Nutrition and adults with intellectual or developmental disabilities: systematic literature review results

Oral Motor Impairments Contribute to Weight Status of Adults with Severe Cerebral Palsy

Adults with severe cerebral palsy (CP) are susceptible to malnutrition and metabolic disorders due to limited daily physical activity and challenges related to eating. We hypothesized that the condition of being underweight arises from inadequate energy intake due to difficulties in eating, rather than heightened total energy expenditure or an elevated resting metabolic rate. The present study encompassed 17 adults with severe CP (classified as GMFSC III-V). Energy intake, utilization, and expenditure were gauged via thorough dietary recordings and double-labeled water (DLW) analyses. Resting metabolic rates were assessed through indirect calorimetry, and metabolic health was investigated via blood samples. Oral motor function, eating assessment during meals, and weight fluctuations throughout the experimental period were also evaluated. We found significant correlations between weight, oral impairments (p < 0.01), and eating difficulties (p < 0.05). While total energy expenditure and daily consumption were similar between underweight (UW) and overweight (OW) individuals, significant variability in both expenditure and intake was evident within the UW group. Particularly, those with lower BMIs experienced heightened mealtime impairments and complications. Our present findings indicate that eating difficulties are the central concern for UW status in this population.

Qualitative Insights from A Novel Staff-Led Oral Health Champions Program Within a Residential Service For People With Intellectual and Developmental Disability

The oral health of people with intellectual and developmental disability is poorer than that of the general community. Any solution for people with intellectual and developmental disability living in residential services needs to include disability support workers (DSWs). Previous studies have used either didactic or train-the-trainer approaches to enhance DSW knowledge and skills. Taking a different approach, a novel program used DSWs as embedded oral health champions. This model provided educational opportunities for DSWs to learn about good oral health and then share with peers and provide benefits to people with intellectual and developmental disability that they support. Interviews with a sample of these champions were conducted and analysed using content analysis. Findings suggest that DSWs are capable of affecting change with the right type and depth of training, management and organisational support. A DSW-led champions model has merit, however requires ongoing expert support to help maintain and sustain benefits over time.

'Get Healthy!' physical activity and healthy eating intervention for adults with intellectual disability: results from the feasibility pilot

BACKGROUND

People with intellectual disabilities (ID) experience high rates of lifestyle related morbidities, in part due to lack of access to tailored health promotion programmes. This study aimed to assess the feasibility and preliminary efficacy of a tailored healthy lifestyle intervention, Get Healthy!

METHODS

Get Healthy! is a 12-week physical activity and healthy eating programme designed to address lifestyle-related risks for adults with mild-moderate ID. The feasibility pilot was designed to assess subjective participant experience and programme feasibility across: recruitment and screening, retention, session attendance and engagement, adverse events, and practicality and reliability of outcome procedures. Exploratory programme efficacy was assessed across the following measures: anthropometry (body mass index, weight, waist circumference), cardiovascular fitness, physical strength, dietary intake, healthy literacy, and quality of life.

RESULTS

Six participants with moderate ID and two carer participants completed the feasibility trial, representing a 100% retention rate. Qualitative data indicated the programme was well received. Participants with ID attended 75% of sessions offered and displayed a high level of engagement in sessions attended (91% mean engagement score). While most data collection procedures were feasible to implement, several measures were either not feasible for our participants, or required a higher level of support to implement than was provided in the existing trial protocol. Participants with ID displayed decreases in mean waist circumference between baseline and endpoint (95% CI: - 3.20, - 0.17 cm) and some improvements in measures of cardiovascular fitness and physical strength. No changes in weight, body mass index, or objectively measured knowledge of nutrition and exercise or quality of life were detected from baseline to programme endpoint. Dietary intake results were mixed.

DISCUSSION

The Get Healthy! programme was feasible to implement and well received by participants with moderate ID and their carers. Exploratory efficacy data indicates the programme has potential to positively impact important cardiometabolic risk factors such as waist circumference, cardiovascular fitness, and physical strength. Several of the proposed data collection instruments will require modification or replacement prior to use in a sufficiently powered efficacy trial.

TRIAL REGISTRATION

ACTRN: ACTRN12618000349246. Registered March 8th 2018-retrospectively registered, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374497 UTN: U1111-1209-3132.

Interviews with parents of adolescents with intellectual and developmental disabilities in a weight management study

BACKGROUND

Adolescents and young adults with intellectual and developmental disabilities are at risk of obesity. Parents influence their diet and physical activity behaviours and therefore, can play important roles in weight management. The aims of this qualitative study were to explore parents' experiences assisting their son or daughter to participate in a weight management study.

METHODS

Interviews were completed at 6 months with 27 parents whose adolescent or young adult had completed the weight loss portion of an 18-month weight management study. Interviews were recorded, transcribed and thematic analysis performed.

RESULTS

Parents shared insights about how well program components worked with their family, and what strategies worked best to adopt healthier dietary choices and become more physically active. The importance of meeting regularly with someone outside the family to encourage healthier habits was stressed.

CONCLUSIONS

Future weight management studies should involve parents and their adolescents to help tailor strategies and adapt intervention approaches.

Obesity and Eligibility for Obesity Treatments Among Adults With Disabilities in the U.S

INTRODUCTION

Obesity has been associated with disability; yet, the proportion who meet clinical criteria for obesity treatment among adults with disabilities remains poorly defined. Characterization of obesity and treatment eligibility by disability type may prioritize high-need groups. This study assessed the prevalence of obesity and eligibility for antiobesity pharmacotherapy and/or bariatric surgery in adults with disability.

METHODS

This cross-sectional weighted analysis of the 2019 National Health Interview Survey, including self-reported health and sociodemographic information, was conducted in 2021. Burden of obesity defined by BMI and odds of meeting consensus criteria for antiobesity pharmacotherapy and/or surgery were calculated by functional disability type: vision, hearing, cognition, communication, mobility, and self-care.

RESULTS

From 29,170 community-dwelling adult respondents (59.1% response), the overall prevalence of disability was 10%. The prevalence of obesity among adults with a disability was 40.1% vs 30.5% for U.S. adults overall (p&lt;0.0001). An estimated 17.1% with disability met the criteria for both bariatric surgery and antiobesity pharmacotherapy; another 39.8% were eligible for pharmacotherapy alone (vs 7.9% and 33.2%, respectively, for adults overall; p&lt;0.0001). In fully adjusted models, disability was associated with greater ORs for mild obesity (OR=1.2; 95% CI=1.1, 1.4), moderate‒severe obesity (OR=2.1; 95% CI=1.8, 2.3), and criteria for bariatric surgery (OR=2.4; 95% CI=2.1, 2.7) and pharmacotherapy (OR=1.3; 95% CI=1.2, 1.4). Mobility, self-care, and cognition disabilities were associated with eligibility for bariatric surgery and antiobesity pharmacotherapy.

