Overweight and obesity in children and adolescents with Down syndrome-prevalence, determinants, consequences, and interventions: A literature review

Comorbidities and Quality of Life in Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a debilitating, chronic inflammatory disease that results in painful nodules, abscess, and draining tunnels which eventuate in morbid scarring. Patients with HS are at risk for various cutaneous and systemic comorbid diseases including inflammatory bowel disease, cardiovascular, endocrine, and psychiatric conditions. Given its high symptom burden, chronic and progressive course, and association with comorbid conditions, HS has a profound life impact on patients.

Hypoglossal Nerve Stimulation Outcomes in Pediatric Trisomy 21 Patients with Overweight or Obesity

OBJECTIVES

To assess the impact of body mass index (BMI) on hypoglossal nerve stimulator (HNS) implantation outcomes in pediatric patients with Down syndrome (DS). We compare outcomes of HNS implantation when comparing children based on overweight or obese status.

METHODS

Retrospective cohort study of patients at a single tertiary pediatric hospital who underwent HNS implantation between 2022 and 2024. Patients with DS under 21 years of age at time of implantation were included. One child with Wolf-Hirschhorn syndrome was also included. The main outcome measured was reduction in apnea-hypopnea index (AHI).

RESULTS

Twenty patients were implanted with HNS during the study period. Eleven patients were implanted with a BMI considered overweight and 8 patients with a BMI considered obese. No significant correlation was found between BMI percentile and AHI reduction (r = 0.06, p = 0.8). No significant differences were found between obese and non-obese groups for preoperative AHI, postoperative AHI, or AHI reduction. Both groups responded favorably to HNS therapy with AHI reduction of 83.8% in obese patients and 81.9% in non-obese patients.

CONCLUSION

We demonstrate no difference in postoperative AHI outcomes when comparing patients with obesity defined as BMI >95th percentile compared to those without.

LEVEL OF EVIDENCE

3 Laryngoscope, 135:1223-1226, 2025.

Diet Quality of Midwest Adolescents and Young Adults With Intellectual Disabilities and Overweight/Obesity Differs by Diagnosis but Not by Weight Category

BACKGROUND

Poor diet may contribute to high rates of overweight/obesity (OW/OB) in adolescents and young adults with intellectual disabilities (IDs).

OBJECTIVE

The purpose of this study was to examine diet quality as assessed by Healthy Eating Index 2015 (HEI-2015) scores in adolescents and young adults with IDs and OW/OB and to compare diet quality by ID diagnosis and weight.

DESIGN

Three-day image-assisted food records from baseline assessments in an 18-month weight-loss trial for adolescents and young adults with IDs and OW/OB were used to calculate HEI-2015 scores, which were compared between ID diagnoses and weight categories.

PARTICIPANTS/SETTING

A total of 102 adolescents and young adults (aged 13 to 21 years) with IDs (48 with Down syndrome [DS], 40 with autism, and 14 with other/unspecified IDs) and OW/OB at a Midwestern academic medical center completed valid food records from November 2015 to November 2019.

MAIN OUTCOME MEASURES

Outcome measures included HEI-2015 scores, energy intake (kcal/d), macronutrient intake as percentage of energy, energy intake per kilogram body weight, and grams protein per kilogram body weight.

STATISTICAL ANALYSES PERFORMED

Differences in HEI-2015 scores and additional dietary measures by weight category and ID diagnosis were examined with analysis of variance or Kruskal-Wallis tests.

RESULTS

Participants with DS had a significantly higher mean ± SD HEI-2015 score (53.9 ± 8.4) compared with participants with autism (49.1 ± 9.6; P = .047). Compared with those with autism, participants with DS had a higher percentage of energy from protein, higher energy intake per kilogram body weight, and higher grams of protein intake per kilogram body weight. For HEI-2015 components, participants with DS had higher scores than participants with autism for total fruits, whole fruits, total vegetables, greens and beans, and total protein foods, but lower scores for sodium. Diet quality was not observed to differ by weight classification.

CONCLUSIONS

Adolescents and young adults with autism had lower overall diet quality scores compared with those with DS. Diet quality was not found to be related to OW/OB. Understanding dietary differences by ID diagnosis may inform intervention strategies.

A Comparison of Commonly Used Prediction Equations for Estimating Resting Metabolic Rate in Adults With Down Syndrome

BACKGROUND

Resting metabolic rate (RMR), the energy required by the body at rest, is the largest part of total daily energy expenditure. Commonly used prediction equations may overestimate RMR in adults with Down syndrome (DS). The purpose of this study was to assess the equivalency of prediction equations for estimating RMR in adults with DS.

METHODS

Twenty-five adults with DS (24 ± 5 years of age, 64% female) completed RMR assessments at an academic medical centre in the United States between November 2021 and July 2023. Measured RMR (kilocalories per day) was compared to estimated RMR from eight prediction equations using a null hypothesis significance (i.e., a paired t-test) and equivalence (i.e., a two one-sided test) tests. Bland-Altman plots, Pearson correlations and linear regressions were used to evaluate the bias between the measured and predicted RMR values.

RESULTS

Measured RMR in adults with DS was 1090 ± 136 kcal/day. Prediction equations overestimated RMR by 8 ± 16% (76 ± 165 kcal/day) to 45 ± 16% (488 ± 165 kcal/day) except for the Bernstein fat-free mass equation which underestimated RMR by 0.2 ± 11.5% (8 ± 123 kcal/day) and was statistically equivalent to measured RMR in our sample (p = 0.027).

CONCLUSIONS

The Bernstein fat-free mass equation offers better accuracy in adults with DS than other RMR prediction equations, but the equation needs to be evaluated in larger, more diverse samples of adults with DS.

Weight Trajectories among Children with Down Syndrome: A Retrospective Chart Review

OBJECTIVES

To evaluate body mass index (BMI) trajectories over time and to evaluate common comorbidities across a large, nationally representative sample of youth with Down syndrome (DS) STUDY DESIGN: This retrospective study included children ages 2 through18 years within the Cerner Health Facts database with a diagnosis of DS and a medical visit between 2010 and 2017. Comorbid conditions were mapped into PheCodes (ie, one or more ICD codes that combine into specific diseases or traits) and were included if they occurred in at least 1% (145 PheCodes) of the sample.

RESULTS

Outcomes trajectories were analyzed through generalized additive mixed models. Estimated modified BMI z-scores showed a general trend of nonlinear increasing weight by age, specifically an increase from age 2 through 5 years, then stabilization until age 10, and thereafter increasing again. When comorbidities were included, some were associated with lower rates of weight gain, while others were associated with higher rates of weight gain.

CONCLUSIONS

This study showed rapid weight gain in early years and early adolescence for youth with DS. This pattern of weight gain is consistent with same-age peers; however, youth with DS have difficulty recovering after these periods due to several factors such as not having the same height gain. Given these patterns, intervention and prevention should target periods of time when recovery is difficult.

Metabolic dysfunction-associated liver disease and biliary lithiasis in children with Down Syndrome: a retrospective study

OBJECTIVE

To investigate the presence of metabolic dysfunction-associated fatty liver disease (MAFLD) and gallbladder abnormalities in a sample of people with Down syndrome in Brazil.

METHODS

This is a retrospective study using medical charts involving Down syndrome patients, diagnosed by karyotype, aged over 5 years, who underwent abdominal ultrasound and were monitored by the same professional in a clinic in Curitiba, Brazil. Data spanned January 1995 to September 2023; all cases with no use of alcohol or hepatotoxic medications.

RESULTS

A total of 124 patients were evaluated, 64 (51.6%) being females. Ages varied between 5 and 30 years (average of 13.2±5.7 years). Body mass index ranged from 14.08 to 44.98 kg/m2, with 27 (21.7%) patients being overweight and 42 (33.8%) obese. The frequency of increased total cholesterol and triglyceride concentrations was significantly higher in children. No age or sex differences were seen in low- and high-density lipoprotein cholesterol. Alanine transferase (ALT) and aspartate transferase (AST) levels were within normal ranges and showed no differences concerning sex or age. Four patients (3.2%) had diagnosis of MAFLD. The prevalence of gallstone varied widely in terms of the number and size of stones among patients, affecting 11 (8.9%) of them, with no significant difference in age or sex.

CONCLUSIONS

MAFLD was found in 3.2% of the individuals, while gallstone disease was identified in 8.9% of the cases studied. Moreover, we noted a significant presence of risk factors associated with MAFLD, with dyslipidemia being the predominant factor.

Screening and Predictive Biomarkers for Down Syndrome Through Amniotic Fluid Metabolomics

BACKGROUND

Down syndrome (DS) is a congenital disorder caused by the presence of an extra copy of all or part of chromosome 21. It is characterized by significant intellectual disability, distinct facial features, and growth and developmental challenges. The utilization of metabolomics to analyze specific metabolic markers in maternal amniotic fluid may provide innovative tools and screening methods for investigating the early pathophysiology of trisomy 21 at the functional level.

