Undernutrition in children with cerebral palsy: comparison of anthropometric measures across gross motor function levels

OBJECTIVE: Nutritional assessment in children with cerebral palsy (CP) remains challenging because growth patterns, body composition, and the feasibility of anthropometric measurements vary according to motor severity. This study aimed to compare anthropometric indicators of undernutrition in children with CP according to Gross Motor Function Classification System (GMFCS) levels. METHODS: In this observational cross-sectional study, forty-three children with CP aged 2-18 years were evaluated. Patients were grouped as GMFCS I-II-III and IV-V. Anthropometric, demographic, and clinical data were analyzed. Undernutrition was defined using age-specific z-scores for height, weight, body mass index (BMI), mid-upper arm circumference (MUAC), and triceps skinfold thickness (TST) based on 'Centers for Disease Control and Prevention' growth charts. Weight-based undernutrition was also re-evaluated using CP-specific Brooks weight-for-age percentiles in a sensitivity analysis. RESULTS: = 0.02, respectively). BMI z-score identified undernutrition more frequently in GMFCS I-II-III, whereas weight-for-age and MUAC z-scores were more informative in GMFCS IV-V. In sensitivity analysis, the higher rate of low weight in the GMFCS IV-V group was less marked with CP-specific Brooks references. DISCUSSION: Undernutrition is frequent in children with CP, particularly in those with more severe motor impairment. Nutritional risk assessment appears to be method- and reference-dependent, supporting a multidimensional anthropometric approach in clinical practice.