Homogeneity in Motor Competence Among Youths With Intellectual Disability With and Without Down Syndrome.

PURPOSE: To determine if there is a homogeneity of scores for youth with intellectual disability (ID) with and without Down syndrome (DS) in 19 test items of motor competence from the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2). Homogeneity was defined as the means for each of the 19 test items scores by sex and the presence or absence of DS sharing the same population mean. METHOD: Participants were 622 youth with ID aged 6 to 21 years. Items for bilateral coordination, balance, and upper limb coordination were examined using the BOT-2. RESULTS: For all 19 BOT-2 items, means between youth with and without DS did not differ from the population mean. CONCLUSION: These results potentiate the development of expected BOT-2 motor competence scores for youth with ID independent of the presence of DS for clinical practice.

Brazilian growth charts for Williams-Beuren Syndrome at ages 2 to 18 years.

OBJECTIVE: To develop growth charts for weight-for-age, height-for-age, and body mass index (BMI)-for-age for both genders aged 2 to 18 years for Brazilian patients with Williams-Beuren Syndrome (WBS). METHODS: This is a multicenter, retrospective, and longitudinal study, data were collected from the medical records of boys and girls with a confirmed diagnosis of WBS in three large university centers in the state of Sao Paulo, Brazil. Growth charts stratified by gender and age in years were developed using LMSchartmaker Pro software. The LMS (Lambda Mu Sigma) method was used to model the charts . The quality of the settings was checked by worm plots. RESULTS: The first Brazilian growth charts for weight-for-age, height-for-age, and BMI-for-age stratified by gender were constructed for WBS patients aged 2 to 18 years. CONCLUSION: The growth charts developed in this study can help to guide family members and to improve the health care offered by health professionals.

Height and body mass index distribution in children and adolescents with and without spina bifida.

OBJECTIVE: Children with spina bifida (SB) are at risk for stunting and overweight. However, height and Body Mass Index (BMI) z-score distribution in children and adolescents with SB are unclear. The aim of this study was to examine height and BMI z-score distribution in Brazilian children and adolescents with and without SB. This study further aimed to examine whether height and BMI z-scores differ between individuals with and without SB. METHOD: This study included 101 participants (SB: n = 18; non-SB: n = 83, aged 7-16 years). The World Health Organization (WHO) AnthroPlus software was used to calculate height and BMI z-scores. AnthroPlus z-score distribution graphs were used to examine individual z-scores based on the 2007 WHO normal distribution curve. Effects of the group (SB vs non-SB) on height and BMI z-scores were examined with sequential regression. RESULTS: In the WHO distribution graph analysis, height z-scores of participants with SB were slightly left-shifted compared to the WHO normal distribution curve. In the regression analysis, group (SB vs non-SB) was a significant predictor of height z-scores after controlling for sex and age (ΔR2 = 0.064, p = 0.010). BMI z-scores of participants with SB were right-shifted compared to the WHO normal curve. However, there was no contribution of the group to BMI z-scores (ΔR2 = 0.011, p = 0.301). CONCLUSIONS: These findings suggest that Brazilian children and adolescents with SB may be at risk for reduced height and increased BMI.

Height and body mass index distribution in children and adolescents with and without spina bifida

Abstract Objective Children with spina bifida (SB) are at risk for stunting and overweight. However, height and Body Mass Index (BMI) z-score distribution in children and adolescents with SB are unclear. The aim of this study was to examine height and BMI z-score distribution in Brazilian children and adolescents with and without SB. This study further aimed to examine whether height and BMI z-scores differ between individuals with and without SB. Method This study included 101 participants (SB: n= 18; non-SB: n= 83, aged 7-16 years). The World Health Organization (WHO) AnthroPlus software was used to calculate height and BMI z-scores. AnthroPlus z-score distribution graphs were used to examine individual z-scores based on the 2007 WHO normal distribution curve. Effects of the group (SB vs non-SB) on height and BMI z-scores were examined with sequential regression. Results In the WHO distribution graph analysis, height z-scores of participants with SB were slightly left-shifted compared to the WHO normal distribution curve. In the regression analysis, group (SB vs non-SB) was a significant predictor of height z-scores after controlling for sex and age (ΔR2= 0.064, p= 0.010). BMI z-scores of participants with SB were right-shifted compared to the WHO normal curve. However, there was no contribution of the group to BMI z-scores (ΔR2= 0.011, p= 0.301). Conclusions These findings suggest that Brazilian children and adolescents with SB may be at risk for reduced height and increased BMI.