METHODS

Amniotic fluid samples were obtained via amniocentesis from 57 pregnancies with DS and 55 control pregnancies between 173/7 and 240/7 weeks of gestation. The targeted metabolomics focused on 34 organic acids, 17 amino acids, and 5 acylcarnitine metabolites. The untargeted metabolomics analysis concentrated on lipid profiles and included 602 metabolites that met quality control standards. Principal Component Analysis, Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA), and false discovery rate (FDR) adjustments were applied. MetaboAnalystR 5.0 was used to perform the metabolic pathway analysis on the identified differential metabolites.

RESULTS

Fifty differential metabolites, including L-glutamine, eight organic acids, and 41 lipids, were significantly altered in DS based on three criteria: VIP > 1 in the OPLS-DA model, FDR-adjusted p-value < 0.05, and |log2FC| > log2(1.5) from a volcano plot of all detected metabolites. An analysis of 212 differential metabolites, selected from both targeted and untargeted approaches (VIP > 1 in the OPLS-DA model and FDR-adjusted p-value < 0.05), revealed significant changes in nine metabolic pathways. Fourteen key metabolites were identified to establish a screening model for DS, achieving an area under the curve of 1.00.

CONCLUSIONS

Our results underscore the potential of metabolomics approaches in identifying concise and reliable biomarker combinations that demonstrate promising screening performance in DS.

Autoimmune Thyroid Disease in Patients with Down Syndrome-Review

Down syndrome develops due to the presence of supernumerary chromosome 21. This diagnosis is made in approximately 1:800 live births. The tendency to develop autoimmune disorders like idiopathic arthritis, celiac disease, diabetes mellitus type 1, vitiligo and autoimmune thyroid disease is strongly expressed in patients with Down syndrome. Autoimmune thyroid diseases consisting of Hashimoto's thyroiditis and Graves' disease are specifically prevalent in patients with Down syndrome. The aim of our study is to collect available data connecting the pathogenesis and clinical course of autoimmune thyroid diseases in patients with Down syndrome of different ages and compare them to control groups. According to published data, the incidence ratio of Hashimoto's thyroiditis diagnosis in patients with Down syndrome is elevated compared to in age-matched controls without this chromosomal aberration, similarly to Graves' disease risk, which is also increased in a group of patients with Down syndrome. What is more, both Hashimoto's thyroiditis and Graves' disease are diagnosed at an earlier age than in the healthy population and are not correlated with gender or a family history of autoimmune diseases.

Association between FTO gene polymorphism and obesity in down syndrome children

Children with Down syndrome (DS) have a higher incidence of overweight and obesity compared to typically developing peers. The fat mass and obesity-associated gene (FTO) is one of the early identified genes linked to obesity in various populations. To date, the FTO rs17817449 gene polymorphism has not been investigated in overweight/obese-DS (ODS) individuals. The current study aimed to explore the potential association between the FTO rs17817449 gene polymorphism and obesity-related markers, and to evaluate the ability of this polymorphism in the prediction of overweight/obesity in DS children and adolescents. This case-control study included 100 DS children under the age of 18, classified into three groups according to BMI-percentile; 50 non-obese DS (NODS), 24 overweight DS, and 26 ODS. Genotyping of FTO gene rs17817449 polymorphism was performed using the restriction fragment length polymorphism (RFLP-PCR) method. Serum lipid and thyroid profiles were also assessed. The results revealed significant increase in the frequency of the FTO rs17817449 T allele among overweight /ODS children compared to NODS children (p=0.0099). Overweight/ODS children exhibited significantly higher frequencies of the FTO rs17817449 GT and TT genotypes compared to NODS children.

CONCLUSION

There is an association between FTO rs17817449 genetic variant and overweight/obesity among the studied DS groups. The FTO rs17817449 GT and TT genotypes, as well as TGs level, were identified as independent risk factors for predicting overweight and obesity in DS children.

WHAT IS KNOWN

• Overweight and obese-DS (ODS) children displayed higher BMI and atherogenic lipid profile than non-obese DS children (NODS). FTO gene polymorphism rs17817449 contributes to obesity development in general population, but there is conflicting information about the risk allele.

WHAT IS NEW

• FTO rs17817449 TT genotype and T allele were considered as independent risk factors for overweight and obesity development in DS children, so they could be used for obesity prediction in DS children.

Five-repetition sit-to-stand test validation in adolescents and adults with intellectual disabilities

This study aims to validate the five repetition sit to stand test (5R-STS) test as a measure of strength and functionality in adolescents and adults with intellectual disabilities (ID). The sample was made up of 159 subjects with ID (85 adolescents and 74 adults) of both sexes, with average age of 18.36 (5.26) years, belonging to four special educational centers from Santiago, Chile. Absolute (AHGS) and relative (RHGS) handgrip strength and countermovement jump (CMJ) were considered as muscle strength evaluation tests. The timed up and go (TUG) and agility test 4 × 10 m were considered as functional tests. Spearman and intraclass correlations, as well as Bland-Altman plots were used to establish the respective correlations. The average values obtained in the 5R-STS test (s) in adolescents were 6.55 and 7.24, while in adults they were 6.82 and 7.17 for men and women, respectively. Significant correlations (p = < 0.05) are established between the 5R-STS test with AHGS (r= -0.48) and RHGS (r= -0.54), CMJ (-0.53), 4 × 10 m test (-0.50) and TUG (-0.49), as well as in the analysis of agreement between 5R-STS and the TUG (ICC = 0.74) and agility 4 × 10 m (ICC = 0.61) tests, both in adolescents and adults of both sexes. The 5R-STS test is a valid, simple and safe tool to evaluate general and lower extremity muscle strength. Its use is suggested as a simple measure for monitoring functional capacity by professionals in educational and health contexts for the adolescent and adult population with ID.

Case reports of oral appliance therapy on three young adults with Down syndrome and OSA

Patients with Down syndrome (DS) have a high incidence of obstructive sleep apnea (OSA) due to hypotonia, weight, underdeveloped midface, and relative macroglossia. This article presents three cases of young adults with DS, who were diagnosed with mild to severe OSA and unable to tolerate positive airway pressure therapy. These patients have been successfully treated with a custom-made mandibular advancement device (MAD) or dual treatment with MAD and bi-level positive airway pressure (PAP) therapy. The baseline apnea-hypopnea index (AHI) of the three patients were 15.5/h, 31.8/h, and 41.3/h. The follow-up AHI after the application of MAD in three patients was 25/h (13 months after), 6/h (ODI 4%, 57 months after), and 21.8/h (21 months after), respectively. The application of MAD to treat OSA in patients with DS is a reasonable alternative when patients refuse PAP therapy. Although MAD might be less effective than PAP therapy, significant symptomatic improvement could be found in patients with DS after oral appliance therapy. The combination of MAD and PAP can decrease the PAP pressure and therefore improve adherence. This is the first case report to show that young adult patients with DS can successfully benefit from oral appliance therapy for OSA treatment.

Assessing the Benefit of Dietary Choline Supplementation Throughout Adulthood in the Ts65Dn Mouse Model of Down Syndrome

BACKGROUND/OBJECTIVES

Down syndrome (DS) is the most common cause of early-onset Alzheimer's disease (AD). Dietary choline has been proposed as a modifiable factor to improve the cognitive and pathological outcomes of AD and DS, especially as many do not reach adequate daily intake levels of choline. While lower circulating choline levels correlate with worse pathological measures in AD patients, choline status and intake in DS is widely understudied. Perinatal choline supplementation (Ch+) in the Ts65Dn mouse model of DS protects offspring against AD-relevant pathology and improves cognition. Further, dietary Ch+ in adult AD models also ameliorates pathology and improves cognition. However, dietary Ch+ in adult Ts65Dn mice has not yet been explored; thus, this study aimed to supply Ch+ throughout adulthood to determine the effects on cognition and DS co-morbidities.

METHODS

We fed trisomic Ts65Dn mice and disomic littermate controls either a choline normal (ChN; 1.1 g/kg) or a Ch+ (5 g/kg) diet from 4.5 to 14 months of age.

RESULTS

We found that Ch+ in adulthood failed to improve genotype-specific deficits in spatial learning. However, in both genotypes of female mice, Ch+ significantly improved cognitive flexibility in a reverse place preference task in the IntelliCage behavioral phenotyping system. Further, Ch+ significantly reduced weight gain and peripheral inflammation in female mice of both genotypes, and significantly improved glucose metabolism in male mice of both genotypes.

CONCLUSIONS

Our findings suggest that adulthood choline supplementation benefits behavioral and biological factors important for general well-being in DS and related to AD risk.

