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• W2517507929 abstract "The global prevalence of nutritional stunting has declined from 3.96 to 2.38 per 1000 over the last 25 years (http://www.who.int/nutrition/publications/jointchildmalnutrition_2015_estimates/en/). In parallel, healthy eating has generally become an everyday preoccupation both for the individual and society. This preoccupation occasionally becomes obsessive (i.e. orthorexia nervosa), but in selected conditions lack of attention to and awareness of nutritional health amounts to neglect. Undernutrition remains a much overlooked and inadequately managed feature in many individuals with developmental disability, including cerebral palsy (CP). It has been related to oral motor impairment and swallowing dysfunction, as well as insufficient mobility, communication impairment, psychological and family-related factors, medication, constipation, and other gastrointestinal problems. Independent and direct correlation of stunting and malnutrition with the degree of gross motor impairment has been documented.1 In turn, undernutrition in CP enhances the motor impairment, e.g. through increased muscle weakness. It also affects bone mineralization and is more generally associated with poor health and well-being. In addition, undernutrition may negatively affect cognitive functioning. Feeding and nutritional intervention strategies are typically offered late along the developmental course, when nutritional status is already severely impaired. At that stage, marked deficits can often be observed in essential fatty acids (linoleic acid, alpha-linolenic acid) and long-chain polyunsaturated fatty acids (e.g. docosahexaenoic acid [DHA]), which are known to play key roles in brain development. Lack of fibre and fluid consumption contribute to constipation. In addition, deficits in micronutrients such as iron, zinc, vitamin D, and folate are common. Some of these further enhance feeding difficulties, as low iron and zinc often result in poor appetite. In many children, energy expenditure is relatively low, implying lower dietary energy requirements than are recommended for typically developing children.2 However, both total energy and particular nutrient needs directly relate to physical activity levels.3 Systematic early assessment, appropriate management, and follow-up of nutritional status should be performed in individuals with CP. Early nutritional intervention primarily supported by families and care providers may result in better outcomes. In addition to improving general health and perhaps motor function, quality of life, and participation, the hypothesis that nutrition optimization might improve developmental outcome through an effect on brain plasticity remains to be explored. Increasing attention has been devoted to effects of dietary supplementation on the brain. Some micronutrients (e.g. iron, choline) and precursors of components of neuronal cell membranes (e.g. uridine, DHA) have been documented to alter synaptic structure and processes, and improve neurological functioning, including cognitive performance in animal studies.4, 5 Critical or sensitive periods for neural plasticity have been described with possible long-term impact on brain functioning.4 Various brain regions (e.g. prefrontal cortex, hippocampus, striatum) show differential sensitivity to given nutrients at different times during maturation based on these regions’ specific developmental requirements. The mechanisms underlying the roles of nutrients in neuroplasticity appear to be multifactorial. They include epigenetic chromatin modifications that affect gene and protein expression and their downstream effectors, with evidence for reversal of these alterations and rescue of the associated changes in neurological functioning by appropriate dietary intervention.4" @default.
• W2517507929 created "2016-09-16" @default.
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• W2517507929 date "2016-08-12" @default.
• W2517507929 modified "2023-10-02" @default.
• W2517507929 title "Nutrition, brain function, and plasticity in cerebral palsy" @default.
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• W2517507929 doi "https://doi.org/10.1111/dmcn.13208" @default.
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