{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:08:30Z","timestamp":1791994110506,"version":"4.4.0"},"reference-count":39,"publisher":"FapUNIFESP (SciELO)","issue":"4","license":[{"start":{"date-parts":[[2018,12,1]],"date-time":"2018-12-01T00:00:00Z","timestamp":1543622400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2018,12,1]],"date-time":"2018-12-01T00:00:00Z","timestamp":1543622400000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2018,12,1]],"date-time":"2018-12-01T00:00:00Z","timestamp":1543622400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Gastroenterol."],"abstract":"<jats:p>ABSTRACT BACKGROUND: Cerebral palsy may be associated with comorbidities such as undernutrition, impaired growth and gastrointestinal symptoms. Children with cerebral palsy exhibit eating problems due to the effect on the anatomical and functional structures involved in the eating function resulting in malnutrition. OBJECTIVE: The aim of this study was to investigate the association between food intake, nutritional status and gastrointestinal symptoms in children with cerebral palsy. METHODS: Cross-sectional study that included 40 children with cerebral palsy (35 with spastic tetraparetic form and 5 with non-spastic choreoathetoid form of cerebral palsy, all requiring wheelchairs or bedridden) aged from 4 to 10 years. The dietary assessment with the parents was performed using the usual household food intake inquiry. Anthropometric data were collected. Gastrointestinal symptoms associated with deglutition disorders, gastroesophageal reflux and chronic constipation were also recorded. RESULTS: The median of height-for-age Z-score (-4.05) was lower (P&lt;0.05) than the median of weight-for-age (-3.29) and weight-for-height (-0.94). There was no statistical difference between weight-for-age and weight-for-height Z-scores. Three patients with cerebral palsy (7.5%) exhibited mild anemia, with normal ferritin levels in two. Symptoms of dysphagia, gastroesophageal reflux, and constipation were found in 82.5% (n=33), 40.0% (n=16), and 60.0% (n=24) of the sample, respectively. The patients with symptoms of dysphagia exhibited lower daily energy (1280.2\u00b1454.8 Kcal vs 1890.3\u00b1847.1 Kcal, P=0.009), carbohydrate (median: 170.9 g vs 234.5 g, P=0.023) and fluid intake (483.1\u00b1294.9 mL vs 992.9\u00b1292.2 mL, P=0.001). The patients with symptoms of gastrointestinal reflux exhibited greater daily fluid intake (720.0\u00b1362.9 mL) than the patients without symptoms of gastroesophageal reflux (483.7\u00b1320.0 mL, P=0.042) and a greater height-for-age deficit (Z-score: -4.9\u00b11.7 vs 3.7\u00b11.5, P=0.033). The patients with symptoms of constipation exhibited lower daily dietary fiber (9.2\u00b14.3 g vs 12.3\u00b14.3 g, P=0.031) and fluid (456.5\u00b1283.1 mL vs 741.1\u00b1379.2 mL, P=0.013) intake. CONCLUSION: Children with cerebral palsy exhibited wide variability in food intake which may partially account for their severe impaired growth and malnutrition. Symptoms of dysphagia, gastroesophageal reflux, and constipation are associated with different food intake patterns. Therefore, nutritional intervention should be tailored considering the gastrointestinal symptoms and nutritional status.<\/jats:p>","DOI":"10.1590\/s0004-2803.201800000-78","type":"journal-article","created":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T13:54:06Z","timestamp":1550238846000},"page":"352-357","source":"Crossref","is-referenced-by-count":48,"title":["FOOD INTAKE, NUTRITIONAL STATUS AND GASTROINTESTINAL SYMPTOMS IN CHILDREN WITH CEREBRAL PALSY"],"prefix":"10.1590","volume":"55","author":[{"given":"Deise Cristina Oliva","family":"CARAMICO-FAVERO","sequence":"first","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zelita Caldeira Ferreira","family":"GUEDES","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4014-5549","authenticated-orcid":false,"given":"Mauro Batista de","family":"MORAIS","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2018,12]]},"reference":[{"key":"ref1","series-title":"Neurologia infantil [Pediatric neurology]","first-page":"901","volume-title":"Encefalopatias cr\u00f4nicas na inf\u00e2ncia (paralisia cerebral) [Chronic encephalopathies in childhood (cerebral palsy)]","volume":"vol. 1","author":"Diament A","year":"2005","edition":"4a ed"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"9400","DOI":"10.3390\/nu7115469","article-title":"Dietary intakes and nutritional issues in neurologically impaired children","author":"Penagini 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Brazil","year":"2003"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1111\/j.1469-8749.2002.tb00307.x","article-title":"Impact of feeding problems on nutritional intake and growth: Oxford feeding study II","volume":"44","author":"Sullivan PB","year":"2002","journal-title":"Dev Med Child Neurol"},{"key":"ref19","series-title":"Sistema de apoio \u00e0 decis\u00e3o em nutri\u00e7\u00e3o-vers\u00e3o 2.5 [Support system for decision-making in nutrition","author":"An\u00e7\u00e3o MS","year":"1993"},{"key":"ref20","series-title":"Dietary Reference Intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids","year":"2002"},{"key":"ref21","first-page":"985:8","article-title":"A new recommendation for dietary fiber in childhood","volume":"96","author":"Willians 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A","year":"2006","journal-title":"Gastroenterology"},{"key":"ref30","series-title":"Sigma Stat 2.0 for Windows (computer progam)","year":"1995","edition":"I st ed"},{"key":"ref31","series-title":"Epi Info TM, a database and statistics program for public health professionals (computer program)","author":"Dean AG","year":"2002"},{"key":"ref32","article-title":"Longitudinal cohort protocol study of oropharyngeal dysphagia: relationships to gross motor attainment, growth and nutritional status in preschool children with cerebral palsy","volume":"0","author":"Benfer KA","year":"2012","journal-title":"BMJ Open"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1177\/0884533610374061","article-title":"Growth in cerebral palsy","volume":"25","author":"Andrew MJ","year":"2010","journal-title":"Nutr Clin Pract"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/01.mpg.0000228124.93841.ea","article-title":"Nutrition support for neurologically 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