Indian J Pediatr DOI 10.1007/s12098-014-1543-z
ORIGINAL ARTICLE
Comparison of Micronutrient Levels in Children with Cerebral Palsy and Neurologically Normal Controls Swati Kalra & Anju Aggarwal & Neelam Chillar & M. M. A. Faridi
Received: 30 January 2014 / Accepted: 14 July 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objective To measure levels of micronutrients in children with cerebral palsy and compare them with neurologically normal children of similar nutritional status. Methods Fifty children with cerebral palsy (2–12 y) and 50 age and sex matched controls of similar nutritional status were enrolled. Detailed dietary history was recorded and nutritional status assessed. Venous blood (3 ml) was drawn for analysis. Micronutrient levels were measured as per standard technique. Results Serum iron was 12.6±5.9 and 20.9±3.3 μmol/L in CP and controls respectively (P0.05). Conclusions The serum levels of iron, copper and magnesium are significantly less in children with cerebral palsy, hence the need for supplementation. S. Kalra : A. Aggarwal : M. M. A. Faridi Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Dilshad Garden, New Delhi, India N. Chillar Department of Neurochemistry, Institute of Human Behaviour and Allied Sciences, Delhi, India A. Aggarwal (*) Flat No. 3C, Block C2B, Janakpuri, New Delhi 110058, India e-mail: [email protected]
Keywords Cerebral palsy . Micronutrients . Nutritional status
Introduction Micronutrients such as iron, zinc, magnesium and copper have been implicated in the functioning of nervous system and their deficiencies are a critical concern among cerebral palsy (CP) children [1–3]. Very few studies in the literature have studied the micronutrient status of children with cerebral palsy [4, 5]. None of the studies from India have determined micronutrient levels in cerebral palsy children and compared them with children of similar nutritional status. Hence, the authors planned to measure levels of micronutrients in children with cerebral palsy and compare them with neurologically normal children of similar nutritional status.
Material and Methods The study was conducted at a tertiary care hospital of North India from February 2011 through March 2012 after getting an approval from the institutional ethical committee. The study protocol was fully explained to the parents/guardian and written informed consent was obtained. Being a pilot study, the sample size of fifty children with cerebral palsy was chosen. Fifty children (aged 2–12 y) having cerebral palsy as per the case definition [6] were enrolled prospectively. These were 50 consecutive children with a diagnosis of cerebral palsy attending child development clinic. Controls consisted of fifty age, sex matched neurologically normal children. There had similar nutritional status i.e., BMI within±10th centile of the cases or weight within 10 % of CP child. Children having neurological disorders like inflammatory brain disease, degenerative brain disease, intracranial space occupying lesion, encephalopathy due to well defined causes
Indian J Pediatr
and those having chronic liver disease or kidney disease were excluded from the study. Clinical characteristics and demographic data was recorded. Anthropometric parameters i.e., weight, height and head circumference were measured as per standard method. Nutritional status assessment was done using WHO growth charts (WHO standards, 2007) [7] and Z scores were calculated using the software “Anthro” (WHO). Detailed dietary history was recorded by 24 h recall method. Protein and calories were calculated from the nutrient composition provided in the standard book (ref: Nutritive Value Of Indian Foods) [8]. Estimation of daily micronutrient intake was done using “dietsoft software” developed by ICMR, Hyderabad. This was done by a dietician. All study subjects underwent neuroimaging and other investigations as per protocol. Hemogram and serum proteins were determined in all cases and controls. For the purpose of estimation of micronutrient levels, 3 ml of venous blood sample was drawn. Serum levels of iron, copper, zinc and magnesium were measured using autoanalyser (Random Access Discrete Autoanalyser, XL-300 from Transasia). Serum levels of copper, iron and zinc were measured by commercially available kit manufactured by Fortress Diagnostics Ltd., UK and the kit manufactured by Centronic GmbH was used for the measurement of serum magnesium levels. All the kits were based on colorimetric method. According to the laboratory, normal copper levels were 70–140 μg/dl; normal magnesium levels 0.70–1.05 mg/dl; normal iron levels 10.0– 26.0 μmol/L and normal zinc levels 10–18 μmol/L. The data was analysed using SPSS Version 17.0. Comparison of serum micronutrient levels was done using Unpaired Student-t test. One way ANOVA was used when there was more than one group for subgroup analysis. Comparison of the serum levels within various grades of malnutrition amongst the two groups was analyzed using two way ANOVA and Tukey’s test. For comparison of qualitative variables, Chisquare test was used. P
