FOOD HABITS IN DRUG
TREATED DOWNS
OF 10 YEARS OR MORE
Renato COCCHI , neurologist and medical
psychologist
Summary
The records of 93 home reared Italian Downs
out of a not selected consecutive series of 526 (48 F + 45 M; age; range: 10-22
at last checkups; average: 13.71 +/- 3.79 years; chromosomal anomalies: Unknown
= 1.1%, pure trisomy 21 = 89.2 %, mosaicisms = 2.2%, translocations = 7.5%)
were reexamined for food habits after at least 2 years of drug therapies
(average: 8.98 +/- 2.95 years). This sample got 34 different drugs, with
average 4.22 drugs to each subject.
Liking for sweets, meat or cube broth, milk
and derivatives, bread and pasta, meat, fish, cooked vegetables, raw vegetables
and fruit were collected and scored according to 3-7 points scales. The results
had their own examination and then a comparison with those coming from
analogous research in non-drug treated Down (Cocchi, 1994).
The results show a fall of the refusal for
every investigated food ( p < .024).
These Downs have a normal or preferred
choice for sweets, meat or cube broth, milk and dairy products, bread and
pasta, and fruit, but the same for meat, and a decreased liking for fish,
cooked and raw vegetables (p < .0009). Since prescribed drugs mainly act
against stress, it is suggested that these results come from a decreased
hyponeophagia, a well-known symptom in stressed animals too.
Key words: Down’s syndrome; food habits;
diet; stress; hyponeophagia; drug therapy.
Drug modulation of stress reactions
Mental retardation
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Following the previous research on food habits in non-drug treated Downs
(Cocchi, 1994), I aimed to accomplish it. Then, I started another survey on food
habits in Downs who took drug therapies prescribed and I checked by myself.
As for myself I have always judged as very
fruitful to collect information in this field. These habits could let us more
know on brain neurotransmitters via their food precursors. I already printed a
study on food precursors of glutamate and GABA in 460 Down individuals (Cocchi,
1990).
I think liking or food refusal a relevant
fact, and I maintain it related to neurotransmitters’ balance. Many kind of
foods bring in the main precursors of them (Fernstrom, 1977; Growdon &
Wurtman, 1979) and vitamins act as catalyst of their syntheses.
Having nearly always collected many data on
food habits since 1979, when I began drug therapies in Downs, I think that
these habits account mainly for biological needs.
Moreover, as the previous research showed
(Cocchi, 1994), they can vary by aging as usual in normal people. Down children
too may get more acquainted with foods along their social growing up.
On the other hand, if we use drugs mainly
acting on stress responses, we expect to have these habits modified, by reduced
hyponeophagia as a symptom of stress (Cocchi, 1993).
I got to a new study on this topic by
thinking of these problems.
Materials
and methods
From the records of a cohort of 526 Italian
home reared Downs I saw about those aged at least 10 years at last checkups,
after at least two-years drug therapy.
I looked into this sample of records by
collecting sex, age at last checkups, chromosomal anomalies, and current
feeding habits. As for drugs I saw about length of drug taking, drugs taken
just before the last checkup and their daily doses.
A year of life encompasses six months before
birthday and six months after it (eg: The 10th year ranges from 9
years and 7 months to 10 years and 6 months).
About feeding habits I checked out liking or
not for sweets, meat broth or cube broth, milk and derivatives, bread and
pasta, meat, fish, cooked vegetables (except potatoes), raw vegetables, fruit.
Any type of food had its rating scale as it
follows.
Sweets: 0 = no information; 1 = refuses any
type of sweet thing; 2 = the subject eats some ice-cream or some chocolate; 3 =
eats ice-creams and chocolate; 4 = eats sweets in a normal way; 5 = likes
sweets; 6 = is very fond of sweets:
Meat broth or cube broth: 0 = no
information; 1 = refuses any food cooked in broth; 2 = tastes only pasta cooked
in it; 3 = eats it in a normal way; 4 = likes broth; 5 = asks for having broth.
Milk and dairy products: 0 = no information;
1 = refuses milk and derivatives: 2 = drinks some milk only at breakfast; 3 =
drinks milk and eats derivatives in a normal way; 4 = likes milk also in the
evening; 5 = seeks milk (usually directly from the fridge) and drinks about a
litre every day.
Bread and pasta: 0 = no information: 1 =
eats bread and pasta in a normal way; 2 = likes bread and pasta; 3 = eats much
bread and asks for pasta twice a day.
