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Sato Y, Kamei A, Endo F, Matsuyama S, Toda H, Kasai T. Vitamin D Supplementation at a Dose of 10 µg/Day in Institutionalized Children with Severe Motor and Intellectual Disabilities. Nutrients 2023; 16:122. [PMID: 38201951 PMCID: PMC10780696 DOI: 10.3390/nu16010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/13/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Vitamin D (VD) deficiency can lead to health-related consequences. This study determined the effects of VD administration in VD-deficient children with severe motor and intellectual disabilities (SMID). Twenty-eight subjects were included. Among them, 25 subjects with parental consent for VD administration were given 10 µg/day (400 IU/day) of VD in April 2021. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured at least 30 days after the start of VD administration. The total VD intake, serum 25(OH)D levels, and ultraviolet (UV) exposure before the blood tests were investigated. The results showed that the median serum 25(OH)D levels were 8.7 ng/mL (4.3-17.2) and 24.0 ng/mL (7.8-39 ng/mL) from March to May in 2020 and 2021, respectively. Among the 25 subjects, 22 with UV exposure had >20 ng/mL serum 25(OH)D level, and 2 without UV exposure had <20 ng/mL serum 25(OH)D level. Three subjects who did not receive VD supplementation had <20 ng/mL serum 25(OH)D level. Taken together, VD supplementation (10 µg/day) is effective in children with SMID in institutional care. Moreover, it may be sufficient for children with UV exposure, but not for those without.
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Affiliation(s)
- Yota Sato
- Nutrition Support Team, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
- Department of Pediatrics, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
| | - Atsushi Kamei
- Department of Developmental Disability Medicine, School of Medicine, Iwate Medical University, Morioka 028-3694, Japan
| | - Fumie Endo
- Nutrition Support Team, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
| | - Sakura Matsuyama
- Nutrition Support Team, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
| | - Hiroyuki Toda
- Department of Pediatrics, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
| | - Takeo Kasai
- Department of Pediatrics, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
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Winterhalder R, McCabe J, Young C, Lamb K, Sawhney I, Jory C, O'Dwyer M, Shankar R. Bone health, intellectual disability and epilepsy: An observational community-based study. Acta Neurol Scand 2022; 145:753-761. [PMID: 35297524 PMCID: PMC9310839 DOI: 10.1111/ane.13612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/08/2022] [Accepted: 03/06/2022] [Indexed: 12/14/2022]
Abstract
Objectives Intellectual disability (ID) and epilepsy are independent risk factors for osteoporosis. Diverse predisposing factors influence this, for example in ID, genetics and poor nutrition and in epilepsy, anti‐seizure medication (ASM). Around 25% people with ID have epilepsy, majority treatment resistant. ASMs polypharmacy is common. However, little is known about the bone‐related characteristics of this vulnerable group. A prospective observational cohort study of bone profile across a community ID Epilepsy service was undertaken to understand this. Materials & Methods Participants were on minimum 2 years of ASMs. Baseline demographics, epilepsy data, bone metabolism biomarkers, bone mineral density (BMD) and vitamin D levels were collected. Doses needed to correct vitamin D insufficiency/deficiency were calculated. Results At baseline, of 104 participants, 92 (90.2%) were vitamin D insufficient/deficient. Seventy‐six (73.1%) had a DEXA scan, 50 of whom—in the osteopaenic/osteoporotic range. DEXA scores between ambulant and non‐ambulant patients were significantly different (p = .05) but not for ID severity. A high alkaline phosphatase (ALP) predicted lower vitamin D levels. Borderline significance (p = .06) in calcium levels between normal and high ALP was identified. There were no significant associations between parathyroid hormone, inorganic phosphate and magnesium levels, with vitamin D status or DEXA hip T‐scores. Normalizing vitamin D levels (mean 101.4 nmol/L) required an average of 1951IU cholecalciferol daily. Conclusions Vitamin D deficiency is highly prevalent in people with ID and epilepsy treated with ASMs impacting likely on their bone health. Screening with vitamin D levels, ALP and DEXA in this group should be pro‐actively and routinely considered.
