Body Composition and Cardiometabolic Risk in Adults with Neuro Developmental Disabilities - A Underappreciated Problem

Objective : Neurodevelopmental disorders (NDD) encompass intellectual disabilities and behavioral dysregulation that begin during development. Improved quality of care has resulted in increasing lifespan of these individuals and many of them are seen in adult clinics. There is growing recognition of cardiovascular morbidity and mortality in this population. However, physicians and endocrinologists are not familiar with the prevalence of obesity and cardiometabolic risk in this population. Management of individuals with NDD requires a good understanding of the factors that lead to obesity and cardiometabolic risk and the ability to address the unique challenges in these individuals.
The aim of the study was to investigate the differences in body composition between adults with NDD and neurotypical adults and determine the prevalence of cardiometabolic risk factors and their association with body composition.

Methods: The study population included individuals with NDD ( N = 116) seen at the Lee Specialty Clinic ( a Clinic that is exclusively for adults with NDD  in Louisville, KY) who had Bioelectric Impedance Analysis. The control population (N = 79) included clinic staff, residential care facility staff or patient care givers. Information about comorbidities and risk factors was collected through  retrospective chart review. Statistical analysis was performed using SPSS. Two-tailed t-test was used to compare NDD and control population and Pearson correlation analysis was used to determine the association between body composition and cardiometabolic risk factors.

Results: The prevalence of obesity in NDD was 68.36%, including 24.4% with Class 3 obesity. NDD population had higher BMI ( 34.76 +/- 12.39 vs 27.94 +/- 6.63, p < 0.01 ), percent body fat (39.65 +/- 11.37% vs 33.50 +/-23.66, p < 0.01), percent truncal fat (p 19.39 +/-  5.32% vs 15.59 +/- 5.7% < 0.01 ) and lower percent skeletal muscle mass (33.55 +/- 6.48 % vs 38.52 +/- 6.5 % p < 0.01). Despite a mean age of 33.4 +/- 12.39 years, there was high prevalence of several cardiometabolic risk factors including diabetes (23.28%), hypertension (35.5%), abnormal lipid profile ( 55.12%), obstructive sleep apnea (23.28%), and elevated liver transaminases ( ALT > 40 U/L =19.2%, 25 - 40 U/L = 17.8%). There was interesting and complex correlation between measures of body composition and cardiometabolic risk factors. There was a positive correlation between BMI and hypertension, abnormal liver enzymes, and C-reactive protein.

Discussion/Conclusion: Adults with NDD have a high prevalence of obesity and abnormal body composition. They also have high rates of cardiometabolic risk factors which appear related, at least in part, to their abnormal body composition. Delineating the factors leading to these abnormalities is important to mitigate future cardiovascular morbidity and mortality. Adults with NDD often receive suboptimal care due to real and perceived challenges noted by their health care providers. There is a need for increasing awareness of these problems and training medical students and residents in caring for these individuals.