Advertisement

Diet Quality and Cardiometabolic Risk Factors in Adolescents with Down Syndrome

Published:August 05, 2022DOI:https://doi.org/10.1016/j.jand.2022.07.017

      Abstract

      Background

      Youth with Down syndrome (DS) have a high prevalence of obesity and dyslipidemia. Diet quality may influence cardiometabolic risk (CMR) in youth.

      Objective

      The aim of this secondary analysis was to investigate the relationship between diet quality (Healthy Eating Index [HEI-2015]) with CMR factors in youth with DS compared with age, sex, race, ethnicity, and body mass index percentile matched, typically developing controls.

      Design

      Adolescents (aged 10 to 20 years) with DS and controls of comparable age, sex, race, ethnicity, and body mass index percentile were recruited from 2012 to 2017 for a cross-sectional study from two large children’s hospitals (Children’s Hospital of Philadelphia and the Children’s National Health System in Washington, DC).

      Participants and setting

      CMRs in 143 adolescents with DS were compared with 100 controls. Exclusion criteria consisted of major organ-system illnesses.

      Main outcome measures

      The average of three 24-hour dietary recalls was used to calculate the HEI-2015. Anthropometrics, blood pressure, and fasting labs were collected.

      Statistical analyses performed

      Group differences were tested using Wilcoxon rank-sum tests. Relationships of CMR factors with HEI-2015 score within DS and controls were tested using linear regression models adjusted for sex, age, race, and body mass index z score.

      Results

      Compared with controls (n = 100, median age = 14.8 years [interquartile range = 12.2 to 17.3 years]; 41% male; 24% African American; 65% with body mass index ≥85th percentile), adolescents with DS (n = 143, median age = 14.7 years [interquartile range = 11.4 to 17.4 years]; 44% male; 18% African American; 62% with body mass index ≥85th percentile) had higher scores (more aligned with dietary recommendations) for total HEI-2015 (DS: 52.7 [interquartile range = 46.8 to 58.6] vs controls: 45.1 [interquartile range = 39.5 to 55.0]; P < 0.0001). Youth with DS also had higher HEI-2015 component scores for fruits, greens/beans, dairy, refined grains, and saturated fats, but lower whole grains and sodium scores. Within the group with DS, total HEI-2015 was not significantly associated with CMR measures. Whereas HEI-2015 in the DS group was negatively associated with fasting glucose levels, the difference did not meet the set level of statistical significance (–0.14, 95% CI –0.29 to 0.00; P = 0.053).

