastrostomy tube feeding on body protein and bone mineralization in malnourished children with cerebral palsy (CP).
  
  
  METHODS
  Children aged between 4 and 18 years with spastic quadriplegic CP (Gross Motor Function Classification System level V) were recruited from the Children's Hospital at Westmead to participate in this prospective cohort study. The children had measurements of anthropometry (weight, height, and skinfold), bone mineral content (BMC) by dual-energy X-ray absorptiometry, and total body protein (TBP) by neutron activation analysis before and after gastrostomy tube feeding. Comparison data were collected prospectively from age-matched healthy children and extracted from databases for this study.
  
  
  RESULTS
  A total of 21 children (nine females, 12 males) participated in the study (median age 8 y 5 mo; interquartile range [IQR] 6 y 9 mo-11 y 10 mo). The median length of time of gastrostomy feeding was 19.4 months (IQR 7.7-29.9 mo). Significant (p<0.05) improvements were found in the median values for weight (15.4-23.3 kg), weight standard deviation scores (SDS; -4.8 to -3.0), height (105.4-118.3 cm), per cent body fat (10.7-16.3), TBP (2.4-3.4 kg), TBP per cent predicted for height (83.4-99.0), and BMC (469-626 g). No significant increases were found in height SDS, TBP per cent predicted for age, or BMC SDS for age or height.
  
  
  CONCLUSIONS
  Malnourished children with quadriplegic CP showed significant increases in body fat and protein with gastrostomy tube feeding. No significant change in bone mineralization predicted for age or height was observed.
authors.affiliation: Department of Gastroenterology, The Children's Hospital at Westmead, New South Wales, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Arrowsmith
authors.forename: Jane
authors.initials: J
authors.lastname: Allen
authors.forename: Kevin
authors.initials: K
authors.lastname: Gaskin
authors.forename: Helen
authors.initials: H
authors.lastname: Somerville
authors.forename: Samantha
authors.initials: S
authors.lastname: Clarke
authors.forename: Edward
authors.initials: E
authors.lastname: O'Loughlin
mesh_terms: D015502:Absorptiometry, Photon; D001823:Body Composition; D001835:Body Weight; D015519:Bone Density; D002547:Cerebral Palsy / Q000150:complications / Q000378:metabolism / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy; D006801:Humans; D008297:Male; D011782:Quadriplegia / Q000150:complications / Q000378:metabolism / Q000628:therapy; D012189:Retrospective Studies; D018709:Statistics, Nonparametric