Body Composition in Outpatient Children with Cerebral Palsy: A Case-Control Study

Figures & data

Table 1 Body Mass Composition Parameters

Abbreviation	Parameter	Definition
WEIGHT	Total Weight (kg)	Total body weight.
BMR	Basal Metabolic Rate (kJ)	The total energy expended by body to maintain normal functions at rest such as respiration and circulation.
FM	Fat Mass (kg)	Fat mass total weight of mass in the body.
FM%	Fat Mass (%)	Percentage of fat mass in total body weight.
FFM	Fat Free Mass (kg)	Fat Free Mass is comprised of muscle, bone, tissue, water, and all other fat free mass in the body.
FFM%	Fat Free Mass (kg)	Percentage of fat free mass in total body weight.
FFMI	Fat Free Mass Index	Fat Free Mass index, and is calculated by the following formula: Fat Free Mass (kg): Height (m²).
TBW	Total Body Water (kg)	Total body water / fluid content.
TBW%	Total Body Water (%)	Percentage of total body water / fluid.
PMM	Muscle Mass (kg)	Predictive muscle mass means bone-free lean tissue mass.
SMM	Skeletal Muscle Mass (kg)	The skeletal muscle mass obtained in BIA expressed in kg.
IMP	Impedance (Ohm)	Impedance reflects the body’s inherent resistance to an electrical current.
SMI	Sarcopenic Index (kg/m²)	Skeletal muscle index (SMI) calculated using the formula (SMM/height2), where SMM is the skeletal muscle mass obtained in BIA expressed in kg (W>5,5kg/m² i M>7,25kg/m²).
BMI Tanita	Body Mass Index	Body Mass Index is a height to weight ratio, and is calculated by the following formula: Weight (kg): Height (m²).
BMI z-score	Body Mass Index z-score	Weight / height index calculated as weight divided by height squared (kg/m2) and calculated using the AnthroPlus application for age and sex, respectively, in the WHO reference.
BMI percentile	Body Mass Index percentile	Weight / height index calculated as weight divided by height squared (kg/m²) and calculated using the AntrhoPlus application for age and sex, respectively, in the WHO reference.
BONEM	Bone Mass (kg)	Predictable bone mineral mass.
PHASEANGLE	Phase angle (°)	Index of the body’s nutrition and cell quality. Low phase angle (W<5° and M <6°) indicates the inability of cells to store energy. High phase angle (W> 5 ° and M> 6 °) means a large number and high quality of cells.

Table 2 Demographic and Antropometric Data of the Study and Reference Groups

Parameters	Study Group (N=90)		Reference Group (N=90)		t	p
Age (years); M±SD, range	11.57±2.42	8–16	11.97±2.28	8–16	−1.14	0.255
Height (cm); M±SD, range	143.62±13.63	119.50–170.00	153.62±12.34	128.00–182.50	−5.16	<0.001
Weight (kg); M±SD, range	35.06±11.34	20.00–60.00	52.53± 9.59	40.00–78.00	−11.16	<0.001
BMI; M±SD, range	16.69±3.21	11.83–24.10	22.13±1.81	18.60–27.30	−14.00	<0.001
BMI z-score; M±SD, range	−1.03±33.96	−4.51–0,98	0.47±1.26	−1.60–3.42	−7.28	<0.001
BMI percentile; M±SD, range	35.53±33.96	0.10–97.90	59.72±33.85	2.20–99.90	−4.78	<0.001
Girls; N (%)	47 (52)		48 (53)		2.76	0.096
Boys; N (%)	43 (48)		42 (47)
GMFCS level 1; N (%)	18 (20)		–
GMFCS level 2; N (%)	72 (80)		–

Abbreviations: M, mean; SD, standard deviation; range, minimum-maximum value; t, Student’s t-test; p, p-value.

Figure 1 Sex-specific BMI percentiles in both groups: thinness (<10c); normal (25–75c); overweight and obese (>75c).

