Scientific Online Resource System

Scripta Scientifica Salutis Publicae

Nutritional status, macro- and micronutrient deficiency in children with neurodevelopmental disorders

Ruzha Zlatanova Pancheva-Dimitrova, Albena Toneva, Miglena Georgieva, Desislava Konstantinova, Stefka Petrova


The nutritional status of children with neurodevelopmental disorders (NDDs) has a significant impact on their overall health and quality of life. Most of the scientific research, exploring NDD children`s nutrition, has been dedicated to cerebral palsy (CP) patients who are reported to suffer from malnutrition in 46% - 90% of the cases. The etiology of malnutrition in children with NDD involves many underlying factors and can be contributed to both nutritional and non-nutritional factors. Obesity typically associated with mentally retarded children and children with genetic syndromes (e.g. Down syndrome) is nowadays less frequently observed. The energy needs of children with severe cases of central nervous system disorder differ from the energy requirements of normally developing children. The difference can be largely attributed to the interplay of several factors affecting the basal metabolic rate. The prevalence of malnutrition can induce or worsen respiratory failure as well as secondary immune deficiency, which in turn affects the prognosis of the underlying disease. Macronutrient deficiency in NDD children is commonly accompanied by micronutrient losses of folate, iron, magnesium, vitamin D, essential fatty acids, etc., which are crucial for a number of metabolic pathways. The lacking in any or all macro- and micronutrients may produce symptoms that are difficult to distinguish from the already present neurological disorder. This situation calls for a comprehensive evaluation and nutritional support for NDD children for an improved prognosis and quality of life, considering the current data and knowledge on the problem.


cerebral palsy; malnutrition; micronutrient deficiency; neurodevelopmental disorder; nutrition; oral health

Full Text


Penagini F, Mameli C, Fabiano V, Brunetti D, Dilillo D, Zuccotti GV. Dietary intakes and nutritional issues in neurologically impaired children. Nutrients. 2015;7(11): 9400-15. doi: 10.3390/nu7115469.

Dahl M, Thommessen M, Rasmussen M, Selberg T. Feeding and nutritional characteristics in children with moderate or severe cerebral palsy. Acta Pediatr. 1996;85(6):697–701.

Stallings VA, Charney FB, Davies JC, Cronk CE. Nutrition-related growth failure of children with quadriplegic cerebral palsy. Dev Med Child Neurol. 1993;35(2):126-38.

Krick J, Murphy PE, Markham JF, Shapiro BK. A proposed formula for calculating energy needs of children with cerebral palsy. Dev Med Child Neurol. 1992;34(6):481-7.

Rieken R, van Goudoever JB, Schierbeek H, Willemsen SP, Calis EA, Tibboel D, et al. Measuring body composition and energy expenditure in children with severe neurological impairment and intellectual disability. Am J Clin Nutr. 2011;94(3):759-66. doi: 10.3945/ajcn.110.003798.

Walker JL, Bell KL, Boyd RN, Davies PSW. Energy requirements in preschool-age children with cerebral palsy. Am J Clin Nutr. 2012;96(6):1309-15. doi: 10.3945/ajcn.112.043430.

Holenweg‐Gross C, Newman CJ, Faouzi M, Poirot-Hodgkinson I, Bérard C, Roulet-Perez E. Undernutrition in children with profound intellectual and multiple disabilities (PIMD): its prevalence and influence on quality of life. Child Care Health Dev. 201;40(4):525-32. doi: 10.1111/cch.12085.

Kilpinen-Loisa P, Pihko H, Vesander U, Paganus A, Ritanen U, Mäkitie O. Insufficient energy and nutrient intake in children with motor disability. Acta Paediatr. 2009(98):1329–33. doi: 10.1111/j.1651-2227.2009.01340.x.

Russell SL, Psoter WJ, Charles GJ, Prophte S, Gebrian B. Protein-energy malnutrition during early childhood and periodontal disease in the permanent dentition of Haitian adolescents aged 12–19 years: a retrospective cohort study. Int J Paediatr Dent. 2010;20(3):222–9. doi: 10.1111/j.1365-263X.2010.01031.x.

Psoter W, Gebrian B, Prophete S, Reid B, Katz R. Effect of early childhood malnutrition on tooth eruption in Haitian adolescents. Community Dent Oral Epidemiol. 2008;36(2):179–89. doi: 10.1111/j.1600-0528.2007.00386.x.

Scardina GA, Messina P. Good Oral Health and Diet. J Biomed Biotechnol. 2012;2012:720692. doi: 10.1155/2012/720692.

Sheetal A, Hiremath VK, Patil AG, Sajjansetty S, Kumar SR. Malnutrition and its oral outcome – a review. J Clin Diagn Res. 2013; 7(1): 178–80. doi: 10.7860/JCDR/2012/5104.2702.

Agarwal PK, Agarwal KN, Agarwal DK. Biochemical changes in saliva of malnourished children. Am J Clin Nutr. 1984;39(2):181–4. doi: 10.1093/ajcn/39.2.181.

González L, Nazario CM, González MJ. Nutrition-related problems of pediatric patients with neuromuscular disorders. P R Health Sci J. 2000;19(1):35-8.

Reinehr T, Dobe M, Winkel K, Schaefer A, Hoffmann D. Obesity in disabled children and adolescents. Dtsch Arztebl Int. 2010;107(15):268-75. doi: 10.3238/arztebl.2010.0268.