Cross-cultural adaptation and concurrent validity of the children's OMNI scale of perceived exertion for Arm-Crank activity in Spina Bifida.

PURPOSE: To perform a cross-cultural adaptation of the OMNI verbal descriptors to Brazilian-Portuguese and examine the validity of the Brazilian version for arm-crank activity. MATERIALS AND METHODS: Cross-cultural adaptation stages were: permission, translation, synthesis, back translation, expert committee review, pretesting, and submission and appraisal. For the concurrent validity, a Brazilian OMNI-Wheel scale was used to obtain rating of perceived exertion for the overall body (RPEOverall) and arms (RPEArms) in participants (n = 9, 10-17 years) with spina bifida. Cardiopulmonary exercise test was used to measure heart rate (HR) and oxygen uptake (VO2). Repeated Measures Correlation (rrm) was used to examine the scale validity. RESULTS: The cross-cultural adaptation produced equivalence between English and Brazilian-Portuguese verbal descriptors based on successful translation and pretesting. The Brazilian OMNI-wheel was validated based on strong associations of RPEOverall with VO2 (rrm (35) = 0.86, 95% CI [0.93, 0.73], p < 0.001) and HR (rrm (35) = 0.89, 95% CI [0.94, 0.79], p < 0.001) and RPEArms with VO2 (rrm (33) = 0.82, 95% CI [0.91, 0.66], p < 0.001) and HR (rrm (33) = 0.82, 95% CI [0.91, 0.66], p < 0.001). CONCLUSIONS: The OMNI scale was cross-culturally adapted to Brazilian-Portuguese. The Brazilian OMNI-Wheel was validated based on strong associations of RPE with HR and VO2. Implications For RehabilitationThe original English OMNI was cross-culturally adapted to Brazilian-Portuguese.A Brazilian wheelchair OMNI was concurrently validated for Arm-Crank Activity in adolescents with spina bifida.This OMNI scale version may aid health providers in monitoring perceived exertion in Brazil.

Atividade física objetiva em jovens com espinha bífida: um protocolo de revisão sistemática / Objective physical activity in youth with spina bifida: a systematic review protocol

Atividade física (AF) diária associa-se a melhora do estado de saúde de jovens. Evidências indicam que crianças com espinha bífida (EB) estão em risco para inatividade física. Este artigo apresenta um protocolo de revisão sistemática que propõe avaliar níveis de AF objetiva diária em crianças e adoles-centes com EB. Este protocolo foi desenvolvido seguindo o Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015. A revisão foi registrada no International Prospective Register of Systematic Reviews (PROSPERO, CRD42022349920). Os critérios de inclu-são baseiam-se em artigos originais: 1) publicados em revistas com revisão por pares; 2) que avaliem AF objetiva diária em crianças e adolescentes com EB; e 3) que utilizem monitores para avaliação da AF (ex: acelerômetros). Palavras-chave foram baseadas no MeSH e literatura existente. As seguin-tes bases de dados serão utilizadas como fontes de informação: PubMed, Embase, SPORTDiscus, LILACS, CINAHL, Scopus, PsycINFO e Web of Science. Os seguintes dados serão extraídos: características do estudo e da amostra, variáveis de AF (protocolos de medição e pontos de corte de classificação de AF) e resultados dos níveis de AF. A qualidade dos estudos será avaliada com o Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields(ERA). A busca e seleção dos estudos, extração de dados e avaliação de qualidade serão realizadas por dois revisores independentes. Espera-se que a revisão forneça evidências para auxiliar na pre-venção e tratamento de inatividade física e guiar futuras pesquisas sobre AF objetiva em crianças e adolescentes com EB