      Conclusions

      Adolescents in both the control and DS groups reported low-quality diets, although the DS group had HEI-2015 scores more closely aligned with recommendations. In the DS group, diet quality was not significantly associated with CMR factors. Although further research is needed, these results suggest that dyslipidemia in youth with DS may not be related to dietary intake.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Basil J.S.
        • Santoro S.L.
        • Martin L.J.
        • Healy K.W.
        • Chini B.A.
        • Saal H.M.
        retrospective study of obesity in children with Down syndrome.
        J Pediatr. 2016; 173: 143-148https://doi.org/10.1016/j.jpeds.2016.02.046
        • O' Shea M.
        • O' Shea C.
        • Gibson L.
        • Leo J.
        • Carty C.
        The prevalence of obesity in children and young people with Down syndrome.
        J Appl Res Intellect Disabil. 2018; 31: 1225-1229https://doi.org/10.1111/jar.12465
        • Bertapelli F.
        • Pitetti K.
        • Agiovlasitis S.
        • Guerra-Junior G.
        Overweight and obesity in children and adolescents with Down syndrome-prevalence, determinants, consequences, and interventions: a literature review.
        Res Dev Disabil. 2016; 57: 181-192https://doi.org/10.1016/j.ridd.2016.06.018
        • Bittles A.H.
        • Glasson E.J.
        Clinical, social, and ethical implications of changing life expectancy in Down syndrome.
        Dev Med Child Neurol. 2004; 46: 282-286https://doi.org/10.1017/s0012162204000441
        • Bittles A.H.
        • Petterson B.A.
        • Sullivan S.G.
        • Hussain R.
        • Glasson E.J.
        • Montgomery P.D.
        The influence of intellectual disability on life expectancy.
        J Gerontol A Biol Sci Med Sci. 2002; 57: M470-M472https://doi.org/10.1093/gerona/57.7.m470
        • Day S.M.
        • Wu Y.W.
        • Strauss D.J.
        • Shavelle R.M.
        • Reynolds R.J.
        Causes of death in remote symptomatic epilepsy.
        Neurology. 2005; 65: 216-222https://doi.org/10.1212/01.wnl.0000169018.44950.68
        • Hill D.A.
        • Gridley G.
        • Cnattingius S.
        • et al.
        Mortality and cancer incidence among individuals with Down syndrome.
        Arch Intern Med. 2003; 163: 705-711https://doi.org/10.1001/archinte.163.6.705
        • Hermon C.
        • Alberman E.
        • Beral V.
        • Swerdlow A.J.
        Mortality and cancer incidence in persons with Down's syndrome, their parents and siblings.
        Ann Hum Genet. 2001; 65: 167-176https://doi.org/10.1017/S0003480001008508
        • Charakida M.
        • Deanfield J.E.
        • Halcox J.P.
        Childhood origins of arterial disease.
        Curr Opin Pediatr. 2007; 19: 538-545https://doi.org/10.1097/MOP.0b013e3282eff585
        • Huang R.C.
        • Burke V.
        • Newnham J.P.
        • et al.
        Perinatal and childhood origins of cardiovascular disease.
        Int J Obes (Lond). 2007; 31: 236-244https://doi.org/10.1038/sj.ijo.0803394
        • DeBoer M.D.
        Obesity, systemic inflammation, and increased risk for cardiovascular disease and diabetes among adolescents: a need for screening tools to target interventions.
        Nutrition. 2013; 29: 379-386https://doi.org/10.1016/j.nut.2012.07.003
        • Magge S.N.
        • Zemel B.S.
        • Pipan M.E.
        • Gidding S.S.
        • Kelly A.
        Cardiometabolic risk and body composition in youth with Down syndrome.
        Pediatrics. 2019; 144e20190137https://doi.org/10.1542/peds.2019-0137
        • Ruiz L.D.
        • Zuelch M.L.
        • Dimitratos S.M.
        • Scherr R.E.
        Adolescent obesity: diet quality, psychosocial health, and cardiometabolic risk factors.
        Nutrients. 2019; 12: 43https://doi.org/10.3390/nu12010043
        • Setayeshgar S.
        • Ekwaru J.P.
        • Maximova K.
        • et al.
        Dietary intake and prospective changes in cardiometabolic risk factors in children and youth.
        Appl Physiol Nutr Metab. 2017; 42: 39-45https://doi.org/10.1139/apnm-2016-0215
        • Shang X.
        • Li Y.
        • Xu H.
        • et al.
        Leading dietary determinants identified using machine learning techniques and a healthy diet score for changes in cardiometabolic risk factors in children: a longitudinal analysis.
        Nutr J. 2020; 19: 105https://doi.org/10.1186/s12937-020-00611-2
        • Krebs-Smith S.M.
        • Pannucci T.E.
        • Subar A.F.
        • et al.
        Update of the Healthy Eating Index: HEI-2015.
        J Acad Nutr Diet. 2018; 118: 1591-1602https://doi.org/10.1016/j.jand.2018.05.021
