IOSR Journal of Nursing and Health Science (IOSR-JNHS)

e-ISSN: 23201959.p- ISSN: 23201940 Volume 4, Issue 3 Ver. III (May. - Jun. 2015), PP 26-34
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Effect of Dietary Intervention on Anthropometric Measurements

And Lipid Profile of Obese Children with Down's Syndrome
Azza A. Moustafa1, Maha E. Khalifa2 and, Samar S. Diab3
1-Assistant Lecturer 2- Professor and 3-Lecturer
Faculty of nursing ,Pediatric Nursing, El- Menofia University

Email of corresponding author :sadiabma@yahoo.com

Abstract: Children with Downs syndrome have a higher prevalence of obesity than children without Downs
syndrome. Obesity has a negative impact upon mortality and morbidity. Studies report that obesity is more
prevalent in individuals with Down syndrome than individuals with intellectual disabilities not associated with
Down syndrome. Aim was to evaluate the effect of healthy diet intervention program on anthropometric
measurements and lipid profile of children aged 4-16 years with down's syndrome their IQ ranged from 50 70.
The IQ level was taken from children' school file.
Hypothesis: Dietary intervention group will have a positive effect on the Anthropometric measurements such
as decrease over weight and lipid profile such as reduce Cholesterol ,Triglyceride ..etc of Downs syndrome
children aged from 4-16 years.
Design: A quasi- experimental research design was used. of 3 classes
Setting was: EL Tarbya El Fekrya School in Shebin El Kom Egypt. The school consisted for children in the
primary stage (nursery), 10 classes for children in the educational stage (primary) and 6 classes for training
stage (preparatory).
Sample was : 60 children who met study criteria. A simple random sample was used to equally divided into
study and control group.
Tools: Tool 1. An interview was conducted to collect data about biosocial characteristics of children and their
parents. Tool 2. Likert scale about childrens eating habits. It was developed by Schaeffer (2007). Tool 3. Biophysiological measurement for measuring weight, height and BMI. It was developed by WHO (2010) and
National Nutrition Institution (2006).
Results: was revealed that more than half of children (56.7%) in the study and approximately two thirds of
control group (66.7%) were boys .The majority of children in the two groups lived in rural areas (66.7%
experimental and 73.3% control groups). Children in the study group who ate 6 fresh fruit snacks were 40%
vs. 32%, fresh vegetables snacks 40% vs. 8%, eating healthy food while he/she is outside the home 5% vs. 8%
and fat utilization in food 90% vs. 48%). There were statistical significant differences between pre test and post
test in positive eating habits, body weight, in children waist circumference in the experimental group. Lipid
profile in the experimental group at pre and post test revealed that there was significant improvement in
cholesterol, HDL and LDL therefore, there was statistical significant differences between pre and post tests.
Conclusion: Healthy diet intervention program help in reduced body weight of down's syndrome children ,
affect abnormal anthropometrics measures and improve lipid profile of children with Down's syndrome. So,
Recommendations were emphasized on provide an educational program about healthy diet intervention for
school health nurses, teachers, children and their parents for prevention and control of obesity among down's
syndrome children. This study should be applied in other settings on large sample to ensure generalizability of
the study.
Key words: Down syndrome ,Obesity, Nutrition, Anthropometric measures, Lipid Profile

I.

Introduction

Down syndrome (trisomies) is one of the most common chromosomal abnormalities found in human
(Mokhtar , et al 2003 and Mandava S, Koppaka N, Bhatia D, Das BR. (2010).). Approximately 95% of all cases
of Down syndrome are attributed to an extra chromosome 21 Hockenberry M ,Wilson D ,(2013).Down
syndrome is a considerable genetic cause of mental retardation. The mental capacity of children with Down
syndrome varies from sever retardation to low-average intelligence. Generally, it ranges from mild to moderate
form of mental retardation (National Down syndrome society, 2003).
In Egypt, it has been reported that the incidence of Down syndrome occurs in 1 per 1000 live births
(Mokhtar et al., 2003, El Gilany et al., 2011). Moreover, 2285 live births have an estimated risk for Down
syndrome annually and most of these cases (98.43%) were diagnosed postnatal ( El Sobky and El Sayed, 2007).
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Effect of Dietary Intervention on Anthropometric Measurements And Lipid Profile of Obese .

