Peer-reviewed article
Prevalence, determinants, and cardiometabolic consequences of overweight and obesity among people with Down syndrome: a systematic review and meta-analysis
Rosemary Nambooze, Ivaan Pitua, Felix Bongomin, Eddy Walakira, Geert Van Hove et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examines overweight and obesity in people with Down syndrome across all ages globally. It finds that obesity affects about one in five children and adolescents with Down syndrome, rising to one in three adults, and is associated with serious health complications like sleep apnea and liver disease. The review notes that measurement methods significantly affect reported rates, and calls for better health monitoring and lifestyle interventions.
Key points
- Overweight and obesity prevalence is 18% in children/adolescents, 36% in adults, and 30% in mixed-age groups with Down syndrome
- Obesity more than doubled the risk of obstructive sleep apnea (RR 2.4)
- Non-alcoholic fatty liver disease was present in 82% of obese versus 45% of non-obese children with Down syndrome
- Choice of growth reference chart is the largest source of variation in prevalence estimates, with DS-specific charts yielding 14-37 percentage points lower estimates
- The review included 26 studies from 14 countries with 7,840 individuals
Limitations
This is a systematic review focused on prevalence and cardiometabolic associations in Down syndrome, not a primary study. It does not evaluate an intervention or causation, and identifies research gaps in low- and middle-income countries where data are scarce.
Abstract
Abstract Objective This systematic review and meta-analysis synthesised the global prevalence of overweight and obesity in people with Down syndrome (DS) across the lifespan, characterised determinants of excess adiposity, and examined associations with adverse cardiometabolic outcomes. Methods Six databases were searched without date or language restriction. Two independent reviewers screened studies, extracted data, and assessed quality using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Prevalence was pooled using a random- effects logit model. A pre-specified subgroup analysis by age band was conducted. Publication bias was assessed with Egger’s test and certainty of evidence with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Twenty-six studies (7,840 individuals; 14 countries) were included. The pooled prevalence was 18% (95% CI 15–22%) in children and adolescents, 36% (95% CI 26–47%) in adults, and 30% (95% CI 20–43%) in mixed-age cohorts; the test for subgroup differences was significant (χ²□= 14.39, p = 0.0007). The overall pooled prevalence was 22% (95% CI 18–26%; prediction interval 7–53%; I² = 95.3%). No publication bias was detected (Egger’s t = 0.39, p = 0.6964). DS-specific growth charts yielded estimates 14–37 percentage points lower than general-population references applied to the same cohorts. Obesity more than doubled obstructive sleep apnea risk (RR 2.4; 95% CI 1.34–4.34) and Non-alcoholic fatty liver disease was present in 82% of obese versus 45% of non-obese children with DS. GRADE certainty was Moderate for prevalence estimates. Conclusions Overweight and obesity in DS are highly prevalent, age-progressive, and substantially exceed general-population rates at every life stage. Roughly one in five people with DS is affected overall, rising to more than one in three adults. The reference chart applied is the single largest source of heterogeneity in reported estimates. Cardiometabolic surveillance, adapted lifestyle interventions, and primary prevalence research from low- and middle-income countries are the highest-priority gaps.