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Food Habits in Drug Treated Downs of 10 Years or More

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Renato Cocchi M.D., Ph.D. (Sociology)
Italian Journal of Intellective Impairment 2: 147-161 (1995) 		  Reprinted with the permission of Renato Cocchi
Via A. Rabbeno, 3
42100 Reggio Emilia, Italy
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URL: http://www.stress-cocchi.net
Key words: Down's syndrome; food habits; diet; stress; hyponeophagia; drug therapy.

Following the previous research on food habits in non-drug treated Downs (Cocchi, 1994), I aimed to accomplish it. Then, I started another survey on food habits in Downs who took drug therapies prescribed and I checked by myself.
As for myself I have always judged as very fruitful to collect information in this field. These habits could let us more know on brain neurotransmitters via their food precursors. I already printed a study on food precursors of glutamate and GABA in 460 Down individuals (Cocchi, 1990).
I think liking or food refusal a relevant fact, and I maintain it related to neurotransmitters' balance. Many kind of foods bring in the main precursors of them (Fernstrom, 1977; Growdon & Wurtman, 1979) and vitamins act as catalyst of their syntheses.
Having nearly always collected many data on food habits since 1979, when I began drug therapies in Downs, I think that these habits account mainly for biological needs.
Moreover, as the previous research showed (Cocchi, 1994), they can vary by aging as usual in normal people. Down children too may get more acquainted with foods along their social growing up.
On the other hand, if we use drugs mainly acting on stress responses, we expect to have these habits modified, by reduced hyponeophagia as a symptom of stress (Cocchi, 1993).
I got to a new study on this topic by thinking of these problems.

Materials and methods

From the records of a cohort of 526 Italian home reared Downs I saw about those aged at least 10 years at last checkups, after at least two-years drug therapy.
I looked into this sample of records by collecting sex, age at last checkups, chromosomal anomalies, and current feeding habits. As for drugs I saw about length of drug taking, drugs taken just before the last checkup and their daily doses.
A year of life encompasses six months before birthday and six months after it (eg: The 10th year ranges from 9 years and 7 months to 10 years and 6 months).
About feeding habits I checked out liking or not for sweets, meat broth or cube broth, milk and derivatives, bread and pasta, meat, fish, cooked vegetables (except potatoes), raw vegetables, fruit.
Any type of food had its rating scale as it follows.
Sweets: 0 = no information; 1 = refuses any type of sweet thing; 2 = the subject eats some ice-cream or some chocolate; 3 = eats ice-creams and chocolate; 4 = eats sweets in a normal way; 5 = likes sweets; 6 = is very fond of sweets.

Meat broth or cube broth: 0 = no information; 1 = refuses any food cooked in broth; 2 = tastes only pasta cooked in it; 3 = eats it in a normal way; 4 = likes broth; 5 = asks for having broth.

Milk and dairy products: 0 = no information; 1 = refuses milk and derivatives: 2 = drinks some milk only at breakfast; 3 = drinks milk and eats derivatives in a normal way; 4 = likes milk also in the evening; 5 = seeks milk (usually directly from the fridge) and drinks about a litre every day.

Bread and pasta: 0 = no information: 1 = eats bread and pasta in a normal way; 2 = likes bread and pasta; 3 = eats much bread and asks for pasta twice a day.

Meat: 0 = no information; 1 = refuses any type of meat; 2 = eats some meat, usually ham; 3 = eats meat in a normal way; 4 = likes to eat meat.

Fish: 0 = no information; 1 = refuses any fish; 2 = tastes some fish; 3 = eats fish in a normal way; 4 = likes to eat fish.

Cooked vegetables (except potatoes): 0 = no information; 1 = refuses any vegetable; 2 = eats some vegetables, mainly as vegetable soup; 3 = eats cooked vegetables in a normal way; 4 = likes to eat cooked vegetables.

Raw vegetables: 0 = no information; 1 = refuses any raw vegetable; 2 = eats some salad leaves, only because forced by the parents; 3 = eats some vegetable, usually tomatoes; 4 = eats raw vegetables in a normal way; 5 = likes to eat raw vegetables.

Fruit: 0 = no information; 1 = refuses any fruit, also fruit juices; 2 = eats some fruit, usually fruit juices or bananas; 3 = eats fruit in quite normal way.
I counted in two ways: first I referred them to the total of the sample. Then, I split the sample up into three sub-samples according to years' ranges such as 10-12, 13-15, 16 and more years. I made comparisons of preferences for each kind of food between sub-samples' percentages.
Finally for each food and for all of them, I compared the current preference to the same in not-treated Italian Downs (Cocchi, 1994). From the previous sample I erased grade 0 (unknown preference) and I rearranged the rates according to new totals.
I tested these comparisons by Chi Square.

