Prevalence of Global Malnutrition in Children With Cerebral Palsy

Nine year boy enjoying a walk in a sunny park using walking frame
In a systematic review and meta-analysis, researchers estimated the prevalence of malnutrition and nutritional deficiencies in children with cerebral palsy.

The global estimated prevalence of malnutrition among children with cerebral palsy (CP) is 40%, according to a systematic review and meta-analysis published in Public Health.

Children with CP often have malnutrition. Prior studies estimating the nutritional status of children with CP have diverged in their diagnosis parameters, relying on the World Health Organization (WHO), the National Center for Health Statistics (NCHS), or their own specific criteria. Each set of criteria is distinct. The few meta-analysis studies estimating the nutritional deficiencies among these children are inconclusive.

The objective of the current study was to examine the prevalence of malnutrition and nutrient deficiencies in children with CP.

The researchers identified 67 articles (453,804 children) through databases and reference lists searches for observational studies or clinical trials. Most studies were published between 2008 and 2019. There were 46 cross-sectional cohort studies.

About half of cohort studies and 8 case-control studies (72.72%) had low risk of bias, according to the Newcastle-Ottawa scale.

Twenty-three of the 26 studies that used WHO criterion used the most recent proposed curves. Five studies used a specific diagnostic criterion for CP. Twenty-eight studies used the WA anthropometric index.

The 9 studies that investigated nutrient deficiency most frequently reported hypocalcemia and reduced serum concentrations of zinc, copper, and vitamin D.

Six studies demonstrated motor changes in patients with CP, including chewing and gastrointestinal complications, influenced malnutrition.

Twenty-five studies classified nutritional status with WHO criteria.

The prevalence of stunting was 46.0% (95% CI, 31.0-61.0) in 12 studies with high heterogeneity. A subgroup meta-analysis showed similar prevalence among African, (50%; 95% CI 37.0-62.0), Asian (58%; 95% CI 13.0-96.0), and South American continents (44%; 95% CI 24.0-64.0), while prevalence was lower in Oceania (12%; 95% CI, 7.0-16.0).

Eleven of 17 cross-sectional studies with weight-age ratio indicated 40% of children with CP are underweight globally (95% CI, 28.0-53.0 I2 95.37%).

Globally, about 30% of children with CP experience wasting (95% CI, 20.0-41.0 I2 = 90.75%), according to 7 cross-sectional studies. South America and Africa had similar rates, but Asia had lower rates (21.0%; 95% CI, 14.0-29.0).

About 36% of children with CP experienced thinness (95% CI, 22.9-51.0 I2 = 95.55%), 8 cross-sectional studies showed, globally, while Oceania (7%; 95% CI, 4.0-12.0) had the lowest prevalence. South America and Africa each had prevalence of about 37.5%. Asia was the continent with the highest prevalence (53.0%; 95% CI, 32.0-44.0).

Nine studies used Centers for Disease Control and Prevention (CDC) Body Mass Index (BMI)-A indicator.

Across continents, 41% of children with CP had thinness (95% CI, 31.0-51.0). Thinness prevalence in North America was 37% (95% CI, 19.0-57.0). It was 46% in Europe (95% CI, 39.0-53.0).

Study limitations included concentration of studies in the US and heterogeneity.

The researchers noted, “We found a high rate of malnutrition in the population in this review, moreover, we suggest that some nutritional deficiencies are associated with food deficit and that the socio-economic and age factors of these children may relate with the poor nutritional outcome.”

“This makes monitoring and personalized nutritional management necessary, in accordance with the characteristics and particularities of children with CP,” they added.


Da Silva DCG, Barreto Da Cunha MDS, De Oliveira Santana A, et al. Malnutrition and nutritional deficiencies in children with cerebral palsy: a systematic review and meta-analysis. Public Health. Published online March 24, 2022. doi:10.1016/j.puhe.2022.01.024