Table 3 Descriptive Characteristics of Individual Body Mass Components’ Parameters and Statistical Analysis

Parameter	Study Group (N=90)		Reference Group (N=90)		t	p	95% CI		d Cohena
	M	SD	M	SD			LL	UL
BMR (kJ)	4755.17	540.23	5941.04	673.95	−13.02	<0.001	−1365.54	−1006.20	1.94
FM (kg)	7.05	4.39	13.13	4.54	−9.11	<0.001	−7.39	−4.76	1.36
FM%	19.38	7.91	24.08	5.53	−4.62	<0.001	−6.71	−2.69	0.69
FFM (kg)	27.71	8.04	35.51	7.60	−6.70	<0.001	−10.11	−5.51	1.00
FFM%	75.92	5.53	80.62	7.91	−4.62	<0.001	−0.99	−0.39	−0.69
FFMI (kg/m²)	13.14	1.97	14.91	1.65	6.53	<0.001	0.66	1.28	1.82
TBW (kg)	19.93	7.64	26.35	5.24	−6.57	<0.001	−8.34	−4.49	0.98
TBW%	0.57	0.09	0.50	0.05	5.60	<0.001	0.04	0.08	0.84
PMM (kg)	26.39	8.31	33.33	6.64	−6.18	<0.001	−9.15	−4.72	0.92
SMM (kg)	14.72	4.14	21.22	2.98	−12.10	<0.001	−7.56	−5.44	1.80
IMP (Ohm)	720.63	55.46	716.54	89.62	0.37	0.713	−17.86	26.04	0.05
SMI (kg/m²)	4.60	0.76	5.65	0.38	−11.76	<0.001	−1.23	−0.87	1.75
BMI Tanita	16.69	3.21	22.13	1.81	−14.00	<0.001	−6.21	−4.67	2.09
BMI z-score	−1.03	1.49	0.47	1.26	−7.28	<0.001	−1.91	−1.10	1.09
BMI percentile	35.53	33.96	59.72	33.85	−4.78	<0.001	−34.16	−14.21	0.71
BONEM (kg)	1.45	0.47	1.85	0.29	−6.93	<0.001	−0.52	−0.29	1.03
PHASEANGLE (°)	5.00	0.33	5.33	0.50	−5.35	<0.001	−0.46	−0.21	0.80

Abbreviations: M, mean; SD, standard deviation; t, Student’s t-test; p, p value; 95% CI, confidence interval; LL and UL, lower and upper limits of the confidence interval; d Cohena, the size of the effect; BMR, basal metabolic rate; FM, fat mass; FM%, percentage of fat mass; FFM, fat free mass; FFM%, percentage of fat free mass; FFMI, fat free mass index; TBW, total body water; TBW%, percentage of total body water; PMM, muscle mass; SMM, skeletal muscle mass; IMP, impedance; SMI, sarcopenic index; BMI Tanita, body mass index; BONEM, bone mass; PHASEANGLE, phase angle.