Results

The results I have obtained are shown as it follows. Ninety and three out of 526 records (17.68%) fitted the study criteria and made the sample up. Table 1 shows epidemiological data of the sample and sub-samples 1-3. Table 1: epidemiological data of the sample and sub-samples. Table 1: Epidemiological data of the sample and sub-samples.
  Sample % Sub-sam.1 % Sub-sam.2 % Sub-sam.3 %
No. of Ss 93   35   40   18  
No. of F 48   16   25   1  
No. of M 45   19   15   11  
F/M 106/100   84/100   167/100   64/100  
Last checkup  
Aver. age yrs 13.71 ± 3.79 11.17 ± 0.75 13.75 ± 0.87 18.44 ± 1.93
Years of drug therapy 
  8.98 ± 2.95 7.53 ± 2.71 8.30 ± 3.31 8.66 ± 2.23
Chrom. anomal. 
Pure trisomy 21 83 89.2 34 97.1 32 80.0 17 94.4
Translocations 7 7.5 1 2.9 5 12.5 1 5.6
Mosaicisms 2 2.2 0 0.0 2 5.0 0 0.0
Unknown 1 1.1 0 0.0 1 2.5 0 0.0
Totals 93 100. 35 100 40 100 18 100

As for drugs each subject was taken average 4.22 drugs. I listed all current drugs in Table 2.

Table 2: Drugs used and their daily doses in mg/day (if not otherwise pointed out) at the moment of this survey
DrugDaily Dosesno. of Ss%
Pyridoxine75-1508187.10
Carbamazepine50-3004649.46
Diazepam2-104649.46
Multivitanimic + mineral salts (DIAGNAN MINERALE RAFFORZATO)1 cps x week4045.01
S-Adenosil-L-methionine2003739.78
Glutamine125-2503638.71
Pyritinol1003638.71
Tetrahydrofolates153436.56
Bromazepam.5-1.52223.66
Delorazepam.3-22122.58
Arginine pidolas5001617.20
Glutamine + pemoline (DEADYN)90 + 101111.83
Glycine + aminoacids and vitamins (BIOTASSINA)2001010.75
Biotin599.68
Vit. B1+B6+B12250+250+50088.60
Viloxazin50-10088.60
Arginine200077.53
Pyridoxine glutarate300-60066.45
Nimodipine15-3066.45
Clonidine (gamma)50-10044.30
Amantadine10044.30
Chlomipramine1044.30
5-hydroxitriptophan25-5033.23
Amitriptyline4-1033.23
Amitriptiline + perphenazine10 + 233.23
Taurine50033.23
Oxazepam1522.15
Clobazam1022.15
Piracetam80022.15
Pantotenate10011.08
Imipramine1011.08
Nortriptyline1011.08
Fluoxetin2011.08
Deanol emisuccinate200011.08
Tables 3-11 show preferences for a single sort of food and the comparison with related preference in not-treated Downs. Table 3 : liking for sweets (sample and sub-samples)

Grade Sample % Sub-sam.1 % Sub-sam.2 % Sub-sam.3 %
1 1 1.08 0 0.00 1 2.50 0 0.00
2 4 4.30 2 5.71 1 2.50 1 5.56
3 8 8.60 4 11.43 3 7.50 1 1.56
4 14 15.04 3 8.57 6 15.00 5 27.77
5 56 60.23 19 54.29 27 67.50 10 55.55
6 10 10.75 7 20.00 2 5.00 1 5.56
Totals 93 100 35 100 40 100 18 100
Comparing the 3 sub-groups of the Tab. 3, we can see the preference for sweets since age 10-12 in most drug treated Downs. Table 3bis: Comparison of sweets preference between not-treated and drug treated Downs.
  Sample of not treated Downs   Sample of drug treated Downs  
 
Grade No. of Ss % No. of Ss %
1 13 14.29 1 1.08
2 27 29.67 4 4.30
3 22 24.18 8 8.60
4 19 20.87 14 15.04
5 10 10.99 56 60.23
6 0 0.00 10 10.75
Totals 91 100 93 100
 Chi Square = 76.689 with 5 df, p 0009  While most of not-treated Downs did not accept sweets, but ice-cream and chocolate, most of drug treated Downs accept or have a greediness for sweets. The difference shows a high significance. Table 4 : liking for meat broth or cube broth.
Grade Sample % Sub-sam.1 % Sub-sam.2 % Sub-sam.3 %
1 8 8.60 2 5.71 4 10.00 2 11.11
2 23 24.73 3 8.57 12 30.00 8 44.44
3 15 16.13 4 11.43 9 22.50 2 11.11
4 40 43.01 23 65.73 11 27.50 6 33.33
5 7 7.53 3 8.57 4 10.00 0 0.00
Totals 93 100 35 100 40 100 11 100
As for Table 4, the comparison among sub-groups shows a decrease of the preference for broth, as age increases. It goes from about 85% of Downs aged 10-12 to 44% of those aged 16 and more. Table 4bis: Comparison of preferences for meat
  Sample of not treated Downs   Sample of drug treated Downs  
 