Meat: 0 = no information; 1 = refuses any
type of meat; 2 = eats some meat, usually ham; 3 = eats meat in a normal way; 4
= likes to eat meat.
Fish: 0 = no information; 1 = refuses any
fish; 2 = tastes some fish; 3 = eats fish in a normal way; 4 = likes to eat
fish.
Cooked vegetables (except potatoes): 0 = no
information; 1 = refuses any vegetable; 2 = eats some vegetables, mainly as
vegetable soup; 3 = eats cooked vegetables in a normal way; 4 = likes to eat
cooked vegetables.
Raw vegetables: 0 = no information; 1 =
refuses any raw vegetable; 2 = eats some salad leaves, only because forced by
the parents; 3 = eats some vegetable, usually tomatoes; 4 = eats raw vegetables
in a normal way; 5 = likes to eat raw vegetables.
Fruit: 0 = no information; 1 = refuses any
fruit, also fruit juices; 2 = eats some fruit, usually fruit juices or bananas;
3 = eats fruit in quite normal way.
I counted in two ways: first I referred them
to the total of the sample. Then, I split the sample up into three sub-samples
according to years’ ranges such as 10-12, 13-15, 16 and more years. I made
comparisons of preferences for each kind of food between sub-samples’
percentages.
Finally for each food and for all of them, I
compared the current preference to the same in not-treated Italian Downs
(Cocchi, 1994). From the previous sample I erased grade 0 (unknown preference)
and I rearranged the rates according to new totals.
I tested these comparisons by Chi Square.
Results
The results I have obtained are shown as it
follows. Ninety and three out of 526 records (17.68%) fitted the study criteria
and made the sample up. Table 1 shows epidemiological data of the sample and
sub-samples 1-3.
Table 1: epidemiological data of the sample
and sub-samples.
|
|
Sample |
% |
Sub-sam.1 |
% |
Sub-sam.2 |
% |
Sub-sam.3 |
% |
|
Nr. of Ss |
93 |
|
35 |
|
40 |
|
18 |
|
|
" " F |
48 |
|
16 |
|
25 |
|
1 |
|
|
" " M |
45 |
|
19 |
|
15 |
|
11 |
|
|
F/M |
106/100 |
|
84/100 |
|
167/100 |
|
64/100 |
|
|
Last checkup |
|
|||||||
|
Aver. age yrs |
13.71 +/- 3.79 |
11.17 +/- 0.75 |
13.75 +/- 0.87 |
18.44 +/- 1.93 |
||||
|
Years of drug therapy |
|
|||||||
|
|
8.98 +/- 2.95 |
7.53 +/- 2.71 |
8.30 +/- 3.31 |
8.66 +/- 2.23 |
||||
|
Chrom. anomal. |
|
|||||||
|
Pure trisomy 21 |
83 |
89.2 |
34 |
97.1 |
32 |
80.0 |
17 |
94.4 |
|
Translocations |
7 |
7.5 |
1 |
2.9 |
5 |
12.5 |
1 |
5.6 |
|
Mosaicisms |
2 |
2.2 |
0 |
0.0 |
2 |
5.0 |
0 |
0.0 |
|
Unknown |
1 |
1.1 |
0 |
0.0 |
1 |
2.5 |
0 |
0.0 |
|
Totals |
93 |
100. |
35 |
100 |
40 |
100 |
18 |
100 |
As for drugs each subject was taken average 4.22
drugs. I listed all current drugs in Table 2.
