Term Paper: Obesity and Down Syndrome

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Down Syndrome and Obesity

Downs syndrome and Obesity

Existing literature has clearly identified a positive correlation between Down syndrome and obesity as a coexisting condition. Though by themselves obesity and downs syndrome have a depth of research material there is a distinct lack of research when it comes to studying the association between them. More research is required for understanding the onset of obesity among the intellectually disabled patients. Weight management interventions constitute an important aspect in the management of down's syndrome and other related intellectual disabilities. Only a coordinated effort from professionals from the fields of Obesity and intellectual disabilities would provide the necessary expertise and ensure quality care provision for patients suffering from such debilitating health conditions

Introduction

Down's syndrome also known as trisomy 21, is one of the chromosomal disorders that result in significant mental and physical disabilities. In the UK, one in every 1000 babies is born with the condition. Infants with the condition are born with an extra copy of the chromosome number 21 causing considerable aberrations in the development of physical and cognitive faculties. [BUPA] Symptoms are varied and it is known that there are more than 50 characteristics that symptomatically identify Down's syndrome. Typical symptoms include short stature, small neck, short stocky arms the presence of a single crease across the palm known as the simian line. Weak muscles, distorted nose and irregular teeth are other easily visible symptoms of the disorder. The prevelance of heart diseases and early onset of alzheimer's disease are common conditions among the down's syndrome population. In general, people with Down syndrome have a relatively shorter span of life with an average of fifty years. Another significant health problem, the condition of obesity, is also found to be more prevelant among people with Down syndrome. In early infancy about 15% of neonates become overweight, about 30 to 50% become overweight by 36 months, and by 9 years of age most of the Down syndrome children are overweight. [Jacqueline Bauer et.al] This very high rate of obesity among people with Down syndrome necessitates more research to identify the cause for the problem and in effective management of obesity and its complications.

Some researchers have focused on identifying the relation between Down syndrome and obesity as a co existing condition. Studies have been conducted to identify the differences in metabolic rates between the Down's syndrome patients and the healthy population. The most recent research has thrown new light in understanding the relation between Down syndrome and obesity. The identification of Leptin resistance as the cause for high incidence of obesity among Down syndrome patients is considered a breakthrough in the obesity -Down syndrome research. A brief overview of existing literature on the subject will provide better insight into the topic and a better understanding of the association between the two conditions.

Literature review

Down's syndrome has been associated with obesity more than any other condition pertaining to intellectual disabilities. A 1998 study by Rubin et.al has attested the high prevalence of overweight and obesity among people with Down syndrome. At the time of the study, prevalence of overweight condition among the general public was 33% among males and 36% among females. The researchers measured the BMI of 283 Down syndrome patients and compared them with the data for the regular population. The results revealed a considerable increase in overweight rates among people with Down's syndrome. The study also concluded that overweight condition among Down syndrome patients was more among those living in a family setting than those in a group home setting. [Rubin et.al, 1998] Another research by Ragusa et.al (1998) also confirmed higher BMI among Down syndrome patients compared to regular subjects in both the males (p=0.000006) and females (p= 0.034829). The study involving a total of 113 subjects (68 males and 45 females) correlated age, BMI and IgF-1 plasma levels. (using radioimmunoassay method) Though a clear correlation was observed for age and IgF levels there was no relation between BMI and Igf. [Ragusa et.al, 1998] recent study by the university of Glasgow, UK, also confirms the high BMI factor. The Glasgow Researchers performed a comprehensive screening in Lancashire to identify all the intellectually disabled adults in the county. Height and weight measurements were noted down for all the individuals who participated in the study and their corresponding Body mass index (BMI) were interpolated. Then, for every individual identified with downs syndrome, a corresponding person with the same age, sex and accommodation type was chosen from the Lancashire Intellectual disabilities database and their data compared. In all, the researchers compared the data pertaining to 247 matched pairs and a significant pattern was obtained. It was found that women with Down syndrome had lower height and weight measurements but higher BMI reading compared to the matched counterparts. Though men with Down syndrome also reported lower body weight and height measurements, they did not vary significantly in their BMI compared to their counterparts. Overall, the resulting statistics projected a general picture that women with Down's syndrome were more likely to be obese (2.7 odds ratio). The odds of men with Down's syndrome to be obese stood at 0.85 indicating that they were more prone to be overweight rather than obese compared to the matched subjects. This research also confirmed the fact that women with downs syndrome are more likely to be obese than men with similar condition when compared against a matched sample. [Melville C. et.al, 2005]

Role of Leptin (the breakthrough) more recent research focused on children with Down's syndrome and the possible link with obesity. This research was conducted by the children's hospital of Philadelphia together with the medical college of Philadelphia. The researchers studied 35 children with Down's syndrome and their siblings (33 in all). All the chosen subjects were within the age group of 4 to 10 and within the Philadelphia area. Severely obese children were excluded from the research to concentrate purely on the risk factors for obesity before its onset. From the collected date it was inferred that children with Down syndrome had significantly higher body mass index and higher body fat compared to their siblings. Of particular importance was the fact that all the children with Down's syndrome showed significantly high levels of the hormone Leptin compared to their siblings. Since, the normal role of the hormone is to suppress appetite and to regulate body weight, it is suspected that Down's syndrome causes a genetic predisposition to obesity by making the body non-responsive to Leptin. This helps explain the relatively high levels of the hormone in their body. As Nicolas Stettler, M.D., MSCE, the senior researcher involved in the study says, "In general, obese people have higher levels of leptin, which suggests that they have some leptin resistance -- their bodies do not respond to the hormone properly. Because Down syndrome is a chromosome disorder, children with Down syndrome may have a genetic predisposition to more severe leptin resistance." [Sheela N. Magge, et. al, 2007]

Metabolic studies

Studies have also focused on the metabolic rates in people with Down syndrome and its effect on increased body weight and obesity. There is a generally accepted notion that children with Down syndrome have lower metabolic rates compared to normal children. Several studies have been examining this subject in detail but the results seem to be quiet varied. For instance, Luke et.al (1994) was one of the oldest studies, which compared 13 prepubescent children with DS with 10-control group children within the same age group. The study reported no significant difference in non-RMR energy expenditure but showed a significant difference in resting metabolic rate (RMR) between the two groups. As a percentage of the basal metabolic rate, the Down's syndrome children showed relatively lesser RMR rates. (79.5% +/- 10.4% and 96.8% +/- 7.8%, p < 0.001). [Luke a, 1994] However, more recent studies show completely different results. The 2005 study by Fernhall B. et al. compared the RMR of 22 subjects with Down's syndrome with that of 20 normal control subjects within similar age group. Both the groups were fasted the previous night and using the ventilated hood system RMR was measured in the morning. After adjustments to RMR in relation to body surface area, it was found that there was no significant difference in RMR between the two groups suggesting a negative association between RMR and obesity among subjects with Down's syndrome. [Fernhall B. et al., 2005]

Jacqueline et.al (2003) was a different study on neonatal energy expenditure among patients with Down syndrome in their early infancy. They study included 16 neonates, 8 of them normal and eight with Down syndrome. (Diagnosis confirmed by chromosomal studies) the subjects chosen were of similar gestational age, birth weights and body length. Neurological examination, oxygen consumption and carbon dioxide production along with nutrition and weight were measured regularly. Using calorimetry the EE (energy expenditure) and REE (resting energy expenditure) data were obtained and compared for each group. The study showed a considerable reduction in VO2, VCO2, and REE values… [END OF PREVIEW]

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