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

[Disability status and consumption of sugar-sweetened beverages: analysis of a Colombian population survey]

INTRODUCTION

according to the World Health Organization (WHO), obesity has tripled in the world as a result of high caloric intake. People with disabilities are more likely to be overweight and obese.

OBJECTIVES

this study aimed to estimate the association between disability status and consumption of sugar-sweetened beverages in the population aged 18 years and older in Colombia in 2017.

METHODS

we conducted a secondary analysis of data from Colombia's 2017 National Quality of Life Survey (ECV). The dependent variable was the consumption of sugar-sweetened beverages, and the independent variable was the disability status. Additionally, confounding variables were incorporated. An ordinal logistic regression was performed to estimate the magnitude of the association. The complex sample design of the 2017 LCS was considered in all results.

RESULTS

we included data from 18,957 persons aged 18 years and older; 7.9 % had a disability, and 64.4 % consumed sugar-sweetened beverages. People with moderate and severe disability were 18 % and 41 %, respectively, less likely to have a higher consumption of sugar-sweetened beverages compared to people without disability (OR: 0.82; 95 % CI: 0.72-0.95 and OR: 0.59; 95 % CI: 0.39-0.90). When stratified by age group, this association remained only in those older than 45.

CONCLUSIONS

in Colombia, in 2017, people with disabilities older than 45 years consumed fewer sugar-sweetened beverages than people without disabilities.

The relationship between the severity of intellectual and developmental disabilities (IDDs) in adults with IDDs and eating and drinking problems and nutritional status

BACKGROUND

Adults with intellectual and developmental disabilities (IDDs) experience eating, drinking and swallowing problems, such as chewing problems, choking, gagging, coughing during eating, aspiration and rumination syndrome, which may lead to poor nutritional status. This study aimed to determine the relationship between IDD levels, eating, drinking and swallowing problems and nutritional status in adults with IDDs.

METHODS

The sample consisted of 71 participants (37 men and 34 women) with a mean age of 22.5 ± 7 years (range 18-60 years). Professionals classified intellectual disability as mild, moderate or severe. The Screening Tool of Feeding Problems scale was applied to the caregivers of adults with IDDs to identify eating, drinking and swallowing problems. Dietary intake was assessed using a 24-h dietary recall and a food and nutrition photograph catalogue. The researchers measured body weight, height and middle upper arm circumference. Body mass index was calculated. Four body mass index categories were determined: underweight (<18.5 kg/m2 ), normal weight (18.5-24.9 kg/m2 ), overweight (25.0-29.9 kg/m2 ) and obese (≥30 kg/m2 ). Chi-squared tests were used to detect the relationship between IDD levels and eating and drinking problems, and analysis of variance tests were conducted to detect the relationship between IDD levels with anthropometric measurements and dietary intake.

RESULTS

Participants had mild (42.3%; n = 30), moderate (29.6%; n = 21) or severe IDD (28.2%; n = 20). They were underweight (12.7%; n = 9), normal weight (59.2%; n = 42) or overweight and/or obese (28.2%; n = 20). Participants with severe IDD had significantly higher Screening Tool of Feeding Problems 'nutrition-related behaviour' and 'eating and drinking skill deficit problem' sub-scale scores than those with mild IDD. However, the groups had no significant difference in 'food refusal and selectivity' sub-scale scores. Participants with severe IDD also had anorexia prevalence similar to those with mild IDD. The groups did not significantly differ in anthropometric measurements, daily energy intake and macronutrient and micronutrient intake.

CONCLUSIONS

While adults with severe IDD had more eating and drinking skill deficits (e.g. chewing problems and independent eating difficulties) and nutrition-related behaviour problems than those with mild IDD, the eating, drinking and swallowing problems, which may critically affect their food intake, were similar to adults with mild IDD. The anthropometric measurements and energy and nutrient intakes of adults with severe IDD were not significantly different from those with mild IDD consistently. Findings indicate that nutritional deficiencies and nutritional behaviour problems may be avoidable in adults with IDDs.

Sex differences in cardiovascular disease and dysregulation in Down syndrome

This meta-analysis, which consisted of a scoping review and retrospective medical record review, is focused on potential sex differences in cardiovascular diseases in patients with Down syndrome. We limited our review to peer-reviewed, primary articles in the English language, in the PubMed and Web of Science databases from 1965 to 2021. Guidelines for scoping reviews were followed throughout the process. Four categorical domains were identified and searched using additional keywords: 1) congenital heart disease, 2) baseline physiology and risk factors, 3) heart disease and hypertension, and 4) stroke and cerebrovascular disease. Articles were included if they reported male and female distinct data, participants with Down syndrome, and one of our keywords. The retrospective medical record review was completed using 75 participating health care organizations to identify the incidence of congenital and cardiovascular diseases and to quantify cardiovascular risk factors in male and female patients. Female patients with Down syndrome are at higher risk of hypertension, ischemic heart disease, and cerebrovascular disease. The risk of congenital heart disease is higher in males with Down syndrome at all ages included in our analyses. Some of the male-to-female sex differences in cardiovascular disease risk in the general patient population are not present, or reversed in the Down syndrome population. This information should be considered for future investigations and ongoing patient care.NEW & NOTEWORTHY In patients with Down syndrome (DS), CHD is the leading cause of death <20 yr old and cardiovascular disease is a leading cause of death in individuals >20 yr old. Men with DS live longer than women. It is unknown if sex differences are present in cardiovascular disease and dysregulation in DS across the lifespan. We observed higher risk of hypertension, ischemic heart disease, and cerebrovascular disease in females and a higher risk of CHD in males with DS.

Effect of the environmental factor of coexistence on the physical condition of people with mild and moderate intellectual disabilities

BACKGROUND

The main objective of this study was to compare the physical condition of people with intellectual disabilities living in residential homes (RH; restricted residential environment) versus independent homes (IH; family houses while performing paid work). The effect of gender on physical condition was also evaluated separately for each group.

METHOD

Sixty individuals with mild to moderate intellectual disability, 30 living in RH and 30 living in IH, participated in this study. The RH and IH groups were homogeneous in terms of gender distribution (17 males and 13 females) and intellectual disability level. Body composition, postural balance, and static and dynamic force were considered as dependent variables.

RESULTS

The IH group performed better in the postural balance and dynamic force tests compared to the RH group, but no significant differences between the groups were observed for any body composition or static force variable. Women in both groups tended to have better postural balance than men, while men presented higher dynamic force.

CONCLUSIONS

The IH group presented a higher physical fitness compared to RH group. This result emphasises the need to increase the frequency and intensity of the physical activity sessions commonly programed for individuals living in RH.

The delivery of healthy lifestyle interventions for people with disability living in supported accommodation: a scoping review of intervention efficacy and consumer involvement

BACKGROUND

People with disability living in supported accommodation experience health disparities that may be partly attributed to sedentary lifestyle behaviors and poor dietary quality. Healthy lifestyle interventions have been suggested as a method of health promotion for this population; however, a synthesis of their efficacy has not yet been conducted.

