FOOD HABITS IN DOWN
OF 10 YEARS OR MORE
Renato COCCHI, a
neurologist and a medical psychologist
Summary
The records of 101 Down subjects out of a not
selected consecutive series of 518 (36 F + 75 M; age: range: 10-43, average:
13.68 years+ 5.16; chromosomal anomalies: Unknown = 6.73%, pure trisomy 21 =
83.17 %, mosaicisms = 6.93%, translocations = 2.97%) were reexamined for food
habits.
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 show that most Downs, since
their 10-12 years appreciate milk and derivatives, bread and pasta, meat and
cooked vegetables. From 10 years Downs increase their taste for fish and about
70% of them like it since their 13-15 years. The taste for raw vegetables seems
well established in about 47% of 10-12 years old Down and it goes further until
adult age. Most Downs normally eat fruit, since they are 16-18. In this study
12 subjects aged 16 or more out of 21 (57.14%) refused or had scarce preference
for sweet things. About 65% of these Downs have a liking for meat broth or cube
broth and most of them since their 10-12 years.
Food habits in Down could inform on diet and
brain neurotransmitters that have their precursors in foods.
Key words: Down’s syndrome; food habits;
diet; neurotransmitters’ precursors.
Down's syndrome
* Mental retardation
* Stress symptoms
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Food habits in Down’s syndrome subjects seem
to have poorly interested the researchers, out of weight gaining cause. As for
myself I have always judged it very important because these habits could inform
us 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).
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.
On the other hand, they can vary by aging as
usual in normal people, and Down children may get acquainted with foods along
their social growing up. We must allow for it if we want to have more precise
information.
I got to a new study on this topic by
thinking of these problems.
Materials
and method
From the records of a cohort of 518 Down
subjects I saw about those of the people aging at least 10 years at first
consultation.
I looked into this sample of records by
collecting sex, age, chromosomal anomalies and feeding habits.
A year of life encompasses 6 months before
birthday and 6 months after it (eg: The 10th year ranges from 9
years and 7 months to 10 years and six 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 four sub-samples
according to years’ ranges such as 10-12, 13-15, 16-18, 19 or more years. I made
comparisons of preferences for each type kind of food between sub-samples’
percentages.
I tested the data by Chi Square, when
suitable.
Results
The results I have obtained are shown as it
follows.
A hundred and one out of 518 records
(19.50%) fitted the study criteria and made the sample up. Table 1 shows
epidemiological data of the sample and sub-samples 1-4.
Table 1: epidemiological data of the sample
and sub-samples.
|
|
Sample |
% |
Sub-s.1 |
% |
Sub-s.2 |
% |
Sub-s.3 |
% |
Sub-s.4 |
% |
|||||||
|
Nr. of Ss. |
101 |
|
55 |
|
25 |
|
11 |
|
10 |
|
|||||||
|
* " F |
36 |
|
25 |
|
5 |
|
4 |
|
2 |
|
|||||||
|
" * M |
75 |
|
30 |
|
20 |
|
7 |
|
8 |
|
|||||||
|
F/M x 100 |
208 |
|
120 |
|
250 |
|
175 |
|
400 |
|
|||||||
|
Average age |
13.68 |
|
10.82 |
|
14.08 |
|
16.36 |
|
22.50 * |
|
|||||||
|
SD |
5.15 |
|
0.82 |
|
0.86 |
|
0.67 |
|
|
|
|||||||
|
Chromos. Anomalies |
|
||||||||||||||||
|
Pure tris. 21 |
84 |
83.2 |
47 |
85.5 |
20 |
80.0 |
10 |
90.9 |
7 |
70.0 |
|||||||
|
Translocat. |
3 |
3.0 |
2 |
3.6 |
1 |
4.0 |
|
|
|
|
|||||||
|
Mosaicisms |
7 |
6.9 |
4 |
7.3 |
2 |
8.0 |
|
|
1 |
10.0 |
|||||||
|
Unknown |
7 |
6.9 |
2 |
3.6 |
2 |
4.0 |
1 |
9.1 |
2 |
20.0 |
|||||||
* median
Tables 2-10 show preferences for a single sort of food.