CONCLUSIONS

Individuals with disabilities have higher odds of obesity and eligibility for antiobesity treatments. Comorbidities should be considered, accommodations should be provided, and insurance coverage should be expanded to ensure access to antiobesity treatments for adults with disabilities.

Development of a Dutch Training/Education Program for a Healthy Lifestyle of People With Intellectual Disability

Individuals with intellectual disability (ID) need support from direct support professionals (DSPs) to engage in a healthy lifestyle. However, literature shows DSPs feel insufficiently equipped to support a healthy lifestyle. Therefore, the aim of this study is to develop a theory-based program for DSPs to support physical activity and healthy nutrition for people with moderate to profound levels of ID, and to design its evaluation. The Intervention Mapping Protocol (IM) was followed to develop a theory-based program for DSPs. The program evaluation consists of process and feasibility evaluations. This study provided a theory-based program consisting of a training and education section with online and face-to-face components to support DSPs in promoting health for people with ID.

Gaining actionable knowledge to improve local health-promoting capacities in long-term care support settings for people with intellectual disabilities

OBJECTIVE

People with intellectual disabilities (ID) are largely dependent on their environment to live healthily and, in this, ID-support organizations play a vital role. An environmental asset mapping tool for ID-support settings has been developed. This study aims to provide insight into whether or not the tool can provide a comprehensive view on assets in the system and actionable knowledge to improve health-promoting capacities in ID-support settings.

METHODS

Fifty-seven users from four setting completed the tool on availability, user satisfaction, and dreams regarding social, physical, organizational, and financial assets.

RESULTS

The findings provide a comprehensive view of available assets. Together with user satisfaction and dreams for improvements, they provide actionable knowledge for improving the health-promoting capacities of the settings, including: (1) how use of available assets can be improved, (2) the type of assets that should be enriched, and (3) the assets that can be added to the system.

CONCLUSION

The asset mapping tool provides a comprehensive view on assets in the system and actionable knowledge to improve health-promoting capacities in ID-support settings.

PRACTICE IMPLICATIONS

ID-support organizations can use the tool to generate actionable bottom-up knowledge for priority setting and implementing interventions to improve their health-promoting capacities.

Implementation of a program to support direct support professionals to promote a healthy lifestyle for people with moderate to profound intellectual disabilities

BACKGROUND

There is a lack of theory-based interventions for direct support professionals (DSPs) to support a healthy lifestyle for people with moderate to profound intellectual disabilities (ID) despite their major role in this. This study aims to evaluate the preparation, implementation, and preliminary outcomes of a theory-based training and education program for DSPs to learn how to support these individuals.

METHODS

The program consisting of e-learning, three in-person sessions, and three assignments was implemented. The implementation process was evaluated with a mixed method design with the following components: preparation phase, implementation phase, and the outcomes. These components were measured with project notes, questionnaires, interviews, reflections, assignments, food diaries, Actigraph/Actiwatch, and an inventory of daily activities.

RESULTS

Regarding the preparation phase, enough potential participants met the inclusion criteria and the time to recruit the participants was 9 months. The program was implemented in four (residential) facilities and involved individuals with moderate to profound ID (n = 24) and DSPs (n = 32). The e-learning was completed by 81% of the DSPs, 72-88% attended the in-person sessions, and 34-47% completed the assignments. Overall, the fidelity of the program was good. DSPs would recommend the program, although they were either negative or positive about the time investment. Mutual agreement on expectations were important for the acceptability and suitability of the program. For the outcomes, the goals of the program were achieved, and the attitudes of DSPs towards a healthy lifestyle were improved after 3 months of the program (nutrition: p = < 0.01; physical activity: p = 0.04). A statistically significant improvement was found for food intake of people with ID (p = 0.047); for physical activity, no statistically significant differences were determined.

CONCLUSIONS

The theory-based program consisting of a training and education section for DSPs to support a healthy lifestyle for people with moderate to profound ID was feasible to implement and, despite some barriers regarding time capacity and mutual expectations, it delivered positive changes in both persons with moderate to profound ID and DSPs. Thus, the program is a promising intervention to support DSPs.

Diet quality among people with intellectual disabilities and borderline intellectual functioning

Background

We sought to assess diet quality among people with intellectual disabilities or borderline intellectual functioning, living in residential facilities or receiving day care.

Methods

We measured diet quality using the Dutch Healthy Diet Food Frequency Questionnaire (DHD) and compared this between participants with (n = 151) and controls without intellectual disabilities (n = 169). Potential correlates of diet quality were explored.

Results

We found lower mean diet quality among people with intellectual disabilities (M = 80.9) compared to controls (M = 111.2; mean adjusted difference −28.4; 95% CI [−32.3, −24.5]; p < .001). Participants with borderline intellectual functioning and mild intellectual disabilities had lower diet quality and higher body mass index than individuals with severe to profound intellectual disabilities. Being female was a predictor of better diet quality.

Conclusions

Overall, we found that diet quality was low in the sample of people with intellectual disabilities or borderline intellectual functioning.

Comparison of energy intake assessed by image-assisted food records to doubly labelled water in adolescents with intellectual and developmental disabilities: a feasibility study

BACKGROUND

There are currently no validated methods for energy intake assessment in adolescents with intellectual and developmental disabilities (IDD). The purpose of this study was to determine the feasibility of collecting 3-day image-assisted food records (IARs) and doubly labelled water (TDEE_DLW ) data in adolescents with IDD and to obtain preliminary estimates of validity and reliability for energy intake estimated by IAR.

METHODS

Adolescents with IDD completed a 14-day assessment of mean daily energy expenditure using doubly labelled water. Participants were asked to complete 3-day IARs twice during the 14-day period. To complete the IAR, participants were asked to fill out a hard copy food record over three consecutive days (two weekdays/one weekend day) and to take before and after digital images of all foods and beverages consumed using an iPad tablet provided by the study. Energy intake from the IAR was calculated using Nutrition Data System for Research. Mean differences, intraclass correlations and Bland-Altman limits of agreement were performed.