Tong HJ, Rudolf MC, Muyombwe T, Duggal MS, Balmer R. An investigation into the dental health of children with obesity: an analysis of dental erosion and caries status. Eur Arch Paediatr Dent. 2014;15(3):203-10. doi: 10.1007/s40368-013-0100-1.

Sfasciotti GL, Marini R, Pacifici A, Ierardo G, Pacifici L, Polimeni A. Childhood overweight-obesity and periodontal diseases: is there a real correlation?. Ann Stomatol (Roma). 2017;7(3):65-72. doi: 10.11138/ads/2016.7.3.065.

Hilgers KK, Akridge M, Scheetz JP, Kinane DE. Childhood obesity and dental development. Pediatr Dent. 2006;28(1):18- 22.

Buffart LM, van den Berg-Emons RJ, Burdorf A, Janssen WG, Stam HJ, Roebroeck ME. Cardiovascular disease risk factors and the relationships with physical activity, aerobic fitness, and body fat in adolescents and young adults with myelomeningocele. Arch Phys Med Rehabil. 2008;89(11):2167-73. doi: 10.1016/j.apmr.2008.04.015.

Rimmer JH, Rowland JL, Yamaki K. Obesity and secondary conditions in adolescents with disabilities: addressing the needs of an underserved population. J Adolesc Health. 2007;41(3):224-9. doi: 10.1016/j.jadohealth.2007.05.005.

Liou TH, Pi-Sunyer FX, Laferrere B. Physical disability and obesity. Nutr Rev. 2005;63(10):321-31.

Dietary Reference Values for the Bulgarian population; Ordinance issued by the Ministry of Health). State Gazette (in press). [in Bulgarian]

Hillesund E, Skranes J, Trygg KU, Bøhmer T. Micronutrient status in children with cerebral palsy. Acta Paediatr. 2007;96(8):1195-8. doi: 10.1111/j.1651-2227.2007.00354.x.

Kalra S, Aggarwal A, Chillar N, Faridi MM. Comparison of micronutrient levels in children with cerebral palsy and neurologically normal controls. Indian J Pediatr. 2015;82(2):140-4. doi: 10.1007/s12098-014-1543-z.

Piccol R, Gelio S, Fratucello A, Valletta E. Risk of low micronutrient intake in neurologically disabled children artificially fed. J Pediatr Gastroenterol Nutr. 2002;35(4):583-4.

Papadopoulos A, Ntaios G, Kaifa G, Girtovitis F, Saouli Z1, Kontoninas Z, et al. Increased incidence of iron deficiency anemia secondary to inadequate iron intake in institutionalized, young patients with cerebral palsy. Int J Hematol. 2008 Dec;88(5):495-497. doi: 10.1007/s12185-008-0191-3.

Baker RD, Greer FR, Committee on Nutrition American Academy of Pediatrics. Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0 -3 Years of Age). Pediatrics. 2010; 126(5):1040-50. doi: 10.1542/peds.2010-2576.

Bruch J, Treister N. Clinical Oral Medicine and Pathology. Humana Press: Springer. London; 2010.

Etani Y, Nishimoto Y, Kawamoto K, Yamada H, Shouji Y, Kawahara H, et al. Selenium deficiency in children and adolescents nourished by enteral nutrition and/or selenium-deficient enteral formula. J Trace Elem Med Biol. 2014;28(4):409-13. doi: 10.1016/j.jtemb.2014.09.001.

Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, Couceiro J, Camiña F, Rodríguez-Segade S. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol. 1998;13(11):546-9. doi: 10.1177/088307389801301104.

Coulter DL. Carnitine deficiency in epilepsy: Risk factors and treatment. J Child Neurol. 1995; 10(Suppl 2):S32-9.

Fukada M, Kawabe M, Takehara M, Iwano S, Kuwabara K, Kikuchi C, et al. Carnitine deficiency: Risk factors and incidence in children with epilepsy. Brain Dev. 2015;37(8):790-6. doi: 10.1016/j.braindev.2014.12.004.

Verrotti A, Greco R, Morgese G, Chiarelli F. Carnitine deficiency and hyperammonemia in children receiving valproic acid with and without other anticonvulsant drugs. Int J Clin Lab Res. 1999;29(1): 36-40.

Hals J, Bjerve KS, Nilsen H, Svalastog AG, Ek J. Essential fatty acids in the nutrition of severely neurologically disabled children. Br J Nutr. 2000;83(3):219-25.

Duleva V, S Petrova, L Rangelova, E Chikova-Ischeber, K Vatralova. Key aspects of nutrition and dietary guidelines for neurologically impaired and mentally retarded children. Bulg J Public Health. 2012; 4:59-70

Gottrand M, Van Biervliet S, Velde SV, Gottrand F, Van Winckel M. Nutritional support in children with neurodevelopmental disabilities. Acta Gastroenterol Belg. 2013;76(3):329-34.

Kuper H, Nyapera V, Evans J, Munyendo D, Zuurmond M, Frison S, et al. Malnutrition and childhood disability in Turkana, Kenya: Results from a case-control study. PloS One. 2015;10(12): e0144926. doi: 10.1371/journal.pone.0144926.



About The Authors

Ruzha Zlatanova Pancheva-Dimitrova
Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna

Albena Toneva
Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna

Miglena Georgieva
Department of Pediatrics, Faculty of Medicine, Medical University of Varna

Desislava Konstantinova
Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University of Varna

Stefka Petrova
National Center of Public Health and Analyses, Bulgaria

Font Size