Daily physical activity (PA) is associated with improvements in health status in youth. However, evidence indicates that children with spina bifida (SB) are at risk for physical inactivity. This paper documents a systematic review protocol that aims to examine daily objective PA levels in children and adolescents with SB. This protocol was developed following the Preferred Reporting Items for Systematic Review and Me-ta-Analysis Protocols (PRISMA-P) 2015. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022349920). The inclusion criteria are based on original articles: 1) published in peer-reviewed journals; 2) examining daily objective PA in children and adolescents with SB; and 3) using PA monitors to measure PA (e.g., accelerometers). Key words were de-termined based on MeSH and existing literature. The following databases will be used as sources of infor-mation: PubMed, Embase, SPORTDiscus, LILACS, CINAHL, Scopus, PsycINFO, and Web of Science. Study and sample characteristics, PA variables (measurement protocols and PA classification cut-points) and PA levels results will be extracted from the studies. The quality of studies will be assessed with the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (ERA). The search and selection of articles, and extraction of data and quality assessment will be performed by two in-dependent reviewers. It is expected that this study provides evidence to support prevention and treatment of physical inactivity and guide future research directions in objective PA in children and adolescents with SB

Estimation of body fat in children with intellectual disability: development and cross-validation of a simple anthropometric method

Abstract Objective Population-level monitoring of body composition requires accurate, biologically-relevant, yet feasible methods for estimating percent body fat (%BF). The aim of this study was to develop and cross-validate an equation for %BF from Body Mass Index (BMI), age, and sex among children with intellectual disability (ID). This study further aimed to examine the performance of an existing BMI-based equation (Deurenberg equation) for %BF in children with ID. Method Participants were 107 children (63 boys; aged 6-15 years) with ID randomly allocated to development (n= 81) and cross-validation (n= 26) samples. Dual-Energy X-Ray Absorptiometry provided the criterion %BF. Results The model including BMI, age, and sex (0 = male; 1 = female) had a significant goodness-of-fit in determining %BF (p< 0.001; R2= 0.69; SEE =5.68%). The equation was: %BF = - 15.416 + (1.394 × BMI) + (4.538 × age) - (0.262 × age2) + (5.489 × sex). The equation was cross-validated in the separate sample based on (i) strong correlation (r = 0.82; p< 0.001) and non-significant differences between actual and predicted %BF (28.6 ± 9.6% and 30.1 ± 7.1%, respectively); (ii) mean absolute error (MAE) = 4.4%; and (iii) reasonable %BF estimations in Bland-Altman plot (mean: 1.48%; 95% CI: 12.5, -9.6). The Deurenberg equation had a large %BF underestimation (mean: -7.1%; 95% CI: 5.3, -19.5), significant difference between actual and estimated %BF (28.6 ± 9.7% and 21.5 ± 7.0%, respectively; p< 0.001), and MAE = 8.1%. Conclusions The developed equation with BMI, sex, and age provides valid %BF estimates for facilitating population-level body fat screening among children with ID.

Estimation of body fat in children with intellectual disability: development and cross-validation of a simple anthropometric method.