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Affiliation(s)
| | | | | | - Kirsten Lamb
- Cornwall Intellectual Disability Epilepsy Research (CIDER) University of Plymouth Peninsula School of Medicine Truro UK
| | | | - Caryn Jory
- Cornwall Partnership NHS Foundation Trust Truro UK
| | - Maire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin 2 Ireland
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust Truro UK
- Cornwall Intellectual Disability Epilepsy Research (CIDER) University of Plymouth Peninsula School of Medicine Truro UK
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Walsh N, Barr O, Lang D, Currid M, Hoey C. Peripheral bone density measurement: An interdisciplinary initiative for improving health outcomes for people with learning disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:18-28. [PMID: 32815754 PMCID: PMC9016660 DOI: 10.1177/1744629520950136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
Challenges exist in respect of people with intellectual disabilities who, with the increasing life expectancy, have a growing risk of age-related degenerative conditions. Changes in bone health are associated with increasing age and the bone health of people who have intellectual disabilities is well documented in the literature as being poor in comparison to the general population. A heel scan clinic was set up in an intellectual disability service as a service improvement initiative. There were 12 females and 17 males scanned using a heel scanner. Only 3 (10.3%) people with intellectual disabilities were in the normal bone mineral density (BMD) range. Peripheral BMD screening for people has been shown to provide important information about the bone health of people with intellectual disabilities which has prompted further treatment by general practitioners and has the potential to provide an accessible way to obtain information on the bone health of people with intellectual disabilities.
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Affiliation(s)
- Niamh Walsh
- Niamh Walsh, School of Nursing, Faculty of
Life and Health Sciences, Room MG048, Ulster University, Northland Road, Derry
BT48 7JL, UK.
| | - Owen Barr
- School of Nursing, Ulster University, UK
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Bone health in adults with epilepsy and intellectual disability. Br J Gen Pract 2022; 72:100-101. [PMID: 35210232 PMCID: PMC8884425 DOI: 10.3399/bjgp22x718553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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5
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Jimoh OF, Ryan H, Killett A, Shiggins C, Langdon PE, Heywood R, Bunning K. A systematic review and narrative synthesis of the research provisions under the Mental Capacity Act (2005) in England and Wales: Recruitment of adults with capacity and communication difficulties. PLoS One 2021; 16:e0256697. [PMID: 34469482 PMCID: PMC8409627 DOI: 10.1371/journal.pone.0256697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The Mental Capacity Act (MCA, 2005) and its accompanying Code of Practice (2007), govern research participation for adults with capacity and communication difficulties in England and Wales. We conducted a systematic review and narrative synthesis to investigate the application of these provisions from 2007 to 2019. METHODS AND FINDINGS We included studies with mental capacity in their criteria, involving participants aged 16 years and above, with capacity-affecting conditions and conducted in England and Wales after the implementation of the MCA. Clinical trials of medicines were excluded. We searched seven databases: Academic Search Complete, ASSIA, MEDLINE, CINAHL, PsycArticles, PsycINFO and Science Direct. We used narrative synthesis to report our results. Our review follows Preferred Reporting Items for Systematic Reviews and is registered on PROSPERO, CRD42020195652. 28 studies of various research designs met our eligibility criteria: 14 (50.0%) were quantitative, 12 (42.9%) qualitative and 2 (7.1%) mixed methods. Included participants were adults with intellectual disabilities (n = 12), dementia (n = 9), mental health disorders (n = 2), autism (n = 3) and aphasia after stroke (n = 2). We found no studies involving adults with acquired brain injury. Diverse strategies were used in the recruitment of adults with capacity and communication difficulties with seven studies excluding individuals deemed to lack capacity. CONCLUSIONS We found relatively few studies including adults with capacity and communication difficulties with existing regulations interpreted variably. Limited use of consultees and exclusions on the basis of capacity and communication difficulties indicate that this group continue to be under-represented in research. If health and social interventions are to be effective for this population, they need to be included in primary research. The use of strategic adaptations and accommodations during the recruitment process, may serve to support their inclusion.
