Evidences from Clinical Trials in Down Syndrome: Diet, Exercise and Body Composition

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Abstract

Down syndrome (DS) is related to diseases like congenital heart disease, obstructive sleep apnea, obesity and overweight. Studies focused on DS associated with obesity and overweight are still scarce. The main objective of this work was to analyze the relationship between dietary intervention, physical exercise and body composition, in DS with overweight and obesity. This review is based on the PRISMA guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Selection criteria for this analysis were: publications between January 1997 and December 2019; DS individuals with overweight and obesity; clinical trials using dietary intervention and physical exercise paying attention to changes in body composition. Selected clinical trials were focused on an exclusive intervention based on physical exercise. The anthropometric measures analyzed were body fat, BMI, waist circumference, body weight and fat free mass. The main conclusion is that prescribing structured physical exercise intervention may be related to a greater variation in body composition. Despite limited number of clinical trials analyzed, it can be assumed that the reported studies have not achieved optimal results and that the design of future clinical trials should be improved. Some guidelines are proposed to contribute to the improvement of knowledge in this field.

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European Guidelines for Obesity Management in Adults

Volkan Yumuk, Constantine Tsigos, Martin Fried … (2015)

Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management.

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Anthropometric measurement error and the assessment of nutritional status.

S Ulijaszek, D A Kerr (1999)

Anthropometry involves the external measurement of morphological traits of human beings. It has a widespread and important place in nutritional assessment, and while the literature on anthropometric measurement and its interpretation is enormous, the extent to which measurement error can influence both measurement and interpretation of nutritional status is little considered. In this article, different types of anthropometric measurement error are reviewed, ways of estimating measurement error are critically evaluated, guidelines for acceptable error presented, and ways in which measures of error can be used to improve the interpretation of anthropometric nutritional status discussed. Possible errors are of two sorts; those that are associated with: (1) repeated measures giving the same value (unreliability, imprecision, undependability); and (2) measurements departing from true values (inaccuracy, bias). Imprecision is due largely to observer error, and is the most commonly used measure of anthropometric measurement error. This can be estimated by carrying out repeated anthropometric measures on the same subjects and calculating one or more of the following: technical error of measurement (TEM); percentage TEM, coefficient of reliability (R), and intraclass correlation coefficient. The first three of these measures are mathematically interrelated. Targets for training in anthropometry are at present far from perfect, and further work is needed in developing appropriate protocols for nutritional anthropometry training. Acceptable levels of measurement error are difficult to ascertain because TEM is age dependent, and the value is also related to the anthropometric characteristics of the group of population under investigation. R > 0.95 should be sought where possible, and reference values of maximum acceptable TEM at set levels of R using published data from the combined National Health and Nutrition Examination Surveys I and II (Frisancho, 1990) are given. There is a clear hierarchy in the precision of different nutritional anthropometric measures, with weight and height being most precise. Waist and hip circumference show strong between-observer differences, and should, where possible, be carried out by one observer. Skinfolds can be associated with such large measurement error that interpretation is problematic. Ways are described in which measurement error can be used to assess the probability that differences in anthropometric measures across time within individuals are due to factors other than imprecision. Anthropometry is an important tool for nutritional assessment, and the techniques reported here should allow increased precision of measurement, and improved interpretation of anthropometric data.

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

Fabio Bertapelli, Ken Pitetti, Stamatis Agiovlasitis … (2016)

Children with Down syndrome (DS) are more likely to be overweight or obese than the general population of youth without DS.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Environ Res Public Health

Journal ID (iso-abbrev): Int J Environ Res Public Health

Journal ID (publisher-id): ijerph

Title: International Journal of Environmental Research and Public Health

Publisher: MDPI

ISSN (Print): 1661-7827

ISSN (Electronic): 1660-4601

Publication date (Electronic): 16 June 2020

Publication date (Print): June 2020

Volume: 17

Issue: 12

Electronic Location Identifier: 4294

Affiliations

[1 ]Division of Biochemistry and Molecular Biology, Department of Agrochemistry and Biochemistry, Faculty of Sciences, University of Alicante, 03690 Alicante, Spain; rosa.martinez@ 123456ua.es

[2 ]Applied Biochemistry Research Group AppBiochem, University of Alicante, 03690 Alicante, Spain; mariola.Molina@ 123456ua.es

[3 ]Department of Mathematics, Faculty of Sciences, University of Alicante, 03690 Alicante, Spain

[4 ]Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Atacama, Avda. Copayapu 2862, III Region, Copiapó 1530000, Chile

[5 ]Noncommunicable Diseases Research Group, Atacama 1410000, Chile

Author notes

[* ]Correspondence: manuel.reig@ 123456uda.cl ; Tel.: +34-52-225-5647

Author information

Rosa María Martínez-Espinosa https://orcid.org/0000-0003-2679-135X

Mariola D Molina Vila https://orcid.org/0000-0002-1767-2714

Manuel Reig García-Galbis https://orcid.org/0000-0002-4428-0652

Article

Publisher ID: ijerph-17-04294

DOI: 10.3390/ijerph17124294

PMC ID: 7344556

PubMed ID: 32560141

SO-VID: 13d816a2-89d2-4733-ac4b-45743e7ab625

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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Evidences from Clinical Trials in Down Syndrome: Diet, Exercise and Body Composition

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Karger: Nutrition and Dietetics

Most cited references 40

European Guidelines for Obesity Management in Adults

Anthropometric measurement error and the assessment of nutritional status.

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

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