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e-ISSN: 23201959.p- ISSN: 23201940 Volume 4, Issue 3 Ver. III (May. - Jun. 2015), PP 26-34
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I.
Introduction
Down syndrome (trisomies) is one of the most common chromosomal abnormalities found in human
(Mokhtar , et al 2003 and Mandava S, Koppaka N, Bhatia D, Das BR. (2010).). Approximately 95% of all cases
of Down syndrome are attributed to an extra chromosome 21 Hockenberry M ,Wilson D ,(2013).Down
syndrome is a considerable genetic cause of mental retardation. The mental capacity of children with Down
syndrome varies from sever retardation to low-average intelligence. Generally, it ranges from mild to moderate
form of mental retardation (National Down syndrome society, 2003).
In Egypt, it has been reported that the incidence of Down syndrome occurs in 1 per 1000 live births
(Mokhtar et al., 2003, El Gilany et al., 2011). Moreover, 2285 live births have an estimated risk for Down
syndrome annually and most of these cases (98.43%) were diagnosed postnatal ( El Sobky and El Sayed, 2007).
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II.
Research Design: A quasi experimental research design was used in carrying out the study.
Setting: EL Tarbya El Fekrya School in Shebin El Kom. The school consisted of 3 classes for children in the
primary stage (nursery), 10 classes for children in the educational stage (primary) and 6 classes for training
stage (preparatory).
Sample: A sample of 60 children who met the study criteria was included. A simple random sample was used
to assign them equally into two groups (study group and control group).
Selection Criteria
Inclusion Criteria: Age ranged between 4 - 16 years. IQ ranged from 50 70 as mentioned in child file .
Tools : Three tools were utilized.
Tool 1: An interview was developed by the researcher. It included data about age, sex, place of residence
parents` level of education and parents` occupation.
Tool 2: Eating habits Likert scale was divided into two parts developed by Schaeffer (2007).
Part one: Positive eating habits. Positive eating habits. It included 4 questions about number of fresh fruits
snacks, number of fresh vegetables snacks, number of times of eating healthy food while they are outside the
home and fat utilization into food.
Scoring system for positive eating habits was: The total score of part one was 12 points. The cutoff point= 75%
of the total score=9 points and positive eating habits was 9 points.
Frequency of positive eating habits/day
0-2
3-5
>5
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Score
1
2
3
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Grad
< 5th percentile
5th - < 85th
85th- < 95th
95th
Grade (Score)
1
2
3
4
Waist hip ratio: Waist hip ratio (WHR) records. It was developed by Lanthi-koski (2001). It included waist and
hip circumferences.
Scoring system for waist hip ratio was: Sex Girls Scoring Items 0.90 Grade 2 , Boys Scoring Items 1.00
Grade 2 .
Lipid profile testing. A blood sample was obtained from each participant before starting the dietary intervention
program. It should be obtained in the morning after fasting for 10-12 hours. It tested Serum Lipid profile (total
Cholesterol, LDL, HDL and triglycerides).
Method
Written Permission: An official permission was obtained to proceed the study.
Protection of Human Right: An acceptance to share in the study was obtained from parents before
participation in the study. Confidentiality and privacy were assured by telling the parents that collected data was
not going to be used for other non research purposes.
-Tools Development:
a. Tools were adopted and developed by the researcher for data collection.
b. Validity of tools was conducted by a group of experts of pediatric nursing
c. Reliability of the tool was determined to assess the extent to which items in the questionnaire were related
to each other by Cronbach's co-efficiency alpha test (r= 0.68).
Pilot study: A pilot study was carried on 5 children with Down's syndrome to test the clarity, applicability and
consistency and feasibility of the tools. No modifications were needed for the tools. So, children in the pilot
study were included.
Data collection procedure: Data collection started on November 2011 and lasted until April 2012. It continued
for 6 months and contained three phases:
A. Phase I (assessment phase): Socio demographic characteristics were obtained from children and their
parents. It was performed before conducting dietary intervention program for children with Down syndrome
and included:
a) Assessment of an anthropometric measurements
b) Assessment of eating habits.
c) Lipid profile testing.
1-A blood sample was obtained from each participant before starting the healthy diet intervention program.
2-It should be obtained in the morning after fasting for 10-12 hours.
