Overweight and Obesity Among Children and Adolescents with Fetal Alcohol Spectrum Disorders

Abstract

Background Because prenatal alcohol exposure is associated with growth deficiency, little attention has been paid to the potential for overweight and obesity in children with fetal alcohol spectrum disorders (FASD). This study examined the prevalence of overweight/obesity (body mass index [BMI]) in a large clinical sample of children with FASD. Methods Children, aged 2 to 19 years, who were evaluated for FASD at University Clinics, included 445 with an FASD diagnosis and 171 with No-FASD diagnosis. Prevalence of overweight/obesity (BMI ≥85 percentile) was compared to national and state prevalence. BMI was examined in relation to FASD diagnosis, gender, and age. Dietary intake data were examined for a young subsample (n = 42). Results Thirty-four percent with any FASD diagnosis were overweight or obese, which did not differ from the No-FASD group or U.S. prevalence. Underweight was prevalent in those with fetal alcohol syndrome (FAS) (17%). However, increased rates of overweight/obesity were seen in those with partial FAS (40%). Among adolescents, those with any FASD diagnosis had increased overweight/obesity (42%), particularly among females (50%). The rate in adolescent females with FASD (50%) was nearly 3 times higher than state prevalence for adolescent females (17 to 18%), p < 0.001. In the young subsample, those who were overweight/obese consumed more calories, protein, and total fat per day than those who were not overweight or obese. Conclusions Rates of overweight/obesity are increased in children with partial FAS. In adolescents, rates are increased for any FASD diagnosis (particularly in females). Results are suggestive of possible metabolic/endocrine disruption in FASD—a hypothesis for which there is evidence from animal models. These data suggest that clinicians may consider prenatal alcohol exposure as a risk factor for metabolic/endocrine disruption, should evaluate diet as a risk in this population, and may need to target interventions to females prior to puberty to effect changes in overweight-related outcomes.

Fetal Alcohol Exposure Alters Blood Flow and Neurological Responses to Transient Cerebral Ischemia in Adult Mice

“…In this context, PAE has been shown, in rodent models, to increase the vulnerability of FASD adults to stress (Hellemans et al, 2010, Lee et al, 2000) and to diet-induced metabolic disease (Xia et al, 2014). Two recent studies on human populations linked FASD with increased obesity in adolescence and with eating disorders (Fuglestad et al, 2014, Werts et al, 2014), suggesting a potential link with emerging metabolic disease. Since obesity (Yau et al, 2012) and hypertension (Fujishima et al, 1995) are associated with decreased brain health, PAE is expected to result in increased risk for adverse outcomes following sudden-onset brain disease in the FASD adult.…”

Prenatal alcohol exposure and adolescent stress increase sensitivity to stress and gonadal hormone influences on cognition in adult female rats

“…Moreover, the rate of female obesity was even higher, at 50%, which was in significantly greater than the approximate 18% rate in typically developing females. We hypothesize, that the increased weight gain observed in PAE and PF females in our study may be related to endocrine/metabolic alterations produced by nutritional restriction in utero (Fuglestad et al, 2014) that may have altered insulin efficiency and HPA axis function, leading to enhanced fat storage but with possible negative influences on other systems including HPG development and cognitive processes, as well as possible increased risk for later-life disorders such as diabetes or cardiovascular disease.…”

“…Thus, it is possible that mild undernutrition during prenatal life may have “benefited” PAE and PF females in their ability to thrive during times of food deprivation in adulthood. Additional support for this comes from a recent study by Fuglestad and colleagues (2014) that found that rates of obesity in children with an FASD was over 40%, which was significantly higher than expected in typically developing individuals. Moreover, the rate of female obesity was even higher, at 50%, which was in significantly greater than the approximate 18% rate in typically developing females.…”

Alcohol-Induced Developmental Origins of Adult-Onset Diseases

“…At birth, defining characteristics of individuals with FASD include low birth weight and/or growth deficiency, dysmorphic facial structures, and neurologic impairment (Jones and Smith, 1973, Hoyme et al, 2005). Conversely, aging in FASD individuals is associated with attenuation of facial dysmorphology (Streissguth et al, 1991), increased rates of obesity (Fuglestad et al, 2014), endocrine dysfunction (Hellemans et al, 2008), as well as learning and memory impairments (Olson et al, 1998) and increased incidence of mental illnesses (Streissguth, 1996). These aging-related problems are complex, requiring high-level of care, and consequential expense.…”