Body mass index in adults with intellectual disability: distribution, associations and service implications: a population-based prevalence study

Promoting a healthy diet and physical activity in adults with intellectual disabilities living in community residences: design and evaluation of a cluster-randomized intervention

BACKGROUND

Many adults with intellectual disabilities have poor dietary habits, low physical activity and weight disturbances. This study protocol describes the design and evaluation of a health intervention aiming to improve diet and physical activity in this target group. In Sweden, adults with intellectual disabilities often live in community residences where the staff has insufficient education regarding the special health needs of residents. No published lifestyle interventions have simultaneously targeted both residents and staff.

METHODS/DESIGN

The intervention is designed to suit the ordinary work routines of community residences. It is based on social cognitive theory and takes 12-15 months to complete. The intervention includes three components: 1) Ten health education sessions for residents in their homes; 2) the appointment of a health ambassador among the staff in each residence and formation of a network; and 3) a study circle for staff in each residence. The intervention is implemented by consultation with managers, training of health educators, and coaching of health ambassadors. Fidelity is assessed based on the participation of residents and staff in the intervention activities. The study design is a cluster-randomised trial with physical activity as primary outcome objectively assessed by pedometry. Secondary outcomes are dietary quality assessed by digital photography, measured weight, height and waist circumference, and quality of life assessed by a quality of life scale. Intermediate outcomes are changes in work routines in the residences assessed by a questionnaire to managers. Adults with mild to moderate intellectual disabilities living in community residences in Stockholm County are eligible for inclusion. Multilevel analysis is used to evaluate effects on primary and secondary outcomes. The impact of the intervention on work routines in community residences is analysed by ordinal regression analysis. Barriers and facilitators of implementation are identified in an explorative qualitative study through observations and semi-structured interviews.

DISCUSSION

Despite several challenges it is our hope that the results from this intervention will lead to new and improved health promotion programs to the benefit of the target group.

TRIAL REGISTRATION NUMBER

ISRCTN33749876.

Obesity, food selectivity, and physical activity in individuals with fragile X syndrome

National survey data from 884 families were used to examine the overall health of children and adults with fragile X syndrome. Results indicate the rate of obesity in adults with fragile X syndrome is similar to the general population (∼30%). Male children with fragile X syndrome, however, had higher rates of obesity (31%) when compared with typically developing same-aged peers (18%). Both males and females displayed food selectivity, especially with regard to texture. Physical activity levels for children were higher than for adults, but neither group met recommended levels. Several cognitive and behavioral characteristics, food selectivity, and physical activity were related to overall health and body mass index. Continued monitoring of the health status of individuals with fragile X syndrome is recommended.

A population-based assessment of the health, functional status, and consequent family impact among children with Down syndrome

BACKGROUND

Many health conditions have been described in children with Down syndrome (DS). However, there are little comparative population-based data available.

OBJECTIVE/HYPOTHESES

We sought to examine the health impacts associated with DS and other disabling conditions in U.S. children included in the 2005-2006 National Survey of Children with Special Health Care Needs.

METHODS

We assessed numerous health and functional outcomes in children with DS and without DS but with (1) mental retardation/developmental delay(1) and another developmental disability associated with a high functional impact; (2) mental retardation/developmental delay but no co-occurring high-impact disability; (3) other special health care needs; and (4) no special health care needs (referent).

RESULTS

Children with DS and in all 3 special health care needs comparison groups had substantially more health and functional difficulties than did the referent sample. Overall, children with DS were fairly comparable to children in the other mental retardation/developmental delay groups on health indicators; however, young children with DS were more likely than young children in both "other mental retardation" groups to have difficulties with breathing/respiration and swallowing/digestion/metabolism. Children with both DS and mental retardation associated with another high-impact disability had the highest levels of functional difficulties, unmet health needs, and family financial impacts. Nearly 60% of families in both groups provided home health care; in over 40%, a family member stopped working because of the child's condition; and about 40% reported the child's condition caused financial problems.

CONCLUSIONS

Children with DS can have substantial health and functional difficulties, with numerous financial impacts on their families.