RESULTS

Nineteen adolescents with IDD, mean age 15.1 years, n = 6 (31.6%) female and n = 6 (31.6%) ethnic/racial minorities, enrolled in the trial. Participants successfully completed their 3-day food records and self-collected doubly labelled water urine samples for 100% of required days. Images were captured for 67.4 ± 30.1% of all meals recorded at assessment 1 and 72.3 ± 29.5% at assessment 2. The energy intake measured by IAR demonstrated acceptable test-retest reliability (intraclass correlation = 0.70). On average, IAR underestimated total energy intake by -299 ± 633 kcal/day (mean per cent error = -9.6 ± 22.2%); however, there was a large amount of individual variability in differences between the IAR and TDEE_DLW (range = -1703 to 430).

CONCLUSIONS

The collection of IAR and TDEE_DLW is feasible in adolescents with IDD. While future validation studies are needed, the preliminary estimates obtained by this study suggest that in adolescents with IDD, the IAR method has acceptable reliability and may underestimate energy intake by ~9%.

The prevalence, awareness, treatment, and control of hypertension in older adults with an intellectual disability in Ireland: a cross sectional study

Aims

Hypertension is a leading risk factor for cardiovascular disease, accounting for almost 50% of ischaemic heart disease mortality. This study aims to identify the prevalence, awareness, treatment, and control of hypertension and their predictors in older adults with an intellectual disability (ID).

Methods and results

This cross-sectional study utilized data from the ID Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Participants were drawn from the nationally representative sample and included those who completed the self/informant report measures, in addition to objective blood pressure (BP) measurement. From the 551 individuals with ID, aged ≥40 years, hypertension prevalence was 35.2% [95% confidence interval (CI) 31.2–39.2%]. Of those with hypertension, 44.3% (95% CI 37.1–51.5%) were aware of their hypertensive status, and 64.2% (95% CI 57.3–71.1) were taking antihypertensive medication. Among those on treatment, 70.8% (95% CI 61.8–78.2%) had their BP controlled to below 140/90 mmHg. Significant predictors of awareness were age (P = 0.036) and level of ID (P = 0.004), predictors of treatment were age (P = 0.002), level of ID (P = 0.019), and diabetes (P = 0.001). Both diabetes and female gender were predictors of control of hypertension (P = 0.013 and P = 0.037, respectively).

Conclusion

The prevalence of hypertension in older adults with ID was lower than reports for the general Irish population, with overall levels of treatment and control, when identified, higher in the ID population. There was under-treatment and lower levels of awareness among those with more severe ID, which requires addressing. The finding, that when diagnosed, people with ID respond well to treatment should encourage addressing the under-treatment found here.

Introducing a nutritional app in supervised residences for independent living: Experiences of individuals with intellectual disabilities and their caregivers

BACKGROUND

Dietary challenges are common among individuals with intellectual disability residing in supervised living in Norway, and this is a major risk factor for health problems. The aim of this study was to explore feasibility of the nutrition tablet app APPetitus, among persons with intellectual disability and their formal caregivers.

METHOD

Joint dyad interviews with residents and caregivers were conducted after five individuals with intellectual disability used APPetitus for eight weeks. Seven formal caregivers and managers participated in subsequent focus group interviews. Thematic analysis informed the data analysis. The study complies with the Consolidated Criteria for Reporting Qualitative Research (COREQ).

RESULTS

The findings were mapped into three themes: APPetitus mediating nutritional conversations, residents' strategies to control the conversation and caregiver support as a required prerequisite for overall user comprehension.

CONCLUSIONS

The study demonstrates that a nutritional app can contribute to and normalize nutritional conversations, and empower residents to participate.

Nutritional and bone health status in young men with mild-to-moderate intellectual disability and without intellectual disability residing in community setting in Malaysia

BACKGROUND

This study aimed to compare the nutritional and bone health status between young men with mild-to-moderate intellectual disability and those without intellectual disability and to determine predictors for their bone health status.

METHOD

A total of 95 men (47 men with intellectual disability; 48 men without intellectual disability), aged 20-39 years, participated in this study. Anthropometric profile, dietary intake, physical activity level and calcaneal speed of sound (SOS) were collected.

RESULTS

The men with intellectual disability had moderate diet quality whilst the men without intellectual disability had poor diet quality. More participants with intellectual disability (97.9%) were inactive compared with their counterparts (10.4%). The SOS value was similar between groups and was lower than the reference. Increasing age and low physical activity level were negative predictors for bone health status.

CONCLUSION

Both young men with and without intellectual disability have suboptimal nutritional and bone health status. Strategies to improve their nutritional and bone health status are warranted.

Improving Environmental Capacities for Health Promotion in Support Settings for People with Intellectual Disabilities: Inclusive Design of the DIHASID Tool

People with intellectual disabilities (ID) have unhealthier lifestyles than the general population. To sustainably improve their lifestyle and health status, a whole-system approach to creating healthy environments is crucial. To gain insight into how support for physical activity and healthy nutrition can be embedded in a setting, asset mapping can be helpful. Asset mapping involves creating a bottom-up overview of promoting and protective factors for health. However, there is no asset mapping tool available for ID support settings. This study aims to develop an asset mapping tool in collaboration with people with ID to gain insight into assets for healthy nutrition and physical activity in such settings. The tool is based on previous research and development continued in an iterative and inclusive process in order to create a clear, comprehensive, and usable tool. Expert interviews (n = 7), interviews with end-users (n = 7), and pilot testing (n = 16) were conducted to refine the tool. Pilot participants perceived the tool as helpful in pinpointing perceived assets and in prompting ideas on how to create inclusive environments with support for physical activity and healthy nutrition. This overview of assets can be helpful for mobilizing assets and building the health-promoting capacities of ID support settings.

Observed Dietary Intake in Adults with Intellectual Disability Living in Group Homes

Background: There is limited information on the dietary intakes of people with intellectual disability (ID) living in group homes. Objective: To describe and evaluate dietary intake in people with ID. Method: Dietary intake was assessed in a convenience sample of people with ID living in group homes. Dietary assessment used three-day weighed food records and digital food photography. Intakes were compared to the Nutrient Reference Values (NRVs) and dietary recommendations. Results: A sample of 33 adults, (men (M): n = 14; women (W): n = 19), mean age 51 ± 14 years, was recruited from seven group homes. Mean daily energy intake was low (M: 7.4 MJ; W: 7.0 MJ; p = 0.46), similar to levels recommended for bed rest. Many participants had intakes below the estimated average requirements (EARs) for the nutrients, magnesium (M: 86%; W: 63%), calcium (M: 43%; W: 78%), iodine (M: 43%; W: 47%) and zinc (M: 43%). Less than half of the recommended daily servings were consumed for vegetables (men and women) and dairy foods (women). Conclusion: Nutrient intake and diet quality of the participants in the group homes studied was poor. Education and policy to support healthier diets is required to improve dietary intake of people with intellectual disability, living in group homes.

