Cardiometabolic health in students and young adults with mild/moderate intellectual disabilities : Results from a longitudinal follow-up study and a school intervention

Sammanfattning: BackgroundAdults 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.AimsThe 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 MethodsSixty-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).ResultsAdolescents 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.ConclusionsAlready 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.

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