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 |