These children are at greater risk than the general population for developing nutritional problems including
defects in lipid metabolism, increased demands on antioxidants defense system, overweight and obesity
Mushtaq MU, Gull S, Mushtaq K, Shahid U, Shad MA, Akram J. (2011).
Obesity prevalence in children with Down syndrome is a major worldwide public health concern
(Hockenberry, and Wilson 2013) because of its immediate impact on the physical and psychological health of
children as well as its risks for developing chronic diseases later in life (Barlow, Dietz, and Klish and
Trowbridge 2002). Therefore, paying a close attention to the weight of a child with Down syndrome is of prime
importance to his or her lifelong health (Collin and Laverty, 2005, and National Down Syndrome Society,
2012).
Primarily, anthropometric measurements assessment such as weight and height..etc is a rapid,
inexpensive and noninvasive way to assess growth and body composition (Hong, 2012). Body mass index is
generally agreed to be the most appropriate proxy measure for defining and diagnosing obesity and overweight
(Reilly, 2010).
During infancy feeding problems and poor weight gain may be observed in some children with Down
Syndrome . In particular, children with significant congenital heart disease may present with failure to thrived
Hockenberry and Wilson (2013) . However, once the congenital heart defect is repaired, the children usually
thrive well subsequently. On the other hand, increased weight gain often becomes apparent in many individuals
with Down Syndrome. Therefore, it is important to inform parents concerning appropriate healthy diet practices
Proper intake of a balanced diet, avoidance of high caloric food items, and regular physical exercises are
important for all children including those with Down Syndrome (Hong, 2012).
Aim
The aim of this study was to evaluate the effect of healthy diet intervention program on
anthropometrical measurements and lipid profile of children with down's syndrome.
Research Hypothesis Dietary intervention group will have a positive effect on the Anthropometric
measurements such as decrease over weight and lipid profile such as reduce Cholesterol ,Triglyceride ..etc of
Downs syndrome children aged from 4-16 years.
Operational definitions
Obesity is : Abnormal amount of fat on the body. The term is usually not employed unless the individual is
from 20% to 30% over average weight for his or her age, sex, and height (Bessensen, 2008).
Anthropometric measurement is :A quantitative techniques for determining an individual's body fat
composition by measuring , recording and analyzing specific diminutions of the body, such as height , and
weight ,skin fold thickness; and bodily circumferences at waist, hip and chest (NICE, 2006; and Reilly, 2010).
Lipid profile is : A blood test, or the results of a blood test, that measures levels of lipids, or fats, including
cholesterol and triglycerides(Singhal et al., 2007).

II.

Subjects and Method

Research Design: A quasi experimental research design was used in carrying out the study.
Setting: EL Tarbya El Fekrya School in Shebin El Kom. The school consisted of 3 classes for children in the
primary stage (nursery), 10 classes for children in the educational stage (primary) and 6 classes for training
stage (preparatory).
Sample: A sample of 60 children who met the study criteria was included. A simple random sample was used
to assign them equally into two groups (study group and control group).
Selection Criteria
Inclusion Criteria: Age ranged between 4 - 16 years. IQ ranged from 50 70 as mentioned in child file .
Tools : Three tools were utilized.
Tool 1: An interview was developed by the researcher. It included data about age, sex, place of residence
parents` level of education and parents` occupation.
Tool 2: Eating habits Likert scale was divided into two parts developed by Schaeffer (2007).
Part one: Positive eating habits. Positive eating habits. It included 4 questions about number of fresh fruits
snacks, number of fresh vegetables snacks, number of times of eating healthy food while they are outside the
home and fat utilization into food.
Scoring system for positive eating habits was: The total score of part one was 12 points. The cutoff point= 75%
of the total score=9 points and positive eating habits was 9 points.
Frequency of positive eating habits/day
0-2
3-5
>5

DOI: 10.9790/1959-04332634

Score
1
2
3

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Effect of Dietary Intervention on Anthropometric Measurements And Lipid Profile of Obese .