Association Between Lifestyle Patterns and Abdominal Obesity with Biochemical and Inflammatory Biomarkers in Adolescents with Down Syndrome: The UP&DOWN Study

BACKGROUND/OBJECTIVES

The main objective of this study was to examine the association between lifestyle patterns (physical activity, screen and sleep time and diet) and abdominal obesity, and endocrine, metabolic, and immunological biomarkers in adolescents with Down syndrome (DS).

METHODS

Eighty-three DS adolescents (38.6% girls), aged 11 to 18 years, from the UP&DOWN study were included. Cluster analysis was performed by including the compliance of recommendations of lifestyle variables, such as moderate to vigorous physical activity (MVPA), screen and sleep time and adherence to the Mediterranean diet (AMD). The waist-to-height ratio was used as an indicator of abdominal obesity. Haematological, biochemical and inflammatory biomarkers were analysed.

RESULTS

A three-cluster solution was identified: Cluster 1: adolescents with low compliance; Cluster 2: youth with medium compliance; and Cluster 3: adolescents with high compliance. Significant differences in MVPA (p = 0.000), screen time (p = 0.004), sleep time (p = 0.0001), AMD (p = 0.000) and abdominal obesity (p = 0.003) were found. Clusters 2 and 3 had lower levels of triglycerides and LDL-cholesterol than Cluster 1. Cluster 2, in which all adolescents met the MVPA recommendations, had the lowest levels of galactin 3.

CONCLUSIONS

Compliance with lifestyle recommendations (PA, screen and sleep time and AMD) and the absence of abdominal obesity seem to be associated with better biochemical and inflammatory values.

The effects of resistance training on health-related physical fitness of people with down syndrome - A systematic review and meta-analysis

PURPOSE

This overview of systematic reviews with meta-analysis aimed to summarize the effects of resistance training (RT) on physical fitness of people with Down syndrom (DS).

MATERIAL AND METHODS

A comprehensive search was conducted across multiple databases, including PubMed, Google Scholar, Cochrane, MEDLINE, Web of Science, and SPORTDiscus, up until January 30th, 2024. The search included key terms like resistance training, strength training, weight training, intellectual disability, and Down syndrome. The quality of the included studies was assessed using the Cochrane Collaboration assessment tool. Eighteen articles were reviewed, with nine included in the meta-analysis.

RESULTS

The results demonstrated that RT interventions positively impacted physical fitness in individuals with DS, with significant improvements in both upper and lower limb strength and cardiorespiratory endurance, as indicated by VO2peak (p = 0.000). Eleven studies were classified as high quality with low risk of bias, four had some methodological concerns, and three non-randomized studies exhibited a high risk of bias.

CONCLUSION

RT interventions appear to significantly enhance physical fitness, including muscle strength, functional abilities, cardiorespiratory fitness, and balance, among individuals with DS, regardless of variations in training methods or program designs.

Swim, Strength, or Combined Programs: Effect on Health-Related Physical Fitness in Adolescents With Down Syndrome

The adolescent population with Down syndrome (DS) appears to show higher levels of body fat and lower levels of cardiorespiratory fitness or muscle strength than their peers without disabilities. There is a need to create physical activity programs to improve these data. The aim of this research was to determine the effects of a 16-week swimming program, strength program, and combined program (swimming and strength training) on body composition and health-related physical fitness on adolescents with DS and to assess whether there are differences in the results of the different training programs. Forty-five adolescents (17 female and 28 male; average age 15.5 [1.53] years) with DS were recruited and randomized to three groups (swim [n = 15], strength [n = 15], and combined [n = 15]). Results showed that the swim group had significant improvements in all health-related physical fitness variables and there was an improvement in some body-composition variables (p < .05). The strength and combined groups obtained minor improvements in the variables analyzed. In summary, a 16-week swim program consisting of three sessions of 60 min is able to improve levels of body composition and health-related physical fitness in adolescents with DS. The swim training program seems to be more effective in improving body composition and health-related physical fitness than the strength or combined program. These findings could be useful in different special-education centers due to the predisposition shown by the population with DS to this sport modality.

Comparison of power spectra from overnight electroencephalography between patients with Down syndrome and matched control subjects

Electroencephalograms can capture brain oscillatory activities during sleep as a form of electrophysiological signals. We analysed electroencephalogram recordings from full-night in-laboratory polysomnography from 100 patients with Down syndrome, and 100 age- and sex-matched controls. The ages of patients with Down syndrome spanned 1 month to 31 years (median 4.4 years); 84 were younger than 12 years, and 54 were male. From each electroencephalogram, we extracted relative power in six frequency bands or rhythms (delta, theta, alpha, slow sigma, fast sigma, and beta) from six channels (frontal F3 and F4, central C3 and C4, and occipital O1 and O2) during five sleep stages (N3, N2, N1, R and W)-180 features in all. We examined differences in relative power between Down syndrome and control electroencephalograms for each feature separately. During wake and N1 sleep stages, alpha rhythms (8.0-10.5 Hz) had significantly lower power in patients with Down syndrome than controls. Moreover, the rate of increase in alpha power with age during rapid eye movement sleep was significantly slower in Down syndrome than control subjects. During wake and N1 sleep, delta rhythms (0.25-4.5 Hz) had higher power in patients with Down syndrome than controls. During N2 sleep, slow sigma rhythms (10.5-12.5 Hz) had lower power in patients with DS than controls. These findings extend previous research from routine electroencephalogram studies demonstrating that patients with Down syndrome had reduced circadian amplitude-the difference between wake alpha power and deep sleep delta power was smaller in Down syndrome than control subjects. We envision that these brain oscillatory activities may be used as surrogate markers for clinical trials for patients with Down syndrome.

Diet and physical activity modification: impact on adaptive behavior and biochemical measures of children with Down syndrome

Objectives

Obesity in children with Down syndrome (DS) has negative implications for behavior. The aim was to assess the influence of weight reduction by diet modification with and without physical therapy sessions on adaptive behavior and some biochemical measures in children with DS with obesity.

Methods

The study included 100 children with DS (56 males, 44 females; age range: 6-9 (8.5 ± 1.7) years. They were subjected to history taking, clinical examination, and the Vineland adaptive behavior scale. They were randomly divided into two groups: Group I underwent nutritional modification, and Group II was subjected to an added exercise program. The biochemical measures were estimated using the automated chemistry analyzer for blood chemistry (lipids), or ELISA.

Results

An elevation of behavioral adaptive scores was noticed after the weight reduction, together with a reduction in the levels of triglycerides and an elevation of high-density lipoprotein-C levels. Levels of interleukin I, interleukin 6, and leptin were reduced in both groups. However, the improvement regarding the estimated measures was greater in Group II (p < 0.05).

Conclusions

Weight reduction in children with DS was beneficial for their adaptive behavior and for adjusting dyslipidemia, along with some measures of inflammation. Combining physical activity with nutritional modification would help in the better advancement of the health and adaptive behavior of children with DS associated with obesity compared with isolated nutritional modification.

Complementary feeding practices of caregivers of infants with Down syndrome as compared to caregivers of typically developing infants

Caregiver feeding practices during the complementary feeding period (6 months-2 years) may be particularly important for infants with Down syndrome (DS) as they are at higher risk for later health conditions (e.g., obesity, diabetes) that can be influenced by early feeding practices. However, how well caregivers of infants with DS are meeting infant feeding evidence-based practices is relatively unknown. Caregivers of infants with DS (N = 75) and caregivers of typically developing (TD) infants (N = 66) aged 0-2 years completed an online survey about their infant feeding practices and information sources. Caregiver practices and information sources were statistically compared between groups. Results indicated that there are significant differences in the feeding practices of caregivers of infants with DS when compared to caregivers of TD infants. Caregivers of infants with DS were less likely to meet infant feeding evidence-based practices than caregivers of TD infants. Caregivers of infants with DS were also more concerned about their infant's food intake and later weight status. Some individual feeding practices also significantly differed between groups, with caregivers of infants with DS more likely to meet evidence-based practices of purchasing iron rich foods and avoiding added salt, but less likely to use responsive feeding practices than caregivers of TD infants. Caregivers of infants with DS were also less likely to receive information about how to navigate the complementary feeding period than caregivers of TD infants. Coupled with existing research, the results of the present study suggest that infant feeding evidence-based practices should be reviewed for their appropriateness for this population and additional support for caregivers of infants with DS should be implemented to help them navigate this important period.

A systematic review and meta-analysis of serum lipid concentrations in people with Down syndrome

BACKGROUND

Down syndrome (DS) is the most prevalent chromosomal disorder, being the leading cause of intellectual disability. The increased life expectancy of individuals with DS has led to a shift in the incidence of non-communicable chronic diseases, resulting in new concerns, particularly cardiovascular disease (CVD) and Alzheimer's disease. This study aimed to analyse the blood lipid profile of a large DS cohort to establish a baseline for evaluating health risk parameters.