OBJECTIVE: Population-level monitoring of body composition requires accurate, biologically-relevant, yet feasible methods for estimating percent body fat (%BF). The aim of this study was to develop and cross-validate an equation for %BF from Body Mass Index (BMI), age, and sex among children with intellectual disability (ID). This study further aimed to examine the performance of an existing BMI-based equation (Deurenberg equation) for %BF in children with ID. METHOD: Participants were 107 children (63 boys; aged 6-15 years) with ID randomly allocated to development (n = 81) and cross-validation (n = 26) samples. Dual-Energy X-Ray Absorptiometry provided the criterion %BF. RESULTS: The model including BMI, age, and sex (0 = male; 1 = female) had a significant goodness-of-fit in determining %BF (p < 0.001; R2 = 0.69; SEE =5.68%). The equation was: %BF = - 15.416 + (1.394 × BMI) + (4.538 × age) - (0.262 × age2) + (5.489 × sex). The equation was cross-validated in the separate sample based on (i) strong correlation (r = 0.82; p < 0.001) and non-significant differences between actual and predicted %BF (28.6 ± 9.6% and 30.1 ± 7.1%, respectively); (ii) mean absolute error (MAE) = 4.4%; and (iii) reasonable %BF estimations in Bland-Altman plot (mean: 1.48%; 95% CI: 12.5, -9.6). The Deurenberg equation had a large %BF underestimation (mean: -7.1%; 95% CI: 5.3, -19.5), significant difference between actual and estimated %BF (28.6 ± 9.7% and 21.5 ± 7.0%, respectively; p < 0.001), and MAE = 8.1%. CONCLUSIONS: The developed equation with BMI, sex, and age provides valid %BF estimates for facilitating population-level body fat screening among children with ID.

Association between sleep quality and physical functioning in adults with Down syndrome: A brief report.

BACKGROUND: Sleep quality is associated with physical functioning in adults, but this has not been examined in those with Down syndrome (DS). High body mass index (BMI) and accelerated aging, both common in adults with DS, may alter the relationship between sleep quality and physical functioning in this population. OBJECTIVE: To examine sleep quality indicators and its association with physical functioning in adults with DS, and whether associations are altered by BMI and age. METHODS: Participants were 15 adults with DS (8 women; age 29 ± 14 years). We evaluated sleep quality over seven days with wrist-worn accelerometers and physical functioning with the timed-up-and-go (TUG) and 6-min walk (6 MW) tests. We examined the associations between sleep quality and physical functioning variables using Spearman's rho. RESULTS: Sleep quality indicators were: total sleep time 407 ± 54 min; latency 26.8 ± 21 min; efficiency 73.9 ± 12 %; wake after sleep onset 122.8 ± 65.2 min; number of awakenings 21.0 ± 6.2; and average length of awakenings 6.1 ± 3 min. Total sleep time and average length of awakenings were significantly associated with 6 MW distances (rho = 0.58 and -0.69; p < 0.05, respectively). After controlling for age and BMI, 6 MW distance was significantly associated with total sleep time, latency, efficiency, and average length of awakenings (rho = 0.56, -0.73, 0.60, and -0.87; p < 0.05, respectively). TUG was significantly associated with total time in bed (rho = 0.71); p < 0.05). CONCLUSIONS: Sleep quality indicators are associated with walking performance in adults with DS. Age and BMI strengthen the relationship between sleep quality and physical functioning.

Development and Cross-Validation of a Simple Model to Estimate Percent Body Fat in Persons with Multiple Sclerosis.

BACKGROUND: Persons with multiple sclerosis (MS) have higher body composition variability compared with the general population. Monitoring body composition requires accurate methods for estimating percent body fat (%BF). We developed and cross-validated an equation for estimating %BF from body mass index (BMI) and sex in persons with MS. METHODS: Seventy-seven adults with MS represented the sample for the equation development. A separate sample of 33 adults with MS permitted the equation cross-validation. Dual-energy x-ray absorptiometry (DXA) provided the criterion %BF. RESULTS: The model including BMI and sex (mean ± SD age: women, 49.2 ± 8.8 years; men, 48.6 ± 9.8 years) had high predictive ability for estimating %BF (P < .001, R2 = 0.77, standard error of estimate = 4.06%). Age, MS type, Patient-Determined Disease Steps score, and MS duration did not improve the model. The equation was %BF = 3.168 + (0.895 × BMI) - (10.191 × sex); sex, 0 = woman; 1 = man. The equation was cross-validated in the separate sample (age: women, 48.4 ± 9.4 years; men, 43.8 ± 15.4 years) based on high accuracy as indicated by strong association (r = 0.89, P < .001), nonsignificant difference (mean: 0.2%, P > .05), small absolute error (mean: 2.7%), root mean square error (3.5%), and small differences and no bias in Bland-Altman analysis (mean difference: 0.2%, 95% CI: -6.98 to 6.55, rs = -0.07, P = .702) between DXA-determined and equation-estimated %BF. CONCLUSIONS: Health care providers can use this developed and cross-validated equation for estimating adiposity in persons with MS when DXA is unavailable.