OBJECTIVE

The primary aims were to (1) identify healthy lifestyle interventions delivered to people with disability living in supported accommodation and (2) examine their efficacy in supporting health and well-being. A secondary aim was to explore whether people with disability have been involved in the codesign of these interventions.

METHODS

A scoping review was conducted following the Joanna Briggs Institute's guidance for conducting scoping reviews, and six databases were searched from January 2011 to November 2021.

RESULTS

Thirty-two studies were included. Identified intervention types included training and education, exercise programs, and multicomponent interventions. A broad range of outcomes were examined; however, findings regarding efficacy were overall mixed and limited due to significant heterogeneity and the underreporting of consistently measured outcomes. The codesign of interventions in consultation with people with disability was underexplored.

CONCLUSIONS

Health promotion training for staff and tailored education for people with disability hold promise in creating a care environment that supports a healthy lifestyle. The paucity of interventions developed in consultation with people with disability is concerning and highlights the importance of meaningful co-design. The development of a theoretically informed intervention that is codesigned and addresses the broader social determinants that influence health behavior is recommended.

Exploration of diet, physical activity, health knowledge and the cardiometabolic profile of young adults with intellectual disability

BACKGROUND

Young adults with intellectual disability (ID) are experiencing early mortality, and it is suggested that they are living with undiagnosed cardiovascular and metabolic risk factors (hereafter referred to as cardiometabolic).

METHODS

We investigated the association between modifiable risk factors and cardiometabolic health profile in adults with ID aged 18-45 years through clinical evaluation of traditional cardiometabolic parameters, and assessment of physical activity levels, diet and associated health knowledge.

RESULTS

We found that young adults with ID have an increased obesity (mean body mass index; ID group: 32.9 ± 8.6 vs. control group: 26.2 ± 5.5, P = 0.001), are engaging in less physical activity than the age-matched general population (total activity minutes per week; ID group: 172.2 ± 148.9 vs. control group: 416.4 ± 277.1, P < 0.001), and overall have unhealthier diets. Additionally, knowledge about nutrition and physical activity appears to be an important predictor of cardiometabolic risk in this population. If young people with ID are to improve their cardiometabolic health to reduce morbidity and early mortality, we need to further explore how to consistently apply health messaging to get lasting behavioural change in this population.

Conducting theory-based qualitative interviews with adults with intellectual disabilities and their carers: Adaptations to facilitate participation

BACKGROUND

Adults with mild-moderate intellectual disabilities have difficulties in accessing traditional evidence-based health promotion initiatives despite experiencing health disparities; yet there are few studies with this group and their carers exploring how their needs can be met.

METHOD

This study adapted a behaviour change theory-based approach to interview this group and their carers and ascertain if this method was feasible and appropriate to explore how healthier behaviour uptake could be improved amongst adults with intellectual disabilities.

RESULTS

A community-based, staged recruitment process and iterative approach to data collection and analysis supported successful participation amongst adults with intellectual disabilities in behaviour-change theory-based interview research. Methodological adaptations enabled richer data collection amongst adults with mild-moderate intellectual disabilities and carers.

CONCLUSIONS

It is feasible and important to include adults with intellectual disabilities in qualitative health research that uses theory-based complex constructs to inform development of person-centred health promotion interventions with this underserved cohort.

Nationwide trends in prevalence of underweight, overweight, and obesity among people with disabilities in South Korea from 2008 to 2017

Objectives

This study investigated the 10-year trends of weight and prevalence of underweight, overweight and obesity according to disability grade and types compared with those without disabilities.

Methods

This serial cross-sectional analysis was conducted using national disability registration data with national general health checkup data from 2008 to 2017. Age-standardized prevalence of underweight and obesity were analyzed for each year, according to the presence, type, and severity of disabilities. Odds of underweight, overweight, obesity, and severe obesity were examined by multinomial logistic regression after adjusting for socio-demographic and clinical variables using data in 2017.

Results

Over 10 million subjects in each year were included in the analysis. In 2017, 14,246,785 people with age between 19 and 110 years were included and 53.1% was men. For 10 years, age-standardized prevalence of obesity and severe obesity showed significant increases regardless of sex and presence of disability. However, age-standardized underweight prevalence in people without disability tended to decrease whereas it was an increase in 2012 and the prevalence has remained steady since in people with disability. People with disabilities had higher odds of underweight compared to those without disability (OR 1.41, 95% CI 1.38–1.44 in male and OR 1.31, 95% CI 1.28–1.34 in female), especially in those with severe disabilities (OR 2.00, 95% CI 1.94–2.06 in male and OR 1.83, 95% CI 1.77–1.89 in female). Women with disabilities are more likely to be obese than those without disabilities regardless of disability severity (OR 1.40, 95% CI 1.38–1.41). Participants with mental disorder showed the highest prevalence of obesity, followed by epilepsy and developmental disability.

Conclusions

Having a disability was associated with higher odds/probability of both obesity and underweight. The intersection of female, severe disability, and mental/developmental disabilities was associated with probability of severe obesity. Simultaneous efforts are needed to develop health policy to reduce both the prevalence of obesity and underweight.

Overweight/obesity and chronic health conditions in older people with intellectual disability in Ireland

BACKGROUND

This study examines overweight/obesity and chronic health conditions (CHCs) in older people with intellectual disability (ID).

METHODS

Data for this cross-sectional observational study emanated from Wave 2 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, a longitudinal study assessing the health and well-being of older Irish adults with ID aged ≥40 years across all levels of ID. Participation involves an interview process and collation of objective health measures. In this study, body mass index (BMI) (n = 572), used as a measure of weight status, was examined with clustered doctor's diagnosed CHCs. Descriptive analysis was conducted where counts (n) and proportions (%) were used to summarise the variables univariately, while cross-tabulations were used for bivariate summary into counts and proportions. With overweight/obesity prevalence established and patterns described using logistical regression, Pearson's chi-squared test was used to test for significant associations.

RESULTS

Overweight/obesity identified in 69% of participants occurred with greater frequency in women (72%). A higher percentage of participants aged <50 years (72.5%) were overweight/obese than those aged 50-64 (70%) and 65+ (61.4%). Level of ID and residence type were significantly associated with weight status (P < 0.001), with overweight/obesity more prevalent in mild (85.7%) than moderate (72%) or severe/profound ID (51.4%). Of those who lived independently/with family, 78.4% were overweight/obese, as were 74% living in a community group home (P < 0.001). Almost all overweight/obese participants' waist measurements were in the substantially increased risk of metabolic disease waist measurement category (92%, P < 0.001). Logistical regression used to model CHCs on BMI showed significant association between BMI and gastrointestinal tract [odds ratio (OR) = 0.57, P < 0.008, 95% confidence interval (CI) = (0.37; 0.86)], respiratory condition [OR = 8.95, P < 0.004, 95% CI = (2.57; 56.72)] and musculoskeletal disorders [OR = 0.40, P < 0.001, 95% CI = (0.25; 0.63)].

CONCLUSIONS

The findings illustrate the strong cross-sectional association between overweight/obesity and CHCs. These findings suggest a need to prioritise weight status as a health risk to people with ID as they age.