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Affiliation(s)
- Oluseyi Florence Jimoh
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Hayley Ryan
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Ciara Shiggins
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne Victoria, Australia
| | - Peter E. Langdon
- Centre for Educational Development, Appraisal and Research, New Education Building, Westwood Campus, University of Warwick, Coventry, United Kingdom
| | - Rob Heywood
- School of Law, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Karen Bunning
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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O'Dwyer M, Watkins L, McCallion P, McCarron M, Henman M, Shankar R. Optimising medicines use in older adults with intellectual disability who have epilepsy: challenges and perspectives. Ther Adv Drug Saf 2021; 12:20420986211025157. [PMID: 34394909 PMCID: PMC8361510 DOI: 10.1177/20420986211025157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Maire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin, 2, Ireland
| | - Lance Watkins
- Swansea Bay University Health Board Ringgold Standard Institution, Neath Port Talbot, UK
| | - Philip McCallion
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mary McCarron
- Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Ireland
| | - Martin Henman
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin, Ireland
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, UK, and Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
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Dudley B, Ostrowski M, Ciausu V, Ince C, McKinnon I. Revisiting vitamin D status and supplementation for in-patients with intellectual and developmental disability in the North of England, UK. BJPsych Bull 2021; 46:1-7. [PMID: 34002690 PMCID: PMC9768500 DOI: 10.1192/bjb.2021.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/19/2021] [Accepted: 04/14/2021] [Indexed: 12/31/2022] Open
Abstract
AIMS AND METHOD To re-evaluate vitamin D testing and supplementation among in-patients with intellectual and developmental disability (IDD) and examine any correlates with physical health conditions, including COVID-19. Records of all in-patients between January 2019 and July 2020 (n = 78) were examined for 25-hydroxyvitamin D (25(OH)D) level, ward area, supplementation status, test seasonality, medication and health status. RESULTS The mean 25(OH)D level for supplemented (800 IU/day) patients was 75 nmol/L (s.d. = 20), compared with 40 nmol/L (s.d. = 19) in the non-supplemented group (P < 0.001). Thirty-eight percent of those who were in-patients during the first wave of the COVID-19 pandemic developed symptoms, but the small sample size could not establish vitamin D levels as a predictor of outcome. CLINICAL IMPLICATIONS Vitamin D (800 IU/day) supplementation is effective but the adequacy of the nationally recommended dose of 400 IU/day is unclear. Links to COVID-19 merit further research.
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Affiliation(s)
- Bethany Dudley
- Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Morpeth, UK
| | - Marcin Ostrowski
- Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Morpeth, UK
| | - Vlad Ciausu
- Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Morpeth, UK
| | - Chris Ince
- Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Morpeth, UK
| | - Iain McKinnon
- Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Morpeth, UK
- Newcastle University, Newcastle upon Tyne, UK
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8
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Savas HB, Sayar E, Kara T. Thiol Disulfide Balance Oxidative Stress and Paraoxonase 1 Activities in Children and Adolescents Aged 6-16 Years with Specific Learning Disorders. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/10837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Higazi AM, Kamel HM, Abdel-Naeem EA, Abdullah NM, Mahrous DM, Osman AM. Expression analysis of selected genes involved in tryptophan metabolic pathways in Egyptian children with Autism Spectrum Disorder and learning disabilities. Sci Rep 2021; 11:6931. [PMID: 33767242 PMCID: PMC7994393 DOI: 10.1038/s41598-021-86162-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2021] [Indexed: 01/31/2023] Open
Abstract
Autism Spectrum Disorder (ASD) and learning disabilities are neurodevelopmental disabilities characterized by dramatically increasing incidence rates, yet the exact etiology for these disabilities is not identified. Impairment in tryptophan metabolism has been suggested to participate in the pathogenesis of ASD, however, further validation of its involvement is required. Additionally, its role in learning disabilities is still uninvestigated. Our objective was to evaluate some aspects of tryptophan metabolism in ASD children (N = 45) compared to children with learning disabilities (N = 44) and healthy controls (N = 40) by measuring the expression levels of the MAOA, HAAO and AADAT genes using real-time RT-qPCR. We also aimed to correlate the expression patterns of these genes with parental ages at the time of childbirth, levels of serum iron, and vitamin D3 and zinc/copper ratio, as possible risk factors for ASD. Results demonstrated a significant decrease in the expression of the selected genes within ASD children (p < 0.001) relative to children with learning disabilities and healthy controls, which significantly associated with the levels of our targeted risk factors (p < 0.05) and negatively correlated to ASD scoring (p < 0.001). In conclusion, this study suggests that the expression of the MAOA, HAAO and AADAT genes may underpin the pathophysiology of ASD.
