Diet Quality of Midwest Adolescents and Young Adults With Intellectual Disabilities and Overweight/Obesity Differs by Diagnosis but Not by Weight Category

Background: Poor diet may contribute to high rates of overweight/obesity (OW/OB) in adolescents and young adults with intellectual disabilities (IDs).

Objective: The purpose of this study was to examine diet quality as assessed by Healthy Eating Index 2015 (HEI-2015) scores in adolescents and young adults with IDs and OW/OB and to compare diet quality by ID diagnosis and weight.

Design: Three-day image-assisted food records from baseline assessments in an 18-month weight-loss trial for adolescents and young adults with IDs and OW/OB were used to calculate HEI-2015 scores, which were compared between ID diagnoses and weight categories.

Participants/setting: A total of 102 adolescents and young adults (aged 13 to 21 years) with IDs (48 with Down syndrome [DS], 40 with autism, and 14 with other/unspecified IDs) and OW/OB at a Midwestern academic medical center completed valid food records from November 2015 to November 2019.

Main outcome measures: Outcome measures included HEI-2015 scores, energy intake (kcal/d), macronutrient intake as percentage of energy, energy intake per kilogram body weight, and grams protein per kilogram body weight.

Statistical analyses performed: Differences in HEI-2015 scores and additional dietary measures by weight category and ID diagnosis were examined with analysis of variance or Kruskal-Wallis tests.

Results: Participants with DS had a significantly higher mean ± SD HEI-2015 score (53.9 ± 8.4) compared with participants with autism (49.1 ± 9.6; P = .047). Compared with those with autism, participants with DS had a higher percentage of energy from protein, higher energy intake per kilogram body weight, and higher grams of protein intake per kilogram body weight. For HEI-2015 components, participants with DS had higher scores than participants with autism for total fruits, whole fruits, total vegetables, greens and beans, and total protein foods, but lower scores for sodium. Diet quality was not observed to differ by weight classification.

Conclusions: Adolescents and young adults with autism had lower overall diet quality scores compared with those with DS. Diet quality was not found to be related to OW/OB. Understanding dietary differences by ID diagnosis may inform intervention strategies.