Health promotion in adults with Down's syndrome: Experiences of caregivers

Individuals with Down's syndrome rely on caregivers to support lifestyle behaviour change. It is therefore important to understand how caregivers put health recommendations into practice. Through conducting semi-structured interviews, the present study sought to understand the facilitators and barriers that caregivers faced when implementing health promotion advice. Five interviews were conducted with paid support staff and four with family carers of individuals attending a specialist multidisciplinary Down's syndrome health promotion screening clinic. Three main themes emerged in their accounts, including active promotion of weight management by caregivers, benefits of working practices such as record keeping and communication channels and the importance of having access to social care services and recreational activities. These findings have important implications for professionals working in specialised healthcare settings who may be able to tailor communication and services to better meet the needs of individuals with Down's syndrome and their caregivers.

Prevalence and incidence of physical health conditions in people with intellectual disability - a systematic review

OBJECTIVE

To synthesize evidence on the prevalence and incidence of physical health conditions in people with intellectual disability (ID).

METHODS

We searched Medline, PsycInfo, and Embase for eligible studies and extracted the prevalence, incidence, and risk of physical health conditions in people with ID.

RESULTS

Of 131 eligible studies, we synthesized results from 77 moderate- to high-quality studies, which was mainly limited to high-income countries. The highest prevalence estimates were observed for epilepsy, ear and eye disorders, cerebral palsy, obesity, osteoporosis, congenital heart defects, and thyroid disorders. Some conditions were more common in people with a genetic syndrome. Compared with the general population, many health conditions occur more frequently among people with ID, including asthma and diabetes, while some conditions such as non-congenital circulatory diseases and solid cancers occur at the same or lower rate. The latter associations may reflect under-detection.

CONCLUSIONS

People with ID have a health profile more complex than previously known. There is a pressing need for targeted, evidence-informed population health initiatives including preventative programs for this population.

How do multimorbidity and lifestyle factors impact the perceived health of adults with intellectual disabilities?

BACKGROUND

Adults with intellectual disability (ID) have poorer physical and perceived health than the general population. Knowledge of perceived health predictors is both limited and important for guiding the development of preventive actions. The aims of this study were to investigate (1) the associations between perceived health and demographics, degree of ID, physical health conditions, and weight and physical activity level and (2) lifestyle factors and multimorbidity as predictors for perceived health adjusted for age, gender, and level of ID.

METHOD

The North Health in Intellectual Disability study is a community based cross-sectional survey. The POMONA-15 health indicators were used. Univariate and multivariate logistic regression analyses with poor versus good health as the dependent variable were applied.

RESULTS

The sample included 214 adults with a mean age 36.1 (SD 13.8) years; 56% were men, and 27% reported perceiving their health as poor. In univariate analyses, there were significant associations between poor health ratings and female gender, lower motor function, number of physical health conditions and several indicators of levels of physical activity. In the final adjusted model, female gender [odds ratio (OR) 2.4, P < 0.05], level of ID (OR 0.65, P < 0.05), numbers of physical health conditions (OR 1.6, P < 0.001) and lower motor function (OR 1.5 P < 0.05) were significant explanatory variables for poor perceived health, with a tendency to independently impact failure to achieve 30 min of physical activity daily (OR 2.0, P = 0.07).

CONCLUSION

Adults with ID with female gender, reduced motor function and more physical health conditions are at increased risk of lower perceived health and should be given attention in health promoting interventions. A lack of physical activity tends to negatively influence perceived health.

Analysis of the Relationship between Obesity Factors and Health-Related Physical Fitness Factors among People with Intellectual Disabilities in South Korea

Little is known about the relationship between health-related physical fitness factors and obesity-related factors in individuals with intellectual disabilities. We investigated the prevalence of obesity and the relationship between obesity-related factors and health-related physical fitness factors among people with intellectual disabilities in South Korea to identify the physical fitness factors that influence the degree of obesity. For obesity-related factors, we measured body composition (height, weight, body mass index—BMI, and body fat percentage) of 108 subjects with intellectual disabilities (mean ± standard deviation; age = 24.4 ± 8.45 years). For health-related physical fitness factors, we measured muscular strength, muscular endurance, and flexibility. There was a significant negative correlation between muscular endurance and obesity factors (BMI, r = −0.306, p < 0.01; body fat percentage, r = −0.402, p < 0.01). Further, the prevalence of obesity (34.3%) and being overweight (17.6%) among people with intellectual disabilities was high in South Korea. In addition, muscular endurance was found to have a significant effect on the obesity level (β = −0.239, p < 0.000). This suggests that a program that considers muscular endurance should be prioritized when implementing an exercise intervention strategy for the treatment of overweight and obesity among people with intellectual disabilities.

Comparison of Oxygen Saturation Between Nasal High-Flow Oxygen and Conventional Nasal Cannula in Obese Patients Undergoing Dental Procedures With Deep Sedation: A Randomized Crossover Trial

PURPOSE

In anesthetic management, it is widely accepted that obese patients are more likely to suffer airway obstructions and reductions in arterial oxygen saturation (SpO₂). Therefore, it is important to take special measures to prevent oxygen desaturation during the deep sedation of obese patients. This clinical study examined whether the use of nasal high-flow systems (NHFS) keep higher SpO₂ and reduced hypoxemia than conventional nasal cannula during the deep sedation of obese patients with intellectual disabilities for dental treatment.

MATERIALS AND METHODS

Eighteen obese patients (body mass index: >25) with intellectual disabilities who underwent dental sedation were enrolled. In each case, sedation was induced using propofol and maintained at a bispectral index of 50 to 70. The subjects were randomly assigned to the control oxygen administration (5 L/min via a nasal cannula) or NHFS (40% O₂, 40 L/min, 37 °C) arm in alternate shifts as a crossover trial. The primary endpoint was the minimum SpO₂ value, and the incidence of hypoxemia during dental treatment was also evaluated.

RESULTS

The mean minimum SpO₂ value was significantly higher in the NHFS arm than in the control arm (95.8 ± 2.1 % vs 93.6 ± 4.1 %, P = 0.0052, 95% confidence interval: 0.608-3.947). Hypoxemic episodes (SpO₂: ≤94%) occurred 3 cases (16.7%) in the NHFS arm and 11 cases (61.1%) in the control arm (P = 0.0076, odds ratio: 0.127, 95% confidence interval 0.0324 - 0.630).

CONCLUSION

NHFS resulted in higher minimum SpO₂ and reduced hypoxemia than nasal cannula in obese patients during deep sedation for dental treatment.

Are Researchers Addressing Cancer Treatment and Survivorship Among People With Intellectual and Developmental Disabilities in the U.S.? A Scoping Review

People with intellectual and developmental disabilities (PWIDD) often encounter barriers in the health care system when seeking general and specialized medical care. Literature has shown that PWIDD experience a lack of proper screening for and prevention of cancer compared to the general population. However, less is known regarding the cancer care and survivorship of PWIDD, especially in the United States. In this review, we examine what is currently known about the primary, psychosocial, and palliative care of PWIDD diagnosed with cancer. Our analyses reveal an immediate need for improvement in caregiver support, collaboration among health care providers, and ethical approaches to information disclosure for this population, as well as the establishment of more reliable standards of care through additional research with PWIDD.