It tested Serum Lipid profile (total Cholesterol, LDL, HDL and triglycerides).
1. The researcher asked the mothers and/or fathers about children's positive and negative eating habits. Then
data was recorded for each child.
2. Afterwards, assessment of anthropometric measurements was done.
3. The researcher measured the weight two times in kilograms (kg) using a weight scale after asking children to
evacuate their bladder, wear light clothes and stand without shoes. The mean of the two weight measurements
was used for data analysis.
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III.
Results
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Sex:
boys
Girls
Age in years:
6-12 years
>12-18 years
(Mean SD)
Father education:
Illiterate
Read & write
Secondary
University
Father occupation:
Not work
Work
Mother education:
Illiterate
Read & write
Secondary
University
Mother occupation:
Not work
Work
NB: ns
X2
P-Value
Control group
(n=30)
N
%
56.7
43.3
20
10
66.7
33.3
0.64
0.43 ns
15
50
15
50
(11.532.45)
18
60.0
12
40.0
(11.792.58)
0.31
0.76 ns
8
5
13
4
26.7
16.7
43.3
13.3
6
8
11
5
20.0
26.7
36.7
16.7
1.36
0.74ns
5
25
16.7
83.3
6
24
20.0
80.0
0.11
0.74 ns
16
4
6
4
53.3
13.3
20
13.3
15
3
9
3
50.0
10.0
30.0
10.0
0.92
0.82 ns
25
5
83.3
26.7
26
4
86.7
13.3
0.13
0.72 ns
Study group
(n=30)
N
17
13
P > 0.05
Figure (1)Distribution of children in the study and control group according their residence place
distribution of children in study and control group according to
their place of residence
80
73.3
66.7
60
33.3
40
Rural
26.7
Urban
20
0
study group
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Control group
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Control group(n=30)
No
%
X2
P-Value
8
22
26.7
73.3
9
21
30
70
0.08
0.77 ns
8
22
26.7
73.3
9
21
30
70
0.08
0.77 ns
9
21
30
70
9
21
30
70
0.0
0.0
22
8
73.3
26.7
21
9
70
30
0.08
0.77 ns
22
8
73.3
26.7
21
9
70
30
0.08
0.77 ns
20
10
66.7
33.3
19
11
63.3
36.7
0.07
0.79 ns
20
10
66.7
33.3
19
11
63.3
36.7
0.07
0.79 ns
22
8
73.3
26.7
22
8
73.3
26.7
0.0
0.0
20
10
66.7
33.3
18
12
60
40
0.29
0.59ns
P > 0.05
Table (3): Comparison between the anthropometric measurements of children in the study and control
groups at pre test.
Anthropometric
Measurements
Weight
Height
Waist circumference
Hip circumference
t-test
0.19
0.1
0.0
0.0
P-value
0.85ns
0.92 ns
0.0
0.0
NB:
ns
p 0.05
X2
P-Value
3
9
8
15
45
40
4
13
8
16.0
52.0
32.0
0.32
0.85ns
7.22
0.02*
3
9
8
15
45
40
9
14
2
36.0
56.0
8.0
4
15
1
20
75
5
11
12
2
44.0
48.0
8.0
3.42
0.18 ns
0
2
18
0.0
10.0
90.0
6
7
12
24.0
28.0
48.0
9.54
0.008*
5
15
25
75
17
8
68.0
32.0
8.22
0.004*
* P<0.05
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NB:
ns
p 0.05
Pre-intervention (n=20)
(Mean SD)
55.0518.0
136.5512.98
8613.36
86.412.87
* P<0.05
Study group
Post-intervention (n=20)
(Mean SD)
51.415.23
136.1511.84
85.212.78
86.412.87
Paired t-test
P-value
3.83
0.9
3.56
0.0
0.001**
0.38ns
0.002*
0.0
** P<0.001
Table (6): Relationship between BMI and age in the study group at pre and post test.
Age
BMI
School age
(<12 years) (n=14)
Pre intervention:
Normal weight
Overweight
Obese
Post intervention:
Normal weight
Overweight
Obese
NB:
ns
Adolescence
( 12 years) (n=6)
2
4
8
14.3
28.6
57.1
0
0
6
0.0
0.0
100
4
4
6
28.6
28.6
42.9
0
2
4
X2
P-value
3.67
0.16 ns
2.22
0.33 ns
0.0
33.3
66.7
p 0.05
Table (7): Comparison between lipid profile in the control group at pre test and post test.