Tab. 2: Drugs used and their daily doses in
mg/die, if not otherwise pointed out
|
Drug |
Daily doses |
No. of Ss |
% |
|
Pyridoxine |
75-150 |
81 |
87.10 |
|
Carbamazepine |
50-300 |
46 |
49.46 |
|
Diazepam |
2-10 |
46 |
49.46 |
|
Multivitaminic + mineral salts |
1 tab. x week |
40 |
45.01 |
|
S-adenosil-l-methionine |
200 |
37 |
39.78 |
|
Glutamine |
125-250 |
36 |
38.71 |
|
Pyritinol |
100 |
36 |
38.71 |
|
Tetrahydrofolates |
15 |
34 |
36.56 |
|
Bromazepam |
0.5-1.5 |
22 |
23.66 |
|
Delorazepam |
0.3-2 |
21 |
22.58 |
|
Arginine pidolas |
500 |
16 |
17.20 |
|
Glutamine + pemoline |
90 + 10 |
11 |
11.83 |
|
Glycine (+ aminoacids and vitamines) |
200 |
10 |
11.83 |
|
Biotin |
5 |
9 |
9.68 |
|
Viloxazine |
50-100 |
8 |
8.60 |
|
Arginine |
2000 |
7 |
7.53 |
|
Pyridoxine glutarate |
300-600 |
6 |
6.45 |
|
Nimodipine |
15-30 |
6 |
6.45 |
|
Clonidine |
50-100 gammas |
6 |
6.45 |
|
Amantadine |
100 |
4 |
4.30 |
|
Chlomipramine |
10 |
4 |
4.30 |
|
5-hydroxytriptophan |
25-50 |
3 |
3.23 |
|
Amitriptyline |
4-10 |
3 |
3.23 |
|
Taurine |
500 |
3 |
3.23 |
|
Oxazepam |
15 |
2 |
2.15 |
|
Clobazam |
10 |
2 |
2.15 |
|
Piracetam |
800 |
2 |
2.15 |
|
Pantotenate |
100 |
1 |
1.08 |
|
Imipramine |
10 |
1 |
1.08 |
|
Nortriptyline |
10 |
1 |
1.08 |
|
Fluoxetin |
20 |
1 |
1.8 |
|
Deanol succinate |
2000 |
1 |
1.08 |
Tables 3-11 show preferences for a single
sort of food and the comparison with related preference in not-treated Downs.
Table 3 : liking for sweets (sample and
sub-samples)
|
Grade |
Sample |
% |
Sub-sam.1 |
% |
Sub-sam.2 |
% |
Sub-sam.3 |
% |
|
1 |
1 |
1.08 |
0 |
0.00 |
1 |
2.50 |
0 |
0.00 |
|
2 |
4 |
4.30 |
2 |
5.71 |
1 |
2.50 |
1 |
5.56 |
|
3 |
8 |
8.60 |
4 |
11.43 |
3 |
7.50 |
1 |
1.56 |
|
4 |
14 |
15.04 |
3 |
8.57 |
6 |
15.00 |
5 |
27.77 |
|
5 |
56 |
60.23 |
19 |
54.29 |
27 |
67.50 |
10 |
55.55 |
|
6 |
10 |
10.75 |
7 |
20.00 |
2 |
5.00 |
1 |
5.56 |
|
Totals |
93 |
100 |
35 |
100 |
40 |
100 |
18 |
100 |
Comparing the 3 sub-groups of the Tab. 3, we
can see the preference for sweets since age 10-12 in most drug treated Downs.
Table 3bis: Comparison of sweets preference
between not-treated and drug treated Downs.
|
|
Sample of not treated Downs |
|
Sample of drug treated Downs |
|
|
|
||||
|
Grade |
No. of Ss |
% |
No. of Ss |
% |
|
1 |
13 |
14.29 |
1 |
1.08 |
|
2 |
27 |
29.67 |
4 |
4.30 |
|
3 |
22 |
24.18 |
8 |
8.60 |
|
4 |
19 |
20.87 |
14 |
15.04 |
|
5 |
10 |
10.99 |
56 |
60.23 |
|
6 |
0 |
0.00 |
10 |
10.75 |
|
Totals |
91 |
100 |
93 |
100 |
Chi Square = 76.689 with 5 df, p
0009
While most of not-treated Downs did
not accept sweets, but ice-cream and chocolate, most of drug treated Downs accept
or have a greediness for sweets. The difference shows a high significance.
Table 4 : liking for meat broth or cube
broth.
|
Grade |
Sample |
% |
Sub-sam.1 |
% |
Sub-sam.2 |
% |
Sub-sam.3 |
% |
|
1 |
8 |
8.60 |
2 |
5.71 |
4 |
10.00 |
2 |
11.11 |
|
2 |
23 |
24.73 |
3 |
8.57 |
12 |
30.00 |
8 |
44.44 |
|
3 |
15 |
16.13 |
4 |
11.43 |
9 |
22.50 |
2 |
11.11 |
|
4 |
40 |
43.01 |
23 |
65.73 |
11 |
27.50 |
6 |
33.33 |
|
5 |
7 |
7.53 |
3 |
8.57 |
4 |
10.00 |
0 |
0.00 |
|
Totals |
93 |
100 |
35 |
100 |
40 |
100 |
11 |
100 |
As for Table 4, the comparison among
sub-groups shows a decrease of the preference for broth, as age increases. It
goes from about 85% of Downs aged 10-12 to 44% of those aged 16 and more.