METHODS

A comprehensive literature search was conducted on PubMed and Virtual Health Library databases to identify original articles published before July 2022. Selected studies were included in the meta-analysis.

RESULTS

Fifteen studies reporting serum lipid levels in individuals with DS were incorporated into the analysis. The meta-analysis used the means and standard deviations extracted from the selected studies. The analysis encompassed 671 participants in the DS group and 898 euploid controls. The results indicated significant differences in total cholesterol [C] (mean difference [MD]: -3.34; CI: 95%: -4.94 to -1.73; P < 0.0001), HDL-C (MD: -3.39; CI: 95%: -6.72 to -0.06; P = 0.05) and triglycerides (MD: 21.48; CI: 95%: 9.32 to 33.65; P = 0.0005) levels between individuals with DS and their control counterparts.

CONCLUSIONS

Individuals with DS have less favourable blood lipid concentrations than their controls, particularly HDL-C, triglycerides, and total-C, even when grouped by age. These findings underscore the importance of closer monitoring of lipid profiles in people with DS and the necessity for specific cut-offs for this population, considering the risk for ischemic heart and Alzheimer's diseases.

Down Syndrome and Autoimmune Disease

Down syndrome is the most common genetic cause of intellectual disability and has previously been associated with a variety of autoimmune disorders affecting multiple organ systems. The high prevalence of autoimmune disease, in conjunction with other inflammatory and infectious diseases, in this population suggests an intrinsic immune dysregulation associated with triplication of chromosome 21. Emerging data on the role of chromosome 21 in interferon activation, cytokine production, and activation of B-cell mediated autoimmunity are emerging hypotheses that may explain the elevated prevalence of autoimmune thyroid disease, celiac disease, type I diabetes, autoimmune skin disease, and a variety of autoimmune neurologic conditions. As the life expectancy for individuals with Down syndrome increases, knowledge of the epidemiology, clinical features, management and underlying causes of these conditions will become increasingly important. Disorders such as Hashimoto's thyroiditis are prevalent in between 13 and 34% of individuals with Down syndrome but only 3% of the neurotypical population, a pattern similarly recognized in individuals with Celiac Disease (5.8% v 0.5-2%), alopecia areata (27.7% v. 2%), and vitiligo (4.4% v. 0.05-1.55%), respectively. Given the chronicity of autoimmune conditions, early identification and management can significantly impact the quality of life of individuals with Down syndrome. This comprehensive review will highlight common clinical autoimmune conditions observed in individuals with Down syndrome and explore our current understanding of the mechanisms of disease in this population.

Integrating Ecological and Feminist Perspectives to Study Maternal Experiences Feeding Children With Down Syndrome

Purpose: The purpose of this article is to propose a theoretical framework integrating an ecological model with feminist theory for guiding future research in holistic nursing and healthcare about maternal experiences feeding children with Down syndrome. Background: Children with Down syndrome are at high risk for overweight and obesity, as well as feeding problems. Therefore, healthy weight promotion is crucial for children with Down syndrome. Feeding is one factor that may contribute to child weight. Literature on maternal experiences feeding children with Down syndrome, including the caregiving work involved in feeding, is limited. Methods: In this article, we identify literature gaps related to the topic of maternal experiences feeding children with Down syndrome. We summarize ecological and feminist perspectives and apply these perspectives to the topic to demonstrate the utility of the proposed framework. Implications for Holistic Nursing and Healthcare: Findings from future studies applying this theoretical framework integrating an ecological model with feminist theory will have implications for practice and research in holistic nursing and healthcare. This framework could be also adapted to inform future research focused on other populations or research topics.

Exploring the Complex Interplay of Obesity, Allergic Diseases, and Sleep-Disordered Breathing in Children

This narrative review study investigates the correlations between obesity, allergies, and sleep-disordered breathing in pediatric populations. Searches for pertinent articles were conducted on the Medline PubMed Advanced Search Builder, Scopus, and Web of Science databases from unlimited to April 2024. Sleep-disordered breathing causes repeated upper airway obstructions, leading to apneas and restless sleep. Childhood obesity, which affects around 20% of children, is often associated with sleep-disordered breathing and allergies such as asthma and allergic rhinitis. It is distinguished between diet-induced obesity (resulting from excess of diet and physical inactivity) and genetic obesity (such as is seen in Down syndrome and Prader-Willi syndrome). In children with diet-induced obesity, chronic inflammation linked to weight can worsen allergies and increase the risk and severity of asthma and rhinitis. Furthermore, the nasal congestion typical of rhinitis can contribute to upper respiratory tract obstruction and obstructive sleep apnea. A vicious circle is created between asthma and sleep-disordered breathing: uncontrolled asthma and sleep-disordered breathing can worsen each other. In children with genetic obesity, despite alterations in the immune system, fewer allergies are observed compared to the broader population. The causes of this reduced allergenicity are unclear but probably involve genetic, immunological, and environmental factors. Additional research is necessary to elucidate the underlying mechanisms. The present narrative review study emphasizes the importance of jointly evaluating and managing allergies, obesity, and obstructive sleep apnea in children considering their close interconnection.

Comparative Health Behaviour of Young People with Disabilities in Hungary: A Cross-Sectional Study

The health status of Hungary's population is unfavorable, with significant differences in health indicators not only compared to the EU15 but also to the Visegrad countries. Unfavorable health indicators can be disproportionate and particularly affect vulnerable groups, such as people with disabilities. In this study, we set out to compare the health behavior of disabled youth and youth with typical development in Hungary. We also aimed to compare the health behavior of adolescents in the Visegrad countries. The eating habits of both groups of young people we examined are unfavorable. Adolescents with disabilities experience a significantly higher rate of school stress than children with typical development in Hungary. The prevalence of somatic complaints and parameters of poor mental well-being are significantly higher in Hungary than in the other Visegrad countries. The results indicate that additional interventions are needed in Hungary and that differentiated, professional health promotion is needed for young people with disabilities. The researchers recommend extending the study to disabled adolescents living in Visegrad countries, on the basis of which an injury-specific health promotion methodology could be developed with international interprofessional cooperation.

Role of child demographic, executive functions, and behavioral challenges on feelings about parenting among parents of youth with Down syndrome

BACKGROUND

Living with a child with Down syndrome (DS) influences the entire family, including caregivers.

AIMS

This study examined positive and negative caregiver feelings about parenting youth with DS and to what extent children's demographic, cognitive, behavioral characteristics, and co-occurring medical conditions are associated with those parental feelings. Specifically, the mediatory role of child behavioral challenges on the relationship between child executive functioning (EF) and parent feelings about parenting a child with DS was examined in a mediation analysis model.

METHODS AND PROCEDURES

Parents of 113 youth with DS aged 6 to 17 year rated their positive and negative feelings about parenting, and their child's behavioral challenges and EF.

OUTCOMES AND RESULTS

Externalizing and Internalizing behavioral challenges and emotional and behavioral regulations of EF were significantly associated with positive and negative parent feelings. Child behavioral challenges fully mediated the relationship between child EF and caregiver feelings about parenting, after controlling for identified covariates of child demographics.

CONCLUSIONS AND IMPLICATIONS

Findings have implications for understanding the role of EF, through its impact on behavioral challenges, on the feelings of caregivers about parenting a child with DS. These findings play a role in understanding outcomes of interventions targeted at EF and behavioral challenges, in the context of other child variables.

Effects of substituting sedentary time with physical activity on body mass index in Japanese adults with Down syndrome: A cross-sectional study

Objective

and Rationale: Obesity is a health challenge for adults with Down syndrome. Therefore, a physical activity promotion program is required to prevent or reduce obesity in adults with this condition. However, there is a lack of evidence of useful risk reduction initiatives. The objective of this study was to suggest a rationale for behaviors that should replace time of inactivity to reduce obesity in Japanese adults with Down syndrome.

Methods

The participants were adults with Down syndrome, aged 18-48 years, living in Japan. The snowball sampling method was used. To detect an effect size of 0.20 for body mass index using an F-test, 80 participants were required, generating a statistical power of 0.8 and a risk level of 0.05. Survey items included sex, age, height, weight, body mass index, and physical activity (min/d). Physical activity was categorized by intensity and further divided into ambulatory and non-ambulatory activities. The body mass index categories were compared using analysis of covariance. An isotemporal substitution model was used to confirm the interdependence of behaviors.

Results

Half of the participants were obese, with a body mass index of 25 kg/m2 or higher. The obese group had significantly fewer light physical activity, moderate-to-vigorous physical activity, and ambulatory moderate-to-vigorous physical activity times than the non-obese group. Replacing 10 min of sedentary behavior with ambulatory moderate-to-vigorous physical activity was significantly associated with a lower body mass index.

