Feasibility and clinical impact of a tailored nutritional protocol in pediatric elite athletes with cerebral palsy: A pilot study

Background Elite athletes with Cerebral Palsy (CP) face high metabolic demands superimposed on clinical vulnerabilities, including malnutrition and gastrointestinal (GI) issues. This pilot case series explored the feasibility and clinical changes associated with a personalized nutritional intervention using targeted Oral Nutritional Supplements (ONS). Methods Seven pediatric high-functioning swimmers with CP (GMFCS I-II) were assessed longitudinally. We evaluated anthropometry, body composition (Arm Muscle Area [AMA], Fat-Free Mass [FFM]), Nutrient Adequacy Ratios (NAR), and GI symptoms at baseline and follow-up. Results AMA and estimated FFM percentage increased (both p = 0.016), while estimated fat mass percentage decreased (p = 0.016). Reported calcium and vitamin D NARs increased to values at or above 1.0 (both p = 0.016). The GI Total Score decreased by more than 50% (p = 0.016), and constipation scores fell to zero among participants affected at baseline. Conclusion An individualized nutritional strategy incorporating ONS was feasible and well tolerated and was associated with favorable changes in body composition estimates, micronutrient adequacy, and GI symptoms over 6 months. These exploratory findings cannot establish causality and require confirmation in larger, controlled studies.