7/2/2020 COPE Webinar Series for Health Professionals July 8, 2020 - PDF document

7/2/2020 COPE Webinar Series for Health Professionals July 8, 2020 Early Life Risk Factors for Obesity in Children with Autism Spectrum Disorder Moderator Lisa K. Diewald MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention and Education M. Louise Fitzpatrick College of Nursing 1 Finding Slides for Today’s Webinar www.villanova.edu/COPE Click on Kral webinar description page 2 Did you use your phone to access the webinar? If you are calling in today rather than using your computer to log on, and need CE credit, please email cope@villanova.edu and provide your name so we can send your certificate. 3 1

7/2/2020 Today’s Webinar Objectives 1. Describe pregnancy-related risk factors for child obesity in children with ASD. 2. Highlight possible dietary and early life risk factors that may be underlying the increased obesity risk in children with ASD. 3. Address feeding and weight-related concerns in children with ASD and directions for future research. 4 Continuing Education Credit Details Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration 5 Continuing Education Credit Details This webinar awards 1 contact hour for nurses and 1 CPEU for dietitians Suggested CDR Learning Need Codes: 5070, 5180, 5370, 9020 Level 2 CDR Performance Indicators: 6.2.5, 6.3.7, 6.3.8 6 2

7/2/2020 Early Life Risk Factors for Obesity in Children with Autism Spectrum Disorder Tanja Kral, PhD Professor School of Nursing & Perelman School of Medicine University of Pennsylvania 7 7 Disclosures The planners and presenter of this program have no conflicts of interest to disclose. Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice displayed in conjunction with an activity. 8 Early Life Risk Factors for Obesity in Children with Autism Spectrum Disorder Tanja Kral, PhD School of Nursing & Perelman School of Medicine University of Pennsylvania McDonald Center for Obesity Prevention and Education (COPE) Webinar Series July 8, 2020 9 3

7/2/2020 My Research Interests 10 Outline of Talk: 1. Obesity in children with Autism Spectrum Disorder (ASD) 2. Pregnancy-related risk factors for childhood obesity in children with ASD 3. ASD symptoms and co-occurring conditions related to obesity risk 4. Feeding difficulties in children with ASD 11 Obesity Risk in Children with ASD 12 4

7/2/2020 Obesity Risk • In some studies, children with ASD show a 4-fold increased risk for overweight and obesity than typically developing children (TDC). • Prevalence rates across studies: • Overweight/Obesity: 34 - 53% • Obesity: 10 - 43% • Children with ASD are also over 3 times more likely to develop the metabolic syndrome. 13 ASD (N = 25) TDC (N = 30) Child Characteristic P -value [ mea mean ± SD SD or or N (% (%)] )] [ mean ± SD or N (%)] Height (cm) 109.4 ± 6.5 112.6 ± 7.2 0.10 Weight (kg) 19.9 ± 3.7 20.1 ± 3.6 0.79 BMI z-score 0.75 ± 1.39 0.17 ± 1.07 0.088 BMI-for-age percentile 66.1 ± 29.9 55.6 ± 30.2 0.20 Waist circumference (cm) 56.2 ± 7.5 51.9 ± 4.0 0.01 Waist-to-height ratio 0.51 ± 0.06 0.46 ± 0.03 < 0.001 Weight status Underweight / normal-weight 14 (56%) 24 (80%) Overweight / obese 11 (44%) 6 (20%) 0.055 Kral et al. (2015). Public Health Nursing , 32(5): 488-497 14 Cardiovascular Risk • Kral et al. (2014) showed that children with ASD, ages 4-6, showed significantly greater abdominal waist circumference and waist-to-height ratio. • Mean waist-to-height ratio for children with ASD: 0.51 ± 0.06 • Castro et al. (2017) reported that nearly 50% of children with ASD, ages 4-16, showed high central adiposity (waist circumference >80 th percentile) and total adiposity (body fat curves >95 th centile). 15 5

7/2/2020 Early Life Risk Factors for Obesity 16 Early Life Risk Factors 1. Maternal pre-pregnancy obesity 2. Excess gestational weight gain 3. Rapid weight gain during infancy 17 Weight Trajectories of Children Born at Low- or High-Risk for Obesity 1.5 Low-Risk * * * * * * High-Risk 1.0 BMI z-score * * * 0.5 0.0 -0.5 0.3 1 2 3 4 5 6 7 8 10 12 13 14 Child Age (yrs) Stunkard et al. , 2004 18 6

