Obesity in Children with Down Syndrome: Background and Recommendations for Management

Julie Murray, MSN, BA, RN, CPNP; Patricia Ryan-Krause, MS, MSN, RN, CPNP

Disclosures

Pediatr Nurs. 2010;36(6):314-319. 

In This Article

Obesity in Children with Down Syndrome

A more recent concern for children born with Down syndrome is their tendency to become overweight and obese. Approximately 17.1% of children in the U.S. are obese (Ogden, Carroll et al., 2006). Some research suggests the number of children with Down syndrome who are obese approximates national trends (Cohen, 1999). However, the rate of obesity may be much higher than the general population; another study stated that up to 30% to 50% of children with Down syndrome are obese (Harris, Rosenberg, Jangda, O'Brien, & Gallagher, 2003). Fonesca, Amaral, Ribeiro, Beserra, and Guimaraes (2005) found children with Down syndrome had an increased risk for developing Type 2 diabetes mellitus due to their propensity for obesity and large amounts of abdominal fat stores. Because of the negative consequences associated with obesity, prevention and interventions in children with Down syndrome should be a major health priority. Although specific associated problems of Down syndrome, both physiological and behavioral, foster the development of obesity, identifying and addressing condition-specific problems in a prevention and management plan is essential when caring for the child with Down syndrome.

Physiological Mechanisms Associated with Obesity in Down Syndrome

Hypothyroidism. In young children, untreated hypothyroidism results in significant growth and developmental retardation, and is implicated in the development of obesity due to the slowing of the body's metabolic rate. Hypo thyroidism is a common congenital or acquired condition in children with Down syndrome. Approximately 30% to 50% of school-aged children with Down syndrome have sub-clinical hypothyroidism due to acquired autoimmune dysfunction (Roizen, 1997).

Decreased Basal Metabolic Rate. Basal metabolic rate refers to the amount of calories the body burns at rest. Although resting metabolic rate has long been researched in adults, Luke, Roizen, Sutton, and Schoeller (1994) were the first to use a controlled trial to study energy expenditure in children with Down syndrome. Their results indicate prepubescent euthyroid children with Down syndrome have a decreased resting metabolic rate compared to children without Down syndrome when corrected for movement. The underlying mechanism is likely to be an abnormality in cellular metabolism or in the composition of fat-free mass. These findings suggest that at rest, euthyroid children with Down syndrome burn fewer calories than their counterparts, contributing to the development of obesity.

More recently, Bauer et al. (2003) found energy expenditure differs in neonates with Down syndrome. These authors document neonates with Down syndrome expend 14% fewer calories compared to nonaffected infants and have significantly decreased muscle tone. This suggests hypotonicity may be a factor that decreases resting energy expenditure (Bauer et al., 2003).

Increased Leptin. Leptin is a hormone that plays an important role in regulating food intake by stimulating satiety and promoting energy homeostasis via energy expenditure. The hormone has been implicated in the development of obesity within the general population and may also be relevant for children with Down syndrome. Typically, increased levels of the hormone correlate with obesity because in excess, the body becomes desensitized to the hormone. As a result, the body responds poorly to leptin, and the individual experiences decreased satiety. Results from a study by Magni et al. (2004) show prepubertal children with Down syndrome have high levels of leptin and posit leptin as a potential factor in the development of obesity-increased leptin levels, which were positively correlated with increased bosdy mass index (BMI) and degree of adiposity (Magni et al., 2004).

Poor Mastication. Children with Down syndrome have difficulty eating raw fruits and vegetables, and chewing firm or fibrous foods. While this subject has not been thoroughly investigated, Hennequin, Allison, Faulks, Orliaguet, and Feine (2005) assert that masticatory dysfunction may lead to nutritional deficiencies in individuals with Down syndrome. Difficulty masticating foods may also lead the child to eat softer foods, which are often higher in carbohydrates, sugars, fats, and cholesterol (Hennequin et al., 2005).

Behavioral Tendencies Associated with Obesity in Down Syndrome

According to a study by Whitt-Glover, O'Neill, and Stettler (2006), children with Down syndrome engage in less vigorous physical activity compared to their siblings. The study examined physical activity over seven days using accelerometers and found children with Down syndrome have similar levels of low-intensity and moderate activity compared to their siblings but perform significantly less vigorous-intensity activity. The children with Down syndrome also had a higher BMI compared to their siblings, leading the authors to assert the discrepancy in less vigorousintensity activity could be a factor in the development of obesity (Whitt-Glover et al., 2006).

Other behavioral tendencies may play a role in the development of obesity. Negativity, impulsivity, oppositional behavior, inattention, disobedience, and noncompliance are behaviors that tend to surface as children with Down syndrome become older, and are particularly evident when they become frustrated (Jahromi, Gulsrud, & Kasari, 2008). Negative behavior may occur when the parent attempts to encourage healthy food choices or involve the child in physical activity, creating barriers that prevent necessary dietary and lifestyle changes.

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