Conclusions

This study suggests a rationale for behaviors that should replace time of inactivity to reduce obesity in adults with Down syndrome. Specifically, replacing 10 min of sedentary behavior with ambulatory moderate-to-vigorous physical activity time may contribute to obesity reduction.

Endocrine, auxological and metabolic profile in children and adolescents with Down syndrome: from infancy to the first steps into adult life

Down syndrome (DS) is the most common chromosomal disorder worldwide. Along with intellectual disability, endocrine disorders represent a remarkable share of the morbidities experienced by children, adolescents and young adults with DS. Auxological parameters are plotted on syndrome-specific charts, as growth rates are reduced compared to healthy age- and gender-matched peers. Furthermore, children with DS are at increased risk for thyroid dysfunctions, diabetes mellitus, osteopenia and obesity compared to general population. Additionally, male individuals with DS often show infertility, while women tend to experience menopause at an overall younger age than healthy controls. Given the recent outstanding improvements in the care of severe DS-related comorbidities, infant mortality has dramatically decreased, with a current average life expectancy exceeding 60 years. Accordingly, the awareness of the specificities of DS in this field is pivotal to timely detect endocrine dysfunctions and to undertake a prompt dedicated treatment. Notably, best practices for the screening and monitoring of pediatric endocrine disorders in DS are still controversial. In addition, specific guidelines for the management of metabolic issues along the challenging period of transitioning from pediatric to adult health care are lacking. By performing a review of published literature, we highlighted the issues specifically involving children and adolescent with DS, aiming at providing clinicians with a detailed up-to-date overview of the endocrine, metabolic and auxological disorders in this selected population, with an additional focus on the management of patients in the critical phase of the transitioning from childhood to adult care.

Natural resistance to cancer: A window of hope

As healthcare systems are improving and thereby the life expectancy of human populations is increasing, cancer is representing itself as the second leading cause of death. Although cancer biologists have put enormous effort on cancer research so far, we still have a long way to go before being able to treat cancers efficiently. One interesting approach in cancer biology is to learn from natural resistance and/or predisposition to cancer. Cancer-resistant species and tissues are thought-provoking models whose study shed light on the inherent cancer resistance mechanisms that arose during the course of evolution. On the other hand, there are some syndromes and factors that increase the risk of cancer development, and revealing their underlying mechanisms will increase our knowledge about the process of cancer formation. Here, we review natural resistance and predisposition to cancer and the known mechanisms at play. Further insights from these natural phenomena will help design future cancer research and could ultimately lead to the development of novel cancer therapeutic strategies.

Homogeneity in Motor Competence Among Youths With Intellectual Disability With and Without Down Syndrome

PURPOSE

To determine if there is a homogeneity of scores for youth with intellectual disability (ID) with and without Down syndrome (DS) in 19 test items of motor competence from the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2). Homogeneity was defined as the means for each of the 19 test items scores by sex and the presence or absence of DS sharing the same population mean.

METHOD

Participants were 622 youth with ID aged 6 to 21 years. Items for bilateral coordination, balance, and upper limb coordination were examined using the BOT-2.

RESULTS

For all 19 BOT-2 items, means between youth with and without DS did not differ from the population mean.

CONCLUSION

These results potentiate the development of expected BOT-2 motor competence scores for youth with ID independent of the presence of DS for clinical practice.

Lipid Profile, Eating Habit, and Physical Activity in Children with Down Syndrome: A Prospective Study

Children with Down Syndrome (DS) frequently undergo health challenges, including a higher prevalence of overweight and obesity. We aimed to evaluate the impact of dietary and physical advice provided by a specialized pediatrician over two years. In this prospective study, 44 children with DS, aged 2 to 17, underwent outpatient follow-up visits every six months between December 2020 and May 2023. Dietary habits, physical activities, anthropometric data, and laboratory results were recorded at baseline and 2-year follow-up. Adherence to the Mediterranean diet and physical activity were investigated using the 'KIDMED' and 'Godin-Shepard Leisure-Time' questionnaires, respectively, completed by the parents of the children. Venous blood samples were taken to determine the lipid profile. A significant reduction in BMI z-scores (p = 0.006) and an improvement in Godin-Shepard questionnaire scores (p = 0.0004) were observed. On the other hand, the lipid profile worsened, with an increase in LDL-c (p = 0.04) and a decrease in HDL-c (p = 0.03). Children with DS may benefit from an educational program on nutrition and physical activity to optimize weight control. Different interventions should target the lipid profile. Preventive intervention and follow-up by the pediatrician are essential for DS, which should continue into adulthood.

Functional fitness of adults with Down syndrome: a longitudinal study

BACKGROUND

Individuals with Down syndrome (DS) are born with and develop many health-related complications. The purpose of this study was to determine the longitudinal functional fitness profile of adults with DS.

METHODS

The functional fitness of adults with DS was tested twice, 12 years apart. Sixty-six adults with DS were tested for body mass, stature and 10 functional fitness tests. Data were categorised according to gender and age-specific categories.

RESULTS

Static balance, shoulder flexibility, trunk strength and aerobic capacity deteriorated significantly with medium to large effect sizes for both DS men and women (most age categories). For women, dynamic balance deteriorated significantly, and for men, leg- and upper body-strength deteriorated significantly.

CONCLUSIONS

Practitioners working in the field of adapted physical activity should take cognisance of the functional fitness ageing profile of adults with DS and timeously develop habitual physical activity interventions to reduce the effect of accelerated ageing experienced by this population.

COVID-19 in patients with Down syndrome: A systematic review

INTRODUCTION

Down syndrome (DS) is associated with multiple comorbid conditions and chronic immune dysfunction. Persons with DS who contract COVID-19 are at high risk for complications and have a poor prognosis. We aimed to study the clinical symptoms, laboratory and biochemical profiles, radiologic findings, treatment, and outcomes of patients with DS and COVID-19.

METHOD

We systematically searched PubMed, MEDLINE, Web of Science, Scopus, and the Cochrane Library using the keywords COVID-19 or coronavirus or SARS-CoV-2 and DS or trisomy 21. Seventeen articles were identified: eight case reports and nine case series published from December 2019 through March 2022, with a total of 55 cases.

RESULTS

Patients averaged 24.8 years (26 days to 60 years); 29 of the patients were male. The most common symptoms were fever, dyspnea, and cough. Gastrointestinal and upper respiratory tract symptoms were commonly reported for pediatric patients. The most common comorbidities present in patients with DS were obesity (49.0%), hypothyroidism (21.6%) and obstructive sleep apnea (15.6%). The patients were hospitalized for a mean of 14.8 days. When the patients were compared with the general COVID-19 population, the mean number of hospitalized days was higher. Most patients had leukopenia, lymphopenia, and elevated inflammatory markers (d-dimer and C-reactive protein). Bilateral infiltrations and bilateral ground-glass opacifications were frequently seen in chest radiographs and chest computed tomographic imaging. Most of the patients were treated with methylprednisolone, macrolides, and hydroxychloroquine. Of the 55 patients, 22 died. The mean age of the patients who died was 42.8 years. Mortality rate was higher in individuals with DS over 40 years of age.

CONCLUSION

More studies are needed to better understand COVID-19 infections among persons with DS. In addition, the study was limited by a lack of statistical analyses and a specific comparison group.

Serum apelin-12 and obesity-related markers in Egyptian children with Down syndrome

Children with Down syndrome (DS) exhibit higher overweight/obesity rates than their typically developing peers. Apelin-12 is a bioactive adipokine that exerts vital roles in obesity-related cardiometabolic comorbidities. To date, apelin-12 has not been investigated in obese-DS. This study aimed to explore the possible association between serum apelin-12 and obesity-related markers and to evaluate the efficiency of apelin-12 in the prediction of metabolic syndrome (MetS) in obese-DS compared to BMI Z-score matched obese-control. The cross-sectional study included 150 prepubertal children classified into three groups; obese-DS (n = 50), obese-control (n = 50), and normal-weight-control (n = 50). Anthropometric parameters, body adiposity, fasting serum levels of blood glucose (FBG), insulin, lipid profile, and apelin-12 were evaluated. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated from FBG and insulin. MetS was defined using Adult Treatment Panel III criteria modified for the pediatric age group. ROC curves were analyzed to evaluate the efficiency of apelin-12 in predicting MetS in obesity groups. Obese-DS exhibited higher body adiposity with marked central fat distribution, atherogenic lipid profile, and higher HOMA-IR compared to obese-control. Apelin-12 was significantly higher in obese-DS and obese-DS with MetS compared to obese-control and obese-control with MetS respectively (p < 0.001). The increase in apelin-12 with higher obesity grades was pronounced in obese-DS. Apelin-12 strongly correlated with body adiposity, several MetS risk factors, and HOMA-IR in obese-DS. Significantly higher AUC for apelin-12 in the diagnosis of MetS among obese-DS than obese-control (AUC = 0.948 vs. AUC = 0.807; p = 0.04).

