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Cardiometabolic health in students and young adults with mild/moderate intellectual disabilities: Results from a longitudinal follow-up study and a school intervention
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Adults with intellectual disabilities (ID) develop the metabolic syndrome and cardiovascular disease morefrequently than individuals without ID. The knowledge about cardiometabolic risk factors in adolescentswith mild/moderate ID is scarce.

Aims

The aims were 1) to examine cardiometabolic health among adolescents with ID 2) to study the progressof cardiometabolic risk factors from adolescence to young adulthood among young adults with andwithout ID 3) to evaluate whether a health-promoting program in an upper secondary school for studentswith ID could reduce cardiometabolic risk factors 4) to evaluate whether the plate model pattern, inlayedin a specially designed lunch plate, increases vegetable intake.

Material and Methods

Sixty-six adolescents with mild/moderate ID, mean age 18.6y recruited from one upper secondary schoolfor students with ID (year 1-4) were investigated in a cross sectional study (Paper I). Controls were 90students without ID, mean age 17.8y, recruited from practical and theoretical programs at schools nearby.In the follow-up study five years later 35% (n=23) of the now young adults with ID and 33% (n =30)from the control group were re-investigated (Paper II). Measures were anthropometrics, blood pressure,DXA, fasting blood samples and a submaximal cardiovascular fitness test. The multifactorial schoolintervention was evaluated on last year students after two years of intervention (n = 11) and comparedwith their base-line data (Paper I) and with last year students in Paper I (Paper III). The special plate withthe plate model inlayed was evaluated in an observational study. The intervention group (n = 27) hadeaten on the special plate during school lunches for at least six months. The control group (n=62) wasrecruited from two other upper secondary schools for students with ID. Food intake was estimated fromvideo recordings and digital photos (Paper IV).

Results

Adolescents with ID had a higher prevalence and severity of cardiometabolic risk factors together withlow cardiovascular fitness compared to the control group. At follow-up as young adults (mean age 24.3)35% were classified as obese and 22% had developed the metabolic syndrome. Those without ID frompractical educational programs also developed cardiometabolic risk factors but they did not reach thesame level as the group with ID. After two years of school intervention cardiometabolic risk factors haddecreased and no one were obese. Evaluation of the special plate showed no difference in vegetableintake between intervention and control group. Eighty-eight percent ate ≥ 37.5% vegetables. Theintervention group chose food with a lower fat content and with more carbohydrates, had less plate wasteand took fewer portions.

Conclusions

Already during adolescence individuals with ID have more cardiometabolic risk factors than thosewithout ID and as young adults individuals with ID in this study has a cardiometabolic health andcardiovascular fitness similar to the Swedish middle-age population. Actions to promote healthy livinghabits during school hours including the use of the special plate were promising. This indicates that it isnot the ID condition itself but the effects ID has on the living conditions that causes the highcardiometabolic risk. Thus, the results in this thesis show that initiatives especially designed forindividuals with ID to promote healthier living habits are required and are likely to be effective.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2013. , 79 p.
Keyword [en]
Intellectual disabilities; cardiometabolic health; school intervention; food habits; physical activity
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-18739ISBN: 978-91-7549-052-6 (print)OAI: oai:DiVA.org:mdh-18739DiVA: diva2:616151
Public defence
2013-02-22, Hörsal M 41, Karolinska Universitetssjukhuset, Huddinge, Stockholm, 13:24 (Swedish)
Opponent
Supervisors
Available from: 2013-04-15 Created: 2013-04-15 Last updated: 2015-11-13Bibliographically approved
List of papers
1. High prevalence of cardio-metabolic risk factors among adolescents with intellectual disability
Open this publication in new window or tab >>High prevalence of cardio-metabolic risk factors among adolescents with intellectual disability
Show others...
2009 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 5, 853-859 p.Article in journal (Refereed) Published
Abstract [en]

Abstract Adults with intellectual disabilities (IDs) have poor lifestyle-related health compared with the general population. Our aim was to study whether such differences are present already in adolescents. Aim: To compare the prevalence and severity of cardio-metabolic risk factors and cardio-vascular fitness in adolescents with and without IDs. Methods: Intellectual disability (ID) students (n = 66) and non-intellectual disability (non-ID) students from practical (non-ID-p) (n = 34) and theoretical (non-ID-t) (n = 56) programmes were recruited from three upper secondary schools. Anthropometric data, blood pressure, body composition, fasting-insulin, fasting-glucose, fasting-lipids and cardio-vascular fitness were measured. Results: Participants with and without ID differed significantly in the prevalence of cardio-metabolic risk factors with participants with ID having a higher percentage of total fat mass, wider waist circumferences (WCs), lower levels of fat-free mass (FFM), lower bone mineral density (BMD) and higher insulin and homeostasis model assessment of insulin resistance (HOMA) levels and poorer cardio-vascular fitness. The healthiest levels were found in the non-ID-t group compared to the group with ID and the group with non-ID-p in between. Conclusion: The prevalence of cardio-metabolic risk factors and poor cardio-vascular fitness was found to be high in this young population with intellectual disabilities. Measures should be taken to improve the health messages directed towards children and adolescents with intellectual disabilities.

