Growth and adiposity of children with down syndrome: effect of total energy expenditure
Date
2017
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Publisher
University of Delaware
Abstract
Children with Down syndrome (DS) have different growth patterns compared to their healthy counterparts and have a higher incidence of overweight (body mass index (BMI) at or above the 85th percentile and below the 95th percentile) and obesity (BMI at or above the 95th percentile) by age three to four years. The factors that contribute of overweight and obesity in this population are not fully understood, although weight gain typically results from positive energy balance, where energy intake exceeds energy requirements. Limited evidence has investigated energy intake (EI), resting energy expenditure (REE), total energy expenditure (TEE), and the ratio of energy intake to total energy expenditure (EI:TEE) in prepubescent children with DS compared to healthy children of similar age. A better understanding of the components of energy balance in this population is needed to inform intervention strategies and prevent children with DS from becoming overweight/obese in childhood. The purpose of this study was to determine whether TEE or EI:TEE differs in children with DS compared to healthy sibling controls at baseline, and whether there was an association between TEE or the EI:TEE ratio and changes in adiposity in the subsequent three year period in children. This study enrolled a total of 72 children, 36 children with DS and 36 healthy sibling controls. Sixty-one children (29 DS and 32 controls) had successful TEE measures. At baseline, TEE (with adjustment for fat free mass) was significantly lower (p<0.001) in children with DS (1466.7 ± 38.4 kcal/d) compared to controls (1593.0 ± 35.2 kcal/d); however, the EI:TEE ratio (1.07 ± 0.0 and 101 ± 0.0 for DS and healthy controls, respectively) was not statistically
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significantly different (p=0.4229) between groups. Consequently, children with DS had a stronger positive association between baseline TEE and change in adiposity over three years compared to their healthy control siblings (p=0.032), but there was no difference in the relationship between EI:TEE ratio and changes in adiposity over time by health status (DS versus healthy controls) (p=0.568). Post-hoc power calculations found that this study was underpowered to detect differences in EI:TEE outcomes between groups, and as such these results should be interpreted with caution. Further analysis with a larger sample size is needed to confirm TEE and EI:TEE associations with changes in adiposity in children with DS.