Socio-demographic factors and health status of adults with disability in Enugu Metropolis, Nigeria

Background

Disability is a major determinant of impaired health and nutritional status. This study aims to assess the health and nutritional status of adults with disability and their relationship with socio-demographic factors.

Methods

A descriptive cross-sectional study of 323 adults with disability in support-centers/schools of disability in Enugu Metropolis, Nigeria was conducted. The participants' socio-demographic factors, behavioural characteristics and 24-hour dietary recall were recorded. Blood pressure and anthropometric measurements of height, weight, waist and hip circumference were obtained. The height and weight measurements of non-ambulatory participants were estimated from knee height and mid-arm circumference. Biochemical analyses of blood samples were also performed. Multiple logistic regression was used to assess the effect of socio-demographic factors on health and nutritional status.

Results

The participants consisted of females (59.3%) within the age of 20 to 30 years (59.1%). The major area of difficulty was in physical mobility (51.1%) and this occurred mostly in females (26.9%). The participants' mean daily intakes of calorie, protein and fat were below the recommended dietary allowances. The participants were overweight (49.2%), obese (4.6%), hypertensive (29.7%) and diabetic (12.1%). Dyslipidemia (81.8%), anemia (63.6%) and zinc deficiency (51.1%) were highly prevalent among the study group. Gender difference was observed in alcohol consumption (p=0.000), smoking habit (p=0.001), waist circumference (WC)(p=0.000), waist-hip-ratio (WHR) (p=0.000), triglyceride (p=0.026) and haemoglobin concentration (p=0.007). Being boarder was a positive predictor of overweight/obesity (OR= 2.974, 95% CI=1.449-6.104), abnormal WHR (OR=2.893, 95% CI = 1.073-7.801) and hypertension (OR=8.381, 95% CI=1.598-13.959). Female gender was associated with abnormal WC (OR=7.219, 95% CI=3.116-14.228) and WHR (OR=3.590, 95% CI=2.095-6.150) whereas older age-group was associated with overweight/obesity (OR=1.908, 95% CI=1.137- 3.202). Being employed was a negative predictor of hypertension.

Conclusion

Overweight/obesity, anemia, zinc deficiency and dyslipidemia were highly prevalent among persons living with disability in Enugu Metropolis.

Prevalence estimation of intellectual disability using national administrative and household survey data: The importance of survey question specificity

Background

Variability in prevalence estimation of intellectual disability has been attributed to heterogeneity in study settings, methodologies, and intellectual disability case definitions. Among studies based on national household survey data specifically, variability in prevalence estimation has partly been attributed to the level of specificity of the survey questions employed to determine the presence of intellectual disability.

Specific aims & method

Using standardised difference scoring, and ‘intellectual disability’ survey data from the 2007 Northern Ireland Survey on Activity Limitation and Disability (NISALD) (N=23,689) and the 2011 Northern Ireland Census (N=1,770,217) the following study had two aims. First, we aimed to demonstrate the effects of survey question specificity on intellectual disability prevalence estimation. Second, we aimed to produce reliable estimates of the geographic variation of intellectual disability within private households in Northern Ireland while also assessing the socio-demographic, health-related and disability characteristics of this population.

Findings

Prevalence estimates generated using the more crudely classified intellectual disability Census data indicated a prevalence of 2% for the overall population, 3.8% for children aged between 0 and 15 years, and 1.5% for citizens aged 16 years or older. Intellectual disability prevalence estimates generated using the more explicitly defined 2007 NISALD data indicated a population prevalence of 0.5% for the overall population, 1.3% for children aged between 0 and 15 years, and 0.3% for citizens aged 16 years or older. The NISALD estimates were consistent with most recent international meta-analysis prevalence estimates. According to the NISALD data, the majority of those with an intellectual disability were male, lived outside Belfast, and experienced severe intellectual disability, with multiple comorbid health conditions.

Discussion

The current findings highlight the importance of survey question specificity in the estimation of intellectual disability prevalence and provide reliable prevalence estimates of intellectual disability in Northern Ireland. The findings also demonstrate the utility of administrative data for detecting and understanding intellectual disability, and inform recommendations on how to maximise use of future intellectual disability Census data

An exploration of lifestyle/obesity programmes for adults with intellectual disabilities through a realist lens: Impact of a 'context, mechanism and outcome' evaluation

BACKGROUND

Obesity is higher in people with intellectual disabilities.

AIMS

There are two aims of this explorative paper. Firstly, using a realist lens, to go beyond 'what works' and examine the 'context, mechanisms and outcomes' (CMO) of lifestyle/obesity programmes for this population. Second, using a logic model framework to inform how these programmes could be implemented within practice.

METHOD

We explored six-review papers and the individual lifestyle/obesity programmes that these papers reviewed using the CMO framework.

RESULTS

There were few theoretically underpinned, multi-component programmes that were effective in the short to long-term and many failed to explore the 'context and mechanisms'. We developed a logic model and engaged in two co-production workshops to refine this model.

DISCUSSION

Using a realist approach, programmes need to be underpinned by both individual and systems change theories, be multi-component, have a closer understanding of the interplay of the 'context and mechanisms', and co-designed using a logic model framework.

Prevalence of underweight, wasting and stunting among young children with a significant cognitive delay in 47 low-income and middle-income countries

BACKGROUND

Undernutrition in early childhood is associated with a range of negative outcomes across the lifespan. Little is known about the prevalence of exposure to undernutrition among young children with significant cognitive delay.

METHOD

Secondary analysis of data collected on 161 188 three- and four-year-old children in 47 low-income and middle-income countries in Rounds 4-6 of UNICEF's Multiple Indicator Cluster Surveys. Of these, 12.3% (95% confidence interval 11.8-12.8%) showed evidence of significant cognitive delay.

RESULTS

In both middle-income and low-income countries, significant cognitive delay was associated with an increased prevalence of exposure to three indicators of undernutrition (underweight, wasting and stunting). Overall, children with significant cognitive delay were more than twice as likely than their peers to be exposed to severe underweight, severe wasting and severe stunting. Among children with significant cognitive delay (and after controlling for country economic classification group), relative household wealth was the strongest and most consistent predictor of exposure to undernutrition.

CONCLUSIONS

Given that undernutrition in early childhood is associated with a range of negative outcomes in later life, it is possible that undernutrition in early childhood may play an important role in accounting for health inequalities and inequities experienced by people with significant cognitive delay in low-income and middle-income countries.

Cardiovascular disease and related risk factors in adults with cerebral palsy: a systematic review

AIM

To summarize the literature on the prevalence of cardiovascular disease (CVD), risk factors of CVD, and CVD-related mortality in adults with cerebral palsy (CP).

METHOD

A systematic review was conducted by searching the PubMed, Embase, MEDLINE (Ovid), Cochrane, and CINAHL databases. Selection criteria included adults with CP aged 18 years or over. Methodological quality was assessed using the Newcastle-Ottawa scale for observational studies. Data were reported descriptively.

