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Abstract
The purpose of this dissertation was to evaluate the skeletal muscle deficits and the level of central adiposity in children with cerebral palsy (CP) with four studies. The aim of the first study was to determine whether fat-free soft tissue mass (FFST), a marker of skeletal muscle mass, from dual-energy X-ray absorptiometry (DXA) is more compromised at the appendicular than non-appendicular sites in children with CP. The main finding was that children with CP have a remarkable FFST deficit that is more pronounced in the appendicular than the non-appendicular regions and more pronounced in the lower than the upper appendages. The aim of the second study was to determine whether DXA accurately estimates midleg muscle mass in ambulatory children with spastic CP. The main finding was that DXA-based statistical models accurately estimate midleg muscle mass in children with CP when the models are composed using data from children with CP rather than typically developing children. The aim of the third study was to determine whether serum levels of myostatin, follistatin and IGF-1 are consistent with the muscle deficit in children with CP. The main finding was that circulating myostatin, follistatin and IGF-1 are not different between ambulatory children with CP and typically developing children. However, FFST per unit IGF-1 was lower in children with CP, suggesting that IGF-1 may play an important role in their muscle underdevelopment. The aim of the fourth study was to determine whether the level of central adiposity in children with CP is related to their motor function and physical activity. The main finding was that the level of central adiposity was greater in children with CP than in typically developing children, but it was not related to the level of gross motor function or physical activity except for subcutaneous fat, which was negatively related to gross motor function.In conclusion, children with CP have much lower skeletal muscle mass and higher central adiposity than their typically developing peers. Future studies should identify intervention strategies that effectively attenuate the muscle deficits and reduce the level of central adiposity in children with CP.