ORIGINAL ARTICLE
Comparison of Micronutrient Levels in Children with Cerebral Palsy and Neurologically Normal Controls Swati Kalra & Anju Aggarwal & Neelam Chillar & M. M. A. Faridi
Received: 30 January 2014 / Accepted: 14 July 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objective To measure levels of micronutrients in children with cerebral palsy and compare them with neurologically normal children of similar nutritional status. Methods Fifty children with cerebral palsy (2–12 y) and 50 age and sex matched controls of similar nutritional status were enrolled. Detailed dietary history was recorded and nutritional status assessed. Venous blood (3 ml) was drawn for analysis. Micronutrient levels were measured as per standard technique. Results Serum iron was 12.6±5.9 and 20.9±3.3 μmol/L in CP and controls respectively (P0.05). Conclusions The serum levels of iron, copper and magnesium are significantly less in children with cerebral palsy, hence the need for supplementation. S. Kalra : A. Aggarwal : M. M. A. Faridi Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Dilshad Garden, New Delhi, India N. Chillar Department of Neurochemistry, Institute of Human Behaviour and Allied Sciences, Delhi, India A. Aggarwal (*) Flat No. 3C, Block C2B, Janakpuri, New Delhi 110058, India e-mail: [email protected]
Keywords Cerebral palsy . Micronutrients . Nutritional status
Introduction Micronutrients such as iron, zinc, magnesium and copper have been implicated in the functioning of nervous system and their deficiencies are a critical concern among cerebral palsy (CP) children [1–3]. Very few studies in the literature have studied the micronutrient status of children with cerebral palsy [4, 5]. None of the studies from India have determined micronutrient levels in cerebral palsy children and compared them with children of similar nutritional status. Hence, the authors planned to measure levels of micronutrients in children with cerebral palsy and compare them with neurologically normal children of similar nutritional status.
Material and Methods The study was conducted at a tertiary care hospital of North India from February 2011 through March 2012 after getting an approval from the institutional ethical committee. The study protocol was fully explained to the parents/guardian and written informed consent was obtained. Being a pilot study, the sample size of fifty children with cerebral palsy was chosen. Fifty children (aged 2–12 y) having cerebral palsy as per the case definition [6] were enrolled prospectively. These were 50 consecutive children with a diagnosis of cerebral palsy attending child development clinic. Controls consisted of fifty age, sex matched neurologically normal children. There had similar nutritional status i.e., BMI within±10th centile of the cases or weight within 10 % of CP child. Children having neurological disorders like inflammatory brain disease, degenerative brain disease, intracranial space occupying lesion, encephalopathy due to well defined causes
Indian J Pediatr
and those having chronic liver disease or kidney disease were excluded from the study. Clinical characteristics and demographic data was recorded. Anthropometric parameters i.e., weight, height and head circumference were measured as per standard method. Nutritional status assessment was done using WHO growth charts (WHO standards, 2007) [7] and Z scores were calculated using the software “Anthro” (WHO). Detailed dietary history was recorded by 24 h recall method. Protein and calories were calculated from the nutrient composition provided in the standard book (ref: Nutritive Value Of Indian Foods) [8]. Estimation of daily micronutrient intake was done using “dietsoft software” developed by ICMR, Hyderabad. This was done by a dietician. All study subjects underwent neuroimaging and other investigations as per protocol. Hemogram and serum proteins were determined in all cases and controls. For the purpose of estimation of micronutrient levels, 3 ml of venous blood sample was drawn. Serum levels of iron, copper, zinc and magnesium were measured using autoanalyser (Random Access Discrete Autoanalyser, XL-300 from Transasia). Serum levels of copper, iron and zinc were measured by commercially available kit manufactured by Fortress Diagnostics Ltd., UK and the kit manufactured by Centronic GmbH was used for the measurement of serum magnesium levels. All the kits were based on colorimetric method. According to the laboratory, normal copper levels were 70–140 μg/dl; normal magnesium levels 0.70–1.05 mg/dl; normal iron levels 10.0– 26.0 μmol/L and normal zinc levels 10–18 μmol/L. The data was analysed using SPSS Version 17.0. Comparison of serum micronutrient levels was done using Unpaired Student-t test. One way ANOVA was used when there was more than one group for subgroup analysis. Comparison of the serum levels within various grades of malnutrition amongst the two groups was analyzed using two way ANOVA and Tukey’s test. For comparison of qualitative variables, Chisquare test was used. P