Laxative use among older adults with intellectual disability: a cross-sectional observational study

BACKGROUND

Chronic constipation is a prevalent issue in older people with intellectual disabilities and may have a significant negative impact on quality of life. The use of laxatives have not been adequately studied in this population.

OBJECTIVE

To examine laxatives in relation to prevalence, pattern, dosage, reported indication and correlates.

SETTING

Older people with intellectual disabilities who live independently, in community group homes or residential care in Ireland.

METHOD

Data was extracted from wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Descriptive statistics, bivariate analyses and multiple logistic regression were carried out. Laxative use was analysed using two indicators for chronic constipation, reported doctor's diagnosis of constipation and Rome III criteria.

MAIN OUTCOME MEASURE

Laxative use.

RESULTS

Among the cohort n = 677, chronic constipation was reported by 38.5% (n = 257). In total 41.5% (n = 281) reported 431 laxatives (mean ± 1.53 ± 0.74), with 74.3% (n = 209) of those with laxative use reporting chronic constipation. There were 40% (n = 113) who took 2 + laxatives, within which, 60% (n = 67) were using a combination from same laxative class. Reporting chronic constipation, living in residential care, exposure to anticholinergics and receiving soft/liquidized food were significantly associated with laxative use.

CONCLUSION

Chronic constipation and laxative use were highly prevalent in this study of older adults with intellectual disabilities. The treatment of constipation appeared to be unsystematic. Intra-class laxative use was frequent. There is a need for evidence-based treatment guidelines developed especially for people with intellectual disabilities to provide effective, quality care.

Physical Activity and Sedentary Time in Active and Non-Active Adults with Intellectual Disability: A Comparative Study

This study describes and compares physical activity (PA) levels and sedentary time (ST) of active (AG) and a non-active (NAG) groups of adults with intellectual disability (ID) versus a group of adults without ID. Thirty-seven participants from the AG, 29 from the NAG, and 31 adults without ID participated in this study. Height and weight were obtained to calculate body mass index (BMI). PA levels and ST were assessed with GT3X Actigraph accelerometers for 7 days. Results revealed that the AG engaged in higher values of moderate to vigorous PA compared with the NAG (all p < 0.05), but were similar to adults without ID. Adults without ID performed less ST and more light PA than the ID groups (all p < 0.05). The participants of the AG did not demonstrate less ST than the NAG. It is concerning that adults with ID (AG or NAG) are spending a higher time in ST and less time in light PA than adults without ID. Our results suggest that integrated, well-designed PA programmes into the ID population workdays can lead to increased PA levels. Nevertheless, these interventions and exercise programmes implemented for adults with ID should be tailored to also reduce ST.

The nutritional status of adult female patients with disabilities in Kuwait

Objectives

Adults with disabilities are at a higher risk of malnutrition than are their non-disabled counterparts owing to feeding problems and associated medical conditions. We evaluated the prevalence of malnutrition in a group of institutionalized women and investigated any feeding difficulties and nutrition-related medical problems.

Methods

This study used two versions of the Mini Nutritional Assessment-Short Form (MNA-SF) to screen malnutrition: the MNA-SF1 which uses the body mass index, and the MNA-SF2 which uses the calf circumference. Data were collected from 53 women with intellectual and physical disabilities in a cross-sectional survey of residents of the Kuwait Rehabilitation Centre.

Results

Of all participants, 63.5% were found to be overweight or obese, while 11.5% were underweight. Using the MNA-SF1, 57.7% were found to be at risk of malnourishment while 11.5% were malnourished. More patients were identified to be at risk of malnutrition or to be actually malnourished using the MNA-SF2 (59.6% and 23.1%, respectively). Reported feeding problems included difficulties in maintaining a sitting position, manipulating food on a plate, conveying food to the mouth, and in swallowing. The presence of infections worsened the prognoses of malnourished women regardless of their weight status.

Conclusions

Our findings suggest that MNA-SF2 is a more sensitive tool for identifying malnourishment than MNA-SF1. Obesity can obscure the identification of malnourished patients if clinicians rely solely on the MNA-SF1, which uses the body mass index.

The Perceived Role of Direct Support Professionals in the Health Promotion Efforts of Adults With Developmental Disabilities Receiving Support Services

Direct support professionals (DSPs) play a large social role in the lives of people with developmental disabilities (DD) and have the potential to influence their health behaviors. Six qualitative focus groups ( n = 48) were conducted with DD community agency administrators, DSPs, family members and adults with DD to better understand the perceived role of DSPs in the health promotion efforts of those with DD. Findings from this study suggest that DSPs experience several barriers when trying to promote the health of those with DD, one of which is fear of violating the rights of people with DD. Future work should identify ways to overcome the barriers experienced by DSPs, so that they can better assist people with DD with health promotion efforts.

Changes in Energy Intake and Diet Quality during an 18-Month Weight-Management Randomized Controlled Trial in Adults with Intellectual and Developmental Disabilities

BACKGROUND

Previous research indicates that individuals with intellectual and developmental disabilities (IDDs) are at risk for poor diet quality.

OBJECTIVE

The purpose of this secondary analysis was to determine whether two different weight-loss diets affect energy intake, macronutrient intake, and diet quality as measured by the Healthy Eating Index-2010 (HEI-2010) during a 6-month weight-loss period and 12-month weight-management period, and to examine differences in energy intake, macronutrient intake, and HEI-2010 between groups.

DESIGN

Overweight/obese adults with IDDs took part in an 18-month randomized controlled trial and were assigned to either an enhanced Stop Light Diet utilizing portion-controlled meals or a conventional diet consisting of reducing energy intake and following the 2010 Dietary Guidelines for Americans. Proxy-assisted 3-day food records were collected at baseline, 6 months, and 18 months, and were analyzed using Nutrition Data System for Research software. HEI-2010 was calculated using the data from Nutrition Data System for Research.

PARTICIPANTS/SETTING

The study took place from June 2011 through May 2014 in the greater Kansas City metropolitan area.

MAIN OUTCOME MEASURES

This was a secondary analysis of a weight-management intervention for adults with IDDs randomized to an enhanced Stop Light Diet or conventional diet, to examine differences in energy intake, macronutrient intake, and HEI-2010 across time and between groups.

STATISTICAL ANALYSES PERFORMED

Independent- and paired-samples t tests and general mixed modeling for repeated measures were performed to examine group differences and changes at baseline, 6 months, and 18 months between the enhanced Stop Light Diet and conventional diet groups.

