Dyslipidemia, Prediabetes More Common in Youth With Down Syndrome

By Megan Brooks

July 18, 2019

NEW YORK (Reuters Health) - Children and young adults with Down syndrome (DS) have a greater prevalence of abnormal lipid levels and prediabetes compared to typically-developing youth, for the same amount of body fat, according to a study online today in Pediatrics.

"It is critical that children with DS and obesity be screened for abnormal lipids and diabetes by their pediatricians," first author Dr. Sheela Magge, Director of the Division of Pediatric Endocrinology at Johns Hopkins University School of Medicine in Baltimore, Maryland, told Reuters Health.

"Thanks to medical advances, individuals with DS are living longer lives, and it is very important that clinicians know how to appropriately care for these children and adults. We know that youth with DS are at increased risk for obesity, but there is conflicting evidence about whether they have increased risk for diabetes and cardiovascular disease, which usually accompanies obesity," Dr. Magge explained in email.

The researchers studied 150 youth with DS and 103 without DS of comparable age (10 to 20 years), sex, race, ethnicity, and BMI percentile. Assessment measures included whole-body dual-energy X-ray absorptiometry, fasting glucose, insulin, lipids, lipoprotein particles, inflammatory factors, and when BMI percentile was at or above 85, an oral glucose tolerance test.

Two-thirds of DS youth had BMI at or above 85. Among these youth, there was no difference in glucose, insulin, or insulin resistance, but prediabetes was more prevalent with DS (26% vs 10%) after adjusting for demographics, pubertal status, and BMI z score (odds ratio, 3.2; P = 0.026).

Among all youth, those with DS had higher significantly LDL cholesterol (median 107 vs 88.5 mg/dL), triglycerides (89.5 vs 71.5 mg/dL), non-HDL cholesterol (128 vs 107 mg/dL) and triglycerides/HDL-C (2.2 vs 1.7 mg/dL) and lower levels of HDL-C (41 vs 45 mg/dL).

Youth with DS also had higher high-sensitivity C-reactive protein, interleukin-6, small LDL particles and total LDL particles, but similar LDL particle size.

Youth with DS had less visceral fat (VFAT), fat mass, and lean mass for BMI z score, but greater VFAT at higher fat mass. However, VFAT did not fully explain the increased prevalence of dyslipidemia or prediabetes in youth with DS, the investigators report.

These findings "support a more atherogenic lipid and lipoprotein profile" in young people with DS, Dr. Magge and colleagues write in their paper, and "will be important to consider when designing specific screening recommendations for youth with DS, a topic highly relevant for general pediatricians caring for these children."

"Further longitudinal studies are needed to elucidate whether increased dyslipidemia in youth with DS translates into increased cardiovascular disease during adulthood and future risk for Alzheimer disease," they conclude.

They also say the preliminary observation of increased prevalence of prediabetes in youth with DS is "intriguing, suggesting the need for studies of insulin secretion in individuals with DS. Continued research is needed to provide evidence-based guidelines for clinical care of youth and adults with DS."

The study had no commercial funding and the authors have no relevant conflicts of interest.

SOURCE: http://bit.ly/2LqcAZt

Pediatrics 2019.