Fabio Bertapelli

Overweight and obesity in children and adolescents with Down syndrome-prevalence, determinants, consequences, and interventions: A literature review

BACKGROUND Children with Down syndrome (DS) are more likely to be overweight or obese than the general population of youth without DS. AIMS To review the prevalence of overweight and obesity and their determinants in youth with DS. The health consequences and the effectiveness of interventions were also examined. METHODS AND PROCEDURES A search using MEDLINE, Embase, Web of Science, Scopus, CINAHL, PsycINFO, SPORTDiscus, LILACS, and COCHRANE was conducted. From a total of 4280 studies, we included 45 original research articles published between 1988 and 2015. OUTCOMES AND RESULTS The combined prevalence of overweight and obesity varied between studies from 23% to 70%. Youth with DS had higher rates of overweight and obesity than youths without DS. Likely determinants of obesity included increased leptin, decreased resting energy expenditure, comorbidities, unfavorable diet, and low physical activity levels. Obesity was positively associated with obstructive sleep apnea, dyslipidemia, hyperinsulinemia, and gait disorder. Interventions for obesity prevention and control were primarily based on exercise-based programs, and were insufficient to achieve weight or fat loss. CONCLUSIONS AND IMPLICATIONS Population-based research is needed to identify risk factors and support multi-factorial strategies for reducing overweight and obesity in children and adolescents with DS.

Growth curves in Down syndrome: implications for clinical practice.

Growth curves have been developed for individuals with Down syndrome (DS) in several countries. However, in order to facilitate the preparation of clinical guidelines it is necessary to verify the eligibility of these curves. The search was conducted according to the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta‐Analyses). It was conducted between July 2012 and June 2013 in MEDLINE/PubMed and BIREME. The inclusion and exclusion criteria were applied to identify the studies and a total of 16 relevant articles were selected. The aspects analyzed in the articles consisted of sample size, number of observations, age group, anthropometric variables, standard deviation scores (SDS), type of study, collection and analysis of data, participants, inclusion/exclusion criteria and outcomes. The mean, standard deviations (SDs) and percentiles for sex and age were used to develop the curve of weight, height, and head circumference. The individuals with DS presented growth between −0.4 and −4.0 SDS in comparison to healthy controls. The variation in these observations can be explained by genetic differences, secular trends in growth and disease status. Regarding the limitations identified, it was observed that most of the studies did not provide data concerning the number of individuals and observations, mean values and respective SDs by sex and age. In addition, most studies did not use LMS methods to evaluate asymmetry, the median and data variability. In conclusion, the results of this review demonstrated that in order to avoid false diagnoses in children and adolescents with DS new growth curves must be developed.

Growth Curves for Girls with Turner Syndrome

The objective of this study was to review the growth curves for Turner syndrome, evaluate the methodological and statistical quality, and suggest potential growth curves for clinical practice guidelines. The search was carried out in the databases Medline and Embase. Of 1006 references identified, 15 were included. Studies constructed curves for weight, height, weight/height, body mass index, head circumference, height velocity, leg length, and sitting height. The sample ranged between 47 and 1,565 (total = 6,273) girls aged 0 to 24 y, born between 1950 and 2006. The number of measures ranged from 580 to 9,011 (total = 28,915). Most studies showed strengths such as sample size, exclusion of the use of growth hormone and androgen, and analysis of confounding variables. However, the growth curves were restricted to height, lack of information about selection bias, limited distributional properties, and smoothing aspects. In conclusion, we observe the need to construct an international growth reference for girls with Turner syndrome, in order to provide support for clinical practice guidelines.

Body mass index reference charts for individuals with Down syndrome aged 2–18 years

OBJECTIVE To develop Brazilian growth charts for body mass index (BMI-for-age) for individuals with Down syndrome (DS). The secondary objective was to compare the BMI-for-age with the Centers for Disease Control and Prevention standards (CDC). METHODS A retrospective and cross-sectional growth study of 706 youth with DS (56.7% males) was performed in 51 centers in São Paulo state, Brazil. Weight and height were used to calculate the BMI (kg/m2). The LMS method was applied to construct the growth charts. Z-scores were based on the CDC 2000 growth standards. RESULTS The BMI-for-age reference charts showed excellent goodness of fit statistics for boys and girls with DS aged 2-18 years. At 2 years of age, the mean BMI Z-scores of boys and girls with DS were lower compared to those of the CDC (Z-score=-0.2). In contrast, children with DS aged 3-18 years had higher mean Z-scores for BMI-for-age when compared to those of the CDC (Z-scores=+0.2 to +1.3). CONCLUSIONS The BMI of Brazilian youth with DS differs from those references established by CDC. These are the first Brazilian BMI-for-age charts for individuals with DS and will hopefully guide clinicians and parents in the evaluation and management of the nutritional status in children and adolescents with DS in Brazil.