RESULTS

Nineteen studies met the inclusion criteria. Only one study reported directly on the presence of CVD in adults with CP, which found adults with CP reported greater CVD conditions than adults without CP (15.1 vs 9.1%, p<0.001). The most commonly reported risk factor of CVD in adults with CP was overweight/obesity. Five studies included data on CVD-related mortality in persons with CP, where CVD-related and circulatory system-related deaths were elevated and more common at a younger age in adults with CP than in the general population.

INTERPRETATION

The prevalence of CVD and the risk of death because of CVD in this population seems increased, though the knowledge base is fragmented by studies that are small in size and geographically isolated. Further research is required to understand prevalence of risk factors among adults with CP, in particular overweight/obesity.

WHAT THIS PAPER ADDS

Overweight and obesity are risk factors of cardiovascular disease (CVD) that are commonly reported in adults with cerebral palsy (CP). CVD-related and circulatory system-related deaths are elevated in individuals with CP compared to the general population.

The effect of copy number variations in chromosome 16p on body weight in patients with intellectual disability

Syndromic monogenic obesity is a rare and severe early-onset form of obesity. It is characterized by intellectual disability, congenital malformations, and/or dysmorphic facies. The diagnosis of patients is challenging due to the genetic heterogenicity of this condition. However, the use of microarray technology in combination with public databases has been successful on genotype-phenotype correlations, especially for body mass index (BMI) alteration. In this study, the relationship between copy number variations (CNVs) detected by microarray mapping on 16p region and BMI alterations in syndromic patients were assessed. In order to achieve this goal, 680 unrelated Spanish children with intellectual disability were included. 16p region was characterized by using microarray platforms. All detected variants were classified as: (I) one previously non-described 10-Mb duplication in 16p13.2p12.3 region considered causal of intellectual disability and severe overweight, and (II) eleven 16p11.2 CNVs of low prevalence but with recurrence in syndromic patients with severe BMI alteration (nine proximal and two distal). Proximal 16p11.2 CNVs have a dose-dependent effect: underweight in carriers of duplication and obesity in carriers of deletion. KCTD13 was identified as a possible candidate gene for BMI alteration on proximal syndromes, whereas SH2B1 gene was identified as candidate for distal syndromes. The results shown in this paper suggest that syndromic patients could constitute a reliable model to evaluate hypothalamic satiety and obesity disorders as well as generate a wide expectation for primary prevention of comorbidities. Furthermore, 16p13.2p12.3 showed to be an important region on the regulation of body fatness.

Effect of yoga practices on psycho-motor abilities among intellectually disabled children

The children with intellectual disabilities show disorders at motor development and coordination. Hence, the objective of this study was to see the effect of yoga practices on psycho-motor abilities of intellectually disabled children. Seventy intellectually disabled children were divided into experimental group and control group. Both experimental and control group were assessed on the first day and after 12 weeks of the yoga intervention for static balance, eye hand coordination, agility and reaction time. The subjects of experimental group then underwent a training of yoga practices, for 1 hr for a total period of 12 weeks. The result of within group comparison revealed significant improvement in static balance, eye hand coordination, agility, and reaction time (P< 0.001) in subjects of yoga group however no change was observed in control group. The present study demonstrated that 12 weeks of yoga is effective in improving psycho-motor abilities of intellectually disabled children.

Contraceptive Provision to Postpartum Women With Intellectual and Developmental Disabilities: A Population-Based Cohort Study

CONTEXT

Women with intellectual and developmental disabilities who experience pregnancy, like all women, require postpartum care that supports their contraceptive knowledge and decision making. Yet, little is known about the postpartum contraceptive care these women receive, or how it compares with care given to other women.

METHODS

A population-based study using linked health and social services administrative data examined provision of postpartum contraceptive care to women who had a live birth in Ontario, Canada, in 2002-2014 and were beneficiaries of Ontario's publicly funded drug plan. Modified Poisson regression was used to compare care between 1,181 women with and 36,259 women without intellectual and developmental disabilities. Outcomes were provision of any nonbarrier contraceptive in the year following the birth and type of method provided.

RESULTS

In the first year postpartum, women with intellectual and developmental disabilities were provided with contraceptives at a higher rate than were other women (relative risk 1.3); the difference was significant for both nonsurgical and surgical methods (1.2 and 1.8, respectively). The higher rate of nonsurgical contraceptive provision was explained by provision of injectables (1.9); there were no differences for pills or IUDs.

CONCLUSION

Nonbarrier contraceptives may be the most appropriate methods for some women with intellectual and developmental disabilities. However, future research should investigate why women with such disabilities are more likely than others to receive injectable contraceptives, which have possible negative side effects, and surgical contraception, which is irreversible. Research also should investigate how these women perceive their participation in contraceptive decision making.

Body mass index and waist circumference of Latin American adult athletes with intellectual disability

OBJECTIVES

To examine both body mass index (BMI) status and waist circunference (WC) in a large international sample of adult Special Olympics participants from Latin America. It also explored the association of age and sex with obesity in this population.

MATERIALS AND METHODS

BMI and WC records from a total of 4174 (2683 male and 1491 female) participant records from the Special Olympics International Health Promotion database were examined.

RESULTS

The prevalence of overweight and obesity was quite high (i.e. > 40%), but generally lower than studies involving adults with intellectual disabilities from Europe and the USA. Chi-square analyses revealed that both increasing age and being female significantly predicted levels of overweight, obesity, and WC.

CONCLUSIONS

These results suggest that efforts need to be made to prevent and reduce rates of overweight and obesity among Latin American Special Olympics participants, particularly women.

The risk, burden, and management of non-communicable diseases in cerebral palsy: a scoping review

AIM

To examine the risk, burden, and management of non-communicable diseases (NCDs) among people with cerebral palsy (CP).

METHOD

Databases (Ovid MEDLINE, Embase Ovid, CINAHL Plus) were systematically searched up to August 2017. Data on the prevalence of risk factors for, and the burden and management of, cardiovascular diseases, diabetes, cancers, and respiratory diseases were extracted.

RESULTS

Thirty-six studies that examined the prevalence of risk factors among people with CP were identified. There was inconsistent evidence that people with CP had higher prevalence of metabolic risk factors such as hypertension, hyperlipidaemia, and obesity, but strong evidence that they participated in low levels of physical activity, compared with people without CP. Seven studies reported on the burden of NCDs. Adults with CP had a higher risk of NCDs, including stroke, chronic obstructive pulmonary disease, and other heart conditions, and death due to NCDs, including cancers, chronic obstructive pulmonary disease, stroke, and ischaemic heart disease, compared with the general population. Only one study reported on the management of NCD, specifically the uptake of breast cancer screening among females.

INTERPRETATION

The burden of NCDs is higher among adults with CP compared with the general population. Further research is required to determine the prevalence of metabolic risk factors and management of NCDs among people with CP.