Part two: Negative eating habits. It included 7 questions about eating while watching TV, eating while making
homework, eating even if not hungry, eating lots of sweets, eating lots of chips and crisps, skipping breakfast
usually and soda consumption. Scoring system for negative eating habits was: The total score of part one was 14
points. The cutoff point= 75% of the total score=10.5 points and right eating habits was 10.5 points. Item Yes
Score1, No, Score 2.
Scoring system for total eating habits part I and part II was: The total score of eating habits part I and part
II was 26 points. The cutoff point= 75% of the total score =19.5 points and right eating habits was 19.5 p
Tool 3: Physiological Measurements tool
It includes; Anthropometric measurements. It was developed by WHO (2010) and National Institute for
Health and Clinical Excellence (2006). It was developed to assess anthropometric measurements. It included
records of weight, height, body mass index, waist circumference, hip circumference and waist hip ratio.
Grading system for BMI:
Item
Underweight
Healthy weight
Overweight
Obese

Grad
< 5th percentile
5th - < 85th
85th- < 95th
95th

Scoring system for BMI:

Scoring Items
Underweight
Healthy weight
Overweight
Obese

Grade (Score)
1
2
3
4

Waist hip ratio: Waist hip ratio (WHR) records. It was developed by Lanthi-koski (2001). It included waist and
hip circumferences.
Scoring system for waist hip ratio was: Sex Girls Scoring Items 0.90 Grade 2 , Boys Scoring Items 1.00
Grade 2 .
Lipid profile testing. A blood sample was obtained from each participant before starting the dietary intervention
program. It should be obtained in the morning after fasting for 10-12 hours. It tested Serum Lipid profile (total
Cholesterol, LDL, HDL and triglycerides).
Method
Written Permission: An official permission was obtained to proceed the study.
Protection of Human Right: An acceptance to share in the study was obtained from parents before
participation in the study. Confidentiality and privacy were assured by telling the parents that collected data was
not going to be used for other non research purposes.
-Tools Development:
a. Tools were adopted and developed by the researcher for data collection.
b. Validity of tools was conducted by a group of experts of pediatric nursing
c. Reliability of the tool was determined to assess the extent to which items in the questionnaire were related
to each other by Cronbach's co-efficiency alpha test (r= 0.68).
Pilot study: A pilot study was carried on 5 children with Down's syndrome to test the clarity, applicability and
consistency and feasibility of the tools. No modifications were needed for the tools. So, children in the pilot
study were included.
Data collection procedure: Data collection started on November 2011 and lasted until April 2012. It continued
for 6 months and contained three phases:
A. Phase I (assessment phase): Socio demographic characteristics were obtained from children and their
parents. It was performed before conducting dietary intervention program for children with Down syndrome
and included:
a) Assessment of an anthropometric measurements
b) Assessment of eating habits.
c) Lipid profile testing.
1-A blood sample was obtained from each participant before starting the healthy diet intervention program.
2-It should be obtained in the morning after fasting for 10-12 hours.
It tested Serum Lipid profile (total Cholesterol, LDL, HDL and triglycerides).
1. The researcher asked the mothers and/or fathers about children's positive and negative eating habits. Then
data was recorded for each child.
2. Afterwards, assessment of anthropometric measurements was done.
3. The researcher measured the weight two times in kilograms (kg) using a weight scale after asking children to
evacuate their bladder, wear light clothes and stand without shoes. The mean of the two weight measurements
was used for data analysis.
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Effect of Dietary Intervention on Anthropometric Measurements And Lipid Profile of Obese .

