Anthropometric outcomes in Saudi children with cerebral palsy: associations with gross motor severity and eating and drinking ability

Background Growth faltering is a prevalent and clinically significant complication of cerebral palsy (CP), yet data from regional populations using standardized anthropometric outcomes remain limited.Objectives To quantify anthropometric deficits using WHO age- and sex-standardized z-scores and identify independent predictors in a clinical cohort of Saudi children with CP.Methods A retrospective cross-sectional study of 107 Saudi children with CP (median age 4.3 years, IQR 2.4–6.2; 68.2% male). Anthropometric outcomes were expressed as weight-for-age (WAZ), height-for-age (HAZ), BMI-for-age (BAZ), and head circumference-for-age (HCAZ) z-scores using WHO 2006/2007 reference standards. Between-group comparisons used Mann-Whitney U and Kruskal-Wallis tests with effect sizes (rank-biserial correlation; epsilon-squared). Four multivariable linear regression models were fitted using seven a priori predictors: age, sex, GMFCS level (IV–V vs I–III), eating and drinking ability (EDACS; Levels II, III, and IV–V vs I), and orthopedic surgery history. Feeding and swallowing difficulty was excluded from all regression models owing to confirmed perfect collinearity with EDACS classification.Results Stunting (HAZ < −2 SD) was the most prevalent anthropometric deficit (65.4%), followed by underweight (40.2%; n = 97), wasting (18.7%), and microcephaly in children aged ≤ 5 years (HCAZ < −2 SD: 23.5%; n = 68). WAZ and HCAZ were significantly lower in GMFCS Levels IV–V than Levels I–III (both p < .05). In multivariable models, three independent predictors emerged: age predicted progressive linear height faltering (HAZ: B = −0.445 per year, p < .001); GMFCS Levels IV–V independently predicted lower WAZ (B = −1.022, p = .047) and lower HCAZ (B = −1.051, p = .006); and orthopedic surgery history was the strongest predictor of lower WAZ (B = −2.427, p = .001) and lower BAZ (B = −2.265, p < .001). EDACS level did not independently predict any z-score after multivariable adjustment. Head circumference-for-age demonstrated greater sensitivity to neurological and feeding-related vulnerabilities than BMI-for-age in younger children.Conclusions Stunting is the dominant nutritional phenotype in this Saudi CP cohort. Motor severity, progressive age-related linear growth faltering, and orthopedic surgery history are independent predictors of anthropometric outcomes. Integration of WHO z-score monitoring with GMFCS and EDACS classification from the point of diagnosis is recommended as a minimum standard for nutritional surveillance in children with CP.