Lipid profile
Cholesterol
Triglyceride
HDL
LDL
NB:
ns
p 0.05
Control group
Pre-intervention (n=25)
(Mean SD)
190.2818.47
76.6819.79
45.084.46
107.3614.59
Post-intervention (n=25)
(Mean SD)
192.5617.29
77.9619.99
45.44.64
107.8414.65
t-test
P-value
3.13
1.98
0.25
1.19
0.005*
0.59ns
0.81 ns
0.25 ns
* p <0.05
Table (8) : Comparison between lipid profile in the study group at pre and post test.
Lipid profile
Cholesterol
Triglyceride
HDL
LDL
NB:
Study group
Pre-intervention (n=20) (Mean Post-intervention (n=20) (Mean
SD)
SD)
186.8520.56
186.119.9
75.3519.31
75.3519.31
45.24.88
45.854.63
108.115.75
104.0510.42
t-test
P-value
2.12
0.0
2.22
2.42
0.04*
0.0
0.03*
0.02*
p < 0.05
IV.
Discussion
Obesity is a serious problem faced by children with Down syndrome. It is caused by a combination of
genetic characteristics and lifestyle with food intake (Chen, 2007).
El-Sobky et al., (2004), Wahab et al., (2006), Chen (2007), Chandra et al., (2010), Mandava et al.,
(2010) and Doctortipster (2011) who study Down syndrome in Egypt are explained (DS) prevalence is higher
between boys than girls, their findings associated with current study findings where the majority of children in
the study and control groups were boys .
As regards to children's positive eating habits, this study revealed that only 20% and 30% of children in
the study and control groups respectively had right eating habits. This result was consistent with WHO (2010)
which indicated that eating habits were decline in the intake of fruits, vegetables, whole grains and legumes, the
sharp increasing intake of food rich in fats, sugar and salt.
As well as poor eating habits the anthropometric measurements in the study and control group at pre
test, the present study findings were indicated that the majority(63.3% and 56.7%) of children in both groups
were obese. This could be related to the tendency of Down syndrome children to be overweight and inactivity.
The current results were agree with Al Husain, 2003who study Growth charts for children with Down's
syndrome in Saudi Arabia: birth to 5 years. and Grammatik Opoulou et al., 2008,who study Nutrient intake and
anthropometry in children and adolescents with Down syndrome-a preliminary study, their results indicating
that children with Down syndrome had a genetic predisposition to become overweight or obese.
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V.
Conclusion
Majority of children were boys in the study and control groups . In relation to fathers' education, more
than one third of them had secondary level of education. Meanwhile, more than half of mothers in study and
control groups were illiterate, the majority of fathers in study and control groups were working . On the other
hand, the majority of mothers in the study and control groups weren't working. No statistical significant
differences were found between socio demographic characteristics of children in the study and control groups .
The majority of children in the two groups lived in rural areas. No statistical significant differences between the
study and control groups at pre intervention in relation to weight, height, waist circumference and hip
circumference. There were statistical significant differences at 5% level between children in study and control
groups at post test except for eating fresh fruits snacks and eating healthy food while they are outside the home.
There were a significant differences at 1% level of statistical significance between pre and posttests in relation
to weight and waist circumference. Also, there was significant decrease in cholesterol, HDL and LDL among
children in the study group. Therefore, there were statistical significant differences between pre and post tests at
5% level of statistical significance. However, no statistical significant differences were found related to
triglyceride level at 5% level of statistical significance.
.
VI.
Recommendations
An educational program about dietary intervention should be provided for school health nurses.
Develop practical guidelines for teachers on prevention and control of obesity among Down syndrome children.
Counseling should be provided to children and parents about nutrition and healthy eating habits. Further
researches are needed to be conducted dietary intervention program for long time up to 6 months and results
should be compared with this study. This study can be applied in other settings on large sample to ensure
generalizability of the study.
Limitation of the study:
Teen children of the study group as well as five children in the control group were excluded as they
didn't complete 60-75% peak hours (22-36 sessions) of attending the program.
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