4. Height was measured two times in centimeter (cm) using a measuring tape. Children stand without shoes,
with heels, shoulders and back in contact with an upright wall and the head in a horizontal position. The mean of
the two height measurements was used for data analysis.
5. Body mass index was easily calculated by dividing the weight (kg) / height (m) 2 (WHO, 2000 and National
Nutrition Institution, 2008).
6. Also, waist and hip circumferences (cm) were measured two times with a measuring tape while the children
were wearing light clothing. Waist circumference was measured at the minimum circumference between the
iliac crest and the rib cage. Hip circumference was measured at the maximum protuberance of the buttocks. The
waist hip ratio (WHR) was calculated by dividing the waist circumference by hip circumference.
7. All measurements were taken by the same researcher and same devices and were conducted in a well-lighted
room, without noises, with a temperature and adequate ventilation. They were obtained at early morning to
avoid variations in size and weight during the day.
B . Phase II (program implementation): the program lasted for 12 weeks with 3 dietary intervention sessions
per week. Each child received 22-36 sessions.
C. Phase III: Evaluation phase (Posttest): Reassessment of anthropometric measurements; "weight, height,
hip circumference, waist circumference, and BMI and waist hip ratio", eating habits after 12 weeks to determine
the effect of dietary intervention program on anthropometric measurements and lipid profile.
Statistical Analysis
Data was coded and transformed into specially designed form. The collected data was analyzed using SPSS
statistical software package version 15.

III.

Results

A. Part one: Characteristics of children in the study and control groups.

Table (1) Shows that more than half of children (56.7%) and approximately two thirds of them (66.7%)
were boys in the study and control groups respectively. In relation to fathers' education, more than one third of
them (43.3% and 36.7%) had secondary level of education. Meanwhile, more than half of mothers in study
(53.3%) and control groups (50%) were illiterate. Regarding to parents' occupation, the majority (83.3% and
80%) of fathers in study and control groups were working.
On the other hand, the majority of mothers (83.3% and 86.7) in the study and control groups respectively
weren't working. No statistical significant differences were found between socio demographic characteristics of
children in the study and control groups at 5% level of statistical significance.
Figure (1) clarifies the distribution of children in the study and control groups according to their place
of residence. The majority of children in the two groups lived in rural areas (66.7% study and 73.3% control
groups). No statistical significant difference was found between the study and control group.
Eating habits of children before conducting dietary intervention program for the study and control group
Table (2) Refers to the negative eating habits were in the study and control groups at pre intervention.
Approximately, three quarters (73.3%) of children had negative eating habits. In relation to children's total
eating habits, more than half (66.7%, 60%) of children in the study and control groups had wrong eating habits.
There were no statistical significant differences.
B. Anthropometric Measurements before conducting dietary intervention program in the study and
control groups.
Table (3) Represents comparison between the anthropometric measurements of children in the study
and control groups before conducting dietary intervention sessions. There were no statistical significant
differences between the study and control groups at pre dietary intervention in relation to weight, height, waist
circumference and hip circumference.
C. Part two: Effect of dietary intervention program on anthropometric measurements of children in
study and control groups.
Table (4) Shows comparison between the study and control groups at post test regards positive eating
habits. It was revealed that children in the study group showed better positive eating habits than their peers in
control group after conducting dietary intervention sessions. Children in the study group who eat 6 fresh fruit
snacks were 40% vs. 32%, fresh vegetables snacks 40% vs. 8%, eating healthy food while he/she is outside the
home 5% vs. 8% and fat utilization in food 90% vs. 48%). Therefore, there were statistical significant
differences at 5% level of statistical significance between children in study and control groups at post test except
for eating fresh fruits snacks and eating healthy food while they are outside the home.

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Effect of Dietary Intervention on Anthropometric Measurements And Lipid Profile of Obese .