RESULTS

One hundred and forty six participants (57% female, mean±standard deviation age=36.2±12.0 years) were randomized to either the enhanced Stop Light Diet or conventional diet group (77 enhanced Stop Light Diet, 69 conventional diet) and provided data for analysis at baseline, 124 completed the 6-month weight-loss period, and 101 completed the 18-month study. Participants on the enhanced Stop Light Diet diet significantly reduced energy intake at 6 and 18 months (both P<0.001), but those on the conventional diet did not (both P=0.13). However, when accounting for age, sex, race, education level, and support level (mild vs moderate IDD), there was a significant decrease during the 18-month intervention in energy intake for the enhanced Stop Light Diet and conventional diet groups combined (P<0.01 for time effect), but no significant group difference in this change (P=0.39 for group-by-time interaction). There was no significant change in total HEI-2010 score at 6 and 18 months (P=0.05 and P=0.38 for the enhanced Stop Light Diet group; P=0.22 and P=0.17 for the conventional diet group), and no significant group difference at 6 and 18 months (P=0.08 and P=0.42). However, when participants' age, sex, race, education level, and support level were accounted for, mixed modeling indicated a significant increase in total HEI-2010 scores for the enhanced Stop Light Diet and conventional diet groups combined during the 18-month intervention (P=0.01 for time effect).

CONCLUSIONS

The results of this study found that after controlling for demographic factors, individuals with IDDs can decrease their energy intake and increase their diet quality, with no significant differences between the enhanced Stop Light Diet and conventional diet groups.

Body Composition in Adults With Intellectual Disabilities: Implications for Practice

Health care professionals require increased knowledge of health and disabilities to effectively implement health promotion initiatives at both the individual and group level for adults with intellectual disabilities (ID). The aim of this review is to examine the feasibility, reliability, and validity of various field-based measurements to assess body composition among adults with ID as compared to nondisabled controls. The literature was systematically searched from 1990 to 2017 for primary articles pertaining to the subject matter that were published in the English language and included only individuals ≥18 years of age. 1,989 studies were screened and 8 studies were included for review. Several field-based measurements for body composition are feasible and reliable yet none have been validated for use in adults with ID. Awareness of the various methods for assessing body composition in adults with ID in clinical practice, while simultaneously understanding their limitations, is necessary.

Constipation management in people with intellectual disability: A systematic review

BACKGROUND

Constipation can lead to serious health issues and death. This systematic review summarizes international research pertaining to the management of constipation in people with intellectual disability.

METHOD

Studies published from 1990 to 2017 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests and cross-citations. Studies were reviewed narratively in relation to identified themes.

RESULTS

Eighteen studies were reviewed in relation to three themes: laxative receipt; interventions (dietary fibre, abdominal massage and macrogol); and staff issues (knowledge and training). Laxative polypharmacy was common. Studies report positive results for dietary fibre and abdominal massage although study quality was limited.

CONCLUSION

The main management response to constipation in people with intellectual disability is laxative use despite limited effectiveness. An improved evidence base is required to support the suggestion that an individualized, integrated bowel management programme may reduce constipation and associated health conditions in people with intellectual disability.

POWERS forID: Personalized Online Weight and Exercise Response System for Individuals with Intellectual Disability: study protocol for a randomized controlled trial

BACKGROUND

Intellectual disability (ID) is characterized by limitations in intellectual functioning and adaptive behavior. Adults with ID exhibit higher rates of obesity and poorer health status compared to the general population. Continuity of care and barriers to health-related activities may contribute to the poorer health status observed in this population. To address this problem, a tailored weight management online health information and communication technology platform, known as POWERSforID, was developed and is being tested to determine if this delivery mechanism can improve weight maintenance/weight loss in adults with ID.

METHODS

Obese adults with mild-to-moderate ID (n = 70) are randomized to the POWERS forID intervention or control group for a 24-week trial. Each group undergoes an assessment that includes body weight, waist circumference, and percent body fat at baseline and at weeks 6, 12, and 24. Physical activity barriers, healthy eating barriers, food frequency, and psychosocial wellbeing are measured at baseline and at weeks 12 and 24. Blood lipids are assessed at baseline and 24 weeks. Participants randomized to POWERS forID receive access to the POWERS forID website and calls from a health coach (weekly during weeks 1-12, biweekly during weeks 13-24). The health coach employs motivational interviewing techniques adapted for individuals with ID to promote behavior change. Participants randomized to the control group receive standard clinical weight-loss care. Differences in weight, waist circumference, blood lipids, percent body fat, and psychosocial self-report will be assessed. Barriers and facilitators of implementation as well as perception of study outcomes will be conducted via qualitative analysis.

DISCUSSION

POWERS forID is a novel information and communication technology platform designed to address health needs for adults with ID. This article describes the development and components of POWERS forID. The overall aim is to assess usability and feasibility of POWERS forID for promoting weight loss for obese adults with ID over the course of a 24-week randomized control trial.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT03139760 . Registered on XXX.

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.

Definitions, measurement and prevalence of sedentary behaviour in adults with intellectual disabilities - A systematic review

Supporting positive change in lifestyle behaviours is a priority in tackling the health inequalities experienced by adults with intellectual disabilities. In this systematic review, we examine the evidence on the definition, measurement and epidemiology of sedentary behaviour of adults with intellectual disabilities. A systematic literature search of PUBMED, EMBASE, MEDLINE and Google Scholar was performed to identify studies published from 1990 up to October 2015. Nineteen papers met the criteria for inclusion in the systematic review. Many researchers do not distinguish between insufficient physical activity and sedentary behaviour. None of the studies reported the reliability and validity of the methods used to measure sedentary behaviour. Sedentary time, assessed objectively, ranged from 522 to 643min/day: higher than in adults without intellectual disabilities. This first-ever review of sedentary behaviour and intellectual disabilities found that at present the evidence base is weak. Studies calibrating accelerometer data with criterion measures for sedentary behaviour are needed to determine specific cut-off points to measure sedentary behaviour in adults with intellectual disabilities. Researchers should also examine the reliability and validity of using proxy-report questionnaires to measure sedentary behaviour in this group. A better understanding of sedentary behaviour will inform the design of novel interventions to change lifestyle behaviours of adults with intellectual disabilities.

