Parent support improves weight loss in adolescents and young adults with Down syndrome

Abstract

Objective: To assess whether parent training in behavioral intervention, combined with a 16-session nutrition and activity education program, would improve weight loss relative to nutrition and activity education alone in adolescents and young adults with Down syndrome.

Study design: Twenty-one patients with Down syndrome aged 13-26 years with a body mass index ≥ 85 th percentile were enrolled and randomized to a 6-month nutrition and activity education intervention (n = 10) or to a nutrition and activity education+behaviorial intervention (n = 11), and followed for 6 months after the active intervention period (1-year follow-up). The primary outcome measure was body weight; secondary outcomes included percentage body fat by bioelectric impedance; intake of fruits, vegetables, and energy-dense low-nutrient snack food (treats) by 3-day food record; and moderate/vigorous physical activity by accelerometry.

Results: At 6 months, mean body weight in the nutrition and activity education+behavioral intervention group was 3.2 kg lower than that in the nutrition and activity education group (95% CI, 1.0-5.5 kg; P = .005). Mean group differences were sustained at 1 year (3.6 kg; 95% CI, 1.4-5.9 kg; P = .002). At 6 months, moderate/vigorous physical activity time increased by an average of 18 minutes/day compared with baseline in the nutrition and activity education+behavioral intervention group (P = .01) and decreased by 7 minutes/day in the nutrition and activity education group (P = .30). These changes were largely maintained at 1 year, but were not statistically significant. Vegetable intake in the nutrition and activity education+behavioral intervention group exceeded that in the nutrition and activity education group by a mean of 1.6 servings at 1 year (P = .009), but not at 6 months. No between-group differences were observed for percentage body fat or consumption of fruits or treats.

Conclusion: Parent-supported behavioral intervention appears to be a successful adjunct to a 6-month nutrition education intervention in achieving weight loss in adolescents and young adults with Down syndrome.

Trial registration: ClinicalTrials.gov NCT01256112.

Keywords: %fat; Percentage body fat.

Copyright © 2013 Mosby, Inc. All rights reserved.

Figures

Figure 1. Trial Design

Figure 2a&b. Least Squares Mean Change from Baseline in Weight or Percentage Body Fat at Pre-Specified Follow-up Visits by Treatment Group with Corresponding 95% Confidence Intervals

nutrition and activity education + behaviorial intervention (…●…), nutrition and activity education (—○—) a Linear mixed model p-values: group = 0.07; time = 0.09; group-by-time interaction = 0.005. At 52 weeks, mean weight decreased 1.95 in nutrition and activity education+behaviorial intervention and increased 1.67kg in nutrition and activity education (mean group difference = −3.62 kg, 95% CI: −5.88, −1.36, p-value = 0.002). b Linear mixed model p-values: group = 0.48; time = 0.009; group-by-time interaction = 0.52. At 52 weeks, mean PBF decreased 0.76 in nutrition and activity education+behaviorial intervention and increased 0.48 in nutrition and activity education (mean group difference = −1.24, 95% CI: −2.78, 0.31, p-value = 0.12).

Figure 3a-d. Least Squares Mean Change from Baseline in Physical Activity, Fruit Consumption, Vegetable Consumption, or Treat Consumption at Pre-Specified Follow-up Visits by Treatment Group with Corresponding 95% Confidence Intervals

nutrition and activity education + behaviorial intervention (…●…), nutrition and activity education (—○—) a Linear mixed model p-values: group = 0.006; time = 0.32; group-by-time interaction = 0.63. At 52 weeks, mean moderate/vigorous physical activity increased 9.26 min/day in nutrition and activity education+behaviorial intervention and decreased 6.29 min/day in nutrition and activity education (mean group difference = −15.55 min/day, 95% CI: −34.49, 3.39, p-value = 0.10). b Linear mixed model p-values: group = 0.13; time = 0.36; group-by-time interaction = 0.69. At 52 weeks, mean fruit consumption increased 0.33 servings/day in nutrition and activity education+behaviorial intervention and increased servings/day 0.70 in nutrition and activity education (mean group difference = −0.37, 95% CI: −1.23, 0.49, p-value = 0.38).c Linear mixed model p-values: group = 0.02; time = 0.76; group-by-time interaction = 0.07. At 52 weeks, mean vegetable consumption increased 1.07 servings/day in nutrition and activity education+behaviorial intervention and decreased 0.56 servings/day in nutrition and activity education (mean group difference = 1.63, 95% CI: 0.44, 2.82, p-value = 0.009).d Linear mixed model p-values: group = 0.78; time = 0.16; group-by-time interaction = 0.57. At 52 weeks, mean treat consumption decreased 143.49 kcal/day in nutrition and activity education+behaviorial intervention and decreased 120.7 servings/day in nutrition and activity education (mean group difference = −22.78, 95% CI: −194.46, 148.9, p-value = 0.79).