Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Overweight & Obesity in Children & Adolescents with Autism Spectrum Disorders - Retrospective Chart Review -

자폐스펙트럼장애(Autism Spectrum Disorder) 소아청소년에서의 과체중 및 비만 연구 - 후향적 의무기록 조사 -

  • Im, Woo Young (Department of Psychiatry, Konyang University Hospital, Konyang University College of Medicine)
  • 임우영 (건양대학교 의과대학 정신과학교실)
  • Received : 2015.12.13
  • Accepted : 2015.12.29
  • Published : 2015.12.31
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Abstract

Objectives : In children and adolescents, the prevalence of overweight has increased in the last 20 years. little research is available on the prevalence of obesity in children with autism spectrum disorders(ASD). The purpose of our study was to determine the prevalence of overweight among a clinical population of children diagnosed with autism spectrum disorders(ASD). Methods : Retrospective chart review of children ages 3-18 years seen between 2012 and 2015 at a Konyang University hospital psychiatric clinic. Diagnostic, medical, and demographic information was extracted from the charts. Body mass index(BMI) was calculated from measures of height and weight recorded in the child's chart. The Center for Disease Control's BMI growth reference was used to determine an age and gender-specific BMI z-score for the children. Results : In our study, children with ASD compared to non ASD group had significantly higher BMI percentiles (p=0.032). The prevalence of overweight($BMI{\geq}85th$ to 95th percentiles) and obesity($BMI{\geq}95th$ percentiles) was 35% and 19% respectively in children with ASD and without ASD. Conclusions : Despite noted limitations, our data suggest that overweight and obesity in children with ASD are more prevalent than without ASD. Longitudinal and further study is needed to examine the factors associated with obesity in this population.

연구목적 지난 20년 동안 아동에 있어 과체중(overweight)의 유병률이 증가하였다. 또한 자폐스펙트럼장애(Autism spectrum disorder, ASD)를 진단 받는 아동의 숫자도 매해 증가하고 있다. ASD를 진단받은 아동의 비만(obesity)에 대한 연구가 미국에서는 활발하게 이루어지고 있으나, 한국에서는 많은 연구가 수행되지는 않았다. 따라서 이 연구의 목적은 ASD를 지닌 아동의 과체중 및 비만의 유병률 및 실태를 알아보고자 한다. 방 법 2012년부터 2015년까지의 3세에서 18세 사이의 소아 청소년을 대상으로 대전 건양대학교병원 정신건강의학과 외래에 내원한 소아 청소년 환자의 의무기록을 조사하였다. 각각의 의무기록으로부터 진단적, 의학적, 인구학적 정보를 추출하였다. 신체질량지수인 Body mass index(BMI)는 병원에서 시행하여 의무기록에 기입되어 있는 키와 체중으로 토대로 계산 하였다. 나이와 성별을 보정한 BMI z-score을 사용하였다. 결 과 ASD를 지닌 아동 군에서 ASD를 지니지 않은 군보다 더 높은 BMI 값을 가지고 있으며, 이는 통계적으로 유의하였다(p=0.032). 또한 ASD를 지닌 아동들이 ASD를 지니지 않은 아동에 비해 비교적 더욱 과체중 및 비만인 것으로 나타났다. 유병률에 있어서는 ASD가 있는 아동(35%)이 ASD가 없는 아동(19%)에 비해 과체중 및 비만인 것으로 간주되었다. 결 론 ASD를 지닌 아동과 지니지 않은 대상에 대한 과체중 및 비만에 관한 연구로서, ASD를 지닌 아동이 그렇지 않은 군에 비해 더욱 과체중 및 비만을 지니고 있음을 보여주었다. 향후 ASD 비만에 대한 유발 및 보호인자에 대한 장기적이고 심화된 연구가 필요하겠다.