Table 4 Rates of Three Factorial Variation Analysis Model

Dependent Variable	Effect		df1	df2	F	P	η^2
FM (kg)	Main	Sex	1	172	4.54	0.035	0.03
		Group	1	172	53.09	<0.001	0.02
		AGE	1	172	3.71	0.056	0.24
	Interaction	Sex × group	1	172	3.05	0.082	0.04
		Sex × age	1	172	7.84	0.006	0.02
		Group × age	1	172	4.71	0.031	0.03
		Sex × group × age	1	172	6.22	0.014	0.04
FM (%)	Main	Sex	1	172	42.41	<0.001	0.20
		Group	1	172	12.41	<0.001	0.01
		Age	1	172	1.34	0.248	0.07
	Interaction	Sex × group	1	172	8.27	0.005	0.08
		Sex × age	1	172	15.57	<0.001	0.05
		Group × age	1	172	14.95	<0.001	0.08
		Sex × group × age	1	172	8.12	0.005	0.05
FFM (kg)	Main	Sex	1	172	12.86	<0.001	0.07
		Group	1	172	35.76	<0.001	0.17
		Age	1	172	41.18	<0.001	0.19
	Interaction	Sex × group	1	172	0.04	0.849	<0.001
		Sex × age	1	172	0.64	0.424	0.004
		Group × age	1	172	0.28	0.597	0.002
		Sex × group × age	1	172	0.41	0.525	0.002
FFM (%)	Main	Sex	1	172	42.40	<0.001	0.20
		Group	1	172	1.34	0.248	0.01
		Age	1	172	12.41	<0.001	0.07
	Interaction	Sex × group	1	172	15.57	<0.001	0.08
		Sex × age	1	172	8.27	0.005	0.05
		Group × age	1	172	14.95	<0.001	0.08
		Sex × group × age	1	172	8.12	0.005	0.05
FFMI (kg/m²)	Main	Sex	1	172	1.99	0.160	0.01
		Group	1	172	3.06	0.082	0.02
		Age	1	172	37.71	<0.001	0.18
	Interaction	Sex × group	1	172	0.70	0.405	0.00
		Sex × age	1	172	0.62	0.431	0.00
		Group × age	1	172	6.95	0.009	0.04
		Sex × group × age	1	172	0.31	0.576	0.00
TBW (kg)	Main	Sex	1	172	7.58	0.007	0.04
		Group	1	172	29.34	<0.001	0.15
		Age	1	172	44.39	<0.001	0.21
	Interaction	Sex × group	1	172	1.44	0.231	0.01
		Sex × age	1	172	1.83	0.177	0.01
		Group × age	1	172	0.59	0.443	0.00
		Sex × group × age	1	172	0.07	0.797	<0.001
TBW (%)	Main	Sex	1	172	5.94	0.016	0.03
		Group	1	172	1.99	0.160	0.01
		Age	1	172	18.99	<0.001	0.10
	Interaction	Sex × group	1	172	1.64	0.202	0.01
		Sex × age	1	172	0.44	0.506	0.00
		Group × age	1	172	0.22	0.642	0.00
		Sex × group × age	1	172	0.02	0.895	<0.001
PMM (kg)	Main	Sex	1	172	0.71	0.398	0.004
		Group	1	172	41.62	<0.001	0.195
		Age	1	172	54.80	<0.001	0.241
	Interaction	Sex × group	1	172	2.31	0.130	0.013
		Sex × age	1	172	0.53	0.469	0.003
		Group × age	1	172	5.27	0.023	0.023
		Sex × group × age	1	172	0.83	0.363	0.004
SMI (kg/m²)	Main	Sex	1	172	4.01	0.046	0.02
		Group	1	172	144.32	<0.001	0.46
		Age	1	172	13.55	<0.001	0.07
	Interaction	Sex × group	1	172	0.36	0.547	<0.01
		Sex × age	1	172	0.16	0.680	<0.01
		Group × age	1	172	8.57	0.003	0.05
		Sex × group × age	1	172	0.35	0.552	<0.01
BMI Tanita	Main	Sex	1	172	7.50	0.007	0.04
		Group	1	172	0.09	0.766	0.00
		Age	1	172	189.61	<0.001	0.52
	Interaction	Sex × group	1	172	0.01	0.948	<0.001
		Sex × age	1	172	1.14	0.288	0.01
		Group × age	1	172	21.94	<0.001	0.11
		Sex × group × age	1	172	0.29	0.592	0.00
BMI z-score	Main	Sex	1	172	3.79	0.053	0.02
		Group	1	172	9.43	0.002	0.05
		Age	1	172	55.21	<0.001	0.24
	Interaction	Sex × group	1	172	1.41	0.237	0.01
		Sex × age	1	172	9.32	0.003	0.05
		Group × age	1	172	8.26	0.005	0.05
		Sex × group × age	1	172	1.09	0.297	0.01
BMI percentile	Main	Sex	1	172	3.95	0.048	0.02
		Group	1	172	8.35	0.004	0.05
		Age	1	172	20.48	<0.001	0.15
	Interaction	Sex × group	1	172	1.71	0.193	0.02
		Sex × age	1	172	2.58	0.110	0.04
		Group × age	1	172	11.94	<0.001	0.07
		Sex × group × age	1	172	2.90	0.090	0.02
PHASEANGLE(°)	Main	Sex	1	172	4.85	0.029	0.03
		Group	1	172	0.40	0.526	0.00
		Age	1	172	22.56	<0.001	0.12
	Interaction	Sex × group	1	172	1.22	0.271	0.01
		Sex × age	1	172	0.69	0.408	0.00
		Group × age	1	172	8.85	0.003	0.05
		Sex × group × age	1	172	2.09	0.150	0.01

Notes: df1, df2, degrees of freedom; F, F-test statistic; p, value of the F-test; η², partial eta-square effect size; the statistically significant differences are printed in bold.