CONCLUSIONS

 The current study supports the crucial role of apelin-12 in obesity-related clinical and biochemical markers and in MetS in obese-DS and obese-control. Serum apelin-12 is a potential diagnostic biomarker for MetS with greater performance in obese-DS than obese-control raising its potential for clinical and therapeutic applications.

WHAT IS KNOWN

• Obese-DS children displayed excess body adiposity, Pronounced central fat distribution, atherogenic lipid profile, higher HOMA-IR, and higher prevalence of MetS than obese-control.

WHAT IS NEW

• Higher serum apelin-12 was observed in obese-DS and obese-DS with MetS than obese-control and obese-control with MetS respectively. The increase in apelin-12 level with increasing obesity grades was more pronounced in obese-DS. • Apelin-12 strongly correlated with obesity-related markers and MetS components in obese-DS. Apelin-12 performed better as a diagnostic biomarker for MetS in obese-DS than obese-control.

Physiological Mechanisms That Impact Exercise Adaptations for Individuals With Down Syndrome

ABSTRACT

Post, EM, and Kraemer, WJ. Physiological mechanisms that impact exercise adaptations for individuals with Down syndrome. J Strength Cond Res 37(12): e646-e655, 2023-Down syndrome (DS) is the most common chromosomal disorder diagnosed in the United States since 2014. There is a wide range of intellectual severities, with the average IQ of individuals with DS at approximately 50 and adults without intellectual delay at approximately 70-130. Individuals with DS vary from mild to severe cognitive impairment, depending on the phenotypic penetration on the 21st chromosome, with the average cognitive capacity equivalent to a cognitive functioning of an 8- to 9-year-old child. To have successful health, all aspects of health must be considered (i.e., overall health, fitness, and social). Both aerobic training and resistance training (RT) are favored for a healthy lifestyle. Resistance training specifically can help improve motor function and overall activities of daily living. Although many motivational and environmental barriers for individuals with DS can make exercising difficult, there are many ways to overcome those barriers (both intrinsically and extrinsically). Individuals with DS should strive for 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise a week or a combination of both. The individual should also strive for 2 or more days a week of strengthening activities, such as RT, involving all muscle groups. These activities will help improve many aspects of life, leading to a better quality of life. Regular group exercise activity can help increase self-confidence and success socially in life. This review will focus on the underlying biological mechanisms related to DS, their influence on exercise, and the roles exercise plays in mediating positive health, physical fitness, and social lifestyle outcomes.

Motor Skills and Executive Functions in Pediatric Patients with Down Syndrome: A Challenge for Tailoring Physical Activity Interventions

Down syndrome (DS) is one of the most common chromosomal disorders. In addition to this variety of dysmorphic features. DS is also associated with a wide range of diseases and related comorbidities affecting different organs and systems. These comorbidities, together with societal and environmental influences, have a negative impact on physical activity in people with DS. Low levels of physical activity and energy expenditure have been identified as crucial players in worsening the acquisition of motor skills and executive functions. Executive functions are critical for the many skills (creativity, flexibility, self-control, and discipline) impacting our quality of life and make it possible to control impulses, mentally play with ideas, and stay focused. We proposed a broad overview of the available literature regarding motor skills and executive functions in pediatric patients with DS to understand the specific challenges for tailoring physical activity interventions. Motor skill interventions are effective in improving motor competence and performance on cognitive, emotional, and physical aspects in children with DS. Interventions based on executive functions in DS subjects are effective to contrast the cognitive decline and improve the everyday use of executive functions in youth and adults. Targeted interventions are mandatory for maximizing the benefits of physical activity, minimizing potential risks, and ultimately improving the overall health outcomes and quality of life for individuals with DS.

A call for obesity prevention interventions for young children with intellectual and developmental disabilities

Health disparities among children with intellectual and developmental disabilities (IDD) are present in early childhood. Yet, this population is underrepresented in health behavior research. In this commentary the authors highlight the need for multi-level physical activity and nutrition research for obesity prevention with a specific focus on young children with Down syndrome, a population at greater risk of developing overweight and obesity compared to typically developing peers. This commentary describes the comorbidities and developmental challenges faced by many children with Down syndrome which may influence weight-related physical activity and nutrition behaviors. Additionally, the authors advocate for involving a multidisciplinary team of experts to inform the adaptation or development of multi-level, theory-driven behavioral interventions to prevent obesity among children with Down syndrome.

Blood tests and use of nutritional supplements in a cohort of Brazilian children with trisomy 21

OBJECTIVE

To describe the use of nutritional supplements and blood status (hemogram, lipidogram, hepatic function, inflammatory markers, minerals, and homocysteine) in a sample of Brazilian T21 children with private health support before their first consultation with a T21 expert.

METHOD

This descriptive cross-sectional study enrolled 102 participants. Brazilian families with a T21 member under 18 years old were contacted and those that consented answered a survey regarding socio-demographics and the use of nutritional supplements and shared the blood tests that their T21 members have collected for the first consultation with a T21 expert.

RESULTS

Frequencies and percentages were used to describe the variables. The most used supplements included vitamins (A, C and D), minerals (zinc and iron), omega-3, and antioxidants (curcumin). Hypothyroidism was observed in 56.9% of the participants. Hemogram alterations (increased hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin and red cell distribution width, leukopenia, and lymphocytopenia), dyslipidemia, altered hepatic and inflammatory blood markers were frequently found.

CONCLUSIONS

Nutritional supplements (mainly vitamins, minerals, omega-3 and antioxidants) are frequently used by Brazilian T21 children independently of professional counseling and/or supervision and should be a question to be raised during the clinical anamnesis since some of them may impact medical conduct. Moreover, many blood tests are altered in this population and clinicians should be aware of them in order to warrant an appropriate screening and the implementation of risk management measures as soon as possible and improve the general health of these persons.

Thyroid function, sensitivity to thyroid hormones, and metabolic syndrome in euthyroid children and adolescents with Down syndrome

PURPOSE

Patients with Down Syndrome (DS) showed multiple comorbidities, including thyroid disorders, obesity, and metabolic derangement. Different thyroid hormone (THs) patterns and sensitivity to thyroid hormone indices (STHI) seem to be associated with metabolic disorders. The study's aim was to evaluate the prevalence of metabolic syndrome (MS) in pediatric patients affected by DS, taking into consideration the relationship between the metabolic parameters, THs and STHI.

METHODS

We enlisted 50 euthyroid patients with DS (9.03 ± 4.46). Clinical parameters, TSH, FT3, FT4 and the presence of MS were recorded. Indexes of peripheral sensitivity (FT3/FT4 ratio) and central sensitivity (TSH index, TSHI; TSH T4 resistance index, TT4RI; TSH T3 resistance index, TT3RI) were also detected. Thirty healthy subjects were included as a control group.

RESULTS

MS was detected in 12% of the subjects with DS. FT3, FT4, and TSH levels were higher in DS than in the control group (p < 0.01); higher levels of FT3/FT4 ratio, TSHI and TT3RI and lower TT4RI values (p < 0.01) were also detected. A significant correlation was detected between FT3 and fasting blood glucose (FBG) (R = 0.46), triglyceride (TG) (r = 0.37), total (r = 0.55) and high density lipoprotein-cholesterol (HDL-C) (r = - 0.38), diastolic blood pressure (DBP) (r = - 0.4); FT3/FT4 ratio and waist circumference (WC) (r = 0.36); TSHI and total (r = 0.30) and HDL cholesterol (r = - 0.31); TT4RI and HDL cholesterol (r = - 0.31); TT3RI and total (r = 0.39) and HDL cholesterol (r = - 032).

CONCLUSION

We confirmed a higher MS prevalence in children with DS compared to the control group. A significant association between THs, STHI, and the glucose and lipid metabolism parameters was detected supporting their role in metabolic alterations related to the DS.

Cut-off points for isometric handgrip and low limb explosive strength in relation to indicators of overweight/obesity in people with intellectual disabilities: analysis by age groups

BACKGROUND

The prevalence of overweight/obesity has been increasing globally and in people with Intellectual Disabilities (IDs), this problem is exacerbated even more, which added to a low physical condition that contributes to the deterioration of functionality and increases the risk of developing chronic diseases in the course of life. Therefore, the aim of this study was to establish cut-off points for levels of isometric handgrip and low limb explosive strength in children, adolescents and adults, which identify overweight/obesity in people with IDs and their respective associations.