Table (5) Shows comparison between the anthropometric measurements in the study group at pre and
post test. It was obvious that there was a significant reduction in weight (55.0518.0 vs. 51.415.23) and waist
circumference (8613.36 vs. 85.212.78) in the study group after conducting the dietary intervention sessions.
There was a significant differences at 1% level of statistical significance between pre and posttests in relation
to weight and waist circumference.
Table( 6) Shows the relationship between BMI and age in the study group at pre and post test. It was
revealed that about two thirds of school age children and all adolescents (57.1%, 100%) were obese before
conducting dietary intervention sessions. Meanwhile, about half of school age children and more than two thirds
of adolescents (42.9%, 66.7%) were still obese after conducting sessions. Therefore, there were no statistical
significant differences between children of different ages in study group regarding their BMI.
Table (7) Shows comparison between lipid profile in the control group at pre and post tests. On post test, the
mean value of cholesterol levels was significantly increased (192.5617.29 vs. 190.2818.47) compared to pre
test levels among children in the control group. Therefore, there were statistical significant differences at 5%
level of statistical significance between pre and post test in the control children.
Table (8) Represents comparison between lipid profile in the study group at pre and post test. On
posttest, there were significant improvement in cholesterol, HDL and LDL (186.8520.56 vs. 186.119.9,
45.24.88 vs. 45.854.63 and 108.115.75 vs. 104.0510.42) among children in the study group. Therefore,
there were statistical significant differences between pre and post tests at 5% level of statistical significance.
However, no statistical significant differences were found related to triglyceride level at 5% level of statistical
significance.
Table (1): Distribution of children in the study and control groups according to their socio-demographic
characteristics.
Socio-demographic data

Sex:
boys
Girls
Age in years:
6-12 years
>12-18 years
(Mean SD)
Father education:
Illiterate
Read & write
Secondary
University
Father occupation:
Not work
Work
Mother education:
Illiterate
Read & write
Secondary
University
Mother occupation:
Not work
Work
NB: ns

X2

P-Value

Control group
(n=30)
N
%

56.7
43.3

20
10

66.7
33.3

0.64

0.43 ns

15
50
15
50
(11.532.45)

18
60.0
12
40.0
(11.792.58)

0.31

0.76 ns

8
5
13
4

26.7
16.7
43.3
13.3

6
8
11
5

20.0
26.7
36.7
16.7

1.36

0.74ns

5
25

16.7
83.3

6
24

20.0
80.0

0.11

0.74 ns

16
4
6
4

53.3
13.3
20
13.3

15
3
9
3

50.0
10.0
30.0
10.0

0.92

0.82 ns

25
5

83.3
26.7

26
4

86.7
13.3

0.13

0.72 ns

Study group
(n=30)
N
17
13

P > 0.05
Figure (1)Distribution of children in the study and control group according their residence place
distribution of children in study and control group according to
their place of residence

80

73.3

66.7

60
33.3
40

Rural
26.7

Urban

20
0
study group

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Control group

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Effect of Dietary Intervention on Anthropometric Measurements And Lipid Profile of Obese .

Table (2): Negative eating habits in the study and control groups at pre test.
Negative Eating Habits
Eat while watching TV:
Yes
No
Eat while making homework:
Yes
No
Eat even if not hungry
Yes
No
Eat lots of sweets:
Yes
No
Eat lots of chips and crisps:
Yes
No
Take breakfast usually
Yes
No
Soda consumption:
Yes
No
Total Negative Eating Habits
Wrong habits
Right habits
Total Eating Habits (negative+ positive)
Wrong habits
Right habits
NB: ns

Study group (n=30)

No
%

Control group(n=30)
No
%

X2

P-Value

8
22

26.7
73.3

9
21

30
70

0.08

0.77 ns

8
22

26.7
73.3

9
21

30
70

0.08

0.77 ns

9
21

30
70

9
21

30
70

0.0

0.0

22
8

73.3
26.7

21
9

70
30

0.08

0.77 ns

22
8

73.3
26.7

21
9

70
30

0.08

0.77 ns

20
10

66.7
33.3

19
11

63.3
36.7

0.07

0.79 ns

20
10

66.7
33.3

19
11

63.3
36.7

0.07

0.79 ns

22
8

73.3
26.7

22
8

73.3
26.7

0.0

0.0

20
10

66.7
33.3

18
12

60
40

0.29

0.59ns

P > 0.05

Table (3): Comparison between the anthropometric measurements of children in the study and control
groups at pre test.
Anthropometric
Measurements
Weight
Height
Waist circumference
Hip circumference

Study group (n=30)

(Mean SD)
54.3717.09
137.1311.92
87.1314.29
87.0312.85

Control group (n=30)