Keywords

References

  1. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 2004; 16:291:2847-2850.
  2. Freedman DS, Khan LK, Serdula MK. The relation of childhood BMI to adult adiposity. The Bogalusa Heart Study. Pediatrics 2005;115:22-27.
  3. Barlow SE, Dietz WH. Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics 1998;102:E29. https://doi.org/10.1542/peds.102.3.e29
  4. Guo SS, Wu W, Chumlea WC, Roche AF. Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence. Am J Clin Nutr 2002;76:653-658. https://doi.org/10.1093/ajcn/76.3.653
  5. He XZ, Baker DW. Body mass index, physical activity, and the risk of decline in overall health and physical functioning in late middle age. Am J Public Health 2004;94:1567-1573. https://doi.org/10.2105/AJPH.94.9.1567
  6. Yan LL, Daviglus ML, Liu K, Pirzada A, Garside DB, Schiffer L, Dyer AR, Greenland P. BMI and health-related quality of life in adults 65 years and older. Obes Res 2004;12:69-76. https://doi.org/10.1038/oby.2004.10
  7. Griffiths LJ, Parsons TJ, Hill AJ. Self-esteem and quality of life in obese children and adolescents: A systematic review. Int J Pediatr Obes 2010;5:282-304. https://doi.org/10.3109/17477160903473697
  8. Williams J, Wake M, Hesketh K. Health-related quality of life of overweight and obese children. JAMA 2005;293:70-76. https://doi.org/10.1001/jama.293.1.70
  9. Finkelstein EA, Trogdon JG, Cohen JW. Annual medical spending attributable to obesity: Payer-and service-specific estimates. Health Aff(Millwood) 2009;28:w822-w831.
  10. Davison KK, Birch LL. Childhood overweight: a contextual model and recommendations for future research. Obesity Reviews 2001;2:159-171. https://doi.org/10.1046/j.1467-789x.2001.00036.x
  11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th edition. Washington, DC 2013.
  12. Holm VA, Cassidy SB, Butler MG, Hanchett JM, Greenswag LR, Whitman BY, Greenberg F. Prader-Willi syndrome: consensus diagnostic criteria. Pediatrics 1993;91:398-402.
  13. Bell AJ, Bhate MS. Prevalence of overweight and obesity in Down syndrome and other mentally handicapped adults living in the community. J Intellect Disabil Res 1992;36:359-364.
  14. Rubin SS, Rimmer JH, Chicoine B, Braddock D, McGuire DE. Overweight prevalence in persons with Down syndrome. Ment Retard 1998;36:175-181. https://doi.org/10.1352/0047-6765(1998)036<0175:OPIPWD>2.0.CO;2
  15. Curtin C, Bandini LG, Perrin EC. Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: A chart review. BMC Pediatr 2005;5:48. https://doi.org/10.1186/1471-2431-5-48
  16. Curtin C, Anderson SE, Must A. The prevalence of obesity in children with autism: A secondary data analysis using nationally representative data from the National Survey of Children's Health. BMC Pediatr 2010;10:11. https://doi.org/10.1186/1471-2431-10-11
  17. National Center for Health & Statistics. CDC Growth Charts. US Department of Health & Human Services;2000.
  18. Zimmer MH, Hart LC, Manning-Courtney P, Murray DS, Bing NM. Food variety as a predictor of nutritional status among children with autism. J Autism Dev Disord 2012;42: 549-556. https://doi.org/10.1007/s10803-011-1268-z
  19. Emond A, Emmett P, Steer C, Golding J. Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics 2010;126:337-342. https://doi.org/10.1542/peds.2009-2391
  20. Hyman SL, Stewart PA, Schmidt B, Cain U, Lemcke N, Foley JT. Nutrient intake from food in children with autism. Pediatrics 2012;130(Suppl 2):S145-S153. https://doi.org/10.1542/peds.2012-0900L
  21. Ho HH, Eaves LC, Peabody D. Nutrient intake and obesity in children with autism. Focus Autism Other Dev Disabl 1997; 12:187-193. https://doi.org/10.1177/108835769701200308
  22. Evans EW, Must A, Anderson SE, Curtin C, Scampini R, Maslin M. Dietary patterns and body mass index in children with autism and typically developing children. Res Autism Spectr Disord 2012;6:399-405. https://doi.org/10.1016/j.rasd.2011.06.014
  23. Levy SE, Souders MC, Ittenbach RF, Giarelli E, Mulberg AE, Pinto-Martin JA. Relationship of dietary intake to gastrointestinal symptoms in children with autistic spectrum disorders. Biol Psychiatry 2007;61:492-497. https://doi.org/10.1016/j.biopsych.2006.07.013
  24. Souza NC, Mendonca JN, Portari GV, Jordao Junior AA, Marchini JS, Chiarello PG. Intestinal permeability and nutritional status in developmental disorders. Altern Ther Health Med 2012;18:19-24.
  25. Hediger ML, England LJ, Molloy CA, Yu KF, Manning- Courtney P, Mills JL. Reduced bone cortical thickness in boys with autism or autism spectrum disorder. J Autism Dev Disord 2008;38:848-856. https://doi.org/10.1007/s10803-007-0453-6