Grade No. of Ss % No. of Ss %
1 16 16.67 8 8.60
2 14 14.58 23 24.73
3 53 55.21 15 16.13
4 12 12.50 40 43.01
5 1 1.04 7 7.53
Totals 96 100 93 100
 Chi Square = 45.632, with 4 df, p < .0009

The two samples mainly differ because more than 50% of drug treated Downs normally eat or like broth, while only about 13% of not-treated Down do so. Table 5 : liking for milk and dairy products.
Grade Sample % Sub-sam.1 % Sub-sam.2 % Sub-sam.3 %
1 2 2.15 1 2.86 1 2.50 0 0.00
2 6 6.45 0 0.00 2 5.00 4 22.22
3 15 16.13 4 11.43 9 22.50 2 11.11
4 62 66.67 25 71.42 25 62.50 12 66.67
5 8 8.60 5 14.29 3 7.50 0 0.00
Totals 93 100 35 100 40 100 18 100
As for milk and dairy products too, the main difference is most of Downs liking milk and derivatives or active searching for them among drug treated subjects. Table 5bis: Comparison for milk and derivatives preference between not-treated and drug treated Downs.
  Sample of not treated Downs   Sample of drug treated Downs  
 
Grade No. of Ss % No. of Ss %
1 17 17.17 2 2.15
2 9 9.09 6 6.45
3 61 61.61 15 16.13
4 11 11.11 62 66.67
5 1 1.01 8 8.60
Totals 99 100 93 100
Chi Square = 81.251 with 4 df, p < .0009 More than 70% of drug treated Downs accept or like milk and dairy products while only about 12% of not-treated Downs do so. Table 6: liking for bread and pasta.
Grade Sample % Sub-sam.1 % Sub-sam.2 % Sub-sam.3 %
1 2 2.15 1 2.86 0 0.00 1 5.56
2 51 54.84 17 48.57 20 50.00 14 77.78
3 40 43.01 17 48.57 20 50.00 13 16.66
Totals 93 1'00 35 100 40 100 18 100
Table 6 presents a stable preference for bread and pasta in drug treated Downs, since they are aged 10-12. Table 6bis: Comparison for bread and pasta preference between not-treated and drug treated Downs.

  Sample of not treated Downs   Sample of drug treated Downs  
 
Grade No. of Ss % No. of Ss %
1 20 19.60 2 2.15
2 50 49.50 51 54.84
3 21 20.79 40 43.01
Totals 101 100 93 100
Chi Square = 20.636 with 2 df, p < .0009 Again among drug treated Downs, there are more subjects greedy for bread and pasta. Table 7 : liking for meat.
Grade Sample % Sub-sam.1 % Sub-sam.2 % Sub-sam.3 %
2 9 8.68 4 11.43 4 10.00 1 5.56
3 69 74.19 26 74.26 31 77.50 12 66.66
4 15 16.13 5 14.29 5 12.50 5 27.76
Totals 93 100 35 100 40 100 18 100
Most of drug treated Downs normally eat of like meat, since they are 10-12 years old, as we can see from the Table 7. Table 7bis: Comparison of the preference for meat between not-treated and drug treated Downs.

  Sample of not treated Downs   Sample of drug treated Downs  
 
Grade No. of Ss % No. of Ss %
1 3 3.16 0 0.00
2 5 5.26 9 9.68
3 82 86.32 69 74.19
4 5 5.26 15 16.13
Totals 95 100 93 100
Chi Square = 10.242 with 3 df, p < .024 Although the two distributions are different, in fact more than 90% of the two samples' subjects like meat. Table 8: Liking for fish.
Grade Sample % Sub-sam.1 % Sub-sam.2 % Sub-sam.3 %
1 6 6.45 3 8.57 1 2.50 2 11.11
2 42 45.16 13 37.14 19 47.50 10 55.56
3 38 40.86 16 45.72 16 40.00 6 33.33
4 7 7.53 3 8.57 4 10.00 0 0.00
Totals 93 100 35 100 40 100 18 100
The comparisons among the three sub-groups show that most Downs eat or like fish, since they are aged 10-12. Table 8bis: Comparison for fish preference between not-treated and drug treated Downs.

  Sample of not treated Downs   Sample of drug treated Downs  
 
Grade No. of Ss % No. of Ss %
1 6 8.96 6 6.45
2 1 1.49 42 45.16
3 57 85.07 38 40.86
4 3 4.48 7 7.53
Totals 67 100 93 100
Chi Square = 41.360 with 3 df, p < . 0009 There is a significant distribution difference, with a larger preference for fish among not-treated Downs. Table 9 : liking for cooked vegetables (except potatoes).