Table 4bis: Comparison of preferences for meat
or cube broth between not-treated and drug treated Downs.
|
|
Sample of not treated Downs |
|
Sample of drug treated Downs |
|
|
|
||||
|
Grade |
No. of Ss |
% |
No. of Ss |
% |
|
1 |
16 |
16.67 |
8 |
8.60 |
|
2 |
14 |
14.58 |
23 |
24.73 |
|
3 |
53 |
55.21 |
15 |
16.13 |
|
4 |
12 |
12.50 |
40 |
43.01 |
|
5 |
1 |
1.04 |
7 |
7.53 |
|
Totals |
96 |
100 |
93 |
100 |
Chi Square = 45.632, with 4 df, p
< .0009
The two samples mainly differ because more than
50% of drug treated Downs normally eat or like broth, while only about 13% of
not-treated Down do so.
Table 5 : liking for milk and dairy
products.
|
Grade |
Sample |
% |
Sub-sam.1 |
% |
Sub-sam.2 |
% |
Sub-sam.3 |
% |
|
1 |
2 |
2.15 |
1 |
2.86 |
1 |
2.50 |
0 |
0.00 |
|
2 |
6 |
6.45 |
0 |
0.00 |
2 |
5.00 |
4 |
22.22 |
|
3 |
15 |
16.13 |
4 |
11.43 |
9 |
22.50 |
2 |
11.11 |
|
4 |
62 |
66.67 |
25 |
71.42 |
25 |
62.50 |
12 |
66.67 |
|
5 |
8 |
8.60 |
5 |
14.29 |
3 |
7.50 |
0 |
0.00 |
|
Totals |
93 |
100 |
35 |
100 |
40 |
100 |
18 |
100 |
As for milk and dairy products too, the main
difference is most of Downs liking milk and derivatives or active searching for
them among drug treated subjects.
Table 5bis: Comparison for milk and derivatives
preference between not-treated and drug treated Downs.
|
|
Sample of not treated Downs |
|
Sample of drug treated Downs |
|
|
|
||||
|
Grade |
Nr. of Ss |
% |
Nr. of Ss |
% |
|
1 |
17 |
17.17 |
2 |
2.15 |
|
2 |
9 |
9.09 |
6 |
6.45 |
|
3 |
61 |
61.61 |
15 |
16.13 |
|
4 |
11 |
11.11 |
62 |
66.67 |
|
5 |
1 |
1.01 |
8 |
8.60 |
|
Totals |
99 |
100 |
93 |
100 |
Chi Square = 81.251 with 4 df, p <
.0009
More than 70% of drug treated Downs accept or
like milk and dairy products while only about 12% of not-treated Downs do so.
Table 6: liking for bread and pasta.
|
Grade |
Sample |
% |
Sub-sam.1 |
% |
Sub-sam.2 |
% |
Sub-sam.3 |
% |
|
1 |
2 |
2.15 |
1 |
2.86 |
0 |
0.00 |
1 |
5.56 |
|
2 |
51 |
54.84 |
17 |
48.57 |
20 |
50.00 |
14 |
77.78 |
|
3 |
40 |
43.01 |
17 |
48.57 |
20 |
50.00 |
13 |
16.66 |
|
Totals |
93 |
1'00 |
35 |
100 |
40 |
100 |
18 |
100 |
Table 6 presents a stable preference for bread
and pasta in drug treated Downs, since they are aged 10-12.
Table 6bis: Comparison for bread and pasta
preference between not-treated and drug treated Downs.
|
|
Sample of not treated Downs |
|
Sample of drug treated Downs |
|
|
|
||||
|
Grade |
Nr. of Ss |
% |
Nr. of Ss |
% |
|
1 |
20 |
19.60 |
2 |
2.15 |
|
2 |
50 |
49.50 |
51 |
54.84 |
|
3 |
21 |
20.79 |
40 |
43.01 |
|
Totals |
101 |
100 |
93 |
100 |
Chi Square = 20.636 with 2 df, p <
.0009
Again among drug treated Downs, there are more
subjects greedy for bread and pasta.