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Affiliation(s)
- Aliaa M. Higazi
- grid.411806.a0000 0000 8999 4945Clinical and Molecular Chemistry Unit, Department of Clinical and Chemical Pathology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Hanan M. Kamel
- grid.411806.a0000 0000 8999 4945Clinical and Molecular Chemistry Unit, Department of Clinical and Chemical Pathology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Emad A. Abdel-Naeem
- grid.411806.a0000 0000 8999 4945Immunology Unit, Department of Clinical and Chemical Pathology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Noha M. Abdullah
- grid.411806.a0000 0000 8999 4945Clinical and Molecular Chemistry Unit, Department of Clinical and Chemical Pathology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Doaa M. Mahrous
- grid.411806.a0000 0000 8999 4945Department of Pediatrics, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ashraf M. Osman
- grid.411806.a0000 0000 8999 4945Clinical and Molecular Chemistry Unit, Department of Clinical and Chemical Pathology, Faculty of Medicine, Minia University, Minia, Egypt
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10
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Vitamins K and D deficiency in severe motor and intellectually disabled patients. Brain Dev 2021; 43:200-207. [PMID: 33139126 DOI: 10.1016/j.braindev.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We aimed to determine serum 25-hydroxyvitamin D (25(OH)D) and undercarboxylated osteocalcin (ucOC) levels in severe motor and intellectual disabilities (SMID) patients and their association with bone turnover biomarkers. METHODS We assessed vitamin D and K levels as indicators of osteoporosis in institutionalized adults with SMID. From December 2019 to February 2020, 93 institutionalized patients (48 men, 45 women; median age, 49 years) underwent annual routine examinations. Serum ucOC, 25(OH)D, bone-specific alkaline phosphatase (BAP), and tartrate-resistant acid phosphatase A 5b (TRACP-5b) levels as bone formation and resorption markers and calcium and phosphorous levels were measured. Vitamin K deficiency was indirectly assessed based on ucOC levels. RESULTS Mean ucOC levels were higher than normal (i.e., vitamin K deficiency). Serum 25(OH)D levels were markedly diminished. Overall, 86% of patients had deficient 25(OH)D levels. These 25(OH)D-deficient patients had higher ucOC levels. Multiple linear regression analysis revealed an inverse correlation between 25(OH)D and ucOC levels. ucOC levels were significantly higher and 25(OH)D levels were significantly lower in tube feeding. TRACP-5b levels were significantly higher in elderly than in young women. BAP and TRACP-5b levels were normal in adults. No relationship existed between vitamin D and antiepileptic drug use. CONCLUSIONS Vitamin K and D co-deficiency was common in SMID patients. Vitamin K and D deficiencies were worse in tube-fed patients than in oral intake patients. SMID patients should undergo regular monitoring of vitamin D and K levels and supplementation of these vitamins.
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11
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Prevalence and Risk Factors of Hypovitaminosis-D in Children with Cognitive and Movement Disorders. Indian J Pediatr 2019; 86:777-783. [PMID: 31020592 DOI: 10.1007/s12098-019-02952-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/03/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To document the prevalence of hypovitaminosis-D in children with intellectual and movement disorders and to identify the risk factors in vitamin D deficient children. METHODS This is a cross-sectional study on 90 children with neurodevelopmental disabilities. The prevalence of hypovitaminosis-D and the risk factors such as sun exposure, age-appropriate mobility, diet, skin color and anti-epileptic medications were examined in children with cognitive disorders and movement disorders. RESULTS The mean serum vitamin D level in children with cognitive disability (n = 46) was found to be 26.7 ± 16.3 ng/L and in the children with movement disability (n = 44) it was 27.9 ± 10.5 ng/L. Though the risk factors were found in greater numbers in children in the deficient group (vitamin D < 30 ng/L), the difference between the two groups was not significant. Of the 90 children, 86 (95.5%) had at least one sign of vitamin D deficiency. Lowest levels of vitamin D were seen in autistic spectrum disorder and learning disabilities in the Cognitive Disability group and hemiplegia in the Movement Disability group. CONCLUSIONS The prevalence of vitamin D deficiency in children with neurodevelopmental disabilities was 72.2%, with 76.1% in the cognitive disability group and 68.2% in the movement disability group. The risk factors were more common in vitamin D deficient children.