Gait patterns in Prader-Willi and Down syndrome patients

Background

Prader-Willi (PWS) and Down Syndrome (DS) are two genetic disorders characterised by some common clinical and functional features. A quantitative description and comparison of their patterns would contribute to a deeper understanding of the determinants of motor disability in these two syndromes. The aim of this study was to measure gait pattern in PWS and DS in order to provide data for developing evidence-based deficit-specific or common rehabilitation strategies.

Methods

19 PWS patients (17.7-40 yr) and 21 DS patients (18-39 yr) were evaluated with an optoelectronic system and force platforms for measuring kinematic and kinetic parameters during walking. The results were compared with those obtained in a group of normal-weight controls (Control Group: CG; 33.4 + 9.6 yr).

Results and Discussion

The results show that PWS and DS are characterised by different gait strategies. Spatio-temporal parameters indicated a cautious, abnormal gait in both groups, but DS walked with a less stable strategy than PWS. As for kinematics, DS showed a significantly reduced hip and knee flexion, especially at initial contact and ankle range of motion than PWS. DS were characterised by lower ranges of motion (p < 0.05) in all joints than CG and PWS. As for ankle kinetics, both PWS and DS showed a significantly lower push-off during terminal stance than CG, with DS yielding the lowest values. Stiffness at hip and ankle level was increased in DS. PWS showed hip stiffness values close to normal. At ankle level, stiffness was significantly decreased in both groups.

Conclusions

Our data show that DS walk with a less physiological gait pattern than PWS. Based on our results, PWS and DS patients need targeted rehabilitation and exercise prescription. Common to both groups is the aim to improve hypotonia, muscle strength and motor control during gait. In DS, improving pelvis and hip range of motion should represent a major specific goal to optimize gait pattern.

Obesity and intellectual disability in New Zealand

BACKGROUND

The international literature suggests that obesity is likely to be more pronounced in the population of people with intellectual disability (ID). However, there are no published New Zealand data for this population.

METHOD

We accessed a database containing anonymous data for a New Zealand ID population. Ninety-eight people of 141 had complete and up-to-date data. The group with complete data did not significantly differ from the group with incomplete data in gender or hours of staff care but were somewhat older. Comparisons were made with the general rates of adult obesity reported by the New Zealand Ministry of Health.

RESULTS

There were significantly higher rates of obesity in the group with ID (51.02%; general population 29.99%). There were significantly more adults with ID in all three obese body mass index (BMI) classes, with the most significant difference in Class III (BMI >or= 40).

CONCLUSIONS

There were more obese men and women with ID in this sample than would be expected, and women in Classes II and III are of particular concern. Research into the factors and potential interventions specific to men and women in this population to promote and maintain weight loss are warranted.

Body mass index as an indicator of adiposity among adults with intellectual disability

BACKGROUND

Body mass index (BMI) has been identified as a key health indicator and determinant of health for people with intellectual disability. Our aim was to examine whether BMI is a useful indicator of adiposity among a sample of adults with intellectual disability.

METHOD

Participants were 46 ambulatory community-dwelling volunteers with mild to moderate intellectual disability. Age ranged from 19 to 60 years, 25 were male, and 17 had Down syndrome. Soft tissue composition was determined using a dual-energy X-ray absorptiometer (DXA) and height and weight were directly assessed.

RESULTS

Regression equations revealed that BMI accounted for 68% of the variance in percent body fat and 83% of the variance in total body fat. Partial correlations of BMI with fat and lean masses determined by DXA were r = .91 and r = -.12, respectively. A BMI of >or= 30 had excellent specificity for obesity, but less than optimal sensitivity.

CONCLUSIONS

BMI appears to be a reasonable indicator of adiposity, although a BMI >or= 30 may misclassify a proportion of individuals assessed by DXA as obese.