Table 2 : liking for sweets (sample and sub-samples)
|
Grade |
Sample |
% |
Sub-s.1 |
% |
Sub-s.2 |
% |
Sub-s.3 |
% |
Sub-s.4 |
% |
|
0 |
10 |
9.9 |
6 |
10.9 |
4 |
16.0 |
0 |
0.0 |
0 |
0.0 |
|
1 |
13 |
12.9 |
10 |
18.2 |
2 |
8.0 |
1 |
9.1 |
0 |
0.0 |
|
2 |
27 |
26.7 |
21 |
38.2 |
3 |
12.0 |
1 |
9.1 |
2 |
20.0 |
|
3 |
22 |
21.8 |
9 |
16.4 |
5 |
20.0 |
3 |
27.28 |
5 |
50.0 |
|
4 |
19 |
18.9 |
7 |
12.7 |
8 |
32.0 |
2 |
18.2 |
2 |
20.0 |
|
5 |
10 |
9.9 |
2 |
3.6 |
3 |
12.0 |
4 |
36.4 |
1 |
10.0 |
|
6 |
0 |
0.0 |
0 |
0.0 |
0 |
0.0 |
0 |
0.0 |
0 |
0.0 |
|
Totals |
101 |
100. |
55 |
100 |
25 |
100 |
11 |
100 |
10 |
100 |
Chi square: sub-s. 1 vs. sub-s.
2: 10.930 5 df p < .057 N.S
.sub-s. 2 vs. sub-s. 3:
4.868 5 df p < .493 N.S.
sub-s. 1 vs. sub-s. 3:
15.582 5 df p < .009
sub-s. 1 vs. sub.s. 3+4:
15.283 5 df p < .002
As for the comparison between sub-samples 1
and 3 shown in Table 2, the taste for sweet things in Down children changed.
Most Downs of 16 years or more accept sweets.
Table 3 : liking for meat broth or cube
broth.
|
Grade |
Sample |
% |
Sub-s.1 |
% |
Sub-s.2 |
% |
Sub-s.3 |
% |
Sub-s.4 |
% |
|
0 |
5 |
4.9 |
1 |
1.8 |
2 |
8 |
1 |
9.1 |
1 |
10.0 |
|
1 |
16 |
15.8 |
11 |
20.0 |
4 |
16.0 |
0 |
0.0 |
1 |
10.0 |
|
2 |
14 |
13.9 |
11 |
20.0 |
3 |
12.0 |
0 |
0.0 |
0 |
0.0 |
|
3 |
53 |
52.5 |
26 |
47.3 |
14 |
56.0 |
9 |
81.8 |
4 |
40.0 |
|
4 |
12 |
11.9 |
6 |
10.9 |
2 |
8.0 |
0 |
0.0 |
4 |
40.0 |
|
5 |
1 |
1.0 |
0 |
0.0 |
0 |
0.0 |
1 |
9.1 |
0 |
0.0 |
|
Totals |
101 |
100 |
55 |
100 |
25 |
100 |
11 |
100 |
10 |
100 |
Chi square: sub-s. 3 vs.
sub-s. 4: 15.788 4 df p < .004
sub-s. 1 vs. sub-s. 3+4:
12.739 5 df p < .003
As for Table 3, the comparison between
sub-samples 1 and 3+4 shows that 85% Downs of 16 years or more like meat or
cube broth while only 58% of them do it at 10-12 years.
Table 4 : liking for milk and dairy
products.
|
Grade |
Sample |
% |
Sub-s.1 |
% |
Sub-s.2 |
% |
Sub-s.3 |
% |
Sub-s.4 |
% |
|
1 |
2 |
2.0 |
1 |
1.8 |
0 |
0.0 |
0 |
0.0 |
1 |
10.0 |
|
2 |
17 |
16.8 |
10 |
18.2 |
3 |
12.0 |
1 |
9.1 |
3 |
30.0 |
|
3 |
9 |
8.9 |
4 |
7.3 |
4 |
16.0 |
0 |
0.0 |
1 |
10.0 |
|
4 |
61 |
60.4 |
34 |
61.8 |
15 |
60.0 |
7 |
63.6 |
5 |
50.0 |
|
5 |
11 |
10.9 |
5 |
9.1 |
3 |
12.0 |
3 |
27.3 |
0 |
0.0 |
|
6 |
1 |
2.0 |
1 |
1.8 |
0 |
0.0 |
0 |
0.0 |
0 |
0.0 |
|
Totals |
101 |
100 |
55 |
100 |
25 |
100 |
11 |
100 |
10 |
100 |
Chi square: sub-s. 1 vs. sub-s.
3+4: 1.479 5 df p = 1.00 N.S.
Table 4 points to a stable taste for milk
and dairy products since their 10-12 years.
Table 5 : liking for bread and pasta.
|
Grade |
Sample |
% |
Sub-s.1 |
% |
Sub-s.2 |
% |
Sub-s.3 |
% |
Sub-s.4 |
% |
|
1 |
20 |
19.8 |
8 |
14.5 |
5 |
20.0 |
3 |
27.3 |
3 |
30.0 |
|
2 |
50 |
49.5 |
34 |
61.8 |
13 |
52.0 |
6 |
54.5 |
6 |
60.0 |
|
3 |
21 |
20.8 |
13 |
23.6 |
7 |
28.0 |
2 |
18.2 |
1 |
10.0 |
|
Totals |
101 |
100 |
55 |
100 |
25 |
100 |
11 |
100 |
10 |
100 |
Chi square: sub-s. 1 vs.
sub-s. 3+4: 2.309 2 df p < .316 N.S.