Table 7 : liking for meat.
|
Grade |
Sample |
% |
Sub-sam.1 |
% |
Sub-sam.2 |
% |
Sub-sam.3 |
% |
|
2 |
9 |
8.68 |
4 |
11.43 |
4 |
10.00 |
1 |
5.56 |
|
3 |
69 |
74.19 |
26 |
74.26 |
31 |
77.50 |
12 |
66.66 |
|
4 |
15 |
16.13 |
5 |
14.29 |
5 |
12.50 |
5 |
27.76 |
|
Totals |
93 |
100 |
35 |
100 |
40 |
100 |
18 |
100 |
Most of drug treated Downs normally eat of
like meat, since they are 10-12 years old, as we can see from the Table 7.
Table 7bis: Comparison of the preference for
meat between not-treated and drug treated Downs.
|
|
Sample of not treated Downs |
|
Sample of drug treated Downs |
|
|
|
||||
|
Grade |
Nr. of Ss |
% |
Nr. of Ss |
% |
|
1 |
3 |
3.16 |
0 |
0.00 |
|
2 |
5 |
5.26 |
9 |
9.68 |
|
3 |
82 |
86.32 |
69 |
74.19 |
|
4 |
5 |
5.26 |
15 |
16.13 |
|
Totals |
95 |
100 |
93 |
100 |
Chi Square = 10.242 with 3 df, p <
.024
Although the two distributions are different,
in fact more than 90% of the two samples’ subjects like meat.
Table 8: Liking for fish.
|
Grade |
Sample |
% |
Sub-sam.1 |
% |
Sub-sam.2 |
% |
Sub-sam.3 |
% |
|
1 |
6 |
6.45 |
3 |
8.57 |
1 |
2.50 |
2 |
11.11 |
|
2 |
42 |
45.16 |
13 |
37.14 |
19 |
47.50 |
10 |
55.56 |
|
3 |
38 |
40.86 |
16 |
45.72 |
16 |
40.00 |
6 |
33.33 |
|
4 |
7 |
7.53 |
3 |
8.57 |
4 |
10.00 |
0 |
0.00 |
|
Totals |
93 |
100 |
35 |
100 |
40 |
100 |
18 |
100 |
The comparisons among the three sub-groups show
that most Downs eat or like fish, since they are aged 10-12.
Table 8bis: Comparison for fish preference
between not-treated and drug treated Downs.
|
|
Sample of not treated Downs |
|
Sample of drug treated Downs |
|
|
|
||||
|
Grade |
Nr. of Ss |
% |
Nr. of Ss |
% |
|
1 |
6 |
8.96 |
6 |
6.45 |
|
2 |
1 |
1.49 |
42 |
45.16 |
|
3 |
57 |
85.07 |
38 |
40.86 |
|
4 |
3 |
4.48 |
7 |
7.53 |
|
Totals |
67 |
100 |
93 |
100 |
Chi Square = 41.360 with 3 df, p < .
0009
There is a significant distribution
difference, with a larger preference for fish among not-treated Downs.
Table 9 : liking for cooked vegetables
(except potatoes).
|
Grade |
Sample |
% |
Sub-sam.1 |
% |
Sub-sam.2 |
% |
Sub-sam.3 |
% |
|
1 |
1 |
1.8 |
1 |
2.86 |
0 |
0.00 |
0 |
0.00 |
|
2 |
36 |
38.71 |
10 |
18.57 |
16 |
40.00 |
10 |
55.56 |
|
3 |
50 |
53.76 |
19 |
54.29 |
23 |
57.00 |
8 |
44.44 |
|
4 |
6 |
6.45 |
5 |
14.29 |
1 |
2.50 |
0 |
0.00 |
|
Totals |
93 |
100 |
35 |
100 |
40 |
100 |
18 |
100 |
According to the Table 9, most of the Downs
aged 10-15 normally eat cooked vegetables. The Downs aged 16 and more seem to
have a lower rate in this food habit.
Table 9bis: Comparison for cooked vegetables
preference between not-treated and drug treated Downs.
|
|
Sample of not treated Downs |
|
Sample of drug treated Downs |
|
|
|
||||
|
Grade |
Nr. of Ss |
% |
Nr. of Ss |
% |
|
1 |
16 |
15.84 |
1 |
1.08 |
|
2 |
11 |
10.89 |
36 |
38.71 |
|
3 |
73 |
72.28 |
50 |
53.76 |
|
4 |
1 |
0.99 |
6 |
6.45 |
|
Totals |
101 |
100 |
93 |
100 |
Chi Square = 34.134 with 3 df, p <
.0009
A larger preference for cooked vegetables
too results in not-treated Downs.