Development and Cross-Validation of a Prediction Equation for Estimating Percentage Body Fat From Body Mass Index in Young People With Intellectual Disability.

The purpose of this study was to develop and cross-validate an equation for estimating percentage body fat (%BF) from body mass index and other potential independent variables among young persons with intellectual disability. Participants were 128 persons with intellectual disability (62 women; age 16-24 years) split between development (n = 98) and cross-validation (n = 30) samples. Dual-energy X-ray absorptiometry served as the reference method for %BF. An equation including 1/body mass index and sex (0 = male; 1 = female) was highly accurate in estimating %BF (p < .001; R2 = .82; standard error of estimate = 5.22%). Mean absolute and root mean square errors were small (3.1% and 3.9%, respectively). A Bland-Altman plot indicated nearly zero mean difference between actual and predicted %BF with modest 95% confidence intervals. The prediction equation was %BF = 56.708 - (729.200 × [1/body mass index]) + (12.134 × sex). Health care professionals may use the prediction equation for monitoring %BF among young people with intellectual disability.

Comparing Motor Competence of Sex- and Age-Matched Youth With Intellectual Disability From Brazil and the United States.

Youth with intellectual disabilities (IDs) demonstrate below-criteria motor competence (MC) compared with typically developing (TD) youth. Whether differences in MC exist for youth with ID from different countries is unknown. This study examined the MC of youth with ID from Brazil (BR) and the United States (US) and compared it with norms for TD youth as established by the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). The authors measured 19 BOT-2 test items for bilateral coordination, balance, and upper limb coordination of 502 youth (BR = 252, US = 250) with ID (6-21 years). Raw scores were converted to %ceiling (percentile of highest expected scores). For all test items, no significant differences were seen between BR and US participants in %ceiling scores. Participants from both countries demonstrated equivalent to slightly below BOT-2 norms in 14 of the 19 test items, with lowest scores seen in contralateral synchronizing bilateral coordination, balancing on one leg, and ball handling.

Growth assessment in children with Williams-Beuren syndrome: a systematic review.

Williams-Beuren syndrome (WBS) is a rare genetic disease caused by a sporadic heterozygous microdeletion in 7q11.23. It is characterized by distinctive facial appearance, cardiopathy, short stature, intellectual disability, and endocrine abnormalities. To evaluate the growth pattern of patients with WBS and to identify the prevalence of malnutrition, overweight, and obesity in this population, a systematic review of studies published in English, between 1987 and 2018, was performed following the PRISMA protocol using the PubMed, Cochrane, and BIREME databases. Original articles and articles that evaluated growth status using weight, or height, or head circumference (HC), or body mass index (BMI) of individuals with WBS were included. Case reports, articles with data from other syndromes, and articles that did not present as a central theme the evaluation of growth were not included. WBS presented specific growth pattern, characterized by intrauterine growth restriction, low weight, length, and HC at birth. This global growth delay persisted during childhood and adolescence. BMI was not different to the reference population, and obesity was not observed in childhood. The mechanisms that determine this typical growth pattern are not totally clear; however, the typical pubertal development of these patients and the intrinsic and secondary lesions caused by microdeletion at 7q11.23 seem to be the major factors involved. Conclusion: Patients with WBS have a growth pattern different from the general reference population. The reference charts for normal population should not be used for WBS patients because it often underestimate their growth. Specific growth charts for WBS patients are necessary.

Growth charts for Brazilian children with Down syndrome: Birth to 20 years of age.

