脳性麻痺の食事摂取と身体組成

就学前脳性麻痺児の食事摂取と身体組成を移動能力別にみた研究を紹介します。

Jacqueline L. Walker, et al. Relationships between Dietary Intake and Body Composition according to Gross Motor Functional Ability in Preschool-Aged Children with Cerebral Palsy. Ann Nutr Metab 2012;61:349-357 (DOI: 10.1159/000342557)

対象は就学前脳性麻痺児（平均年齢2.8歳）73人（GMFCS levelsはI = 39, II = 9, III = 9, IV = 7, V = 9。ⅠとⅡを移動自立、ⅢからⅤを移動困難の2群に分類）と、健常発達児16人です。3日間の食事摂取量と身体組成を横断研究で調査しました。

結果ですが、食事摂取量と除脂肪指数にのみ有意な関連を認め、脳性麻痺児より健常発達児のほうがより強い関連でした。身体組成と移動能力には関連を認めました。移動困難で経管栄養の場合、経口摂取と比較して蛋白摂取量が有意に少なかったです。

以上より、この年代の身体組成には食事摂取よりも身体活動レベルのほうがより大きな影響を与えている可能性があるという結論です。

脳性麻痺の場合、痙直型かアテトーゼ型かによってもエネルギー消費量がかなり異なります。タイプ分類せずに一律に脳性麻痺として研究するのは、やや無理があるのかなと感じます。食事摂取と身体活動の両方とも当然、身体組成への影響が大きいかと思います。

Abstract
Background/Aims: We aimed to determine the relationships between energy intake, macronutrient intake and body composition in preschool-aged children with cerebral palsy (CP) according to gross motor functional ability in comparison with typically developing children (TDC). Methods: Seventy-three children with CP (70% male) of all functional abilities and 16 TDC (63% male) aged 2.8 ± 0.9 years participated in this study. Dietary intake was measured via a validated 3-day weighed food record. Body composition was determined via isotope dilution techniques. Results: There was a significant relationship between energy intake and fat-free mass index, which was stronger in TDC compared to children with CP. There were no significant correlations between other dietary intake and body composition variables, despite differences in body composition as ambulatory status declined. Non-ambulant, tube-fed children had significantly lower protein intakes compared to orally fed children. No other differences in macronutrient intake between children with CP and TDC were apparent. Conclusions: Results suggest that relationships between dietary intake and body composition are not evident in this population, but develop over time. Physical activity levels may have a greater impact on body composition at this age. Longitudinal research is required to examine these factors.