METHODS

The sample was made up of 131 individuals with IDs, belonging to four special and community educational centres in the city of Santiago, Chile. Body mass index (BMI) and waist-to-height ratio (WHR) were used as indicators of overweight/obesity. Handgrip strength was used as a measure of isometric strength, and countermovement jump was used as a measure of low limb explosive strength. For the comparison of variables by age group, the analysis of Ancova, Kruskal-Wallis and chi-square tests were used. The total area under the receiver operating characteristic curve of isometric handgrip and low limb explosive strength was identified as an indicator of overweight/obesity according to age groups. A logistic regression model was used to quantify the effect that strength categories below the cut-off point have on the risk of overweight and obesity.

RESULTS

Significant differences were observed between the age groups for body weight, height, BMI and WHR, as well as in the levels of absolute handgrip strength and vertical jump with countermovement (P ≤ 0.05). Children showed the lowest cut-off points for absolute and relative strength. The adolescent group showed the highest cut-off points for relative strength and countermovement jump and adults showed the highest value for absolute strength as indicators of overweight/obesity. Different associations between cut-off points with BMI and WHR were found.

CONCLUSIONS

Adolescents showed the highest cut-off point for relative strength and countermovement jump, and adults showed the highest value for absolute strength, according to overweight/obesity indicators (BMI and WHR). It is suggested to adjust resistance training programmes according to age categories for the prevention of overweight/obesity in people with IDs.

Factors That Influence Physical Activity in Individuals With Down Syndrome: Perspectives of Guardians and Health Professionals

Identifying factors that influence physical activity (PA) among individuals with Down syndrome is essential for PA promotion. Insight can be gained from guardians and health professionals. The purpose of this study was to explore the perspectives of guardians and health professionals on facilitators and barriers of PA in individuals with Down syndrome. Interviews were conducted with 11 guardians (five mothers, four fathers, and two legal guardians) and 11 professionals (four PA specialists, three physical therapists, and four occupational therapists). Grounded theory was applied. Barriers and facilitators fit the levels of the ecological model of health behavior: (a) intrapersonal (perceived rewards), (b) interpersonal (interaction), (c) community (availability of programs), (d) organizational (school systems), and (e) policy (education). Guardians and professionals agreed on the importance of enjoyment, interaction, and programs to promote PA. Differences between groups were identified at the organizational and policy levels. PA in persons with Down syndrome is influenced by interactions between individual and environmental factors.

Body composition and laboratory parameters in children with down syndrome: The DONUT study

BACKGROUND & AIMS

Children affected by Down syndrome (DS) have a higher prevalence of obesity, dyslipidemia, and altered liver enzymes. This study investigates a small sample of pediatric patients with DS and possible associations among their anthropometric and laboratory data.

METHODS

Cross-sectional study involving 33 children (5-17 years old) affected by DS. Children underwent the measurement of anthropometric parameters through bioelectrical impedance analysis and a venous sampling to check their hepatic and lipid profiles.

RESULTS

54.6% of subjects were overweight or obese according to WHO (BMI z-score ≥1) and 42% of subjects were overweight or obese according to McCarthy et al. with a percentage of body fat (PBF) ≥ 85° centiles. 28% of subjects were dyslipidemic, showing an alteration of total, LDL, HDL cholesterol or triglycerides according to our laboratory reference values, and a low HDL value (under the normal range for gender and age) was the most frequent lipidic alteration (12.5%). An association was found between some values: lower HDL value was associated with higher PBF (p = 0.025); higher ALT value was associated with higher BMI z-score (p = 0.01) and higher PBF (p = 0.01); higher GGT value was associated with higher BMI z-score (p = 0.002) and higher PBF (p = 0.002).

CONCLUSIONS

Children with DS are at high risk for obesity and its complications. Our results show dyslipidemia and altered liver enzymes in obese subjects. Pediatricians should monitor children with DS for obesity and consider liver function testing and lipid profiles on children with DS and obesity.

Observations of feeding practices of US parents of young children with Down syndrome

Parental behaviours influence food acceptance in young children, but few studies have measured these behaviours using observational methods, especially among children with Down syndrome (CWDS). The overall goal of this study was to understand parent feeding practices used during snack time with young CWDS (N = 111, aged 11-58 months). A coding scheme was developed to focus on feeding practices used by parents of CWDS from a structured home-use test involving tasting variously textured snack products. Behavioural coding was used to categorise parental feeding practices and quantify their frequencies (N = 212 video feeding sessions). A feeding prompt was coded as successful if the child ate the target food product or completed the prompt within 20 s of the prompt being given without a refusal behaviour. CWDS more frequently consumed the test foods and completed tasks in response to Autonomy-Supportive Prompts to Eat (49.3%), than to Coercive-Controlling Prompts to Eat (24.2%). By exploring the parent-CWDS relationship during feeding, we can identify potentially desirable parent practices to encourage successful feeding for CWDS. Future research should build upon the knowledge gained from this study to confirm longitudinal associations of parent practices with child behaviours during feeding.

Parent factors associated with BMI, diet, and physical activity of adolescents with intellectual and developmental disabilities

BACKGROUND

Adolescents with intellectual and developmental disabilities (IDD) experience overweight and obesity (OW/OB) up to 1.8 times the rate of their typically developing peers. Parents may influence adolescent weight management behaviors in this population, but the association between parent factors and adolescent weight management behaviors is unclear.

OBJECTIVE

To examine the associations between parent BMI and sociodemographic characteristics with adolescents' BMI, diet quality, daily energy intake, moderate to vigorous physical activity (MVPA), and sedentary behavior.

METHODS

This study analyzed baseline data from an 18-month randomized controlled weight loss trial for adolescents with IDD. We assessed parent BMI (kg/m2) and sociodemographic factors, and adolescent BMI z-score, MVPA, sedentary time, daily energy intake, and diet quality. Associations between parent and adolescent factors were assessed with Pearson, Spearman or Kendall Tau-b correlations; mean differences for categorical outcomes were assessed with independent samples t-tests/Mann-Whitney U tests or ANOVA/Kruskall-Wallis tests.

RESULTS

Ninety-five adolescent and parent dyads were included. Parent BMI was positively correlated with adolescent BMI z-score (n = 94: rs = 0.37, p < 0.01). Household income was inversely correlated with adolescent BMI z-score (n = 95: Tb = -0.18, p = 0.02). Parents with less than a bachelor's degree had adolescents with higher BMI z-scores than those with bachelor's or higher (2.1 ± 0.5 vs. 1.8 ± 0.5, p = 0.02) as well as higher sedentary behavior (n = 28, 515.2 ± 102.6 min/day vs. n = 40, 463.9 ± 148.1 min/day, p = 0.02).

CONCLUSION

We found parent BMI, income, and education associated with adolescent BMI z-score. These findings contribute to the sparse literature on parental factors associated with OW/OB in this population.

CLINICAL TRIALS NUMBER

NCT02561754.

A slightly adapted treadmill protocol for the determination of maximal oxygen uptake in adults with Down syndrome

INTRODUCTION

The VO2 max test is the gold standard measure for aerobic fitness. A standardised treadmill protocol was developed years ago for individuals with Down syndrome but with variations in terms of starting speed, load increases and time spent at each stage. However, we realised that the most widely used protocol for adults with Down syndrome, trouble participants with high treadmill speeds. Consequently, the purpose of the current study was to determine whether an adapted protocol provided improved maximal test performance.

METHOD

Twelve adults (33 ± 6 years) randomly performed two variations of the standardised treadmill test.

RESULTS

The protocol that added another incremental incline stage increase yielded a significant improvement in absolute and relative VO2 peak, time to exhaustion, minute ventilation and heart rate max.

CONCLUSION

A treadmill protocol with the addition of an incremental incline stage allowed for a significant improvement in maximal test performance.

Are obesity and physical fitness associated with cardiovascular disease risk in adolescents with Down syndrome? The longitudinal UP&DOWN study

INTRODUCTION

The aims of this study were to examine cross-sectional, and longitudinal association of different measures of obesity and physical fitness with cardiovascular disease (CVD) risk factors in adolescents with Down syndrome.

METHODS

Longitudinal analysis included 90 adolescents with Down syndrome. Obesity and physical fitness were measured following the ALPHA battery. Blood pressure and blood samplings (glucose, total cholesterol, high-density lipoprotein cholesterol, and serum lipid triglycerides levels (mg/dl) were determinated.

RESULTS

In cross-sectional analyses, obesity was positively associated with single CVD risk factors and CVD risk factor index (all p < .05). In the prospective analyses, obesity was not associated with single CVD risk factors, but components of physical fitness at baseline impact in some single CVD risk factors (all p < .05).

CONCLUSION

Obesity might be more strongly related to current cardiovascular-health, while components of physical fitness might be more related to future cardiovascular-health in adolescents with Down syndrome.