(Mean SD)
53.9316.4
137.4311.29
87.1314.29
87.0312.85

t-test
0.19
0.1
0.0
0.0

P-value
0.85ns
0.92 ns
0.0
0.0

NB: ns P > 0.05

Table (4): Comparison between the study and control groups at post test regards to positive eating
habits.
Positive Eating Habits

Number of fresh fruit snacks:

0-2
3-5
6
Number of fresh vegetables snacks:
0-2
35
6

Number of eating healthy food while you are outside

the home:
0-2
3-5
6
Fat utilization in food:
Mild
Moderate
Extensive
Total Positive Eating Habits :
Wrong habits
Right habits

NB:

ns

p 0.05

Study group (post)

n=20
No
%

Control group (post)

n=25
No
%

X2

P-Value

3
9
8

15
45
40

4
13
8

16.0
52.0
32.0

0.32

0.85ns

7.22

0.02*

3
9
8

15
45
40

9
14
2

36.0
56.0
8.0

4
15
1

20
75
5

11
12
2

44.0
48.0
8.0

3.42

0.18 ns

0
2
18

0.0
10.0
90.0

6
7
12

24.0
28.0
48.0

9.54

0.008*

5
15

25
75

17
8

68.0
32.0

8.22

0.004*

* P<0.05

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Effect of Dietary Intervention on Anthropometric Measurements And Lipid Profile of Obese .

Table (5): Comparison between the anthropometric measurements in the study group at pre and post
test.
Anthropometric
Measurements
Weight
Height
Waist circumference
Hip circumference

NB:

ns

p 0.05

Pre-intervention (n=20)
(Mean SD)
55.0518.0
136.5512.98
8613.36
86.412.87

* P<0.05

Study group
Post-intervention (n=20)
(Mean SD)
51.415.23
136.1511.84
85.212.78
86.412.87

Paired t-test

P-value

3.83
0.9
3.56
0.0

0.001**
0.38ns
0.002*
0.0

** P<0.001

Table (6): Relationship between BMI and age in the study group at pre and post test.
Age
BMI

School age
(<12 years) (n=14)

Pre intervention:
Normal weight
Overweight
Obese
Post intervention:
Normal weight
Overweight
Obese

NB:

ns

Adolescence
( 12 years) (n=6)

2
4
8

14.3
28.6
57.1

0
0
6

0.0
0.0
100

4
4
6

28.6
28.6
42.9

0
2
4

X2

P-value

3.67

0.16 ns

2.22

0.33 ns

0.0
33.3
66.7

p 0.05
Table (7): Comparison between lipid profile in the control group at pre test and post test.

Lipid profile

Cholesterol
Triglyceride
HDL
LDL

NB:

ns

p 0.05

Control group
Pre-intervention (n=25)
(Mean SD)
190.2818.47
76.6819.79
45.084.46
107.3614.59

Post-intervention (n=25)
(Mean SD)
192.5617.29
77.9619.99
45.44.64
107.8414.65

t-test

P-value

3.13
1.98
0.25
1.19

0.005*
0.59ns
0.81 ns
0.25 ns

* p <0.05

Table (8) : Comparison between lipid profile in the study group at pre and post test.
Lipid profile

Cholesterol
Triglyceride
HDL
LDL

NB:

Study group
Pre-intervention (n=20) (Mean Post-intervention (n=20) (Mean
SD)
SD)
186.8520.56
186.119.9
75.3519.31
75.3519.31
45.24.88
45.854.63
108.115.75
104.0510.42

t-test

P-value

2.12
0.0
2.22
2.42

0.04*
0.0
0.03*
0.02*

p < 0.05

IV.

