Energy expenditure in children with Down syndrome: Correcting metabolic rate for movement☆,☆☆,★,★★

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Abstract

Children with Down syndrome (DS) have a high prevalence of obesity. To investigate the relation between energy expenditure and obesity, we measured body composition, resting metabolic rate (RMR), and total energy expenditure in 13 prepubescent children with DS and in 10 control subjects matched for age, weight, and percentage of fat, using indirect calorimetry and the doubly labeled water method. Measurement of RMR was complicated by excessive movement by both the DS and control subjects. We therefore developed a method of subtracting the energy expended in movement and calculated the corrected RMR. The corrected RMR was significantly lower in those with DS than in control subjects when expressed as a percentage of the basal metabolic rate, predicted by the World Health Organization: 79.5% ± 10.4% and 96.8% ± 7.8%, respectively (p <0.001). No significant differences were detected in total daily energy expenditure or non-RMR expenditure between the subject groups. In the DS group, 60% of the variability in fat mass could be accounted for by non-RMR expenditure expressed per kilogram of body weight (p <0.02). No relation was detected between fat mass and non-RMR expenditure in control subjects, nor were any measures of energy expenditure predictive of changes in fatness among the subjects with DS during a 1-year follow-up. The results of this study indicate that prepubescent children with DS have decreased RMR compared with control children. (J PEDIATR 1994;125:829-38)

Section snippets

Subjects

Thirteen prepubescent children with DS, aged 5 to 11 years, were initially recruited from the DS clinics of the University of Chicago Wyler Children's Hospital and LaRabida Children's Hospital, Chicago, Ill., and through the National Association for Down Syndrome, Oak Brook, Ill.; the data from nine subjects with DS were complete. The data obtained from three of the other four subjects were not complete because resting metabolic rate measurements were confounded by excessive movement and no

Thyroid function

Of the 10 DS subjects with complete RMR measurements, 8 were euthyroid (normal values: T4, 5 to 12 μg/dl; thyrotropin, 0.5 to 4 mIU/L), 1 was compensated euthyroid (T4, 7.4 μg/dl; thyrotropin, >25 mIU/L), and 1 was hypothyroid (T4, <5 μg/dl; thyrotropin, >25 mIU/L). Data from the hypothyroid subject were excluded from the results.

Body composition

Table I compares the anthropometric measures of subjects with DS and those of the control subjects. There were no statistically significant differences between the

DISCUSSION

Our results indicate that prepubescent children with DS have decreased RMR compared with control children. Although lower RMR cannot solely account for obesity, metabolic differences may predispose children with DS to weight gain early in life. There are few studies with which the RMR data of our study can be compared. The one study in which RMR was measured reported significantly lower oxygen consumption in subjects with DS in comparison with published reference data.10 That study, however, is

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    • Cited by (0)

    ☆

    From the Committee for Human Nutrition and Nutritional Biology, University of Chicago, Chicago, Illinois

    ☆☆

    Supported by the Down Syndrome Research Foundation and by National Institutes of Health grants RR00055 and DK26678.

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    Reprint requests: Dale A. Schoeller, PhD, Committee for Human Nutrition and Nutritional Biology, University of Chicago, MC 4080, 5841 S. Maryland Ave., Chicago, IL 60637.

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    0022-3476/94/$3.00 + 0 9/73/59281

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