Feasibility of Assessing Diet with a Mobile Food Record for Adolescents and Young Adults with Down Syndrome

Technology-based methods for assessing diet in those with disability remains largely unexplored. The aim was to assess the feasibility of assessing diet with an image-based mobile food record application (mFR) in 51 adolescents and young adults with Down syndrome (PANDs). Adherence was also assessed with the instruction to include a fiducial marker object in the before and after eating images. The PANDs sample completed a four-day mFR and results were compared with a sample of young adults from the Connecting Health and Technology study (CHAT, n = 244). Compared to the CHAT sample, PANDs participants reported more fruit (2.2 ± 1.8 versus 1.0 ± 0.9 serves respectively) and vegetables (2.4 ± 1.3 versus 1.9 ± 1.0 serves, respectively), but no differences in energy-dense nutrient-poor (EDNP) foods and beverages were observed. Compared to CHAT, PANDs participants captured fewer images with the mFR (4.9 ± 2.3 versus 4.0 ± 1.5 images, respectively). Adherence to the instruction to include the fiducial marker in images was lower for PANDs compared with the CHAT sample (90.3% versus 96.5%). Due to the quality of information captured in images and the high acceptability of the fiducial marker, the mFR shows great promise as a feasible method of assessing diet in adolescents and young adults with Down syndrome.

Dietary and physical activity behaviors of adults with developmental disabilities and their direct support professional providers

BACKGROUND

People with developmental disabilities lead more sedentary lifestyles, consume poorer diets, as well as have higher rates of chronic conditions such as diabetes and heart disease when compared to members of the general population. Direct support professionals play a large social role in the lives of their clients with developmental disabilities, and thus have the ability to influence the health behaviors of their clients.

OBJECTIVES

The overall purpose of this study was to examine the relationship between the dietary and physical activity behaviors of direct support professionals and their clients with developmental disabilities, as well as to assess how direct support professionals facilitate the health behaviors of their clients.

METHODS

A statewide random sample of direct support professionals (n = 398) completed an online survey about their own dietary/physical activity behaviors and these same health behaviors of their adult clients with developmental disabilities. Pearson/Spearman correlations were used to examine the relationship between the health behaviors of direct support professionals and their clients with developmental disabilities.

RESULTS

Small-to-moderate correlations (ρ or r = 0.127-0.333) between direct support professionals' and clients' behaviors existed for all dietary and physical activity health behaviors except for participation in some sort of moderate-to-vigorous physical activity each week (ρ = 0.098, p = 0.06).

CONCLUSIONS

Direct support professionals appear to play a role in the dietary/physical activity behaviors of their clients; however, future research on this topic should also include other key members of the social networks of adults with developmental disabilities such as family members, roommates, and day-habilitation providers.

Development and Pilot Testing of a Healthy Eating Video-Supported Program for Adults with Developmental Disabilities

Video technology is a potentially effective means to teach individuals with developmental disabilities (DD) about healthy eating. Research in this area, however, is relatively unexplored. This study developed and tested a video intervention to teach healthy eating to adults with DD. A 5-segment educational video, an accompanying workbook, and a facilitator guide were developed to teach basic healthy eating concepts to adults with DD. Twelve adults with DD took part in a 5-week educational program led by trained facilitators using the materials created. Pre- and posttests were used to measure knowledge gained from participating in the intervention. Seventy-five percent (n = 9) of participants improved their knowledge scores, 8% (n = 1) maintained residue knowledge, and 17% (n = 2) had a decrease in their score. Video instructions can be an effective intervention modality to increase knowledge in adults with DD about healthy eating. Key enablers identified for participants' knowledge gain included video content developed based on the learning need and cognitive level of intended users; program delivered by facilitators trained in effective teaching strategies; and engaging the participants' staff, family, and caregivers to provide ongoing reinforcement about healthy eating.

Weight, nutrition, food choice, and physical activity in adults with intellectual disability

BACKGROUND

The aim of this study was to describe the nutrition, food choice, physical activity and weight status in a group of adults with intellectual disability (ID) in Victoria, Australia.

METHOD

Disability workers and adults with ID were recruited through disability services. In total, 51 disability workers (11 men, 40 women) and 68 (47 men, 21 women) adults with ID participated in the research. Disability workers provided information about the nutrition, food choice and physical activity levels of adults with ID through a questionnaire administered by a general practitioner or research nurse. The questionnaire also included The Australian Nutrition Screening Initiative checklist.

RESULTS

Body Mass Index was in the healthy range for only 37.5% of participants and in the obese range for almost half (41%). Similarly, the majority of participants had an abdominal circumference in a range that put them at increased or substantially increased risk of metabolic complications. The mean score obtained on the Australian Nutrition Screening Initiative checklist indicated a moderate risk of malnutrition (M = 4.2); however, 17.6% of participants achieved scores that put them in the high-risk category. More than half of the participants were reported to have a little choice in the type of food they ate and when they ate. Physical activity data indicated that the majority of participants (60.3%) did not meet national physical activity guidelines.

CONCLUSIONS

These findings suggest that people with ID are at risk of developing diseases associated with obesity, inactivity, and poor nutrition. Strategies to encourage people with ID to engage in physical activity and healthy eating are, therefore, a matter of priority and should involve their disability workers.

Morbidity and mortality of women and men with intellectual and developmental disabilities newly initiating antipsychotic drugs

BACKGROUND

While up to 45% of individuals with intellectual and developmental disabilities (IDD) have a comorbid psychiatric disorder, and antipsychotics are commonly prescribed, gender differences in the safety of antipsychotics have rarely been studied in this population.

AIMS

To compare men and women with IDD on medical outcomes after antipsychotic initiation.

METHOD

Our population-based study in Ontario, Canada, compared 1457 women and 1951 men with IDD newly initiating antipsychotic medication on risk for diabetes mellitus, hypertension, venous thromboembolism, myocardial infarction, stroke and death, with up to 4 years of follow-up.

RESULTS

Women were older and more medically complex at baseline. Women had higher risks for venous thromboembolism (HR 1.72, 95% CI 1.15-2.59) and death (HR 1.46, 95% CI 1.02-2.10) in crude analyses; but only thromboembolism risk was greater for women after covariate adjustment (aHR 1.58, 95% CI 1.05-2.38).

CONCLUSIONS

Gender should be considered in decision-making around antipsychotic medications for individuals with IDD.

DECLARATION OF INTEREST

None.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Feasibility of bioelectrical impedance analysis in persons with severe intellectual and visual disabilities

BACKGROUND

Body composition measurements provide important information about physical fitness and nutritional status. People with severe intellectual and visual disabilities (SIVD) have an increased risk for altered body composition. Bioelectrical impedance analysis (BIA) has been evidenced as a reliable and non-invasive method to asses body composition in healthy persons and various patient populations; however, currently, there is no feasible method available to determine body composition in people with SIVD. In this study, therefore, we aimed to assess the feasibility of BIA measurements in persons with SIVD.