Physical Activity in Youth with Down Syndrome and Its Relationship with Adiposity

PURPOSE

The aims of this study are to (1) compare physical activity (PA) and sedentary activity (SA) in youth with and without Down syndrome (DS and non-DS) and examine the relationships of PA and SA with their traditional risk factors (age, sex, race, and body mass index Z score [BMI-Z]) and (2) explore the relationship of PA with visceral fat (VFAT) in both groups.

METHODS

SenseWear accelerometry data from at least 2 weekdays and 1 weekend day were collected from youth with DS (N = 77) and non-DS (N = 57) youth. VFAT was measured by dual x-ray absorptiometry.

RESULTS

In age-, sex-, race-, and BMI-Z-adjusted models, those with DS engaged in more minutes of light PA (LPA) ( p < 0.0001) and less SA ( p = 0.003) and trended toward fewer minutes of moderate-to-vigorous PA (MVPA) ( p = 0.08) than non-DS youth. No race or sex differences in MVPA were detected in those with DS, unlike non-DS. After additional adjustment for pubertal status, the relationship between MVPA and VFAT approached significance ( p = 0.06), whereas the relationships of LPA and SA with VFAT were maintained ( p ≤ 0.0001 for both).

CONCLUSION

Youth with DS engage in more LPA compared with non-DS, which, in typically developing populations, can confer a more favorable weight status. Increasing the opportunity for youth with DS to engage in LPA as part of their activities of daily living may offer a viable strategy for achieving healthy weight when barriers restrict pursuit of more vigorous PA.

Energy expenditure and weight-related behaviors in youth with Down syndrome: a protocol

Background

The consequences of obesity are ominous, yet healthcare professionals are not adequately preventing or treating obesity in youth with Down syndrome (DS). Total daily energy expenditure (TDEE) is the energy expended in 24 h through physical activity and life-sustaining physiologic processes. An individual's TDEE is essential for determining the daily caloric intake needed to maintain or change body weight. Successful prevention and treatment of obesity in youth with DS is severely compromised by the lack of data on TDEE and information on weight-related behaviors for this high-risk population. This manuscript describes the protocol for the federally funded study that is in process to determine daily energy expenditure in a large cohort of children with DS.

Methods

This observational cross-sectional study will include a national sample of 230 youth with DS, stratified by age (5-11 and 12-18 years of age) and sex. Doubly Labeled Water analysis will provide the criterion body fat%, fat-free mass, and TDEE. To increase accessibility and decrease the burden on participants, the entire study, including obtaining consent and data collection, is conducted virtually within the participant's home environment on weekdays and weekends. The study team supervises all data collection via a video conferencing platform, e.g., Zoom. This study will (1) examine and determine average TDEE based on age and sex, (2) develop a prediction equation based on measured TDEE to predict energy requirements with a best-fit model based on fat-free mass, sex, age, and height and/or weight, and (3) use 24-hour dietary recalls, a nutrition and physical activity screener, wearable devices, and sleep questionnaire to describe the patterns and quality of dietary intake, sleep, and physical activity status in youth with DS.

Discussion

The lack of accurate information on energy expenditure and weight-related behaviors in youth with DS significantly impedes the successful prevention and treatment of obesity for this vulnerable population. The findings of this study will provide a further understanding of weight-related behaviors as obesity risk factors, currently not well understood for this population. This study will advance the science of weight management in individuals with disabilities and shift clinical practice paradigms.

Parental perception of facilitators and barriers to health among young children with down syndrome: a qualitative study

Background

Despite high rates of obesity and weight-related conditions observed in children with Down syndrome, little is known about how to prevent these conditions.

Purpose

The purpose of this study was to identify parent-perceived facilitators and barriers to health for toddlers (12-36 months old) with Down syndrome.

Materials and methods

We conducted in-depth, semi-structured interviews with the mothers of 25 toddlers with Down syndrome. All interviews were conducted using Zoom Video Technology, audio recorded and transcribed before being coded in NVivo software using a structured protocol. Thematic analysis was used to identify themes in perceived facilitators and barriers to health at the level of the child, family, and community. Data were triangulated using reflective journaling, video review of child meals, and member-checking techniques.

Results

We identified unique themes for facilitators (on the move and sound sleep) and barriers (co-occurring conditions and eating behaviors) at the level of the child. At the level of the family and community, overarching themes that were viewed as either a facilitator or barrier, depending on the context, were identified (role models matter, time is critical, the importance of place, and social support).

Conclusion

These themes can help clinicians and researchers tailor their health promotion interventions to meet the unique needs of children with Down syndrome by using strength-based approaches and providing families with the tools to overcome barriers.

Effects of school-based physical activity interventions on physical fitness and cardiometabolic health in children and adolescents with disabilities: a systematic review

Background: This study aimed to examine the influence of school-based physical exercise programs on physical fitness and cardiometabolic health in children and adolescents with disabilities. Methods: Web of Science, Scopus, and PubMed were thoroughly searched to identify relevant investigations. To be included in the systematic review, studies needed to fulfill the following inclusion criteria: 1) performed school-based physical exercise interventions; 2) parameters evaluated referred to health-related physical fitness (HRPF), skill-related physical fitness (SRPF), and cardiometabolic health; 3) a sample of participants consisted of children and adolescents with disabilities; 4) the mean age of respondents was less than 18 years; and 5) were written in the English language. Results: After searching the databases, a total of 474 studies have been identified, 18 of them met the eligibility criteria, and their outcomes were presented. Relating to the respondents' characteristics, the investigations involved 681 children and adolescents with disabilities, out of which 440 were male and 241 female. Regarding types of physical exercise interventions, the most commonly implemented were combined aerobic and resistance training, aerobic exercise, sports games, adapted high-intensity interval training, as well as sprint interval training. The obtained results unambiguously demonstrated that applied exercise interventions improved HRPF components such as cardiorespiratory fitness, muscular fitness, and flexibility. In terms of the SRPF, agility, balance, coordination, and power were considerably enhanced following the school-based exercise. On the other hand, the influence on indices of body composition and cardiometabolic health is quite controversial. The majority of the available studies did not find favorable effects. Additionally, no adverse events were reported in 7 of 8 research, and adherence to exercise was approximately 92%. Conclusion: School-based physical exercise programs were very efficient in improving HRPF and SRPF in children and adolescents with disabilities, while the evidence concerning the variables of body composition and cardiometabolic health is inconclusive and warrants further investigations.

Hypermetabolism in mice carrying a near-complete human chromosome 21

The consequences of aneuploidy have traditionally been studied in cell and animal models in which the extrachromosomal DNA is from the same species. Here, we explore a fundamental question concerning the impact of aneuploidy on systemic metabolism using a non-mosaic transchromosomic mouse model (TcMAC21) carrying a near-complete human chromosome 21. Independent of diets and housing temperatures, TcMAC21 mice consume more calories, are hyperactive and hypermetabolic, remain consistently lean and profoundly insulin sensitive, and have a higher body temperature. The hypermetabolism and elevated thermogenesis are likely due to a combination of increased activity level and sarcolipin overexpression in the skeletal muscle, resulting in futile sarco(endo)plasmic reticulum Ca2+ ATPase (SERCA) activity and energy dissipation. Mitochondrial respiration is also markedly increased in skeletal muscle to meet the high ATP demand created by the futile cycle and hyperactivity. This serendipitous discovery provides proof-of-concept that sarcolipin-mediated thermogenesis via uncoupling of the SERCA pump can be harnessed to promote energy expenditure and metabolic health.

Anticipatory postural adjustments and kinematic analysis of step ascent and descent in adults with Down syndrome

BACKGROUND

Step ascent and descent is one of the most common daily tasks. Although it is generally considered a rather simple movement, it may not be so easy for participants with Down syndrome.

METHODS

A kinematic analysis of step ascent and descent was conducted, and a comparison between 11 adult participants with Down syndrome and 23 healthy participants was carried out. This analysis was accompanied by a posturographic analysis with the aim of evaluating aspects relating to balance. The principal aim of postural control was to investigate the trajectory of the centre of pressure, while the kinematic analysis of movement included the following: (1) the analysis of anticipatory postural adjustments, (2) the calculation of spatiotemporal parameters and (3) the evaluation of articular range of motion.

RESULTS

A general instability for participants with Down syndrome, highlighted in the postural control by an increased anteroposterior and mediolateral excursion, when the test was conducted with both open and closed eyes, was found out. Regarding anticipatory postural adjustments, this deficit in balance control was revealed by the execution of small steps before completing the movement and by a much longer preparation time anticipating the movement. In addition, the kinematic analysis reported a longer ascent and descent time and a lower velocity, accompanied by a greater rising of both limbs in ascent, which indicates an increased perception of the obstacle. Finally, a wider trunk range of motion in both the sagittal and frontal planes was revealed.

CONCLUSIONS

All the data confirm a compromised balance control that could be associated with damage to the sensorimotor centre.