Table 10: Liking for raw vegetables.
|
Grade |
Sample |
% |
Sub-sam.1 |
% |
Sub-sam.2 |
% |
Sub-sam.3 |
% |
|
1 |
12 |
12.90 |
6 |
17.14 |
6 |
15.00 |
0 |
0.00 |
|
2 |
12 |
12.90 |
2 |
5.71 |
1 |
2.50 |
8 |
50.00 |
|
3 |
31 |
33.33 |
11 |
31.43 |
15 |
37.50 |
5 |
27.77 |
|
4 |
31 |
33.33 |
12 |
34.29 |
16 |
40.00 |
3 |
16.67 |
|
5 |
7 |
7.56 |
4 |
12.43 |
2 |
5.00 |
1 |
5.56 |
|
Totals |
93 |
100 |
35 |
100 |
40 |
100 |
18 |
100 |
The Table 10 suggests a preference for raw
vegetables in at least 50% of drug treated Downs, since they are 10-12.
Table 10bis: Comparison for raw vegetables preference
between not-treated and drug treated Downs
|
|
Sample of not treated Downs |
|
Sample of drug treated Downs |
|
|
|
||||
|
Grade |
Nr. of Ss |
% |
Nr. of Ss |
% |
|
1 |
45 |
45.92 |
12 |
12.90 |
|
2 |
2 |
2.04 |
12 |
12.90 |
|
3 |
9 |
9.18 |
31 |
33.33 |
|
4 |
40 |
40.83 |
31 |
33.33 |
|
5 |
2 |
2.03 |
7 |
7.53 |
|
Totals |
98 |
100 |
93 |
100 |
Chi Square = 43.407 with 4 df, p <
.0009
The comparison shows a halved rate of raw
vegetables refusal in the sample of drug treated Downs.
Table 11: Liking fruit.
|
Grade |
Sample |
% |
Sub-sam.1 |
% |
Sub-sam.2 |
% |
Sub-sam.3 |
% |
|
1 |
3 |
3.23 |
1 |
2.86 |
1 |
2.50 |
1 |
5.56 |
|
2 |
32 |
34.41 |
9 |
25.71 |
14 |
35.00 |
9 |
50.00 |
|
3 |
58 |
62.36 |
25 |
71.43 |
25 |
62.50 |
8 |
44.44 |
|
Totals |
93 |
100 |
35 |
100 |
40 |
100 |
18 |
100 |
The preference for fruit results more than
90% and stable in drug treated Downs, since they are 10-12.
Table 11bis: Comparison for fruit preference
between not-treated and drug treated Downs.
|
|
Sample of not treated Downs |
|
Sample of drug treated Downs |
|
|
|
||||
|
Grade |
Nr. of Ss |
% |
Nr. of Ss |
% |
|
1 |
31 |
30.69 |
3 |
3.23 |
|
2 |
20 |
19.80 |
32 |
34.41 |
|
3 |
44 |
43.56 |
58 |
62.36 |
|
Totals |
95 |
100 |
93 |
100 |
Chi Square = 27.731 with 2 df, p <
.0009
Drug treated Downs have a larger preference
for fruit, at a 96% rate vs 64%.
Table 12: Comparison for the prevalence of
refusal for foods between not-treated and drug treated Downs
|
|
Sample of not treated Downs |
|
Sample of drug treated Downs |
|
|
|
||||
|
Food |
No. of Ss |
% |
No. of Ss |
% |
|
Sweets |
13 |
14.29 |
1 |
1.08 |
|
Broth |
16 |
16.67 |
8 |
8.60 |
|
Milk and dairy's |
17 |
17.17 |
2 |
2.15 |
|
Bread and pasta |
20 |
19.80 |
2 |
2.15 |
|
Meat |
3 |
3.16 |
0 |
0.00 |
|
Fish |
6 |
8.96 |
6 |
6.45 |
|
Cooked vegetab. |
16 |
15.84 |
1 |
1.08 |
|
Raw vegetables |
45 |
45.92 |
12 |
12.90 |
|
Fruit |
31 |
30.69 |
3 |
3.23 |
Chi Square ( on rates) = 17.791 with 8 df, p
< .024
As we can see, there is a significant
decreasing of refusals for all the foods investigated.