METHODS

In 33 participants with SIVD and Gross Motor Functioning Classification System (GMFCS) Scale I, II, III, or IV, two BIA measurements were sequentially performed employing Resistance and Reactance in Ohm and fat-free mass (FFM) in kg as outcome variables, utilizing the Bodystat(®) QuadScan 4000. Feasibility was considered sufficient if ≥ 80% of the first measurement was performed successfully. Agreement between two repeated measurements was determined by using the paired t-test and Intraclass Correlation Coefficient (ICC; two way random, absolute agreement). Bland-Altman analyses were utilized to determine limits of agreement (LOAs) and systematic error. Agreement was considered acceptable if LOAs were <10% of the mean of the first measurement.

RESULTS

The first BIA measurements were completed successfully in 88% of the participants. The paired t-test demonstrated no significant differences in Resistance, Reactance, and FFM between BIA Measurements 1 and 2 (P=0.140, 0.091, and 0.866). ICC was 0.965 (95% CI: 0.922-0.984) for Resistance; 0.858 (95% CI: 0.705-0.934) for Reactance; and 0.992 (95% CI: 0.982-0.996) for FFM. LOAs expressed as a percentage of the mean of Measurement 1 were 6.1% for Resistance, 17.6% for Reactance, and 3.8% for FFM.

CONCLUSIONS

The results of this study suggest that BIA measurements seem to be feasible in persons with SIVD. Although these results require confirmation in a more extensive sample of persons with SIVD, the findings of this study are an important first step in the assessment of applicability of BIA measurements for non-invasive monitoring of physical fitness and nutritional status of persons with SIVD.

Food security among young adults with disabilities in the United States: Findings from the National Health Interview Survey

BACKGROUND

Prior research has suggested that young adults with disabilities face economic, health and social disadvantage. Food security, an area of disadvantage that can influence overall health, has not been fully explored for this population.

OBJECTIVE/HYPOTHESIS

To examine levels of food security between young adults with and without disabilities, controlling for individual characteristics.

METHODS

Logistic regression analysis of a nationally representative sample of young adults (age 18-25) (n = 32,795) with and without disabilities, using pooled data form the 2011-2013 National Health Interview Survey.

RESULTS

Young adults with disabilities have significantly higher odds (OR: 2.58, p < 0.001) of living in a household that is food insecure than young adults without disabilities, even when controlling for individual characteristics. Odds of living in a household that is food insecure are particularly high (OR: 5.35, p < 0.001) among young adults with high levels of psychological distress, controlling for other factors.

CONCLUSIONS

Young adults with disabilities have increased odds of living in a household that is food insecure. This study has important policy and community program implications.

Dietary aspects related to health and obesity in Williams syndrome, Down syndrome, and Prader-Willi syndrome

Background

Dietary aspects that might contribute to development of obesity and secondary conditions are not well documented in genetic subgroups associated with intellectual disability.

Objective

To describe the intake frequencies of selected foods in participants with Prader–Willi syndrome (PWS), Down syndrome (DS), and Williams syndrome (WS), and investigate the association with body mass index (BMI). To explore food-related autonomy and intake frequencies among persons with DS in different living arrangements.

Methods

Self-reported intake frequencies and measurement of plasma carotenoids and erythrocyte content of omega-3 fatty acids (FAs) were investigated in persons aged 16–42 years, with WS (n=21), DS (n=40), and PWS (n=20).

Results

A larger proportion of participants with PWS showed high-frequency intake of fruits (p=0.012) and vegetables (p=0.004), and had higher plasma carotenoids (p<0.001) compared to participants with DS and WS. Furthermore, a larger proportion of participants with WS were low-frequency consumers of fish (p=0.005), less likely to use omega-3 FA supplements (p=0.023), and had reduced erythrocyte concentrations of long-chain omega-3 FAs (p<0.001), compared to participants with PWS and DS. In DS, BMI was negatively associated with plasma carotenoids. Increased proportions of participants living in communities showed high-frequency intake of precooked meals (p=0.030), and a tendency toward high-frequency consumption of soft drinks (p=0.079), when compared to peers living with relatives. Participants in community residences were also more likely to participate frequently in food-related decisions and preparations.

Conclusions

Persons with WS had a less-favorable dietary pattern when compared to persons with PWS. A larger proportion of persons living in communities frequently consumed precooked meals and showed a tendency of high-frequency soft drink consumption. Otherwise, their intake frequencies of the investigated foods were similar to those living with relatives, but they participated more frequently in decisions and preparations of foods.

Primary care for adults on the autism spectrum

Autism spectrum disorder (ASD) is defined by differences in social communication and restricted, repetitive patterns of behavior, interests, or activities. Skills and challenges can change depending on environmental stimuli, supports, and stressors. Quality of life can be improved by the use of accommodations, assistive technologies, therapies to improve adaptive function or communication, caregiver training, acceptance, access, and inclusion. This article focuses on the identification of ASD in adults, referrals for services, the recognition of associated conditions, strategies and accommodations to facilitate effective primary care services, and ethical issues related to caring for autistic adults.

Implementation of a group-based physical activity programme for ageing adults with ID: a process evaluation

RATIONALE, AIM AND OBJECTIVES

This paper describes the results of the process evaluation of a physical activity programme for people with intellectual disabilities (ID), including information about the concepts 'fidelity', 'dose delivered', 'satisfaction' and 'context'.

METHODS

Qualitative and quantitative methods among participants and programme leaders were used.

RESULTS

The programme was well accepted, feasible and applicable to ageing people with ID. It was successfully implemented in terms of fidelity and dose delivered, although differences between day-activity centres were observed.

CONCLUSIONS

The hampering factors that are revealed in this study and the facilitating activities that were part of the implementation plan may be used by care provider services for (ageing) people with ID and other groups of people with cognitive and/or physical deficits, such as frail elderly people or people with dementia when developing and or preparing implementation of health promotion programmes.

Evaluating a health behaviour model for persons with and without an intellectual disability

BACKGROUND

Based on the idea of the Common Sense Model of Illness Representations by Leventhal as well as Lohaus's concepts of health and illness, a health behaviour model was designed to explain health behaviours applied by persons with intellectual disabilities (ID). The key proposal of this model is that the way someone understands the concepts of health, illness and disability influences the way they perceive themselves and what behavioural approaches to them they take.

METHOD

To test this model and explain health differences between the general population and person with ID, 230 people with ID and a comparative sample of 533 persons without ID were included in this Austrian study. Data were collected on general socio-demographics, personal perceptions of illness and disability, perceptions of oneself and health-related behaviours.

