7/2/2020 Finding Slides for Todays Webinar COPE Webinar Series for - PDF document

7/2/2020 Finding Slides for Today’s Webinar COPE Webinar Series for Health Professionals July 8, 2020 Early Life Risk Factors for Obesity www.villanova.edu/COPE in Children with Autism Spectrum Disorder Click on Kral webinar description page Moderator Lisa K. Diewald MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention and Education M. Louise Fitzpatrick College of Nursing 1 2 Today’s Webinar Objectives Did you use your phone to access the webinar? If you are calling in today rather than using 1. Describe pregnancy-related risk factors for child obesity in children with ASD. your computer to log on, and need CE credit, please email cope@villanova.edu and 2. Highlight possible dietary and early life risk factors that may be provide your name so we can send your underlying the increased obesity risk in children with ASD. certificate. 3. Address feeding and weight-related concerns in children with ASD and directions for future research. 3 4 Continuing Education Credit Details Continuing Education Credit Details This webinar awards 1 contact hour for nurses and 1 CPEU for Villanova University College of Nursing is accredited as a dietitians provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation Suggested CDR Learning Need Codes: 5070, 5180, 5370, 9020 Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Level 2 Accredited Provider with the Commission on Dietetic Registration CDR Performance Indicators: 6.2.5, 6.3.7, 6.3.8 5 6 1

7/2/2020 Early Life Risk Factors for Obesity in Disclosures Children with Autism Spectrum Disorder The planners and presenter of this program have no conflicts of interest to disclose. Tanja Kral, PhD Professor Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing School of Nursing & Perelman School Center of any commercial products or medical/nutrition of Medicine advice displayed in conjunction with an activity. University of Pennsylvania 7 7 8 Early Life Risk Factors for My Research Interests 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 10 Outline of Talk: 1. Obesity in children with Autism Obesity Risk in Children Spectrum Disorder (ASD) 2. Pregnancy-related risk factors for with ASD 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 12 2

7/2/2020 Obesity Risk ASD (N = 25) TDC (N = 30) Child Characteristic P -value [ mea mean ± SD SD or or N (% (%)] )] [ mean ± SD or N (%)] • In some studies, children with ASD show a 4-fold Height (cm) 109.4 ± 6.5 112.6 ± 7.2 0.10 increased risk for overweight and obesity than Weight (kg) 19.9 ± 3.7 20.1 ± 3.6 0.79 typically developing children (TDC). 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 • Prevalence rates across studies: Waist circumference (cm) 56.2 ± 7.5 51.9 ± 4.0 0.01 • Overweight/Obesity: 34 - 53% Waist-to-height ratio 0.51 ± 0.06 0.46 ± 0.03 < 0.001 • Obesity: 10 - 43% Weight status Underweight / normal-weight 14 (56%) 24 (80%) Overweight / obese • Children with ASD are also over 3 times more likely 11 (44%) 6 (20%) 0.055 to develop the metabolic syndrome. Kral et al. (2015). Public Health Nursing , 32(5): 488-497 13 14 Cardiovascular Risk • Kral et al. (2014) showed that children with ASD, ages 4-6, showed significantly greater abdominal waist circumference Early Life Risk Factors and waist-to-height ratio. • Mean waist-to-height ratio for children with ASD: 0.51 ± 0.06 for Obesity • 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 16 Weight Trajectories of Children Born at Early Life Risk Factors Low- or High-Risk for Obesity 1. Maternal pre-pregnancy obesity 1.5 Low-Risk * * * * * * 2. Excess gestational weight gain High-Risk 1.0 BMI z-score * * 3. Rapid weight gain during infancy * 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 17 18 3

7/2/2020 Rapid Weight Gain During Infancy Institute of Medicine (IOM) Pregnancy and Obesity Risk Weight Gain Recommendations  Rapid weight gain Recommended weight during the first year of Pre-pregnancy weight status gain during pregnancy life conferred a 2-fold Underweight (BMI < 18.5 kg/m 2 ) 28 – 40 pounds higher risk of childhood Normal-weight (BMI 18.5 – 24.9 kg/m 2 ) 25 – 35 pounds obesity and a 23% Overweight (BMI 25.0 – 29.9 kg/m 2 ) 15 – 25 pounds higher risk of adult Obese (BMI > 30 kg/m 2 ) 11 – 20 pounds obesity (Druet et al., 2012).  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 20 Study to Explore Early Development (SEED) 21 22 Study to Explore Early Group Classification Development (SEED) ASD DD POP (Autism Spectrum (Developmental (General Population Disorder) Delays / Disorders) Controls) 23 24 4

7/2/2020 Sample 25 26 Maternal Weight-Related Child Weight-Related Variables Variables • Child heights/lengths and weights:  Maternal pre-pregnancy BMI • Birth to 6 months: Neonatal and pediatric medical records • Ages 2-5: In-person clinic visit  Maternal gestational weight gain: • Child age- and sex-specific weight-for-age or BMI z-  Compared to IOM guidelines scores and percentiles were calculated from:  Recommended weight gain met (yes / no) • WHO Growth Charts (birth to 24 months) • CDC Growth Charts (>24 months)  Gestational weight gain (< / = / > than recommendations) • Rapid weight gain: Change in weight-for-age z-scores from birth to 6 months >0.67 SD (Monteiro and Victora, 2005) 27 28 Co-Occurring Medical, Behavioral, and Psychiatric Conditions Demographic, Maternal, and Behavioral, Developmental or Birth Variables Medical Conditions or Symptoms Psychiatric Conditions or Symptoms Asthma ADHD Demographic Maternal Birth Birth defects Behavioral problems Child age Diabetes Birth weight Cardiac diseases / disorders Cognitive delay Child sex High blood pressure (BP) Prematurity status Endocrine diseases / disorders Feeding difficulties Maternal education Pregnancy-related high BP Gestational age Gastrointestinal diseases / disorders Motor delay (eclampsia, pregnancy- induced hypertension, Genetic disorders Psychiatric disorders HELLP syndrome) Immune disorders Sensory disorders Maternal race Eating disorders (bulimia Duration of breastfeeding Metabolic disorders Sleep problems nervosa, anorexia nervosa, Neurological abnormalities / Speech delay dieting during pregnancy) symptoms Poverty status Intrauterine growth Renal diseases / disorders restriction (IUGR) Smoking during pregnancy Respiratory diseases / disorders Seizure disorders 29 30 5