The Appendicular Lean Mass Index Is a Suitable Surrogate for Muscle Mass in Children with Cerebral Palsy

Ibrahim Duran*, Kyriakos Martakis, Mirko Rehberg, Christina Stark, Anne Koy, Eckhard Schoenau

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Densitometrically measured lean body mass (LBM) is often used to quantify skeletal muscle mass in children with cerebral palsy (CP). Since LBM depends on the individual's height, the evaluation of LBM/height(2) (lean BMI) is often recommended. However, LBM includes not only skeletal muscle mass but also the mass of skin, internal organs, tendons, and other components. This limitation applies to a far lesser extent to the appendicular lean mass index (LMIapp).

Objectives: The aim of the study was to evaluate skeletal muscle mass in children with CP using total lean BMI (LMItot) and LMIapp.

Methods: The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation program. In total, 329 children with CP [148 females; Gross Motor Function Classification Scale (GMFCS) I, 32 children; GMFCS II, 73 children; GMFCS III, 133 children; GMFCS IV, 78 children; and GMFCS V, 13 children] were eligible for analysis. The mean age was 12.3 +/- 2.75 y. Pediatric reference centiles for age-adjusted LMIapp were generated using data from NHANES 1999-2004. Low skeletal muscle mass was defined as a z score for DXA determined LMItot and LMIapp less than or equal to-2.0.

Results: The z scores for LMIapp were significantly lower than LMItot in children with CP, GMFCS levels II-V (P <0.001), with the exception of GMFCS level I (P = 0.121), where no significant difference was found. The prevalence of low LMItot (16.1%; 95% CI: 16.1, 20.1%) was significantly lower (P <0.001) than the prevalence of LMIapp (42.2%; 95% CI: 36.9, 47.9%) in the study population.

Conclusions: The prevalence of low skeletal muscle mass in children with CP might be underestimated by LMItot. LMIapp is more suitable for the evaluation of skeletal muscle mass in children with CP.

Original languageEnglish
Pages (from-to)1863-1868
Number of pages6
JournalJournal of Nutrition
Issue number10
Publication statusPublished - Oct 2019


  • children
  • cerebral palsy
  • muscle mass
  • appendicular lean mass index
  • reference centiles
  • FAT


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