WHAT THIS PAPER ADDS

Adults with cerebral palsy (CP) have an increased risk of non-communicable diseases (NCDs) and increased risk of death because of NCDs. Evidence is inconsistent about the elevated prevalence of metabolic risk factors for NCDs. Evidence is consistent that people with CP participate in reduced physical activity. Only one study reported on management of NCD among people with CP. Available evidence suggests people with CP are less likely to receive preventive medicine.

The lifestyle behaviours of young adults with intellectual disabilities as they transition from school to adulthood: A pilot and feasibility study

BACKGROUND

In the general population, the transition from adolescence to adulthood has been identified as a "high-risk" period for weight gain. There has been no research examining health behaviours over this transition in adults with intellectual disabilities.

METHODS/DESIGN

The feasibility of recruitment, retention and relevant health behaviours were measured in 31 adolescents with mild-moderate intellectual disabilities. Anthropometric, objective physical activity, dietary and self-determination measures were collected over a 12-month transitional period from school to adulthood.

RESULTS

Key results suggest weight and BMI increased significantly from month 6 to month 12 (p = 0.044 and p = 0.043). Waist circumference increased significantly from baseline to month 12 (p = 0.049), and from month 6 to month 12 (p = 0.03).

DISCUSSION

Recruiting and retaining young adults with intellectual disabilities over a 12-month health behaviour study is feasible. The data indicate the transition from school to adulthood may be the start of a high-risk period for weight gain.

Gait Characteristics of Adults With Intellectual Disability

Gait is a relevant and complex aspect of motor functioning. Disturbances are related to negative health outcomes. Gait characteristics of 31 adults with intellectual disability (ID) without Down syndrome (DS) (42.77±16.70 years) were investigated, and associations with age, sex, body mass index (BMI), and level of ID were assessed. Sex and BMI were significantly associated with some of the gait parameters, while age and level of ID were not. Gait characteristics of adults with ID seem to be comparable to those of the general population of older adults (average 20 years older), except that adults with ID seem to spend less time in stance and double support phase and walk more variable and with a broader base of support.

Reported gum disease as a cardiovascular risk factor in adults with intellectual disabilities

BACKGROUND

Several risk factors for cardiovascular disease (CVD) have been identified among adults with intellectual disabilities (ID). Periodontitis has been reported to increase the risk of developing a CVD in the general population. Given that individuals with ID have been reported to have a higher prevalence of poor oral health than the general population, the purpose of this study was to determine whether adults with ID with informant reported gum disease present greater reported CVD than those who do not have reported gum disease and whether gum disease can be considered a risk factor for CVD.

METHODS

Using baseline data from the Longitudinal Health and Intellectual Disability Study from which informant survey data were collected, 128 participants with reported gum disease and 1252 subjects without reported gum disease were identified. A series of univariate logistic regressions was conducted to identify potential confounding factors for a multiple logistic regression.

RESULTS

The series of univariate logistic regressions identified age, Down syndrome, hypercholesterolemia, hypertension, reported gum disease, daily consumption of fruits and vegetables and the addition of table salt as significant risk factors for reported CVD. When the significant factors from the univariate logistic regression were included in the multiple logistic analysis, reported gum disease remained as an independent risk factor for reported CVD after adjusting for the remaining risk factors. Compared with the adults with ID without reported gum disease, adults in the gum disease group demonstrated a significantly higher prevalence of reported CVD (19.5% vs. 9.7%; P = .001).

CONCLUSION

After controlling for other risk factors, reported gum disease among adults with ID may be associated with a higher risk of CVD. However, further research that also includes clinical indices of periodontal disease and CVD for this population is needed to determine if there is a causal relationship between gum disease and CVD.

Prevalence of physical conditions and multimorbidity in a cohort of adults with intellectual disabilities with and without Down syndrome: cross-sectional study

OBJECTIVES

To investigate the prevalence of multimorbidity in adults with intellectual disabilities with and without Down syndrome.

DESIGN

Large, population-based cross-sectional study.

SETTING

The geographical area of one Health Board, Scotland.

PARTICIPANTS

All adults (aged 16+ years) known to general practitioners to have intellectual disabilities and adults receiving services provided or paid by intellectual disabilities health or social work services. 1023/1562 potential participants took part (65.5%); 562 (54.9%) men and 461 (45.1%) women, aged 43.9 years (16-83 years). 186 had Down syndrome and 837 did not.

MAIN OUTCOME MEASURES

The prevalence of International Statistical Classification of Diseases, 10th revision, physical health conditions and multimorbidity detected at a comprehensive health assessment.

RESULTS

The mean number of physical health conditions/participant was 11.04, and 98.7% had multimorbidity. The most prevalent conditions are painful and/or disabling and, in some cases, life threatening. The five most prevalent were visual impairment, obesity, epilepsy, constipation and ataxic/gait disorders. The pattern of multimorbidity differs from that seen in the general population and is spread across the entire adult life course. The extent of multimorbidity in the adults with Down syndrome was similar to that of the adults without Down syndrome, while the prevalence of individual conditions differed.

CONCLUSIONS

This robustly designed study with a large population found an extremely high prevalence of multimorbidity in adults with intellectual disabilities across the entire adult life course. This increases complexity of medical management that secondary healthcare services and medical education are not yet geared towards, as these tend to focus on single conditions. This is in addition to complexity due to limitations in communication and understanding. As the physical conditions within their multimorbidity also differ from that seen in the older general population, urgent attention is needed to develop the care pathways and guidelines that are required to inform and so improve their healthcare.

The effects of multi-component weight management interventions on weight loss in adults with intellectual disabilities and obesity: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Adults with intellectual disabilities have been shown to experience higher rates of obesity in comparison to the general population.

AIM

To examine the effectiveness of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity.

METHODS AND PROCEDURES

A systematic search of six electronic databases was conducted from database inception to January 2016. Risk of bias was assessed by the Cochrane Collaboration tool. Behavioural change techniques were defined by coding against the Coventry Aberdeen LOndon REfined (CALO-RE) taxonomy. Meta-analyses were conducted as Weighted Mean Difference (WMD) between intervention and control/comparator intervention.

OUTCOMES AND RESULTS

Six randomised controlled trials were included. The interventions did not adhere to clinical recommendations [the inclusion of an energy deficit diet (EDD), physical activity, and behaviour change techniques]. Meta-analysis revealed that current multi-component weight management interventions are not more effective than no treatment (WMD: -0.38kg; 95% CI -1.34kg to 0.58kg; p=0.44).

CONCLUSION AND IMPLICATIONS

There is a paucity of randomised controlled trials of multi-component weight management interventions for adults with intellectual disabilities and overweight/obesity. Current interventions, based on a health education approach are ineffective. Future long-term interventions that include an EDD and adhere to clinical recommendations on the management of obesity are warranted.

Exploration of body perception and body dissatisfaction in young adults with intellectual disability

BACKGROUND

People with intellectual disability (ID) are more likely to be overweight or obese. Research has shown that body dissatisfaction is a key factor in influencing unhealthy eating behaviour. More evidence is needed relating to how people with ID perceive their bodies in order to provide effectively targeted weight management programmes.