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Frighi V, Morovat A, Andrews TM, Rana F, Stephenson MT, White SJ, Fower E, Roast J, Goodwin GM. Vitamin D, bone mineral density and risk of fracture in people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:357-367. [PMID: 30569589 DOI: 10.1111/jir.12581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/12/2018] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND People with intellectual disabilities (IDs) have very high rates of osteoporosis and fractures, to which their widespread vitamin D deficiency and other factors could contribute. We aimed to assess in people with IDs previously treated for vitamin D deficiency (1) long-term adherence to vitamin D supplementation and (2) bone mineral density (BMD), as an indicator for risk of fractures, according to vitamin D supplementation and other factors. METHOD We recorded height, weight, medical, pharmacological, dietary and lifestyle assessment. Blood sample were taken for vitamin D and related analytes. dual-energy X-ray absorptiometry for BMD was performed. RESULTS Of 51 study participants (mean [standard deviation, SD] age 51.5 [13.6] years, 57% male), 41 (80.4%) were taking vitamin D and 10 were not. Mean [SD] serum vitamin D was 81.3 [21.3] vs. 25.2 [10.2] nmol/L (P < 0.0001), respectively. Thirty-six participants underwent a dual-energy X-ray absorptiometry scan, which showed osteoporosis in 23.7% and osteopenia in 52.6%. Participants on vitamin D had higher BMD than those who were not, a statistically significant difference when confounders (lack of mobility and hypogonadism) were removed. BMD was significantly different according to mobility, particularly in wheelchair users, in whom hip BMD was 33% lower (P < 0.0001) than in participants with normal mobility. Participants still taking vitamin D showed a 6.1% increase in BMD at the spine (P = 0.003) after mean [SD] 7.4 [1.5] years vitamin D treatment. CONCLUSIONS In people with IDs and previous vitamin D deficiency, BMD increases on long-term vitamin D supplementation. However, additional strategies must be considered for osteoporosis and fracture prevention in this population.
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Affiliation(s)
- V Frighi
- Department of Psychiatry, University of Oxford, Oxford, UK
- Learning Disabilities, Oxford Health NHS Foundation Trust, Oxford, UK
| | - A Morovat
- Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - T M Andrews
- Department of Psychiatry, University of Oxford, Oxford, UK
- Learning Disabilities, Oxford Health NHS Foundation Trust, Oxford, UK
| | - F Rana
- Learning Disabilities, Oxford Health NHS Foundation Trust, Oxford, UK
| | - M T Stephenson
- Learning Disabilities, Oxford Health NHS Foundation Trust, Oxford, UK
| | - S J White
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - E Fower
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J Roast
- Department of Learning Disabilities, Family Support Network, Didcot, Oxfordshire, UK
| | - G M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
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Abstract
Vitamin D is a prohormone that is essential to good health. As very few foods (fish, egg yolks, milk) are rich in vitamin D, the main source of the vitamin is synthesized in the skin in the presence of ultraviolet B rays from sunlight. However, due to Canada's northern latitude, sufficient amounts of vitamin D cannot be synthesized using sunlight during the fall and winter months and, consequently, there is a concern that many Canadians are not achieving adequate levels of vitamin D. A wide array of inconsistent evidence derived from serum and dietary assessments has been published and the results are inconclusive. This paper serves to outline the issues and challenges regarding nationwide intervention strategies such as fortification to increase vitamin D intake in the Canadian population. Given the potential for excessive intakes and the lack of informed Canadian data, implementing an intervention to increase vitamin D intake in the entire population may be irresponsible; however, further investigation of vitamin D intakes in certain subgroups of the Canadian population is warranted.
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Affiliation(s)
- Meghan McGee
- Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
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14
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Finlayson J, De Amicis L, Gallacher S, Munro R, Crockett J, Godwin J, Feeney W, Skelton DA. Reasonable adjustments to provide equitable and inclusive assessment, screening and treatment of osteoporosis for adults with intellectual disabilities: A feasibility study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:300-312. [PMID: 30175427 DOI: 10.1111/jar.12526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/26/2018] [Accepted: 08/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with intellectual disabilities are a high risk population for developing osteoporosis and fragility fractures, yet they experience barriers to accessing dual-energy x-ray absorptiometry (DXA) bone mineral density (BMD) screening and fracture assessment. Reasonable adjustments are a statutory requirement in the UK, but there is a paucity of evidence-based examples to assist their identification, implementation and evaluation. METHOD Thirty adults with intellectual disabilities underwent DXA BMD screening and fracture risk assessment. Reasonable adjustments were identified and implemented. RESULTS The presence of osteopenia or osteoporosis was detected in 23 out of 29 (79%) participants. Osteoporosis professionals report that 17 of 18 reasonable adjustments identified and implemented are both important and easy to implement. CONCLUSION Adults across all levels of intellectual disabilities can complete DXA BMD screening with reasonable adjustments. Widely implementing these reasonable adjustments would contribute to reducing inequalities in health care for adults with intellectual disabilities.
