Developmental neurorehabilitation · 2026
Anthropometric outcomes in Saudi children with cerebral palsy: associations with gross motor severity and eating and drinking ability.
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Alghadier Mshari
Аннотация
BACKGROUND: Growth faltering is a prevalent and clinically significant complication of cerebral palsy (CP), yet data from regional populations using standardized anthropometric outcomes remain limited.
OBJECTIVES: To quantify anthropometric deficits using WHO age- and sex-standardized z-scores and identify independent predictors in a clinical cohort of Saudi children with CP.
METHODS: A retrospective cross-sectional study of 107 Saudi children with CP (median age 4.3 years, IQR 2.4-6.2; 68.2% male). Anthropometric outcomes were expressed as weight-for-age (WAZ), height-for-age (HAZ), BMI-for-age (BAZ), and head circumference-for-age (HCAZ) z-scores using WHO 2006/2007 reference standards. Between-group comparisons used Mann-Whitney U and Kruskal-Wallis tests with effect sizes (rank-biserial correlation; epsilon-squared). Four multivariable linear regression models were fitted using seven a priori predictors: age, sex, GMFCS level (IV-V vs I-III), eating and drinking ability (EDACS; Levels II, III, and IV-V vs I), and orthopedic surgery history. Feeding and swallowing difficulty was excluded from all regression models owing to confirmed perfect collinearity with EDACS classification.
RESULTS: Stunting (HAZ < -2 SD) was the most prevalent anthropometric deficit (65.4%), followed by underweight (40.2%; n = 97), wasting (18.7%), and microcephaly in children aged ≤ 5 years (HCAZ < -2 SD: 23.5%; n = 68). WAZ and HCAZ were significantly lower in GMFCS Levels IV-V than Levels I-III (both p < .05). In multivariable models, three independent predictors emerged: age predicted progressive linear height faltering (HAZ: B = -0.445 per year, p < .001); GMFCS Levels IV-V independently predicted lower WAZ (B = -1.022, p = .047) and lower HCAZ (B = -1.051, p = .006); and orthopedic surgery history was the strongest predictor of lower WAZ (B = -2.427, p = .001) and lower BAZ (B = -2.265, p < .001). EDACS level did not independently predict any z-score after multivariable adjustment. Head circumference-for-age demonstrated greater sensitivity to neurological and feeding-related vulnerabilities than BMI-for-age in younger children.
CONCLUSIONS: Stunting is the dominant nutritional phenotype in this Saudi CP cohort. Motor severity, progressive age-related linear growth faltering, and orthopedic surgery history are independent predictors of anthropometric outcomes. Integration of WHO z-score monitoring with GMFCS and EDACS classification from the point of diagnosis is recommended as a minimum standard for nutritional surveillance in children with CP.
OBJECTIVES: To quantify anthropometric deficits using WHO age- and sex-standardized z-scores and identify independent predictors in a clinical cohort of Saudi children with CP.
METHODS: A retrospective cross-sectional study of 107 Saudi children with CP (median age 4.3 years, IQR 2.4-6.2; 68.2% male). Anthropometric outcomes were expressed as weight-for-age (WAZ), height-for-age (HAZ), BMI-for-age (BAZ), and head circumference-for-age (HCAZ) z-scores using WHO 2006/2007 reference standards. Between-group comparisons used Mann-Whitney U and Kruskal-Wallis tests with effect sizes (rank-biserial correlation; epsilon-squared). Four multivariable linear regression models were fitted using seven a priori predictors: age, sex, GMFCS level (IV-V vs I-III), eating and drinking ability (EDACS; Levels II, III, and IV-V vs I), and orthopedic surgery history. Feeding and swallowing difficulty was excluded from all regression models owing to confirmed perfect collinearity with EDACS classification.
RESULTS: Stunting (HAZ < -2 SD) was the most prevalent anthropometric deficit (65.4%), followed by underweight (40.2%; n = 97), wasting (18.7%), and microcephaly in children aged ≤ 5 years (HCAZ < -2 SD: 23.5%; n = 68). WAZ and HCAZ were significantly lower in GMFCS Levels IV-V than Levels I-III (both p < .05). In multivariable models, three independent predictors emerged: age predicted progressive linear height faltering (HAZ: B = -0.445 per year, p < .001); GMFCS Levels IV-V independently predicted lower WAZ (B = -1.022, p = .047) and lower HCAZ (B = -1.051, p = .006); and orthopedic surgery history was the strongest predictor of lower WAZ (B = -2.427, p = .001) and lower BAZ (B = -2.265, p < .001). EDACS level did not independently predict any z-score after multivariable adjustment. Head circumference-for-age demonstrated greater sensitivity to neurological and feeding-related vulnerabilities than BMI-for-age in younger children.
CONCLUSIONS: Stunting is the dominant nutritional phenotype in this Saudi CP cohort. Motor severity, progressive age-related linear growth faltering, and orthopedic surgery history are independent predictors of anthropometric outcomes. Integration of WHO z-score monitoring with GMFCS and EDACS classification from the point of diagnosis is recommended as a minimum standard for nutritional surveillance in children with CP.