Keyword
Cardiorespiratory fitness; Cross-sectional study; Learning disability; Metabolic Risk factors; Youth
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-5000 (URN)10.1111/j.1651-2227.2008.01197.x (DOI)000264878100019 ()19183118 (PubMedID)2-s2.0-64149115562 (Scopus ID)
Available from: 2009-02-10 Created: 2009-02-10 Last updated: 2016-01-15Bibliographically approved
2. Progress of cardiometabolic risk factors from adolescence to adulthood inindividuals with intellectual disabilities: A five-year follow-up study
Open this publication in new window or tab >>Progress of cardiometabolic risk factors from adolescence to adulthood inindividuals with intellectual disabilities: A five-year follow-up study
(English)Article in journal (Other academic) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-18740 (URN)
Available from: 2013-04-15 Created: 2013-04-15 Last updated: 2015-08-05Bibliographically approved
3. A school-based intervention associated with improvements in cardiometabolic risk profiles in young people with intellectual disabilities
Open this publication in new window or tab >>A school-based intervention associated with improvements in cardiometabolic risk profiles in young people with intellectual disabilities
2013 (English)In: Journal of Intellectual Disabilities, ISSN 1744-6295, E-ISSN 1744-6309, Vol. 17, no 1, 38-50 p.Article in journal (Refereed) Published
Abstract [en]

This study evaluates a multifactorial school-based intervention with the aim of decreasing cardiometabolic risk factors by means of a healthy lifestyle, primarily with daily physical activity and healthy food during school hours, at an upper secondary school for students with intellectual disabilities. The outcome is measured in terms of cardiometabolic risk factors and cardiovascular fitness, both known to increase the risk of future cardiovascular disease, type 2 diabetes and cancer. Two years of intervention resulted in a positive trend in several measured cardiometabolic risk factors, with no increase in fat mass. Cardiovascular fitness levels were unchanged. We conclude that a healthy school environment can contribute to a deceleration of both fat mass gain and loss of cardiovascular fitness.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-18738 (URN)10.1177/1744629512472116 (DOI)2-s2.0-84875511105 (Scopus ID)
Available from: 2013-04-15 Created: 2013-04-15 Last updated: 2015-11-13Bibliographically approved
4. Eating patterns among students with intellectual disabilities after a multifactorial school intervention using the plate model
Open this publication in new window or tab >>Eating patterns among students with intellectual disabilities after a multifactorial school intervention using the plate model
2013 (English)In: Journal of Policy and Practice in Intellectual Disabilities, ISSN 1741-1122, E-ISSN 1741-1130, Vol. 10, no 1, 45-53 p.Article in journal (Refereed) Published
Abstract [en]

Adolescents with intellectual disabilities (ID) have an increased prevalence of being overweight and having cardiometabolic diseases as adults, in part due to poor eating habits with an inadequate intake of vegetables. The aim of this study was to evaluate whether a multifactorial school intervention using the "Plate Model" results in improved healthy food choices with recommended ≥37.5% of vegetables. Participants with mild/moderate intellectual disabilities from an intervention school (n=27) were compared with controls (n=62) from two other upper secondary schools for students with ID. All were offered a test buffet lunch with meatballs, potatoes, sauce, and eight different vegetables presented in identical bowls. Their servings and food intake were evaluated from digital images and video films. The majority (88%) of the total group filled their plate with ≥37.5% of vegetables. The mean energy intake did not differ between the groups (576kcal (min 196-max 1444)). The intervention participants had a lower intake of fat (21% (SD 6) vs. 24% (SD 7), p=031), a higher intake of carbohydrates (57% (SD 7) vs. 53% (SD 8), p=035), less plate waste (5 (SD 10) grams vs. 25 (SD 43) grams, p=021), and more participants took only one portion (56% vs. 32%, p=039) compared with the control group. The participants from the intervention school made healthier food choices. In this setting, most adolescents with ID ate a sufficient amount of vegetables.

Keyword
Food habits, Intellectual disabilities, Observation, School intervention, Vegetables
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mdh:diva-18733 (URN)10.1111/jppi.12020 (DOI)000316968100004 ()2-s2.0-84875551932 (Scopus ID)
Available from: 2013-04-12 Created: 2013-04-12 Last updated: 2015-11-13Bibliographically approved

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