BACKGROUND: The growth of youth with Down syndrome (DS) differs from that of youth without DS, and growth charts specific to DS have been developed. However, little is known about the growth of Brazilian youth with DS. The objective of this study was to construct growth charts for Brazilian youth with DS and compare the growth data with the Child Growth Standards of the World Health Organization (WHO) and charts for children with DS from other studies. METHODS: Mixed longitudinal and cross-sectional data were collected at University of Campinas, 48 specialized centers for people with intellectual disabilities, and two foundations for people with DS between 2012 and 2015. A total of 10,516 growth measurements from birth to 20 years of age were available from 938 youth with DS (53.7% boys) born between 1980 and 2013. The Lambda Mu Sigma method was applied to construct the curves using generalized additive models for location, scale, and shape. RESULTS: Length/height-for-age, weight-for-age, and head circumference-for-age percentile curves were generated for Brazilian boys and girls from birth to 20 years of age. Differences in growth of Brazilian youth ranged from -0.8 to -3.2 z-scores compared to WHO standards, and -1.9 to +1.3 compared to children with DS in other studies. CONCLUSIONS: These specific growth charts may guide clinicians and families in monitoring the growth of Brazilian children and adolescents with DS.

Body mass index reference charts for individuals with Down syndrome aged 2-18 years / Gráfico de referência do Índice de Massa Corporal para os indivíduos com síndrome de Down entre 2 e 18 anos de idade

Abstract: Objective: To develop Brazilian growth charts for body mass index (BMI-for-age) for individuals with Down syndrome (DS). The secondary objective was to compare the BMI-for-age with the Centers for Disease Control and Prevention standards (CDC). Methods: A retrospective and cross-sectional growth study of 706 youth with DS (56.7% males) was performed in 51 centers in São Paulo state, Brazil. Weight and height were used to calculate the BMI (kg/m2). The LMS method was applied to construct the growth charts. Z-scores were based on the CDC 2000 growth standards. Results: The BMI-for-age reference charts showed excellent goodness of fit statistics for boys and girls with DS aged 2-18 years. At 2 years of age, the mean BMI Z-scores of boys and girls with DS were lower compared to those of the CDC (Z-score = −0.2). In contrast, children with DS aged 3-18 years had higher mean Z-scores for BMI-for-age when compared to those of the CDC (Z-scores = +0.2 to +1.3). Conclusions: The BMI of Brazilian youth with DS differs from those references established by CDC. These are the first Brazilian BMI-for-age charts for individuals with DS and will hopefully guide clinicians and parents in the evaluation and management of the nutritional status in children and adolescents with DS in Brazil.

Resumo: Objetivo: Desenvolver curvas específicas de índice de massa corporal (IMC-para-idade) para população brasileira com síndrome de Down (SD). O objetivo secundário foi comparar os valores de IMC-para-idade com os valores normativos dos Centros de Controle e Prevenção de Doenças dos Estados Unidos (CDC). Métodos: Estudo do tipo retrospectivo e transversal. A amostra foi constituída de 706 jovens com SD (56,7%, meninos) recrutados em 51 instituições no Estado de São Paulo, Brasil. Peso e estatura foram obtidos e empregados para o cálculo de IMC (Kg/m2). O método LMS foi usado para a construção das curvas. Escores Z foram calculados com base na referência do CDC 2000. Resultados: As curvas de referência de IMC-para-idade para meninos e meninas com SD na faixa entre 2-18 anos apresentaram excelente ajuste estatístico. Aos 2 anos, o escore Z médio IMC de crianças com SD apresentou-se menor quando comparado com o CDC (escore Z = -0,2). Em contraste, os escores Z médios de IMC de jovens com SD foram superiores entre 3-18 anos (escores Z = +0,2 a +1,3). Conclusões: A população brasileira com SD apresentou diferentes padrões de IMC quando comparada com as referências do CDC. As curvas desenvolvidas neste estudo representam a primeira referência nacional de IMC-para-idade para jovens com SD. Espera-se, portanto, que essas curvas possam guiar pais e profissionais na avaliação do estado nutricional de crianças e adolescentes com SD no território brasileiro.