AIMS

This study aimed to investigate whether people with ID have concepts for underweight, overweight and healthyweight, and whether they can apply these concepts to themselves. It also aimed to explore body perception bias through comparison of perceived self to independent figure ratings, and body dissatisfaction through perceived-ideal body discrepancy measurement and a series of open-ended questions.

METHOD

Mixed methodology was used to explore body perception and body dissatisfaction in 40 young adults with ID compared to 48 individuals without ID. The Stunkard Figure Rating Scale assessed how participants would like to look, and their concepts of weight categories.

RESULTS

Young adults with ID tend to hold positive beliefs about their bodies. Females with ID were likely to underestimate their body size. Individuals with ID understood what is meant by 'overweight', 'healthy-weight' and 'underweight' although these concepts were different to those without ID. Individuals with ID were unable to accurately apply these body size categories to themselves.

CONCLUSION

These findings suggest that individuals with ID will first need support to understand how concepts of body size apply to themselves in order to facilitate weight management.

An examination of the nutritional intake and anthropometric status of individuals with intellectual disabilities: Results from the SOPHIE study

The prevalence of obesity appears greater in people with intellectual disabilities than those in the general population. This study aimed to examine the nutritional intake and anthropometric status of individuals with intellectual disabilities. Participants aged 16-64 years were recruited from intellectual disability service provider organizations ( n = 131). Data were collected using questionnaires; 4-day food dairies and weight, height and waist circumference measurements. Participants' mean body mass index (BMI) was 29.4 kg/m² ± 6.1, 2.4% were underweight, 22.6% were normal weight, 28.2% were overweight and 46.8% were obese. Having a diagnosis of Down syndrome ( p = 0.03) was associated with increasing BMI. Increasing waist circumference was associated with increasing severity of ID ( p = 0.04). The mean-reported energy intake was 1890 kcal/day. Mean energy intakes from sugar, fat and saturated fat were above recommendations and few participants met micronutrient recommended daily amounts. This study highlights the alarming prevalence of overweight and obesity and poor diet quality of individuals with intellectual disabilities.

Utilizing health records to characterize obesity, comorbidities, and health-care services in one human service agency in the United States

US surveys report higher prevalence of obesity in adults with intellectual disability. Health records of 40 adults with intellectual disability were retrospectively reviewed for data on health status, problem lists with International Classification of Diseases, Ninth Revision codes, medication lists, and health encounters over 18 months. Mean age was 49.5 years, 53% were males. Prevalence of overweight, obese, and morbidly obese was 28%, 58%, and 23%, respectively. Primary diagnosis was intellectual disability (50% mild, 33% moderate, 10% severe, and 8% profound), 85% had mental health disorders (67.5% with affective or mood and 42.5% had anxiety disorders). On average, residents consumed 2.63 psychotropic medications daily with additional 5.75 medications for axis 3 diagnoses and made 39.2 health visits over past 18 months. Our analysis supports increased prevalence of overweight/obesity, higher comorbidities, dual psychiatric diagnosis, substantial medication consumption, and higher utilization of health-care services in adults with intellectual disabilities. Targeted health interventions are therefore essential to improve their health and quality of life.

The Feldenkrais Method improves functioning and body balance in people with intellectual disability in supported employment: A randomized clinical trial

Loss of functioning and age-related health problems tend to appear earlier in individuals with intellectual disability (ID) than in their non-disabled peers. The Feldenkrais method (FM) is a movement-based form of learning that enhances body balance and physical functioning. We carried out an intervention based on Awareness Through Movement, a form of the FM. Thirty-two middle-aged (48.94±6.01years old) adults with ID who were in supported employment were recruited and randomly assigned to the experimental group (EG) or control group (CG). The EG received 30 Awareness Through Movement classes while the CG did not receive any movement-based intervention. Physical functioning (body balance, gait speed and chair stands) was assessed with the Short Physical Performance Battery (SPPB) and balance by stabilometry. After 30 FM classes, individuals in the EG had significantly improved their chair stand test score (p<0.005) and SPPB total score (p<0.005), and reduced their sway area (p<0.05) in the stabilometric test. These results indicate that the FM could be a good tool for the prevention of loss of functioning and body balance in middle-aged individuals with ID.

[Body weight and mental disorders : Results from a clinical psychiatric cross-sectional study of people with intellectual disabilities]

BACKGROUND

People with intellectual disabilities (ID) have a shorter life expectancy and higher mortality rate and more often suffer from various physical and mental disorders (WHO: 3-4 times more often than the general population). Obesity is an important risk factor for various disorders. This cross-sectional study examined the body weight and its risk factors in a clinical population of adults with ID.

METHODS

The prevalence of underweight, normal weight, and overweight was determined using the body mass index (BMI) for 633 patients of an outpatient clinic for people with ID and mental disorders. A multiple logistic regression analysis was used to assess factors for alterations in body weight.

RESULTS

Approximately one out of two men and two out of three women with ID and mental disorders were overweight. Adults with mild and moderate ID, female gender, increasing age, Down's syndrome, behavioral disorders, and a less supported living situation were associated with a higher rate of obesity. People with dementia and autism spectrum disorders showed a lower rate of obesity.

CONCLUSION

Young women with ID and mental disorders were particularly at risk for obesity. The respective factors may support the development of specific prevention programs to reduce the risk of overweight and thereby lead to better mental and physical health in people with ID.

A cluster randomised control trial of a multi-component weight management programme for adults with intellectual disabilities and obesity

There have been few published controlled studies of multi-component weight management programmes that include an energy deficit diet (EDD), for adults with intellectual disabilities and obesity. The objective of this study was to conduct a single-blind, cluster randomised controlled trial comparing a multi-component weight management programme to a health education programme. Participants were randomised to either TAKE 5, which included an EDD or Waist Winners Too (WWToo), based on health education principles. Outcomes measured at baseline, 6 months (after a weight loss phase) and 12 months (after a 6-month weight maintenance phase), by a researcher blinded to treatment allocation, included: weight; BMI; waist circumference; physical activity; sedentary behaviour and health-related quality of life. The recruitment strategy was effective with fifty participants successfully recruited. Both programmes were acceptable to adults with intellectual disabilities, evidenced by high retention rates (90 %). Exploratory efficacy analysis revealed that at 12 months there was a trend for more participants in TAKE 5 (50·0 %) to achieve a clinically important weight loss of 5–10 %, in comparison to WWToo (20·8 %) (OR 3·76; 95 % CI 0·92, 15·30; 0·064). This study found that a multi-component weight management programme that included an EDD, is feasible and an acceptable approach to weight loss when tailored to meet the needs of adults with intellectual disabilities and obesity.

Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review

Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study's purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Background

The prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.

Objectives

The objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).

Setting

Leicestershire, UK.

Participants

Adults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.

Main outcome measures

The primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.

Data sources

Participants were recruited from general practices, specialist ID services and clinics, and through direct contact.

Results

A total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.

Limitations

We were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.

Conclusions

The results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.

Future work

Further work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.