Prevalence of Overweight and Mothers’ Perception of Weight Status of Their Children With Intellectual Disabilities in South Korea

The purpose of this study was to estimate the prevalence of overweight and examine relationships between weight status of children with intellectual disabilities (IDs), mothers’ perceived weight status of children, and socioeconomic status (SES). A cross-sectional study of 206 mothers of children with IDs in six special schools in Seoul, South Korea, was conducted. Data were collected through school health record abstraction and parent survey during December 2004. Relationships between measures were assessed using chi-square (χ2) with Fisher’s exact test, analysis of variance (ANOVA), and logistic regression modeling while stratifying by mothers who overestimated versus underestimated their children’s weight status. Almost half (46.6%) of the children were overweight, and 72.8% of mothers accurately perceived their children’s weight status. Overweight among children with IDs in South Korea appears to be a more prevalent problem than expected. This study suggests the need for school-based weight management interventions for children with special needs.

Prevalence of cardiovascular risk factors in older people with intellectual disability

The prevalence and correlates of cardiovascular risk factors in older adults with intellectual disability was examined. We conducted a cross-sectional study with 50- to 90-year-old clients (N = 470) of three Dutch intellectual disability care providing organizations and found that healthy behavior was low, with 98.9% of the participants having an unhealthy diet and 68.3%, a lack of exercise. Smoking (13.6%) and alcohol abuse (0.3%) were relatively minor problems. Abdominal overweight (70.4%), diabetes (8.7%), hypertension (36.8%), and hypercholesterolemia (31.8%) were highly prevalent. These profiles have important implications in determining the risk of cardiovascular disease in people with intellectual disability. Campaigns to promote health should be focused on education and the introduction of preventive screening programs.

Functional impairment severity is associated with health status among older persons with intellectual disability and cerebral palsy

BACKGROUND

Studies have noted high rates of specific health disorders in adults with cerebral palsy (CP). However, it remains unclear how growing older with a lifelong neuromotor physical disability confers risk for health outcomes in adults who have both intellectual disability (ID) and CP.

AIM

To assess the relationship between health status in older adults with ID either with or without coincident diagnoses of CP.

METHOD

Health status data were drawn from 1373 adults aged 33 to 79 years with ID living in small group homes in New York State. Their health status was defined by the presence of common health disorders. Of these, 177 subjects had coincident CP. Prevalence data for nine diseases representing different organ systems were obtained and compared in individuals with and without CP. A Severity of Functional Impairment Index (SFII) was developed based on subjects' capabilities in activities of daily living (ADLs) and mobility. Two logistic regression analyses were conducted to determine if CP diagnosis was an independent predictor of health disorder prevalence, or rather exerted effects similar to those without CP via severity of functional impairment as determined by SFII scores. In addition, older age, gender, and severity of intellectual disability were examined as predictors of health disorder prevalence in all study subjects.

RESULTS

Individuals with CP had higher frequencies in four out of the nine health disorders (overweight/obesity, gastroesophageal reflux, urinary tract infections and dysphagia). Analysis revealed a statistically significant association between SFII score and CP diagnosis. CP diagnosis alone was a statistically significant predictor for all of the above four common disorders; however, after adjustment for SFII score was included in health disorder models, only dysphagia showed an independent correlation with a CP diagnosis.

CONCLUSION

With the exception of dysphagia, impairment in ADLs and walking capabilities, and not CP diagnosis alone, accounted for disparities in specific diseases. Although the diagnosis of CP may be correlated with functional impairment, it alone may play a minor role in determining health trajectories in older persons with conjoint ID and CP.

Pain in adults with cerebral palsy: impact and solutions

Studies of health in adults with cerebral palsy (CP) have identified pain as a significant concern. Investigations regarding incidence, intensity, and location in adults with CP found that increasing age and inactivity appeared to be related to pain. Activity and participation in adults with CP seem to be only moderately affected by presence of pain. Various sources of pain have been identified in adults with CP but have not been well studied. These include orthopedic issues, poor bone mineral density and related fractures, dental and jaw problems, and nutrition-related pain. Limited healthcare utilization studies suggest that adults with CP use healthcare services, especially preventative and rehabilitative services less, and do not consult physicians regarding pain. Medication solutions for chronic pain are not well studied. Botulinum toxin and intrathecal baclofen have been demonstrated to minimize pain; however, the impact of other medications needs further investigation. Other interventions for pain include small studies examining the use of biofeedback and exercise. Larger studies are needed to establish effectiveness. In order to prevent future generations of adults with CP from experiencing high levels of pain, environmental sources of pain need more specific study, as do interventions that are affordable and easily accessed.