Growth charts for Brazilian children with Down syndrome: Birth to 20 years of age

Background The growth of youth with Down syndrome (DS) differs from that of youth without DS, and growth charts specific to DS have been developed. However, little is known about the growth of Brazilian youth with DS. The objective of this study was to construct growth charts for Brazilian youth with DS and compare the growth data with the Child Growth Standards of the World Health Organization (WHO) and charts for children with DS from other studies. Methods Mixed longitudinal and cross-sectional data were collected at University of Campinas, 48 specialized centers for people with intellectual disabilities, and two foundations for people with DS between 2012 and 2015. A total of 10,516 growth measurements from birth to 20 years of age were available from 938 youth with DS (53.7% boys) born between 1980 and 2013. The Lambda Mu Sigma method was applied to construct the curves using generalized additive models for location, scale, and shape. Results Length/height-for-age, weight-for-age, and head circumference-for-age percentile curves were generated for Brazilian boys and girls from birth to 20 years of age. Differences in growth of Brazilian youth ranged from −0.8 to −3.2 z-scores compared to WHO standards, and −1.9 to +1.3 compared to children with DS in other studies. Conclusions These specific growth charts may guide clinicians and families in monitoring the growth of Brazilian children and adolescents with DS.

Artigo OriginalBody mass index reference charts for the individuals with Down syndrome aged 2‐18 yearsGráfico de referência do Índice de Massa Corporal para os indivíduos com síndrome de Down entre 2 e 18 anos de idade☆☆☆

Objective To develop Brazilian growth charts for body mass index (BMI-for-age) for individuals with Down syndrome (DS). The secondary objective was to compare the BMI-for-age with the Centers for Disease Control and Prevention standards (CDC).

Desenvolvimento de padrão de referência de perímetro cefálico para população Brasileira com síndrome de Down de zero a cinco anos de idade.

Resumo Justificativa: Há apenas um estudo brasileiro que construiu curvas de peso, estatura e perímetro cefálico de indivíduos com síndrome de Down, na faixa etária de zero a oito anos, na cidade de São Paulo, porém com amostra de 174 casos. Objetivo: Construir uma curva de medida do perímetro cefálico em pacientes com síndrome de Down, na faixa etária de zero a cinco anos, de ambos os sexos. Casuística e Métodos: Foram incluídas 1.183 medidas de perímetro cefálico de 198 crianças com síndrome de Down de zero a cinco anos de idade. Os dados foram conseguidos de prontuários de pacientes nos Ambulatórios de Pediatria e de síndrome de Down do Hospital de Clínicas da Universidade Estadual de Campinas e das Instituições de atendimento às crianças com síndrome de Down de Campinas (SP). Foram calculados os percentis 3, 10, 25, 50, 75, 90 e 97 por sexo e idade. Na construção das curvas foi utilizada a técnica de alisamento LMS. Resultados: 93,5% das medidas conseguidas de perímetro cefálico foram até os dois anos de idade. Não houve diferenças nas medidas de perímetro cefálico entre os sexos até os dois anos de idade. Conclusões: A medida do perímetro cefálico em crianças com síndrome de Down não é feita de rotina em crianças acima de dois anos de idade e não há diferenças nesta medida entre os sexos nesta faixa etária.

Avaliação de variáveis que possam interferir na medida do perímetro cefálico de crianças brasileiras com síndrome de Down de zero a cinco anos de idade.