Table 13: Comparison for the prevalence of a
normal or increased preference for investigated the foods between not-treated
and drug treated Downs.
|
|
Sample of not treated Downs |
|
Sample of drug treated Downs |
|
|
|
Food (add two last grades) |
|||||
|
Nr. of Ss |
% |
Nr. of Ss |
% |
|
|
|
Sweets |
10 |
10.99 |
66 |
50.54 |
|
|
Broth |
13 |
13.54 |
47 |
50.54 |
|
|
Milk and dairy's |
13 |
12.12 |
70 |
75.27 |
|
|
Bread and pasta |
71 |
70.29 |
91 |
75.27 |
|
|
Meat |
87 |
91.58 |
84 |
90.32 |
|
|
Fish |
60 |
89.55 |
56 |
60.21 |
|
|
Cooked vegetab. |
74 |
73.27 |
37 |
60.21 |
|
|
Raw vegetables |
42 |
42.86 |
37 |
40.86 |
|
|
Fruit |
64 |
63.36 |
90 |
96.77 |
|
Chi Square (on rates) =
114.189 with 8 df, p < .0009
As we can see, we have a larger preference
in Drug treated Downs for all foods, except fish, cooked vegetables and raw
vegetables. The preference for meat is about the same.
Discussion
For this sample too I have to say what I
previously wrote on the sample of Down not treated by drugs (Cocchi, 1994).
Although a sample of 93 Down subjects out of
526 could be representative, the F/M ratio differs very much from the expected
about 100/135. On the other hand, the distribution of the chromosomal anomalies
does not totally match the Italian and International distributions. In our
sample translocations’ forms are over-represented. The 3 sub-samples add to
these difficulties.
As for gender or chromosomal anomaly differences
in foods’ taste I did not find any of them both for sweets and meat broth or
cube broth, in research on 460 Down subjects (Cocchi, 1990).
No information has been found on either gender
or chromosomal differences in taste for the remaining sort of foods I have
checked up, but I need to be cautious.
We can think this sample and these
sub-samples only as a second term for comparison, the first one being that of
the previous survey (Cocchi, 1994). In this way I can finish this study on food
habits in Downs. Food habits regarding rice and eggs would have also been
valuable, but I never asked for these.
As for the drugs I reported, they are not
all of them every subject took, but only those he/she was taking when he/she
came for the last checkup. The choice of the drugs has always been individually
tailored.
The analysis of food habits I have
done suggests that most drug treated Downs, since their 10-12 years show their
taste for sweets, meat or cube broth, milk and dairy products, bread and pasta,
meat, cooked vegetables and fruit. Unlike not-treated Downs, they have also
stable taste for sweets and fruit. Under this viewpoint I maintain that drug
treated Downs do not differ from normal people of comparable age.
The whole preference for meat or cube broth,
and for fish seems age decreasing.
The preference for cooked and raw vegetables
goes down in 16 and more years sub-group. The rationale for these results is
unclear. Chance and the reduced sub-groups’ size could play a role on it.
Most drug treated Downs show a good feeding
balance as for seven out of nine investigated fields except the taste for fish
or cooked vegetables. Refusal or scarce preference for a certain kind of food
differs from one food to another.
It goes from 5-10% for bread and pasta to
nearly 50% for meat or cube broth.
A strong refusal for a certain kind of food
varies from 0.0% for meat to 12.90% for raw vegetables. It is to say that drug
therapies significantly reduced the rates of refusal for all investigated foods
(Tab. 12). The finding of refusal or scarce preference drives at problems of
controlling precursors that these foods supply to the body.
As for example, when there is a refusal of
milk and dairy products, we first ought to think about triptophan, the
precursor of serotonin.
The taste for raw vegetables seems well
established in about 47% of 10-12 years old Down and it progress until adult
age. In spite of this, about 12% of drug treated Downs refuse raw vegetables.
Surely the intake of folates and perhaps other vitamins does not match the
body’s needs. As referred by Lejeune et al., 1986, Downs requires more folates
than normal individuals.
In my experience, other same age
"normal" subjects refuse to eat raw vegetables, but I think they are
less, and I have always seen them during consultation for mild psychiatric
problems.
In a different way I can treat the
preference for eating sweets, because I sat on it both in Down subjects
(Cocchi, 1990) and in depressed children (Cocchi, 1980).
In this study 12 subjects aged 16 or more
out of 21 (57.14%) refused or had scarce preference for sweet things. A hundred
and four out of 460 Downs (78.46%) did the same in my previous research without
age limits (Cocchi, 1990).
It seems that a biological limiting avoids
the brain of Down individuals to have too much glucose, by acting on its
intake. Glucose is a precursor of l-glutamic acid via the Krebs’ cycle, and
l-glutamic acid, in its turn, is the precursor of GABA.