In Table 5 we observe that most Down’s
subjects like bread and pasta since their 10-12 years.
Table 6 : liking for meat.
|
Grade |
Sample |
% |
Sub-s.1 |
% |
Sub-s.2 |
% |
Sub-s.3 |
% |
Sub-s.4 |
% |
|
0 |
6 |
5.9 |
4 |
7.3 |
1 |
4.0 |
0 |
0,0 |
1 |
10.0 |
|
1 |
3 |
3.0 |
2 |
3.7 |
0 |
0.0 |
1 |
9.1 |
0 |
0.0 |
|
2 |
5 |
5.0 |
4 |
7.3 |
1 |
4.0 |
0 |
0.0 |
0 |
0.0 |
|
3 |
82 |
81.2 |
42 |
76.4 |
21 |
84.0 |
10 |
10.0 |
9 |
9.0 |
|
4 |
5 |
5.0 |
3 |
5.4 |
2 |
8.0 |
0 |
0.0 |
0 |
0.0 |
|
Totals |
101 |
100 |
55 |
100 |
25 |
100 |
11 |
100 |
10 |
100 |
Chi Square: sub-s. 1 vs.
sub-s. 3+4: 3.244 4 df p < .518 N.S.
In most Down, the taste for meat keeps up
from 10-12 years, as shown in Table 6.
Table 7 : liking for fish.
|
Grade |
Sample |
% |
Sub-s.1 |
% |
Sub-s.2 |
% |
Sub-s.3 |
% |
Sub-s.4 |
% |
|
0 |
34 |
33.7 |
23 |
41.8 |
6 |
24.0 |
3 |
27.3 |
2 |
20.0 |
|
1 |
6 |
6.0 |
5 |
9.1 |
1 |
4.0 |
0 |
0.0 |
0 |
0.0 |
|
2 |
1 |
1.0 |
0 |
0.0 |
1 |
4.0 |
0 |
0.0 |
0 |
0.0 |
|
3 |
57 |
56.4 |
25 |
45.4 |
16 |
64.0 |
8 |
72.7 |
8 |
80.0 |
|
4 |
3 |
3.0 |
2 |
3.6 |
1 |
4.0 |
0 |
0.0 |
0 |
0.0 |
|
Totals |
101 |
100 |
55 |
100 |
25 |
100 |
11 |
100 |
10 |
100 |
Chi square: sub-s. 1 vs. sub-s.
2: 5.459 4 df p < .243 N.S.
sub-s. 1 vs. sub-s. 3+4:
46.570 3 df p < .0009
The comparison of sub-samples 1 and 3+4 of
Table 7 drive at a liking for fish in most Down since their 16-18 years.
Table 8 : liking for cooked vegetables
(except potatoes).
|
Grade |
Sample |
% |
Sub-s.1 |
% |
Sub-s.2 |
% |
Sub-s.3 |
% |
Sub-s.4 |
% |
|
1 |
16 |
15.8 |
9 |
16.4 |
6 |
24.0 |
1 |
9.1 |
0 |
0.0 |
|
2 |
11 |
10.9 |
7 |
12.7 |
1 |
4.0 |
0 |
0.0 |
3 |
30.0 |
|
3 |
73 |
72.3 |
39 |
70.9 |
18 |
72.0 |
10 |
90.9 |
6 |
60.0 |
|
4 |
1 |
1.0 |
0 |
0.0 |
0 |
0.0 |
0 |
0.0 |
1 |
10.0 |
|
Totals |
101 |
100 |
55 |
100 |
25 |
100 |
11 |
100 |
10 |
100 |
Chi Square: sub-s. 1 vs.
sub-s. 3+4: 4.260 3 df p < .315 N.S.
According to Table 8, cooked vegetables are
eaten by most Down children, since they are 10-12 years old.
Table 9 : liking for raw vegetables.
|
Grade |
Sample |
% |
Sub-s.1 |
% |
Sub-s.2 |
% |
Sub-s.3 |
% |
Sub-s.4 |
% |
|
0 |
3 |
2.8 |
1 |
1.8 |
0 |
0.0 |
1 |
9.1 |
1 |
10.0 |
|
1 |
45 |
45.6 |
26 |
47.3 |
13 |
52.0 |
4 |
36.4 |
2 |
20.0 |
|
2 |
2 |
2.0 |
1 |
1.8 |
1 |
4.0 |
0 |
0.0 |
0 |
0.0 |
|
3 |
9 |
8.9 |
7 |
12.7 |
1 |
4.0 |
0 |
0.0 |
1 |
10.0 |
|
4 |
40 |
39.6 |
19 |
34.5 |
10 |
40.0 |
5 |
45.5 |
6 |
60.0 |
|
5 |
2 |
2.0 |
1 |
1.8 |
0 |
0.0 |
1 |
9.1 |
0 |
0.0 |
|
Totals |
101 |
100 |
55 |
100 |
25 |
100 |
11 |
100 |
10 |
100 |
Chi Square: sub-s. 1 vs.
sub-s. 3+4: 6.571 5 df p < .273 N.S.