Discussion

Obesity is a serious problem faced by children with Down syndrome. It is caused by a combination of
genetic characteristics and lifestyle with food intake (Chen, 2007).
El-Sobky et al., (2004), Wahab et al., (2006), Chen (2007), Chandra et al., (2010), Mandava et al.,
(2010) and Doctortipster (2011) who study Down syndrome in Egypt are explained (DS) prevalence is higher
between boys than girls, their findings associated with current study findings where the majority of children in
the study and control groups were boys .
As regards to children's positive eating habits, this study revealed that only 20% and 30% of children in
the study and control groups respectively had right eating habits. This result was consistent with WHO (2010)
which indicated that eating habits were decline in the intake of fruits, vegetables, whole grains and legumes, the
sharp increasing intake of food rich in fats, sugar and salt.
As well as poor eating habits the anthropometric measurements in the study and control group at pre
test, the present study findings were indicated that the majority(63.3% and 56.7%) of children in both groups
were obese. This could be related to the tendency of Down syndrome children to be overweight and inactivity.
The current results were agree with Al Husain, 2003who study Growth charts for children with Down's
syndrome in Saudi Arabia: birth to 5 years. and Grammatik Opoulou et al., 2008,who study Nutrient intake and
anthropometry in children and adolescents with Down syndrome-a preliminary study, their results indicating
that children with Down syndrome had a genetic predisposition to become overweight or obese.
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Effect of Dietary Intervention on Anthropometric Measurements And Lipid Profile of Obese .

However, the absolute effect of the program seemed to be small. This could be related to negative
eating habits of children in the experimental and control groups which didn't improve enough. Above all, the
significant improvement in positive eating habits didn't induce the desirable dietary control on weight, BMI and
waist circumference. Consistently, Largues et al., (2011) who study the Assessment of a school-based
intervention in eating habits and physical activity in school children. Was stated that the biggest impact on BMI
had been obtained through interventions that deal with food habits and physical activity simultaneously.
The current study reported that weight and waist circumference declined significantly at the post
intervention phase. These results were supported by Steven , Katz , Huxley (2010). Associations between
gender, age and waist circumference. Who illustrated that there was a significant decline in weight and waist
circumference in Down syndrome adolescents after completing session's program.
Concerning the effect of dietary intervention program on serum lipid profile in the experimental group
on post test the present results showed that there was significant improvements in lipid profile (increased HDL,
decreased LDL and total cholesterol). However, there were no significant improvements in triglyceride.
In relation to the control group, the results revealed that total cholesterol level increased significantly at
post test. This indicated that those children were at a great risk for developing cardiovascular problems. Perhaps,
this could reflect their need for implementing the dietary intervention program.
Finally, the results of the present study clarified that dietary intervention program had a positive impact
on the anthropometric measurements of children with Down syndrome. So that, dietary intervention sessions
effectively prevented measures the development of obesity consequences in children with Down syndrome and
in turn promotes their health and well being.

V.

Conclusion

Majority of children were boys in the study and control groups . In relation to fathers' education, more
than one third of them had secondary level of education. Meanwhile, more than half of mothers in study and
control groups were illiterate, the majority of fathers in study and control groups were working . On the other
hand, the majority of mothers in the study and control groups weren't working. No statistical significant
differences were found between socio demographic characteristics of children in the study and control groups .
The majority of children in the two groups lived in rural areas. No statistical significant differences between the
study and control groups at pre intervention in relation to weight, height, waist circumference and hip
circumference. There were statistical significant differences at 5% level between children in study and control
groups at post test except for eating fresh fruits snacks and eating healthy food while they are outside the home.
There were a significant differences at 1% level of statistical significance between pre and posttests in relation
to weight and waist circumference. Also, there was significant decrease in cholesterol, HDL and LDL among
children in the study group. Therefore, there were statistical significant differences between pre and post tests at
5% level of statistical significance. However, no statistical significant differences were found related to
triglyceride level at 5% level of statistical significance.
.

VI.

Recommendations

An educational program about dietary intervention should be provided for school health nurses.
Develop practical guidelines for teachers on prevention and control of obesity among Down syndrome children.
Counseling should be provided to children and parents about nutrition and healthy eating habits. Further
researches are needed to be conducted dietary intervention program for long time up to 6 months and results
should be compared with this study. This study can be applied in other settings on large sample to ensure
generalizability of the study.
Limitation of the study:
Teen children of the study group as well as five children in the control group were excluded as they
didn't complete 60-75% peak hours (22-36 sessions) of attending the program.

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