Comparison of nutritional diagnoses according to WHO and CDC reference standards in children and adolescents with cerebral palsy

Abstract

Introduction: Nutritional assessment in children and adolescents (NNA) with cerebral palsy (CP) is a challenge in clinical practice and still lacks international agreements. Various references, such as the WHO and CDC growth standards, are used to assess their nutritional status. In this sense, it is relevant to analyze the degree of agreement between both standards for their appropriate application in children and adolescents with CP.

Objective: To compare the agreement in nutritional status among children and adolescents aged 2 to 18 years diagnosed with cerebral palsy, according to WHO and CDC growth standards.

Materials and Methods: Observational, cross-sectional study. Children with CP from Argentina included in the Argentine Cerebral Palsy Registry (RAR-PC) were analyzed. Nutritional status was assessed in z-scores using the WHO Anthro Plus 2007 software and CDC 2000 growth charts, and then categorized by nutritional status. Agreement in nutritional status between WHO and CDC was evaluated using Cohen’s Kappa with 95% CI.

Results: A total of 366 records were analyzed. 204 were male (55.7% [50.4;60.9]). 258 were under 10 years old (70.5% [65.5;75.1]). The mean age was 8 years (± 4 years 6 months). 231 presented severe motor impairment (66% [60.9;70.8]).
When comparing weight/age and height/age, classified as normal, moderate, and severe, the agreement between WHO and CDC was Kappa 0.92 [0.88;0.96] and 0.81 [0.76;0.85], respectively. For BMI/A (according to moderate or severe wasting, overweight, obesity, or normal), the Kappa coefficient was 0.86 [0.82;0.90].

Conclusion: A substantial agreement was observed between the WHO and CDC standards for evaluating nutritional status in children and adolescents with CP. Both methods classify nutritional status similarly and may be used complementarily in clinical practice.