Table 9 suggests a non significant progression
in eating raw vegetables from 10-12 years to adult life.
Table 10 : liking for fruit.
|
Grade |
Sample |
% |
Sub-s.1 |
% |
Sub-s.2 |
% |
Sub-s.3 |
% |
Sub-s.4 |
% |
|
0 |
6 |
5.9 |
3 |
5.4 |
1 |
4.0 |
1 |
9.1 |
1 |
10.0 |
|
1 |
31 |
30.7 |
21 |
38.2 |
8 |
24.0 |
1 |
9.1 |
1 |
10.0 |
|
2 |
20 |
19.8 |
12 |
21.8 |
4 |
12.0 |
2 |
18.2 |
2 |
20.0 |
|
3 |
44 |
43.6 |
19 |
34.5 |
12 |
48.0 |
7 |
63.6 |
6 |
60.0 |
|
Totals |
101 |
100 |
55 |
100 |
25 |
100 |
11 |
100 |
10 |
100 |
Chi square: sub-s. 1 vs.
sub-s. 2: 1.384 3 df p < .982 N.S.
sub-s. 2 vs. sub-s. 3:
2.336 3 df p < .690 N.S.
sub-s. 1 vs. sub-s. 3+4:
7.264 3 df p < .083 N.S.
Liking for fruit has a strong trend to increase
from 10-12 years of life in Downs, as it comes in the Table 10.
Discussion
Although a sample of 101 Down subjects out
of 518 had to 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 mosaic forms are over-represented.
The 4 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 foods I have
checked up, but I need to be cautious. We can think this sample and these
sub-samples only as good points of departure to study food habits in Downs.
Food habits regarding rice and eggs would have also been valuable, but I never
asked for these.
The analysis of food habits I have done
suggests that Downs, The since their 10-12 years do not vary their taste for
milk and derivatives, bread and pasta, meat and cooked vegetables. Most Downs
prefer these foods and, in this respect, I think that Downs do not differ from
same age normals. The finding of the contrary drives at problems of controlling
precursors that these foods supply to the body. As for example, when there is a
refusal of milk and derivatives, we first ought to think about triptophan, the
precursor of serotonin.
From 10-12 years Downs increase their taste
for fish and about 70% of them like it since their 13-15 years. There is not
any refusal in our sample after 15 years. For this food too, the data suggest a
normal development of this preference.
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 24% of 16 or more years Down refuse raw vegetables
or eat them in very small amount. 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.
As for these subjects, three points arise:
i. Have they a hyponeophagic habit, symptom of a long lasting state of masked
stress? ii. Could some reduced supply partly be the cause of present
psychiatric troubles? iii. If points (i) and (ii) were both true, could they
have a negative synergic action? Moreover, I do not know if there is or there
is not a lucky fate for truly normal subjects refusing to eat raw vegetables,
because they do not ask for my psychiatric help.
We can use the same ways of reasoning, with
suitable adaptation, for about 10% of Down aged 16 or more who refuse to eat
fruit.
In a quite 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). While in this study 12 subjects
aged 16 or more out of 21 (57.14%) refused or had scarce preference for sweet
things, 204 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-glutamica 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 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 ought to modify the taste for sweets. In my experience
it seems to happen so, but I have to bear it out by a special study.
The tasting 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 the limiting of its intake works less.
About 65% of these Downs have a liking for meat broth or cube broth and most of
them since their 10-12 years.
In my previous research without age limits
284 out of 460 Downs (61.74%, nearly same percentage) did not refuse it.
This fact could drive at some speculations
on the different biological value of glucose and glutamine as precursors of
brain glutamate and GABA.
Conclusion.
The study of food habits in Down subjects of
10 years or more pointed up 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 sweets, raw vegetables and
fruit appear higher than one would expect.
I think this fact relevant, and I maintain
it related to neurotransmitters’ balance, since many foods bring in the main
precursors of them (Fernstrom, 1977; Growdon & Wurtman, 1979) and vitamins
acting as catalyst of their syntheses.
The topic should deserve further research
concerning either normal individuals, or 7-9 years old Downs subjects, or 10
years or more Down subjects who underwent at least 3 years drug therapy.
I hope I shall do something about a group of
younger Downs and a group of Downs under drug therapy.
References
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Author’s address: dr. Renato COCCHI, via
Rabbeno, 3
42100 Reggio Emilia (Italy)
renatococchi@libero.it
Down's syndrome
* Mental retardation
* Stress symptoms
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