Abbreviations: FM(kg), fat mass; FM%, percentage of fat mass; FFM(kg), fat free mass; FFM%, percentage of fat free mass; FFMI(kg/m²), fat free mass index; TBW(kg), total body water; TBW%, percentage of total body water; PMM(kg), muscle mass; SMI(kg/m²), sarcopenic index; BMI Tanita, body mass index; BMI z-score, body mass index z-score; BMI percentile, body mass index percentile; PHASEANGLE(°), phase angle.

Table 5 Linear Regression Model Ratios

Response Variable	Predictors	B	LLCI	ULCI	t	p	R^2
BMR (kJ)	(Constant)	248.72	−754.32	1251.75	0.49	0.625	0.72
	Height	31.38	24.42	38.33	8.91	<0.001
	Group	762.35	−789.11	2313.81	0.97	0.334
	Height*group	0.71	−9.65	11.07	0.14	0.892
BONEM (kg)	(Constant)	−2.12	−2.70	−1.53	−7.18	0.625	0.64
	Height	0.02	0.02	0.03	12.14	<0.001
	Group	1.18	0.28	2.08	2.59	0.334
	Height*group	−0.01	−0.01	0.00	−2.19	0.030

Abbreviations: B, beta factor; LLCl and ULCl, lower and upper limits of the confidence interval; t, Student’s t-test; p, p value; R², the square of the correlation coefficient; the statistically significant differences are printed in bold; BMR(kJ), basal metabolic rate; BONEM(kg), bone mass.

Table 6 Pearson’s r Correlations Between Age, Height, and BMI and Individual Quantitative Body Composition Measures Without Group Breakdown

Parameter	Age		Height		BMI		BMI Percentile		BMI z-Score
	r	p	r	p	r	p	r	p	r	p
BMR (kJ)	0.26	0.00	0.70	0.00	0.73	0.00	0.46	0.00	0.55	0.00
FM (%)	0.06	0.41	0.20	0.01	0.64	0.00	0.70	0.00	0.66	0.00
FM (kg)	0.29	0.00	0.53	0.00	0.79	0.00	0.68	0.00	0.67	0.00
FFM (kg)	0,57	0.00	0,88	0.00	0.65	0.00	0.40	0.00	0.45	0.00
FFM (%)	−0.06	0.41	−0.20	0.01	−0.64	0.00	−0.70	0.00	−0.66	0.00
FFMI (kg/m²)	0.23	0.00	0.44	0.00	0.75	0.00	0.70	0.00	0.76	0.00
TBW (kg)	0,51	0.00	0,84	0.00	0,67	0.00	0.43	0.00	0.47	0.00
TBW (%)	0.06	0.46	0.05	0.54	−0.31	0.00	−0.10	0.19	−0.08	0.28
PMM (kg)	0,61	0.00	0,89	0.00	0.62	0.00	0.38	0.00	0.40	0.00
SMM (kg)	0,36	0.00	0,58	0.00	0.70	0.00	0.32	0.00	0.40	0.00
IMP (Ohm)	0,03	0.70	−0,06	0.41	−0,20	0.01	−0.43	0.00	−0.35	0.00
SMI (kg/m²)	0.26	0.00	0.50	0.00	0.78	0.00	0.45	0.00	0.57	0.00
PHASEANGLE (°)	0.02	0.80	0.24	0.00	0.28	0.00	0.25	0.00	0.27	0.00

Abbreviations: BMR(kJ), basal metabolic rate; FM(kg), fat mass; FM%, percentage of fat mass; FFM(kg), fat free mass; FFM, percentage of fat free mass; FFMI(kg/m²), fat free mass index; TBW(kg), total body water; TBW%, percentage of total body water; PMM(kg), muscle mass; SMI(kg/m²), sarcopenic index; BMI Tanita, body mass index; BMI z-score, body mass index z-score; BMI percentile, body mass index percentile; PHASEANGLE(°), phase angle.

Figure 2 Regression line for a variable BONEM in a group division.