Body mass index reference charts for individuals with Down syndrome aged 2-18 years.

OBJECTIVE: To develop Brazilian growth charts for body mass index (BMI-for-age) for individuals with Down syndrome (DS). The secondary objective was to compare the BMI-for-age with the Centers for Disease Control and Prevention standards (CDC). METHODS: A retrospective and cross-sectional growth study of 706 youth with DS (56.7% males) was performed in 51 centers in São Paulo state, Brazil. Weight and height were used to calculate the BMI (kg/m2). The LMS method was applied to construct the growth charts. Z-scores were based on the CDC 2000 growth standards. RESULTS: The BMI-for-age reference charts showed excellent goodness of fit statistics for boys and girls with DS aged 2-18 years. At 2 years of age, the mean BMI Z-scores of boys and girls with DS were lower compared to those of the CDC (Z-score=-0.2). In contrast, children with DS aged 3-18 years had higher mean Z-scores for BMI-for-age when compared to those of the CDC (Z-scores=+0.2 to +1.3). CONCLUSIONS: The BMI of Brazilian youth with DS differs from those references established by CDC. These are the first Brazilian BMI-for-age charts for individuals with DS and will hopefully guide clinicians and parents in the evaluation and management of the nutritional status in children and adolescents with DS in Brazil.

Body mass index cutoff point estimation as obesity diagnostic criteria in Down syndrome adolescents.

INTRODUCTION: Adolescents with Down syndrome (DS) show high rate of overweight and tend to accumulate high amount of fat compared to the same people without the syndrome. OBJECTIVE: To estimate the cutoff point of the Body Mass Index (BMI) for the diagnosis of obesity in adolescents with DS according to different references for BMI in relation to the percentage of body fat (%BF) measured by dual-energy X-ray absorptiometry (DXA). METHODS: The sample was composed of 34 adolescents with DS (aged: 10 to 17 years old). BMI was evaluated according to the references of the International Obesity Task Force (IOTF), the World Health Organization (WHO) for the general population, and Myrelid et al. and Styles et al. for people with DS. The %BF was assessed by whole body DXA and classified according to National Health And Nutrition Examination Survey (NHANES, 2011). RESULTS: The boys were significantly taller than the girls and this %BF higher than boys. All references who have used BMI to assess obesity was positively associated with %BF measured by DXA in the diagnosis of obesity. Using the ROC curve in relation to %BF by DXA, all references showed high sensitivity, but the z-score of BMI by WHO showed better specificity, with the value of the accuracy of 0.82 for the cutoff point above 2.14. CONCLUSIONS: All the references used for the diagnosis of obesity were associated with %BF measured by DXA, and the cutoff point of z-scores above 2.14 by WHO showed better specificity.

Body mass index cutoff point estimation as obesity diagnostic criteria in Down syndrome adolescents / Estimación del punto de corte del índice de masa corporal como criterio diagnóstico de obesidad en adolescentes con síndrome de Down

Introduction: Adolescents with Down syndrome (DS) show high rate of overweight and tend to accumulate high amount of fat compared to the same people without the syndrome. Objective: To estimate the cutoff point of the Body Mass Index (BMI) for the diagnosis of obesity in adolescents with DS according to different references for BMI in relation to the percentage of body fat (%BF) measured by dual-energy X-ray absorptiometry (DXA). Methods: The sample was composed of 34 adolescents with DS (aged: 10 to 17 years old). BMI was evaluated according to the references of the International Obesity Task Force (IOTF), the World Health Organization (WHO) for the general population, and Myrelid et al. and Styles et al. for people with DS. The %BF was assessed by whole body DXA and classified according to National Health And Nutrition Examination Survey (NHANES, 2011). Results: The boys were significantly taller than the girls and this %BF higher than boys. All references who have used BMI to assess obesity was positively associated with %BF measured by DXA in the diagnosis of obesity. Using the ROC curve in relation to %BF by DXA, all references showed high sensitivity, but the z-score of BMI by WHO showed better specificity, with the value of the accuracy of 0.82 for the cutoff point above 2.14. Conclusions: All the references used for the diagnosis of obesity were associated with %BF measured by DXA, and the cutoff point of z-scores above 2.14 by WHO showed better specificity (AU)