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Affiliation(s)
- Janet Finlayson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Leyla De Amicis
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Stephen Gallacher
- Centre for Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Robin Munro
- Department of Rheumatology, Wishaw General Hospital, Lanarkshire, UK
| | | | - Jon Godwin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Wendy Feeney
- Department of Rheumatology, Wishaw General Hospital, Lanarkshire, UK
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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15
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Burke ÉA, Carroll R, O’Dwyer M, Walsh JB, McCallion P, McCarron M. Osteoporosis and People with Down Syndrome: A Preliminary Descriptive Examination of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing Wave 1 Results. Health (London) 2018. [DOI: 10.4236/health.2018.109095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chester V, Simmons H, Henriksen M, Alexander RT. Vitamin D deficiency in an inpatient forensic intellectual disability service. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2017; 21:134-143. [PMID: 27193572 DOI: 10.1177/1744629516649124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
No research has examined vitamin D deficiency among inpatients within forensic intellectual disability services, despite their potentially increased risk. Tests of serum 25(OHD) concentration in blood are routinely offered to patients within the service as part of the admission and annual physical health check. Results were classified as deficient <25, insufficient <50, sufficient 50-75 or optimal >75. Deficient or insufficient patients were offered supplement treatment and retested within 6 months. Levels were compared between groups: level of security and gender. At baseline, 87% of patients were deficient or insufficient, whilst 13% were sufficient or optimal. At follow-up, 53% had sufficient or optimal levels. However, some patients remained deficient (13%) or insufficient (34%) due to non-compliance with treatment. Women appeared more likely to be deficient. High levels of vitamin D deficiency were found among this population. Vitamin D screening and treatment is a simple and effective way of improving the physical health of this population.
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García-Hoyos M, Riancho JA, Valero C. Bone health in Down syndrome. Med Clin (Barc) 2017; 149:78-82. [PMID: 28571965 DOI: 10.1016/j.medcli.2017.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 01/08/2023]
Abstract
Patients with Down syndrome have a number of risk factors that theoretically could predispose them to osteoporosis, such as early aging, development disorders, reduced physical activity, limited sun exposure, frequent comorbidities and use of drug therapies which could affect bone metabolism. In addition, the bone mass of these people may be affected by their anthropometric and body composition peculiarities. In general terms, studies in adults with Down syndrome reported that these people have lower areal bone mineral density (g/cm2) than the general population. However, most of them have not taken the smaller bone size of people with Down syndrome into account. In fact, when body mineral density is adjusted by bone size and we obtain volumetric body mineral density (g/cm3), the difference between both populations disappears. On the other hand, although people with Down syndrome have risk factor of hypovitaminosis D, the results of studies regarding 25(OH)D in this population are not clear. Likewise, the studies about biochemical bone markers or the prevalence of fractures are not conclusive.
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Affiliation(s)
- Marta García-Hoyos
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España
| | - José Antonio Riancho
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España
| | - Carmen Valero
- Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España.
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Hess M, Campagna EJ, Jensen KM. Low bone mineral density risk factors and testing patterns in institutionalized adults with intellectual and developmental disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:157-164. [PMID: 28247586 DOI: 10.1111/jar.12341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adults with intellectual or developmental disability (ID/DD) have multiple risks for low bone mineral density (BMD) without formal guidelines to guide testing. We sought to identify risk factors and patterns of BMD testing among institutionalized adults with ID/DD. METHODS We evaluated risk factors for low BMD (Z-/T-score < -1) and patterns of BMD testing among adults with ID/DD receiving care at a state-run residential facility. Kruskal-Wallis, Fisher's exact and Pearson's chi-squared tests were used as appropriate. RESULTS Of the 140 eligible patients, only 44% ever had BMD testing of which 89% had low BMD. Median age at diagnosis was 42 years old. Individuals with low BMD were more likely to be older, non-weight bearing, Caucasian and have severe cognitive delay. CONCLUSIONS Adults with ID/DD in this facility had a high prevalence of low BMD. Further studies are needed to better characterize risk factors and inform screening within this high-risk population.
