Table 1.
Health conditions and risk factors common in youth with Down syndrome that can impact weight control via either diet or physical activity.
| Medical condition | Impact on weight management | Impact on dietary intake | Impact on physical activity |
|---|---|---|---|
| Sensory Input | |||
| Visual Impairment | Glaucoma, visual field defects, and keratoconus are diseases of the eye that can limit vision. Limited vision can impact feeding and participation in exercise and sports. | ☑ | ☑ |
| Oral and Digestive System | |||
| Dental Disease | Certain dental conditions including delayed tooth eruption and missing teeth can make eating healthy foods more difficult. | ☑ | |
| Esophageal and Swallowing disorders | Esophageal disorders causing strictures along with other esophageal motility disorders can lead to food avoidance and result in decreased eating due to inability to properly swallow foods. | ☑ | |
| Intestinal obstruction, Hirschsprung Disease, Congenital Duodenal Atresia | Intestinal disorders characterized by obstruction can cause loss of appetite. Children with a prior surgical repair of the intestinal tract, such as a repaired congenital duodenal atresia, can develop a late-term complication called intestinal strictures, which can decrease intestinal motility and may consequently result in food avoidance. | ☑ | |
| Celiac Disease | Poorly controlled Celiac disease can cause inflammation of the cells lining the intestinal tract, resulting in poor absorption of nutrients and inadequate calorie absorption. Poorly controlled Celiac disease can also cause changes in bowel habits including increased stooling frequency and diarrhea, which can cause weight loss. Slight weight increases along with decreased appetite gain can also be the result of abdominal bloating, another symptom of poorly controlled Celiac disease. Following a gluten-free diet may result in low intake of fiber, Vitamin D, Vitamin B12, and folate. Many gluten-free food alternatives (e.g., gluten free cookies) are high in saturated fat, added sugar, and calories, promoting weight gain. | ☑ | |
| Endocrine | |||
| Thyroid Disease | Inadequately controlled hypothyroidism can result in changes in appetite and weight changes. An under-functioning thyroid can cause fatigue and a decreased desire to engage in physical activity. | ☑ | ☑ |
| Cardiovascular | |||
| Congenital heart disease | Uncorrected congenital heart disease can lead to decreased physical activity and participation in sports due to fatigue with exertion. Active congenital heart disease can lead to fluid retention presenting as weight gain. | ☑ | |
| Acquired heart disease | Diseases of the heart valves can develop during childhood and adolescence that may cause fatigue and a decreased desire to engage in physical activity. Heart valve disease can cause fluid retention presenting as weight gain. | ☑ | |
| Moya-Moya Disease | Strokes associated with Moya-Moya disease can limit physical activity. | ☑ | |
| Vascular ring | Aberrant right subclavian artery can sometimes cause compression of the esophagus, limiting solid food intake. | ☑ | |
| Pulmonary | |||
| Pneumonia and Bronchitis | Acute lung infections can cause systemic symptoms, including loss of appetite and when severe can result in decreased physical activity capacity. | ☑ | ☑ |
| Obstructive Sleep Apnea | Inadequately controlled sleep apnea can result in daytime fatigue and a decreased desire to engage in physical activity. Inadequately controlled sleep apnea may result in a lower metabolism, which can lead to weight gain. Use of CPAP may also lead to slight weight gain by decreasing your basal metabolic rate. | ☑ | |
| Musculoskeletal | |||
| Hypotonia (Low Muscle Tone) | Poor muscle tone can make participating in exercise and sports difficult, resulting in less physical activity. Low muscle tone can result in a decreased metabolism with lower daily energy requirements. | ☑ | ☑ |
| Arthritis (Joint Disease) | Arthritis and joint pain can limit physical activity. Some classes of medications used to treat inflammatory type arthritides, including steroids, can cause increased appetite as well as weight gain. | ☑ | |
| Joint stability and Posture | Loose ligaments (ligament laxity) and other causes of poor joint stability can limit physical activity capacity. Poor or misaligned posture from flat feet and other common foot, ankle, and hip conditions can cause pain that limits physical activity. | ☑ | |
| Osteoporosis | Low bone density is common in individuals with DS. Increased consumption of foods rich in calcium and vitamin D, as well as regular weight bearing physical activity can increase bone density and decrease the risk for bone fractures in individuals with DS. | ☑ | ☑ |
| Atlanto-axial instability (AAI) | Some sports and activities are contraindicated in individuals with atlanto-axial instability/subluxation. | ☑ | |
| Neurologic | |||
| Seizure disorder | Certain medications used to treat seizures can cause either loss of appetite or weight gain. | ☑ | |
| Regression disorder in DS | A decrease in global activity results in decreased eating and decreased physical activity. | ☑ | ☑ |
| Developmental Delay | Autism Spectrum Disorder can impact eating and physical activity levels. | ☑ | ☑ |
| Psychiatric | |||
| Mental Health (Anxiety, Obsessive Compulsive Disease, Depression, Schizophrenia) | Emotional eating can be seen with Anxiety and Depression which is often associated with increased caloric intake and consumption of unhealthy foods. Depression can cause a decreased desire to engage in physical activity. Antipsychotic medications can cause increased appetite and weight gain. | ☑ | ☑ |
| Cancer | |||
| Leukemia, Testicular cancer | Cancer treatments can cause appetite loss and weakness resulting in decreased physical activity levels. Steroid medications can lead to increased appetite and weight gain. | ☑ | ☑ |