2016 Gatlinburg Conference Poster
PS-70
Title: Nutrition Choices and Decision Making in Individuals with Fragile X Syndrome
Authors: Kylee Miller, Alexandra Alvarez, Anne Wheeler, Margaret DeRamus
Introduction: Individuals with intellectual and developmental disabilities (IDD) are at risk for being overweight and experiencing
malnutrition (Van Riper, 2010), both health problems with known medical comorbidities. While much consideration has been
given to assessing intake of specific nutrients in individuals with IDD, little is known about food choices relative to cognitive
functioning and adaptive behavior; particularly for individuals who are living in more independent settings. This study explores
the relationship between decisions regarding healthy lifestyle and food choices, cognitive functioning, and weight in a sample of
adolescents and adults with fragile X syndrome (FXS).
Methods: Data was collected as part of a larger study designed to assess factors that contribute to decisional capacity in FXS.
Direct assessment measures include weight, height, the Stanford Binet -5 as a measure of general cognitive skills, and four
measures of executive functioning from the DKEFS: 20 Questions, Color-Word, Tower, and Trails. Guardian-reported adaptive
skills from the SIB-R and an evaluation of each child's history with minor and major life decision making are also collected. The
nutritional evaluation is adapted from the Healthy Eating Adds Up curriculum, a nutrition education program developed for
individuals with IDD (Johnson, 2012). Preliminary analysis explored nutritional knowledge and decision making in individuals
with FXS, and cognitive contributors to healthier outcomes.
Results: Participants included 83 adolescents and adults with FXS. Nearly ¾ of the sample met criteria for intellectual disability
[no ID, n=20, 34%; mild ID, n=27, 32%; moderate ID, n=21, 25%; severe ID, n=15, 18%]. On each of the four decision making
questions, the majority of participants were rated as being able to make the decision independently or with minimal help [what
to cook=95%; select snack items=98%; when to exercise=90%; what to order from a menu=100%]. Correlations between IQ and
decision making experiences revealed strong positive relationships (r=0.55), specifically with how often daily decisions are made
for individuals with FXS by others. Multiple regression was conducted to determine the best linear combination of gender, age,
IQ, BMI, anxiety, cognitive flexibility, inhibition, abstract thinking, and decision making experiences for cooking, choosing snacks,
exercising, ordering from a menu for predicting nutrition decision making. Assumptions were checked and met. This combination
of variables significantly predicted healthy nutrition decision making, F (15,28)=2.733, p=.01, with the variables of IQ and
previously making their own decisions of when to exercise significantly contributing to the prediction. The adjusted R squared
value was .38; indicating that 38% of the variance in nutrition decision making was explained by the model. The beta weights
suggest a high IQ (β= .60) contributed the most to making healthier nutrition decision, and that exhibiting higher levels of
disinhibition is associated with fewer healthy decisions (DKEFS Color Word, β=-.32 ).
Discussion: Initial results indicate that having a higher IQ is associated with healthier nutritional decisions. Disinhibition also
contributed to the model, suggesting that a high IQ is not necessarily a protective factor, and that certain executive functions,
namely inhibiting a response or choice, significantly impacts ones' ability to make healthy decisions. Understanding nutritional
decision-making and the cognitive processes behind how individuals make these decisions has important implications for
individuals with IDD, including the development of targeted nutritional interventions.
References/Citations:
• Humphries, K., Traci, M. A., & Seekins, T. (2009). Nutrition and adults with intellectual or developmental disabilities:
Systematic literature review results. Intellectual and Developmental Disabilities, 47(3), 163-185.
• Johnson, C. (2012). Healthy eating adds up., 2013, http://healthyeatingaddsup.com/
• Van Riper, C., & American Dietetic Association. (2010). Position of the american dietetic association: Providing nutrition
services for people with developmental disabilities and special health care needs. Journal of the American Dietetic
Association, 110(2), 296-307.