        • US Department of Agriculture
        Healthy Eating Index.
        • Kirkpatrick S.I.
        • Reedy J.
        • Krebs-Smith S.M.
        • et al.
        Applications of the Healthy Eating Index for Surveillance, Epidemiology, and Intervention Research: Considerations and Caveats.
        J Acad Nutr Diet. 2018; 118: 1603-1621https://doi.org/10.1016/j.jand.2018.05.020
        • Reedy J.
        • Lerman J.L.
        • Krebs-Smith S.M.
        • et al.
        Evaluation of the Healthy Eating Index-2015.
        J Acad Nutr Diet. 2018; 118: 1622-1633https://doi.org/10.1016/j.jand.2018.05.019
        • Zemel B.S.
        • Pipan M.
        • Stallings V.A.
        • et al.
        Growth charts for children with Down syndrome in the United States.
        Pediatrics. 2015; 136: e1204-e1211https://doi.org/10.1542/peds.2015-1652
        • Kelly A.
        • Gidding S.S.
        • Walega R.
        • et al.
        Relationships of body composition to cardiac structure and function in adolescents with Down syndrome are different than in adolescents without Down syndrome.
        Pediatr Cardiol. 2019; 40: 421-430https://doi.org/10.1007/s00246-018-2014-5
        • Kuczmarski R.J.
        • Ogden C.L.
        • Guo S.S.
        • et al.
        2000 CDC Growth Charts for the United States: methods and development.
        Vital Health Stat 11. 2002; : 1-190
        • Centers for Disease Control and Prevention
        Modified z scores in the CDC growth charts.
        • Hatch-Stein J.A.
        • Zemel B.S.
        • Prasad D.
        • et al.
        Body composition and BMI growth charts in children with Down syndrome.
        Pediatrics. 2016; 138e20160541https://doi.org/10.1542/peds.2016-0541
        • Harnack L.
        Nutrition Data System for Research (NDSR).
        in: Gellman M.D. Turner J.R. Encyclopedia of Behavioral Medicine. Springer, 2013: 1348-1350
        • National Cancer Institute: Division of Cancer Control & Population Sciences
        HEI Scores for Examining Association between Diet and Another Variable.
        • US Depts of Health and Human Services and Agriculture
        2015-2020 Dietary Guidelines for Americans.
        8th edition. 2015
      1. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.
        • Haffner S.M.
        • Kennedy E.
        • Gonzalez C.
        • Stern M.P.
        • Miettinen H.
        A prospective analysis of the HOMA model. The Mexico City Diabetes Study.
        Diabetes Care. 1996; 19: 1138-1141https://doi.org/10.2337/diacare.19.10.1138
      2. Stata Statistical Software.Release 13. StataCorp LP, 2013
        • Bull M.J.
        Down syndrome.
        N Engl J Med. 2020; 382: 2344-2352https://doi.org/10.1056/NEJMra1706537
        • Newton K.P.
        • Singer S.A.
        Celiac disease in children and adolescents: special considerations.
        Semin Immunopathol. 2012; 34: 479-496https://doi.org/10.1007/s00281-012-0313-0
        • Institutes of Medicine
        Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids.
        The National Academies Press, 2005: 1358
        • Lichtman S.W.
        • Pisarska K.
        • Berman E.R.
        • et al.
        Discrepancy between self-reported and actual caloric intake and exercise in obese subjects.
        N Engl J Med. 1992; 327: 1893-1898https://doi.org/10.1056/NEJM199212313272701
        • Chung S.T.
        • Onuzuruike A.U.
        • Magge S.N.
        Cardiometabolic risk in obese children.
        Ann N Y Acad Sci. 2018; 1411: 166-183https://doi.org/10.1111/nyas.13602
        • Wahi G.
        • Anand S.S.
        Race/ethnicity, obesity, and related cardio-metabolic risk factors: a life-course perspective.
        Curr Cardiovasc Risk Rep. 2013; 7: 326-335https://doi.org/10.1007/s12170-013-0329-6
        • Gerdts E.
        • Regitz-Zagrosek V.
        Sex differences in cardiometabolic disorders.
        Nat Med. 2019; 25: 1657-1666https://doi.org/10.1038/s41591-019-0643-8
        • Collins C.E.
        • Watson J.
        • Burrows T.
        Measuring dietary intake in children and adolescents in the context of overweight and obesity.
        Int J Obes (Lond). 2010; 34: 1103-1115https://doi.org/10.1038/ijo.2009.241
      3. US Dept of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion. Average Healthy Eating Index-2015 scores for all Americans by age groups.
        What We Eat in America, NHANES 2017-2018. 2022;
        https://www.fns.usda.gov/hei-scores-americans
        Date accessed: August 12, 2022
        • Gu X.
        • Tucker K.L.
        Dietary quality of the US child and adolescent population: trends from 1999 to 2012 and associations with the use of federal nutrition assistance programs.