Avaliação de variáveis que possam interferir na medida do perímetro cefálico de crianças brasileiras com síndrome de Down de zero a cinco anos de idade. Maira R. Machado * (IC), Raísa V. Roso * (IC), Fábio Bertapelli ** (PG), Gil Guerra-Júnior (PQ). Laboratório de Crescimento e Desenvolvimento (LabCreD) – Centro de Investigação em Pediatria (CIPED) – FCM – UNICAMP. Resumo Justificativa: A medida do perímetro cefálico (PC) constitui um método simples, barato, rápido e disponível que contribui para avaliar o desenvolvimento do sistema nervoso central. Não existem muitos estudos com medidas de PC na síndrome de Down (SD), destacando-se o de Palmer et al. (1992) 1 com população norteamericana, que é utilizado internacionalmente. Objetivo: Avaliar a medida de PC em crianças de zero a cinco anos de idade com a SD e verificar a influência da idade gestacional (IG), do peso ao nascimento (PN), do aleitamento materno exclusivo (AME) e da cardiopatia nestas medidas. Casuística e Métodos: A amostra foi composta de 198 crianças com diagnóstico citogenético da SD acompanhadas nas instituições assistenciais de Campinas (SP) ou no Hospital de Clínicas da UNICAMP. Foram avaliadas 1.183 medidas (606 no sexo feminino) entre zero e cinco anos de idade. Também foram avaliados: IG (< ou > 37 semanas), PN (< ou > 2.500 g), AME (< ou > 6 meses), e cardiopatia (sim ou não). A análise estatística foi feita pelo método de regressão linear múltipla (método enter com variáveis dummy – “0” = normal; “1” = risco) e depois aplicado o método stepwise com as variáveis preditoras, com nível de significância de 0,05. Resultados: 93,5% das medidas foram feitas entre zero e dois anos de idade. No grupo total (meninos + meninas), o PN (p=0,001), a IG (p=0,001) e o AME (p=0,042) foram significativos (R 2 =0,04), sendo entre os meninos o PN (p=0,001) e a IG (p=0,001) (R 2 =0,04) e entre as meninas o PN (p=0,001), a IG (p=0,001) e o AME (p=0,039) (R 2 =0,04). Conclusão: o PC na SD é uma medida pouco avaliada após os dois anos de idade e sofre pouca influência da IG, do PN e do AME. Palavras Chave: síndrome de Down, perímetro cefálico, cardiopatia

Body mass index cutoff point estimation as obesity diagnostic criteria in Down syndrome adolescents

INTRODUCTION Adolescents with Down syndrome (DS) show high rate of overweight and tend to accumulate high amount of fat compared to the same people without the syndrome. OBJECTIVE To estimate the cutoff point of the Body Mass Index (BMI) for the diagnosis of obesity in adolescents with DS according to different references for BMI in relation to the percentage of body fat (%BF) measured by dual-energy X-ray absorptiometry (DXA). METHODS The sample was composed of 34 adolescents with DS (aged: 10 to 17 years old). BMI was evaluated according to the references of the International Obesity Task Force (IOTF), the World Health Organization (WHO) for the general population, and Myrelid et al. and Styles et al. for people with DS. The %BF was assessed by whole body DXA and classified according to National Health And Nutrition Examination Survey (NHANES, 2011). RESULTS The boys were significantly taller than the girls and this %BF higher than boys. All references who have used BMI to assess obesity was positively associated with %BF measured by DXA in the diagnosis of obesity. Using the ROC curve in relation to %BF by DXA, all references showed high sensitivity, but the z-score of BMI by WHO showed better specificity, with the value of the accuracy of 0.82 for the cutoff point above 2.14. CONCLUSIONS All the references used for the diagnosis of obesity were associated with %BF measured by DXA, and the cutoff point of z-scores above 2.14 by WHO showed better specificity.

Proporção Corporal em Crianças e Adolescentes com Síndrome de Down

The present study aimed to evaluate the body proportions of sitting height and leg length in children and adolescents with Down’s syndrome (DS). The sample consisted of 99 individuals with DS (40 girls with an average age of 11.45 ± 2.6 years and 59 boys with an average age of 12.07 ± 3.0 years). The following parameters were studied: chronological age, height, sitting height and leg length. The body proportions of each segment were calculated using body indices and the Phantom model. For the statistical analysis, the normality test and descriptive analyses of central tendency and dispersion were performed, and Student’s t-test was used. For all treatments, the statistical software program SPSS version 13.0 was used, and a significance level of p < 0.05 was set. The body proportion of the upper and lower segments of children and adolescents with DS differed from those of the typical population in terms of leg length, whereas the seated height values of individuals with DS †were similar to those of individuals without DS.