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Affiliation(s)
- Mailee Hess
- Department of Internal Medicine, UCLA-Harbor Medical Center, Torrance, CA, USA
| | - Elizabeth J Campagna
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA
| | - Kristin M Jensen
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA.,Departments of Pediatrics and Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Kelley L, Sanders AFP, Beaton EA. Vitamin D deficiency, behavioral atypicality, anxiety and depression in children with chromosome 22q11.2 deletion syndrome. J Dev Orig Health Dis 2016; 7:616-625. [PMID: 27827293 PMCID: PMC5922262 DOI: 10.1017/s2040174416000428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chromosome 22q11.2 deletion syndrome (22q11.2DS) is a complex developmental disorder with serious medical, cognitive and emotional symptoms across the lifespan. This genetic deletion also imparts a lifetime risk for developing schizophrenia that is 25-30 times that of the general population. The origin of this risk is multifactorial and may include dysregulation of the stress response and immunological systems in relation to brain development. Vitamin D is involved in brain development and neuroprotection, gene transcription, immunological regulation and influences neuronal signal transduction. Low levels of vitamin D are associated with schizophrenia, depression and anxiety in the general population. Yet, little is known about how vitamin D levels in children with 22q11.2DS could mediate risk of psychosis in adulthood. Blood plasma levels of vitamin D were measured in children aged 7-16 years with (n=11) and without (n=16) 22q11.2DS in relation to parent reports of children's anxiety and atypicality. Anxiety and atypicality in childhood are risk indicators for the development of schizophrenia in those with 22q11.2DS and the general population. Children with 22q11.2DS had lower vitamin D levels, as well as elevated anxiety and atypicality compared with typical peers. Higher levels of anxiety, depression and internalizing problems but not atypicality were associated with lower levels of vitamin D. Vitamin D insufficiency may relate to higher levels of anxiety and depression, in turn contributing to the elevated risk of psychosis in this population. Further study is required to determine casual linkages between anxiety, stress, mood and vitamin D in children with 22q11.2DS.
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Affiliation(s)
- L. Kelley
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
| | - A. F. P. Sanders
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
| | - E. A. Beaton
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
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Skorpen S, Nicolaisen M, Langballe EM. Hospitalisation in adults with intellectual disabilities compared with the general population in Norway. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:365-377. [PMID: 26915087 DOI: 10.1111/jir.12255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 10/16/2015] [Accepted: 12/02/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Previous studies have found that adults with intellectual disabilities (ID) are hospitalised more often than the general population (GP). This study investigates hospital discharge rates and main diagnostic causes for hospitalisation among administratively defined people with ID compared with the GP in Norway. METHOD Data from the Norwegian Labour and Welfare Service was combined with data from the Norwegian Patient Register (Ntotal = 1 764 072 and NID = 7573) for the period 2008-2011. Data from a Norwegian patient report generator and Statistics Norway are also analysed. RESULTS During the study period, 11% of people with ID and 11.5% of the GP were admitted to hospitals. The length of the average hospital stay was just over 4 days for both groups. Among those who were hospitalised, the majority were only admitted to hospital once during the study period: ID 66% and GP 70%. People with ID were admitted somewhat more often than people in the GP. Contrary to the GP, adults with ID were more frequently hospitalised at a younger age and less frequently at old age. The most common International Classification of Diseases diagnostic group for hospitalisation among people with ID is injury, poisoning and certain other consequences of external causes, whereas for the GP, it is diseases of the circulatory system. CONCLUSION This study finds that the proportion of people being hospitalised per year is statistically, but only slightly, different among adult people with ID and the GP. The results must be interpreted in light of the organisation of the health care system in Norway.