Introducción: adolescentes con síndrome de Down (SD) muestran alta tasa de sobrepeso y tienden a acumular gran cantidad de grasa en comparación con los adolescentes sin el síndrome. Objetivo: estimar el punto de corte del índice de masa corporal (IMC) para el diagnóstico de obesidad en adolescentes con SD de acuerdo con las diferentes referencias para el IMC en relación con el porcentaje de grasa corporal (%GC) obtenido por el absorciometría con rayos X de doble energía (DXA). Métodos: la muestra se compone de 34 adolescentes con SD (10 a 17 años). El IMC se evaluó de acuerdo con las referencias de la International Obesity Task Force (IOTF), Organización Mundial de la Salud (OMS) para la población general, y Myrelid et al. y Estyles et al. para personas con SD. El %GC fue evaluado por DXA y clasificado según NHANES (2011). Resultados: los niños fueron significativamente más altos que las niñas, y estas con mayor %GC que los niños. Todas las referencias que han utilizado el IMC se asociaron positivamente con el %GC medido por DXA en el diagnóstico de la obesidad. Utilizando la curva ROC en relación con %GC por DXA todas las referencias mostraron alta sensibilidad, pero el score-z del IMC por la OMS mostró mejor especificidad, con el valor de exactitud de 0,82 para el punto de corte por encima de 2,14. Conclusiones: todas las referencias utilizadas para el diagnóstico de obesidad se asociaron con el %GC medido por DXA, y el punto de corte del score-z por encima de 2,14 por la OMS mostró mejor especificidad (AU)

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

BACKGROUND: Children with Down syndrome (DS) are more likely to be overweight or obese than the general population of youth without DS. AIMS: To review the prevalence of overweight and obesity and their determinants in youth with DS. The health consequences and the effectiveness of interventions were also examined. METHODS AND PROCEDURES: A search using MEDLINE, Embase, Web of Science, Scopus, CINAHL, PsycINFO, SPORTDiscus, LILACS, and COCHRANE was conducted. From a total of 4280 studies, we included 45 original research articles published between 1988 and 2015. OUTCOMES AND RESULTS: The combined prevalence of overweight and obesity varied between studies from 23% to 70%. Youth with DS had higher rates of overweight and obesity than youths without DS. Likely determinants of obesity included increased leptin, decreased resting energy expenditure, comorbidities, unfavorable diet, and low physical activity levels. Obesity was positively associated with obstructive sleep apnea, dyslipidemia, hyperinsulinemia, and gait disorder. Interventions for obesity prevention and control were primarily based on exercise-based programs, and were insufficient to achieve weight or fat loss. CONCLUSIONS AND IMPLICATIONS: Population-based research is needed to identify risk factors and support multi-factorial strategies for reducing overweight and obesity in children and adolescents with DS.

Growth curves for girls with Turner syndrome.

The objective of this study was to review the growth curves for Turner syndrome, evaluate the methodological and statistical quality, and suggest potential growth curves for clinical practice guidelines. The search was carried out in the databases Medline and Embase. Of 1006 references identified, 15 were included. Studies constructed curves for weight, height, weight/height, body mass index, head circumference, height velocity, leg length, and sitting height. The sample ranged between 47 and 1,565 (total = 6,273) girls aged 0 to 24 y, born between 1950 and 2006. The number of measures ranged from 580 to 9,011 (total = 28,915). Most studies showed strengths such as sample size, exclusion of the use of growth hormone and androgen, and analysis of confounding variables. However, the growth curves were restricted to height, lack of information about selection bias, limited distributional properties, and smoothing aspects. In conclusion, we observe the need to construct an international growth reference for girls with Turner syndrome, in order to provide support for clinical practice guidelines.