RESULTS

Psychometric analysis of the instruments used showed that they were valid and reliable and hence can provide a valuable tool for studying health-related issues in persons with and without ID. With respect to the testing of the suggested health model, two latent variables were defined in accordance to the theory. The general model fit was evaluated by calculating different absolute and descriptive fit indices. Most indices indicated an acceptable model fit for all samples.

CONCLUSIONS

This study presents the first attempt to explore the systematic differences in health behaviour between people with and without ID based on a suggested health model. Limitations of the study as well as implications for practice and future research are discussed.

Diet Quality of Overweight and Obese Adults with Intellectual and Developmental Disabilities as Measured by the Healthy Eating Index-2005

BACKGROUND

Little research has been conducted to examine diet quality of overweight and obese adults with intellectual and developmental disabilities (IDD) in the United States. The purpose of this study was to determine diet quality, as measured by the Healthy Eating Index-2005 (HEI-2005), of overweight and obese adults with IDD.

METHODS

Data were obtained from community-dwelling overweight individuals. 3-day food records were administered and completed with assistance by staff or family members and then reviewed by a dietitian. All records were analyzed and HEI-2005 was calculated using NDSR output.

RESULTS

178 records were analyzed from 70 subjects (28 male, 42 female; mean age 33.9 ±11.5 years). The mean energy intake was 1928 ± 891 kcals and the mean total HEI-2005 score was 46.7± 11.5. Participants scored the lowest in total fruits, whole grains, dark green and orange vegetables, non-hydrogenated vegetable oils, and sodium. Both male and females had diets deficient in fiber, vitamin A, vitamin D, vitamin E, folate, and potassium. Additionally men were deficient in vitamin K, and women were deficient in calcium.

CONCLUSIONS

Overweight and Obese adults with IDD had a lower HEI-2005 score compared to the general population and are at an increased risk of poor diet quality and nutritional deficiencies that could contribute to the development of diabetes, cardiovascular disease, cancer and other health complications.

Health and wellbeing of Victorian adults with intellectual disability compared to the general Victorian population

Multiple measures of health and wellbeing of people with intellectual disability (ID) and the general Victorian population were compared using representative population level data. The sample consisted of adults with ID (N=897) and the general Victorian population (N=34,168) living in the state of Victoria in Australia. Proxy respondents were interviewed on behalf of people with ID, while respondents from the general Victorian population were interviewed directly. The data were weighted to reflect the age/sex/geographic distribution of the population. Results revealed that adults with ID reported higher prevalence of poor social determinants of health, behavioural risk factors, depression, diabetes, poor or fair health. A higher proportion of people with ID reported blood pressure and blood glucose checks, while a lower proportion reported cervical and breast cancer screening, compared with the general Victorian population. The survey identified areas where targeted approaches may be undertaken to improve the health outcomes of people with ID and provide an important understanding of the health and wellbeing of these Victorians.

Photo-assisted recall increases estimates of energy and macronutrient intake in adults with intellectual and developmental disabilities

Diet assessment of adults with intellectual and developmental disabilities is challenging because of their limited cognitive abilities. The objective of this study was to examine the feasibility and outcomes of combining photos with 24-hour dietary recalls for the assessment of energy and macronutrient intakes in adults with intellectual and developmental disabilities. Participants used an iPad 2 tablet computer (Apple) to take photos of all food and beverages consumed before a standard, multiple-pass, 24-hour dietary recall. After the standard 24-hour diet recall, the photos were reviewed with the participant for clarification details (eg, portion size) and differences were recorded. The standard 24-hour recall and photo-assisted recall were entered separately into the Nutrition Data System for Research for computerized dietary analysis. Sixty-four eating occasions were entered from 23 participants (48% female; mean age 26.4±9.7 years). Participants captured photos for 66.5%±30.4% of all recorded eating occasions. Greater energy intake per eating occasion was reported with the photo-assisted recalls than the standard recalls (625.6±85.7 kcal vs 497.2±86.6 kcal; P=0.002) and a greater intake of grams of fat (P=0.006), protein (P=0.029), and carbohydrates (P=0.003). Photo-assisted 24-hour recalls provided a significant increase in total calories and macronutrient content compared with a standard 24-hour recall and may be a feasible method to enhance dietary assessment in adults with intellectual and developmental disabilities.

The state of the science of health and wellness for adults with intellectual and developmental disabilities

Historically, people with intellectual and developmental disabilities (IDD) have experienced health disparities related to several factors including: a lack of access to high quality medical care, inadequate preparation of health care providers to meet their needs, the social determinants of health (e.g., poverty, race and gender), and the failure to include people with IDD in public health efforts and other prevention activities. Over the past decade, a greater effort has been made to both identify and begin to address myriad health disparities experienced by people with IDD through a variety of activities including programs that address health lifestyles and greater attention to the training of health care providers. Gaps in the literature include the lack of intervention trials, replications of successful approaches, and data that allow for better comparisons between people with IDD and without IDD living in the same communities. Implications for future research needed to reduce health disparities for people with IDD include: better monitoring and treatment for chronic conditions common in the general population that are also experienced by people with IDD, an enhanced understanding of how to promote health among those in the IDD population who are aging, addressing the health needs of people with IDD who are not part of the disability service system, developing a better understanding of how to include people with IDD in health and wellness programs, and improving methods for addressing the health care needs of members of this group in an efficient and cost-effective manner, either through better access to general medical care or specialized programs.

Assessment and management of nutrition and growth in Rett syndrome

OBJECTIVES

We developed recommendations for the clinical management of poor growth and weight gain in Rett syndrome through evidence review and the consensus of an expert panel of clinicians.

METHODS

Initial draft recommendations were created based upon literature review and 34 open-ended questions in which the literature was lacking. Statements and questions were made available to an international, multidisciplinary panel of clinicians in an online format and a Microsoft Word-formatted version of the draft via e-mail. Input was sought using a 2-stage modified Delphi process to reach consensus. Items included clinical assessment of growth, anthropometry, feeding difficulties and management to increase energy intake, decrease feeding difficulties, and consideration of gastrostomy.

RESULTS

Agreement was achieved on 101 of 112 statements. A comprehensive approach to the management of poor growth in Rett syndrome is recommended that takes into account factors such as feeding difficulties and nutritional needs. A body mass index of approximately the 25th centile can be considered as a reasonable target in clinical practice. Gastrostomy is indicated for extremely poor growth, if there is risk of aspiration and if feeding times are prolonged.

CONCLUSIONS

These evidence- and consensus-based recommendations have the potential to improve care of nutrition and growth in a rare condition and stimulate research to improve the present limited evidence base.