Asthma, smoking and BMI in adults with intellectual disabilities: a community-based survey

BACKGROUND

Recent research evidence from the general population has shown that tobacco smoking and raised body mass index (BMI) are associated with worse asthma outcomes. There are indications that asthma morbidity and mortality may be higher among people with intellectual disabilities (ID) than the general population, but the reason for this is not known. This is the first study to investigate the extent of smoking and higher than recommended BMI among adults with ID and a diagnosis of asthma.

METHOD

Health-related data for 1097 adults with ID were collected from 28 primary care practices in Bristol, UK.

RESULTS

Prevalence of asthma in this sample of adults with ID was 12% which was much higher than among the general population living in the region. The 132 patients with asthma were found to be nearly twice as likely to be current smokers as patients with ID who did not have asthma (29.5% vs. 15.6%). Smoking rates were higher among men than women with asthma (35.7% vs. 22.6%). Patients diagnosed with asthma were also more likely to be obese (BMI >or= 30) than patients with ID but no asthma (42.7% vs. 31.6%). Obesity was particularly a problem among women with asthma as more than half (52.1%) had a BMI >or= 30.

CONCLUSIONS

A very high proportion of patients with ID and asthma were found to be current smokers and/or obese. There is now strong research evidence that both smoking and obesity are implicated in the development of asthma and associated with worse disease outcomes. This study highlights the urgent need for programmes aimed at providing support for people with ID and asthma to stop smoking and to achieve a healthy body weight.

Feasibility and reliability of body composition measurements in adults with severe intellectual and sensory disabilities

BACKGROUND

Anthropometric measurements are widely used to reliably quantify body composition and to estimate risks of overweight in healthy subjects and in patients. However, information about the reliability of anthropometric measurements in subjects with severe intellectual and sensory disabilities is lacking.

OBJECTIVE

The purpose of this study was to determine the feasibility and the test-retest reliability of body composition measures in subjects with severe intellectual and sensory disabilities.

METHOD

The study population consisted of 45 subjects with severe intellectual and sensory disabilities. Body mass index, waist circumference, skin folds and tibia length were measured. Reliability was assessed by Wilcoxon signed rank test, limits of agreement (LOA) and intraclass correlation coefficients. The outcomes were compared with values provided by the World Health Organization.

RESULTS

There were no significant differences between test and retest (P < 0.05). For the skinfold measurements, however, the LOA was insufficient. Intraclass correlation coefficients for all variables, except skinfold measurements, were 0.90 or above.

CONCLUSION

Test-retest reliability and feasibility for all measurements are acceptable in subjects with severe intellectual and sensory disabilities. Skinfold measurements, however, could not be reliably performed in these subjects. Measuring tibia length and using the determined formula to calculate body height from tibia length is a reliable alternative for measuring body height. Although measuring the body height of subjects with severe disabilities was feasible, measuring tibia length was more feasible.

Following up fighting fit: the long-term impact of health practitioner input on obesity and BMI amongst adults with intellectual disabilities

This article presents findings on the long-term impact of health practitioner input to reduce obesity amongst adults with intellectual disabilities. Body mass index (BMI) was measured for an input group (N = 33) and a comparison group (N = 40) 6 years after the input group first received input. Data on BMI were collected at baseline, 6 months, 1 year and 6 years. Mean BMI for the input group reduced steadily over 6 years. Mean BMI in the non-input group rose initially, stabilized and then decreased (although remaining higher than at baseline). The input group demonstrated improvements in obesity levels and lost more weight than the non-input group. However, the differences between groups did not reach statistical significance. This and the improvements in BMI within the non-input group may be due to the relatively small sample size, effect size and the impact of other local initiatives.