Trial registration

ClinicalTrials.gov NCT02513277.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

Validity of proxy-reported height and weight to derive body mass index in adults participating in Special Olympics

BACKGROUND

Overweight and obesity are common in adults with intellectual disabilities, which complicates their health. To meet their health needs, individuals with intellectual disability frequently rely on proxies to answer questions on their behalf. In the general population, the use of proxy-reported height and weight to compute body mass index (BMI) has been validated, but not among adults with intellectual disability. The objective of this study was to determine the accuracy of proxy-reported height, weight and derived BMI among adults with intellectual disability.

METHODS

Proxies were asked to report height and weight on behalf of adults with intellectual disability who participate in Special Olympics Ontario; their answers were compared to measured height and weight.

RESULTS

Proxies reported height and weight accurately; the sensitivity of proxy reports for classifying individuals with intellectual disability as overweight and/or obese was 84.6%.

CONCLUSION

Proxy reports may be useful when direct measurements of individuals with intellectual disability are not available.

Antipsychotic Use and Metabolic Monitoring in Individuals with Developmental Disabilities Served in a Medicaid Medical Home

This study describes antipsychotic use and metabolic monitoring rates among individuals with developmental disabilities enrolled in a subspecialty medical home (N = 826). Four hundred ninety-nine participants (60.4 %) were taking antipsychotics, which was associated with male gender (p = 0.01), intellectual disability with and without autism spectrum disorder (p = 0.001 and p = 0.04, respectively), and inversely associated with the youngest and oldest age categories (p = 0.001 and p = 0.04, respectively). Among those taking antipsychotics, annual metabolic monitoring rates ranged from 89 % (lipids) to 99 % (weight). Age was positively associated with glucose (p < 0.001) and lipid monitoring (p < 0.001). Adult participants with dyslipidemia (p < 0.01), prediabetes/diabetes (p = 0.04), and hypertension (p = 0.02) were significantly more likely to obtain lipid monitoring. These values exceeded previously reported rates suggesting the importance of an integrated care model.

Obesity in British children with and without intellectual disability: cohort study

Background

Reducing the prevalence of and inequities in the distribution of child obesity will require developing interventions that are sensitive to the situation of ‘high risk’ groups of children. Children with intellectual disability appear to be one such group. We aimed to estimate the prevalence of obesity in children with and without intellectual disability in a longitudinal representative sample of British children and identify risk factors associated with obesity at age 11.

Methods

Information was collected on a nationally representative sample of over 18,000 at ages 9 months, 3, 5, 7 and 11 years. We used UK 1990 gender-specific growth reference charts and the LMS Growth programme to identify age and gender-specific overweight and obesity BMI thresholds for each child at ages 5, 7 and 11 years.

Results

Children with intellectual disabilities were significantly more likely than other children to be obese at ages five (OR = 1.32[1.03–1.68]), seven (OR = 1.39[1.05–1.83]) and eleven (OR = 1.68[1.39–2.03]). At ages five and seven increased risk of obesity among children with intellectual disabilities was only apparent among boys. Among children with intellectual disability risk of obesity at age eleven was associated with persistent maternal obesity, maternal education, child ethnicity and being bullied at age five.

Conclusions

Children with intellectual disability are a high-risk group for the development of obesity, accounting for 5–6 % of all obese children. Interventions to reduce the prevalence and inequities in the distribution of child obesity will need to take account of the specific situation of this group of children.

Process evaluation of the Walk Well study: a cluster-randomised controlled trial of a community based walking programme for adults with intellectual disabilities

BACKGROUND

Walking interventions can be effective in encouraging sedentary populations to become more active; however, limited research has explored the effectiveness of walking interventions for adults with intellectual disabilities. This process evaluation explored the delivery of a community based walking intervention for adults with intellectual disabilities.

METHODS

Walk Well was a single-blind cluster randomised controlled trial of a 12-week physical activity consultation-led walking intervention. 102 participants were randomised to the Walk Well intervention or a waiting list control group. Participants in the intervention group received three physical activity consultations with a walking advisor at baseline, 6 & 12-weeks. They were encouraged to use a pedometer to set goals and monitor their daily step count. Primary outcome was change in daily step count at 12-weeks. Process evaluation measures included qualitative interviews with key stakeholders (n = 6) and quantifiable data collected as part of the intervention. Additional process data were extracted from a sub-set of qualitative interviews with participants and carers (n = 20). Data were analysed for process information related to context, recruitment and retention, reach, implementation, and fidelity.

RESULTS

Walk Well was not effective in significantly increasing levels of physical activity. The process evaluation did, however, highlight several important areas for consideration in future studies, including: a successful recruitment and retention strategy reaching a representative sample of adults with intellectual disabilities in the community; feasible and (for most) enjoyable methods of engaging adults with intellectual disabilities in activities to support behaviour change; potential need for greater intervention duration and frequency of contact; advantages and disadvantages of using pedometers as a behaviour change tool; the need for strategies which engage carers in supporting participants; and the complex issue of 'freedom of choice' in relation to lifestyle behaviours and study participation.

CONCLUSIONS

Walking interventions for adults with intellectual disabilities can be feasibly delivered in the community in relation to reach, recruitment, retention and intervention fidelity. More intensive intervention methods need to be explored as well as strategies to engage and motivate carers in their support of participants.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN50494254 (3(rd) April 2012).

Preparing Tomorrow's Doctors to Care for Patients With Autism Spectrum Disorder

People with autism spectrum disorder (ASD) and other developmental disabilities have poorer health and face unique barriers to health care compared to people without disabilities. These health disparities can be partially attributed to physicians' limited knowledge about caring for patients with developmental disabilities. The purpose of this study was to determine the effectiveness of ASD training for medical students. Our training included a lecture and a panel presentation that featured people with ASD and family members. Students reported improved knowledge, skills, confidence, and comfort in caring for patients with ASD.

Prevalence of overweight and obesity among students with intellectual disabilities in Taiwan: A secondary analysis

PURPOSE

The study aims to investigate the prevalence and likelihood of overweight and obesity in a large sample of students with intellectual disabilities (ID) from Taiwan.

METHOD

A secondary analysis of a cross sectional study was employed to examine the body weight status among 7 to 18 year-old students with ID enrolled in public special education schools in 2013. The students were divided into three age groups (7-12 yrs, 13-15 yrs, and 16-18 yrs), four ID levels (mild, moderate, severe, and profound) and six comorbidities of ID (ID only, ID caused by genetic disorders, ID with physical disability, ID with multiple disabilities without physical disabilities, ID with autism spectrum disorders, and others with rare diseases).

RESULTS

The sample represented 34.8% of students with ID attending public special education schools in Taiwan. Within this sample, 35.2% were identified as being overweight or obese. The 16 to 18 year-old age group were approximately two times (AOR=2.02, more likely to be obese than the 7-12 year-old group. Students with ID caused by genetic disorders such as Down syndrome (AOR=2.00) appeared to be more overweight or obese in comparison to those with ID only. Students with moderate (AOR=1.64) and severe ID (AOR=1.49) were more overweight/obese compared to those with profound ID.

CONCLUSION

The findings not only highlight the high prevalence of overweight/obesity but also stress the need for health promotion initiatives to address issues of overweight/obesity within this population.