The transformation of l-glutamic acid into
GABA has been found reduced in a state of stress, and so an increasing amount
of glutamate could be neurotoxic.
Should the reduced intake of sweets in many
Down subjects be a compensation mechanism, a kind of self-medication that aims
to lower the risk that glutamate becomes neurotoxic?
If this is true, drug therapies able to
lower stress reactions could have modified the taste for sweets.
The comparison between not-treated and drug
treated Downs (Tab. 3bis, grades 5-6) strongly supports this opinion.
The taste for broth, when prepared by meat
or by cube, looks rather different. This broth holds glutamine, glutamate or
monosodium glutamate. Only glutamine, as second precursor of brain glutamate
(Ward, Thanki & Bradford, 1983) can cross the blood-brain barrier, but
blood glutamate can be transformed into glutamine (Meister 1956; Meister 1969).
Although a larger supply of glutamine can
promote glutamate neurotoxicity, here to limit its intake works less.
About 68% of not-treated Downs have a liking
for meat broth or cube broth and most of them since their 10-12 years (Cocchi,
1994).
In my previous research without age limits,
284 out of 460 Downs (61.74%, nearly same percentage) did not refuse it
(Cocchi, 1990).
In drug treated Downs, about 67% again do
not have a refusal for meat or cube broth, nearly the same rate found in
not-treated Downs.
This fact could drive at some speculations
on the different biological value of glucose and glutamine as precursors of
brain glutamate and GABA.
If we watch out the last two grades of every
comparison between not-treated and drug treated Downs, we can get a final
outlook (Tab. 13). Drug treated Downs show increased preferences for sweets,
broth, milk and dairy products, bread and pasta, and fruit. As for meat they
have nearly the same as not-treated Downs.
Fish, cooked and raw vegetables are less
preferred by drug treated Downs.
Conclusion
This research on feeding habits in Downs aged
10 and more, and treated at least for two years by drug therapies brought to
light some interesting results.
Ten-twelve years, as lower age limit, seem a
good choice to avoid the effects of social learning in food taste.
Although we must view this sample of Downs
as not representative, the rates of refusal for all the investigated foods
decreased, as compared to same age not-treated Downs. I think it relevant, and
I maintain it related to the anti-hyponeophagic effect of the therapies, as
mainly anti-stress therapies. On the other side, the increasing in food
preferences seems to get drug treated Downs closer to same age feeding in
normals. But then, to support such hypotheses, I have not data to compare.
References
Cocchi R.: Greediness for sweet things in
children as a symptom of antidepressive homeostatic compensation: 41 cases.
Acta Paedopsychiat. 1980, 45: 293-300.
Cocchi R.: Precursori dell’ac. glutammico e
del GABA e abitudini alimentari nei Down: Indagine epidemiologica su 460
soggetti. Riv. Ital. Disturbo Intellet. 1990, 3: 307-312.
Cocchi R.: Drug therapy in Down’s syndrome:
A theoretical context. It. J. Intellect. Impair. 1993, 6: 143-154.
Cocchi R.: Food habits in Down of 10 years
or more. It. J. Intellect. Impair. 1994, 7: 149-157.
Fernstrom J.D.: Effects of the diet on brain
neurotransmitters. Metabolism 1977, 26: 207-213.
Growdon J.H., Wurtman R.G.: Dietary
influences on the synthesis of neurotransmitters in the brain. Nutr. Rev. 1979,
37: 129-136.
Lejeune J., Rethore’ M.O., DeBlois M.C.,
Mannoury-Burolla C. et al.: Metabolisme des monocarbones et trisomie 21:
sensibilite’ au MTX. Ann. Genet. 1986, 29: 16-19.
Meister A.: Metabolism of Glutamine.
Physiol. Rev. 1956, 36: 103-127.
Meister A.: On the synthesis and utilisation
of glutamine. Harvey Lect. 1969, 63: 139-168.
Ward H.K., Thanki C.M., Bradford H.F.:
Glutamine and glucose as precursors of transmitters aminoacids: Ex vivo
studies. J. Neurochem. 1983, 40: 855-860.
First printed on It. J. Intellect. Impair. 1995, 8: 147-161
Author’s address: dr Renato COCCHI, via
Rabbeno, 3
42100 Reggio Emilia (Italy)
renatococchi@libero.it
Italian translation
Down's syndrome
Drug modulation of stress reactions
Mental retardation
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