        Am J Clin Nutr. 2017; 105: 194-202https://doi.org/10.3945/ajcn.116.135095
        • Camhi S.M.
        • Whitney Evans E.
        • Hayman L.L.
        • Lichtenstein A.H.
        • Must A.
        Healthy eating index and metabolically healthy obesity in U.S. adolescents and adults.
        Prev Med. 2015; 77: 23-27https://doi.org/10.1016/j.ypmed.2015.04.023
        • Magenis M.L.
        • Machado A.G.
        • Bongiolo A.M.
        • Silva M.A.D.
        • Castro K.
        • Perry I.D.S.
        Dietary practices of children and adolescents with Down syndrome.
        J Intellect Disabil. 2018; 22: 125-134https://doi.org/10.1177/1744629516686571
        • Klop B.
        • Elte J.W.
        • Cabezas M.C.
        Dyslipidemia in obesity: mechanisms and potential targets.
        Nutrients. 2013; 5: 1218-1240https://doi.org/10.3390/nu5041218
        • Cook S.
        • Kavey R.E.
        Dyslipidemia and pediatric obesity.
        Pediatr Clin North Am. 2011; 58 (ix): 1363-1373https://doi.org/10.1016/j.pcl.2011.09.003
        • Adelekan T.
        • Magge S.
        • Shults J.
        • Stallings V.
        • Stettler N.
        Lipid profiles of children with Down syndrome compared with their siblings.
        Pediatrics. 2012; 129: e1382-e1387https://doi.org/10.1542/peds.2011-1262
        • Pajukanta P.
        • Terwilliger J.D.
        • Perola M.
        • et al.
        Genomewide scan for familial combined hyperlipidemia genes in finnish families, suggesting multiple susceptibility loci influencing triglyceride, cholesterol, and apolipoprotein B levels.
        Am J Hum Genet. 1999; 64: 1453-1463https://doi.org/10.1086/302365
        • Bocconi L.
        • Nava S.
        • Fogliani R.
        • Nicolini U.
        Trisomy 21 is associated with hypercholesterolemia during intrauterine life.
        Am J Obstet Gynecol. 1997; 176: 540-543https://doi.org/10.1016/s0002-9378(97)70544-1
        • Magge S.N.
        • O'Neill K.L.
        • Shults J.
        • Stallings V.A.
        • Stettler N.
        Leptin levels among prepubertal children with Down syndrome compared with their siblings.
        J Pediatr. 2008; 152: 321-326https://doi.org/10.1016/j.jpeds.2007.08.008
        • Polfuss M.
        • Sawin K.J.
        • Papanek P.E.
        • et al.
        Total energy expenditure and body composition of children with developmental disabilities.
        Disabil Health J. 2018; 11: 442-446https://doi.org/10.1016/j.dhjo.2017.12.009
        • Hill D.L.
        • Parks E.P.
        • Zemel B.S.
        • Shults J.
        • Stallings V.A.
        • Stettler N.
        Resting energy expenditure and adiposity accretion among children with Down syndrome: a 3-year prospective study.
        Eur J Clin Nutr. 2013; 67: 1087-1091https://doi.org/10.1038/ejcn.2013.137
        • Ames M.E.
        • Leadbeater B.J.
        • MacDonald S.W.S.
        Health behavior changes in adolescence and young adulthood: implications for cardiometabolic risk.
        Health Psychol. 2018; 37: 103-113https://doi.org/10.1037/hea0000560
        • Kracht C.L.
        • Champagne C.M.
        • Hsia D.S.
        • et al.
        Association between meeting physical activity, sleep, and dietary guidelines and cardiometabolic risk factors and adiposity in adolescents.
        J Adolesc Health. 2020; 66: 733-739https://doi.org/10.1016/j.jadohealth.2019.12.011
        • Robson S.M.
        • Lozano A.J.
        • Papas M.
        • Patterson F.
        Food insecurity and cardiometabolic risk factors in adolescents.
        Prev Chronic Dis. 2017; 14: E110https://doi.org/10.5888/pcd14.170222
        • Slopen N.
        • Goodman E.
        • Koenen K.C.
        • Kubzansky L.D.
        Socioeconomic and other social stressors and biomarkers of cardiometabolic risk in youth: a systematic review of less studied risk factors.
        PLoS One. 2013; 8e64418https://doi.org/10.1371/journal.pone.0064418

      Biography

      N. Anand is a resident physician, Boston Combined Residency Program, Boston Children’s Hospital & Boston Medical Center, Boston, MA.

      Biography

      B. Zemel is a professor, pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

      Biography

      M. Pipan is director, Trisomy 21 Program, Division of Developmental Behavioral Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

      Biography

      A. Kelly is a professor, pediatrics, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

      Biography

      S. Magge is director, Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, and an associate professor, pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.