7/2/2020 Institute of Medicine (IOM) Pregnancy Weight Gain Recommendations Recommended weight Pre-pregnancy weight status gain during pregnancy Underweight (BMI < 18.5 kg/m 2 ) 28 – 40 pounds Normal-weight (BMI 18.5 – 24.9 kg/m 2 ) 25 – 35 pounds Overweight (BMI 25.0 – 29.9 kg/m 2 ) 15 – 25 pounds Obese (BMI > 30 kg/m 2 ) 11 – 20 pounds  Exceeding the IOM gestational weight gain recommendations was associated with a 46% increase in the odds of having a child with overweight or obesity at ages 2-5 years (Sridhar et al., 2014). 19 Rapid Weight Gain During Infancy and Obesity Risk  Rapid weight gain during the first year of life conferred a 2-fold higher risk of childhood obesity and a 23% higher risk of adult obesity (Druet et al., 2012). 20 Study to Explore Early Development (SEED) 21 7

7/2/2020 22 Study to Explore Early Development (SEED) 23 Group Classification ASD DD POP (Autism Spectrum (Developmental (General Population Disorder) Delays / Disorders) Controls) 24 8

7/2/2020 25 Sample 26 Maternal Weight-Related Variables  Maternal pre-pregnancy BMI  Maternal gestational weight gain:  Compared to IOM guidelines  Recommended weight gain met (yes / no)  Gestational weight gain (< / = / > than recommendations) 27 9

7/2/2020 Child Weight-Related Variables • Child heights/lengths and weights: • Birth to 6 months: Neonatal and pediatric medical records • Ages 2-5: In-person clinic visit • Child age- and sex-specific weight-for-age or BMI z- scores and percentiles were calculated from: • WHO Growth Charts (birth to 24 months) • CDC Growth Charts (>24 months) • Rapid weight gain: Change in weight-for-age z-scores from birth to 6 months >0.67 SD (Monteiro and Victora, 2005) 28 Demographic, Maternal, and Birth Variables Demographic Maternal Birth Child age Diabetes Birth weight Child sex High blood pressure (BP) Prematurity status Maternal education Pregnancy-related high BP Gestational age (eclampsia, pregnancy- induced hypertension, HELLP syndrome) Maternal race Eating disorders (bulimia Duration of breastfeeding nervosa, anorexia nervosa, dieting during pregnancy) Poverty status Intrauterine growth restriction (IUGR) Smoking during pregnancy 29 Co-Occurring Medical, Behavioral, and Psychiatric Conditions Behavioral, Developmental or Medical Conditions or Symptoms Psychiatric Conditions or Symptoms Asthma ADHD Birth defects Behavioral problems Cardiac diseases / disorders Cognitive delay Endocrine diseases / disorders Feeding difficulties Gastrointestinal diseases / disorders Motor delay Genetic disorders Psychiatric disorders Immune disorders Sensory disorders Metabolic disorders Sleep problems Neurological abnormalities / Speech delay symptoms Renal diseases / disorders Respiratory diseases / disorders Seizure disorders 30 10

7/2/2020 Autism Severity • Ohio State University Autism Rating Scale (OARS) • Scores 2-3: Mild range of severity (21%) • Scores 4-5: Moderate range of severity (49%) • Scores 6-7: Severe range (22%) • Autism Calibrated Severity Score (ACSS) OARS ACSS • Measures severity of global • Measures severity of ASD functioning symptoms, independent of developmental factors • Most impacted by adaptive abilities and expressive language skills • May not take into account overall degree of impairment 31 Results: Descriptive Characteristics 32 Child Demographic and Anthropometric Characteristics ASD DD POP Mean  SD Mean  SD Mean  SD Characteristic P-Value or N (%) or N (%) or N (%) 59.3  6.6 59.2  7.2 59.2  7.4 Age (months) 0.99 Sex (male/female) 82% / 18% 66% / 34% 52% / 48% <.001 Prematurity status Very preterm (< 32 weeks) 39 (7.2%) 64 (8.6%) 25 (3.5%) Moderate to late preterm (32 to < 37 weeks) 74 (13.6%) 136 (18.3%) 76 (10.5%) Term (37 to < or equal 41 weeks) 411 (75.4%) 513 (69.1%) 591 (81.5%) Post-term (> 41 weeks) 21 (3.8%) 30 (4.5%) 33 (4.5%) <.001 0.35  1.16 0.26  1.20 0.14  1.12 BMI z-score 0.001 Weight status Underweight (BMI-for-age <5 th percentile) 30 (4.5%) 44 (4.8) 56 (6.3%) Normal-weight (BMI-for-age 5-84 th percentile) 454 (68.0%) 642 (70.2%) 656 (74.2%) Overweight (BMI-for-age 85-94 th percentile) 101 (15.1%) 125 (13.7%) 103 (11.7%) Obese (BMI-for-age > or equal 95 th percentile) 83 (12.4%) 103 (11.3%) 69 (7.8%) 0.007 33 11