The effect of different dietary structure on gastrointestinal dysfunction in children with cerebral palsy and epilepsy based on intestinal flora

Background: Gastrointestinal (GI) difficulties are very common among children with cerebral palsy (CP) and comorbid epilepsy. GI function is influenced by dietary structure on intestinal flora. The aim of this study was to compare intestinal flora changes in two dietary groups of this population and examine whether such differences are related to GI dysfunction. Methods: Forty children with CP and epilepsy were recruited from among patients being cared for at a social welfare center, including 23 consuming a (semi)fluid diet (liquid diet group) and 17 consuming a normal diet (general diet group). Bacterial DNA was extracted from feces, the V3-V4 region of the 16S rRNA gene was amplified from the DNA, and high-throughput sequencing of the amplified sequences was performed. Microbe prevalence levels were compared on multiple phylogenic levels. Results: Gut microbial populations differed substantially between the liquid diet and general diet groups. The only two phyla that differed significantly between the two groups were Bacteroidetes ( p = 0.034) and Actinobacteria ( p = 0.013). Regarding representation of genera, Prevotella species were selectively predominant in the general diet group (25.849% vs. 3.612% in the liquid diet group , p < 0.001), while Bifidobacterium species were selectively predominant in the liquid diet group (24.929% vs. 12.947% in the general diet group, p = 0.013). The gut flora of children in the general diet group contained more butyric acid-producing flora which was also common in healthy people (e.g. Lachnoclostridium, Dorea, Ruminococcus, Faecalibacterium, Roseburia, and Coprococcus ). The gut flora of children in liquid diet group however, were rich in symbiotic pathogenic bacteria (e.g. Collinsella , Alistipes , and Eggerthella ). Conclusion: The intestinal flora of children with CP and epilepsy consuming a liquid diet had elevated levels of symbiotic pathogens and diminished intestinal barrier protection bacteria, relative to a general diet group. These alterations in bacterial flora were associated with GI dysfunction symptoms. Key words Obstipation; Cerebral palsy; Epilepsy; Intestinal flora; Gastrointestinal dysfunction