  26. Moore C, Murphy MM, Keast DR, Holick MF. Vitamin D intake in the United States. J Am Diet Assoc 2004;104:980-983. https://doi.org/10.1016/j.jada.2004.03.028
  27. Must A, Parisi SM. Sedentary behavior and sleep: paradoxical effects in association with childhood obesity. Int J Obes 2009;33(Suppl 1):S82-S86.
  28. Chen X, Beydoun MA, Wang Y. Is sleep duration associated with childhood obesity? A systematic review and meta-analysis. Obesity(Silver Spring, Md.) 2008;16:265-274. https://doi.org/10.1038/oby.2007.63
  29. Wiggs L, Stores G. Sleep patterns and sleep disorders in children with autistic spectrum disorders: Insight using parent report and actigraphy. Dev Med Child Neurol 2004;46:372-380.
  30. Gail Williams P, Sears LL, Allard A. Sleep problems in children with autism. J Sleep Res 2004;13:265-268. https://doi.org/10.1111/j.1365-2869.2004.00405.x
  31. Elia M, Ferri R, Musumeci SA. Sleep in subjects with autistic disorder: a neurophysiological and psychological study. Brain Dev 2000;22:88-92. https://doi.org/10.1016/S0387-7604(99)00119-9
  32. Rechtschaffen A, Bergmann BM, Everson CA, Kushida CA, Gilliland MA. Sleep deprivation in the rat: X. Integration and discussion of the findings. Sleep 1989;12:68-87.
  33. Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004;141:846-850. https://doi.org/10.7326/0003-4819-141-11-200412070-00008
  34. Ahearn WH, Castine T, Nault K, Green G. An assessment of food acceptance in children with autism or pervasive developmental disorder-not otherwise specified. J Autism Dev Disord 2001;31:505-511. https://doi.org/10.1023/A:1012221026124
  35. Klein U, Nowak AJ. Characteristics of patients with autistic disorder(AD) presenting for dental treatment: a survey and chart review. Spec Care Dentist 1999;19:200-207. https://doi.org/10.1111/j.1754-4505.1999.tb01386.x
  36. Raiten DJ, Massaro T. Perspectives on the nutritional ecology of autistic children. J Autism Dev Disord 1986;16:133-143. https://doi.org/10.1007/BF01531725
  37. Williams PG, Dalrymple N, Neal J. Eating habits of children with autism. Pediatr Nurs 2000;26:259-264.
  38. Van Cleave J, Gortmaker SL, Perrin JM. Dynamics of obesity and chronic health conditions among children and youth. JAMA 2010;303:623-630. https://doi.org/10.1001/jama.2010.104
  39. Schreck KA, Williams K, Smith AF. A comparison of eating behaviors between children with and without autism. J Autism Dev Disord 2004;34:433-438. https://doi.org/10.1023/B:JADD.0000037419.78531.86
  40. Schreck KA, Williams K. Food preferences and factors influencing food selectivity for children with autism spectrum disorders. Res Dev Disabil 2006;27:353-363. https://doi.org/10.1016/j.ridd.2005.03.005
  41. Yamaki K, Fujiura GT. Employment and income status of adults with developmental disabilities living in the community. Ment Retard 2002;40:132-141. https://doi.org/10.1352/0047-6765(2002)040<0132:EAISOA>2.0.CO;2
  42. Rurangirwa J, Van Naarden Braun K, Schendel D, Yeargin-Allsopp M. Healthy behaviors and lifestyles in young adults with a history of developmental disabilities. Res Dev Disabil 2006;27:381-399. https://doi.org/10.1016/j.ridd.2005.01.003
  43. Dewey D, Cantell M, Crawford SG. Motor and gestural performance in children with autism spectrum disorders, developmental coordination disorder, and/or attention deficit hyperactivity disorder. J Int Neuropsychol Soc 2007;13:246-256.
  44. Minshew NJ, Sung K, Jones BL, Furman JM. Underdevelopment of the postural control system in autism. Neurology 2004;63:2056-2061. https://doi.org/10.1212/01.WNL.0000145771.98657.62
  45. Molloy CA, Dietrich KN, Bhattacharya A. Postural stability in children with autism spectrum disorder. J Autism Dev Disord 2003;33:643-652. https://doi.org/10.1023/B:JADD.0000006001.00667.4c
  46. Klin A, Volkmar FR, Sparrow SS. Autistic social dysfunction: some limitations of the theory of mind hypothesis. J Child Psychol Psychiatry 1992;33:861-876. https://doi.org/10.1111/j.1469-7610.1992.tb01961.x
  47. Baranek GT. Efficacy of sensory and motor interventions for children with autism. J Autism Dev Disord 2002;32:397-422. https://doi.org/10.1023/A:1020541906063
  48. MacDonald M, Esposito P, Ulrich D. The physical activity patterns of children with autism. BMC Res Notes 2011;4:422-426. https://doi.org/10.1186/1756-0500-4-422
  49. Rosser DD, Frey GC. Comparison on physical activity levels between children with and without autistic spectrum disorders. Medicine & Science in Sports & Exercise 2003;35:S1. S76.
  50. Carol Curtin. Obesity in Children with Autism Spectrum Disorders. Harv Rev Psychiatry 2014;22:93-103. https://doi.org/10.1097/HRP.0000000000000031