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Affiliation(s)
- S Skorpen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway
| | - M Nicolaisen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - E M Langballe
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, and Department of Geriatric Medicine, Oslo University Hospital, Norway
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Mapping the Needs of Adults with Autism and Co-Morbid Intellectual Disability. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0071-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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McQuire C, Hassiotis A, Harrison B, Pilling S. Pharmacological interventions for challenging behaviour in children with intellectual disabilities: a systematic review and meta-analysis. BMC Psychiatry 2015; 15:303. [PMID: 26611280 PMCID: PMC4662033 DOI: 10.1186/s12888-015-0688-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 11/20/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Psychotropic medications are frequently used to treat challenging behaviour in children with intellectual disabilities, despite a lack of evidence for their efficacy. This systematic review and meta-analysis aimed to determine the safety and efficacy of pharmacological interventions for challenging behaviour among children with intellectual disabilities. METHODS Electronic databases were searched and supplemented with a hand search of reference lists and trial registries. Randomised controlled trials of pharmacological interventions for challenging behaviour among children with intellectual disabilities were included. Data were analysed using meta-analysis or described narratively if meta-analysis was not possible. For quality assessment, the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were used. RESULTS Fourteen studies including 912 participants met inclusion criteria. Antipsychotic medication reduced challenging behaviour among children with intellectual disabilities in the short-term (SMD = -1.09, p < 0.001 for risperidone; SMD = -0.64, p <0.001 for aripiprazole). However, there were significant side-effects including elevated prolactin levels (SMD = 3.22, p < 0.001) and weight gain (SMD = 0.82, p < 0.001). Evidence was inconclusive regarding the effectiveness of anticonvulsants and antioxidants for reducing challenging behaviour. The quality of all evidence was low and there were no long term follow up studies. CONCLUSIONS Antipsychotic medications appear to be effective for reducing challenging behaviour in the short-term among children with intellectual disabilities, but they carry a risk of significant side effects. Findings from this review must be interpreted with caution as studies were typically of low quality and most outcomes were based on a small number of studies. Further long-term, high-quality research is needed to determine the effectiveness and safety of psychotropic medication for reducing challenging behaviour.
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Affiliation(s)
- Cheryl McQuire
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB, UK.
| | - Angela Hassiotis
- Division of Psychiatry, University College London, Charles Bell House, 1st and 2nd Floor, 67-73 Riding House Street, London, W1W 7EJ, UK.
| | - Bronwyn Harrison
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, 21 Prescot Street, London, E1 8BB, UK.
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Grant WB, Wimalawansa SJ, Holick MF, Cannell JJ, Pludowski P, Lappe JM, Pittaway M, May P. Emphasizing the health benefits of vitamin D for those with neurodevelopmental disorders and intellectual disabilities. Nutrients 2015; 7:1538-64. [PMID: 25734565 PMCID: PMC4377865 DOI: 10.3390/nu7031538] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/16/2015] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
People with neurodevelopmental disorders and intellectual disabilities have much greater health care needs. Mainly staying indoors, such people generally have low 25-hydroxyvitamin D (25(OH)D) concentrations. The Vitamin D Task Force of the American Academy of Developmental Medicine and Dentistry (AADMD) reviewed the evidence of 25(OH)D concentrations that benefit the health of persons with developmental disabilities. Maintaining recommended optimal serum 25(OH)D concentrations year long will benefit skeletal development in infants, children, and adolescents, and benefit musculoskeletal health and neuromuscular coordination in adult patients, and decrease risk of falls. Maintaining optimal concentrations decreases risks and severities of autoimmune diseases, cardiovascular disease, many types of cancer, dementia, types 1 and 2 diabetes mellitus, and respiratory tract infections. Other benefits include improved dental and oral health and improved physical performance. The Task Force recommends that 25(OH)D concentrations for optimal health to be in the range of 75 to 125 nmol/L, which can be achieved using between 800 and 4000 IU/day vitamin D3 and sensible exposure to solar UVB radiation. The paper also discusses the potential risks of higher 25(OH)D concentrations, the evidence from and limitations of randomized controlled trials, and the recommendations by various groups and agencies.
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Affiliation(s)
- William B Grant
- Sunlight, Nutrition, and Health Research Center, PO Box 641603, San Francisco, CA 94164-1603, USA.
| | - Sunil J Wimalawansa
- Department of Medicine & Endocrinology, Cardio Metabolic Institute, Somerset, NJ 08873, USA.
| | - Michael F Holick
- Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, and the Vitamin D, Skin, and Bone Research Laboratory, Boston University Medical Center, Boston, MA 02118, USA.
| | - John J Cannell
- Vitamin D Council and San Luis Obispo Integrative Medicine, San Luis Obispo, CA 93401, USA.
| | - Pawel Pludowski
- Department of Biochemistry, Radioimmunology, and Experimental Medicine, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
| | - Joan M Lappe
- Creighton University School of Medicine, Omaha, NE 68131, USA.
| | - Mary Pittaway
- Global Clinical Advisor-Health Promotion, Special Olympics International and Affiliate Faculty, College of Education and Human Sciences, University of Montana, Missoula, MT 59812, USA.
| | - Philip May
- International Foundation for Chronic Disabilities, Inc., PO Box 166, Oxford, NJ 07863, USA.
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