Assessment of Nutritional Status Using Mid-Upper Arm Circumference Z-Score in Children With Cerebral Palsy

Cerebral palsy is a non-progressive neurodevelopmental condition frequently associated with motor dysfunction, feeding difficulties, and impaired growth. Malnutrition remains a common and clinically important comorbidity in children with cerebral palsy and is associated with adverse health outcomes, including increased susceptibility to infections, reduced muscle strength, and diminished quality of life. Despite its clinical relevance, accurate nutritional assessment in this population is often complicated by postural limitations, contractures, and difficulties in obtaining reliable weight and height measurements.

This cross-sectional, observational study is designed to assess nutritional status in children with cerebral palsy using anthropometric indicators, with a particular focus on the mid-upper arm circumference Z-score (MUACZ). MUACZ is derived from age- and sex-adjusted reference standards and can be obtained with minimal equipment, making it potentially suitable for use across a wide range of functional severity levels.

The study will include pediatric patients with a confirmed diagnosis of cerebral palsy who attend routine follow-up visits at a tertiary care center. Anthropometric measurements, including mid-upper arm circumference, body mass index-for-age, and height-for-age Z-scores, will be recorded according to standardized procedures. Functional severity will be classified using the Gross Motor Function Classification System (GMFCS) and the Eating and Drinking Ability Classification System (EDACS).

Nutritional status will be categorized based on predefined Z-score thresholds. Statistical analyses will examine the distribution of nutritional status across functional severity levels and evaluate the performance of MUACZ in identifying undernutrition using established cutoff values. All analyses will be conducted using appropriate statistical software, and the study will adhere to relevant ethical standards, with informed consent obtained from parents or legal guardians.

This study does not involve any intervention or alteration of standard clinical care. Data are collected solely for observational and analytical purposes.

Inclusion criteria

• Children and adolescents with a confirmed diagnosis of cerebral palsy
• Age between 18 months and 18 years at the time of assessment
• Attendance at routine outpatient follow-up at the study center during the study period
• Availability of anthropometric measurements required for nutritional assessment
• Availability of functional classification using the Gross Motor Function Classification System (GMFCS) and/or the Eating and Drinking Ability Classification System (EDACS)
• Written informed consent obtained from a parent or legal guardian

Exclusion criteria

• Presence of acute illness or infection at the time of assessment that could interfere with anthropometric measurements
• Known genetic syndromes or metabolic disorders affecting growth independently of cerebral palsy
• Incomplete clinical or anthropometric data preventing classification of nutritional status
• Previous major surgery or hospitalization within a period that could significantly influence nutritional measurements (as determined by the treating clinician)