Grade Sample % Sub-sam.1 % Sub-sam.2 % Sub-sam.3 %
1 1 1.8 1 2.86 0 0.00 0 0.00
2 36 38.71 10 18.57 16 40.00 10 55.56
3 50 53.76 19 54.29 23 57.00 8 44.44
4 6 6.45 5 14.29 1 2.50 0 0.00
Totals 93 100 35 100 40 100 18 100
According to the Table 9, most of the Downs aged 10-15 normally eat cooked vegetables. The Downs aged 16 and more seem to have a lower rate in this food habit. Table 9bis: Comparison for cooked vegetables preference between not-treated and drug treated Downs.

  Sample of not treated Downs   Sample of drug treated Downs  
 
Grade No. of Ss % No. of Ss %
1 16 15.84 1 1.08
2 11 10.89 36 38.71
3 73 72.28 50 53.76
4 1 0.99 6 6.45
Totals 101 100 93 100
Chi Square = 34.134 with 3 df, p < .0009 A larger preference for cooked vegetables too results in not-treated Downs. Table 10: Liking for raw vegetables.

Grade Sample % Sub-sam.1 % Sub-sam.2 % Sub-sam.3 %
1 12 12.90 6 17.14 6 15.00 0 0.00
2 12 12.90 2 5.71 1 2.50 8 50.00
3 31 33.33 11 31.43 15 37.50 5 27.77
4 31 33.33 12 34.29 16 40.00 3 16.67
5 7 7.56 4 12.43 2 5.00 1 5.56
Totals 93 100 35 100 40 100 18 100
The Table 10 suggests a preference for raw vegetables in at least 50% of drug treated Downs, since they are 10-12. Table 10bis: Comparison for raw vegetables preference between not-treated and drug treated Downs

  Sample of not treated Downs   Sample of drug treated Downs  
 
Grade No. of Ss % No. of Ss %
1 45 45.92 12 12.90
2 2 2.04 12 12.90
3 9 9.18 31 33.33
4 40 40.83 31 33.33
5 2 2.03 7 7.53
Totals 98 100 93 100
Chi Square = 43.407 with 4 df, p < .0009 The comparison shows a halved rate of raw vegetables refusal in the sample of drug treated Downs. Table 11: Liking fruit.

Grade Sample % Sub-sam.1 % Sub-sam.2 % Sub-sam.3 %
1 3 3.23 1 2.86 1 2.50 1 5.56
2 32 34.41 9 25.71 14 35.00 9 50.00
3 58 62.36 25 71.43 25 62.50 8 44.44
Totals 93 100 35 100 40 100 18 100
The preference for fruit results more than 90% and stable in drug treated Downs, since they are 10-12. Table 11bis: Comparison for fruit preference between not-treated and drug treated Downs.

  Sample of not treated Downs   Sample of drug treated Downs  
 
Grade No. of Ss % No. of Ss %
1 31 30.69 3 3.23
2 20 19.80 32 34.41
3 44 43.56 58 62.36
Totals 95 100 93 100
Chi Square = 27.731 with 2 df, p < .0009 Drug treated Downs have a larger preference for fruit, at a 96% rate vs 64%.

Table 12: Comparison for the prevalence of refusal for foods between non-treated and drug treated Downs
 Sample ofSample of
Non-treated DownsDrug treated Downs
FoodSs No.%SS No.%
Sweets1314.2911.08
Broth1616.6788.60
Milk & deriv.1717.1722.15
Bread & pasta2019.8022.15
Meat33.1600.00
Fish68.9666.45
Cooked vegetables1615.8411.08
Raw Vegetables4545.921212.90
Fruit3130.6933.23

Chi Square (on rates) = 17.791 with 8 df, p < .024
As we can see, there is a significant decreasing of refusals for all the foods investigated.

Table 13: Comparison for the prevalence of a normal or increased preference for investigated the foods between non treated and drug treated Downs
 Sample ofSample of
Non-treated DownsDrug treated Downs
Food (add two last grades)Ss No.%SS No.%
Sweets1010.996670.98
Broth1313.544750.54
Milk & deriv.1312.127075.27
Bread & pasta7170.299197.85
Meat8791.588490.32
Fish6089.554548.39
Cooked vegetables7473.275660.21
Raw Vegetables4242.863740.86
Fruit6463.369096.77

Chi Square (on rates) = 114.189 with 8 df, p < .0009
As we can see, we have a larger preference in Drug treated Downs for all foods, except fish, cooked vegetables and raw vegetables. The preference for meat is about the same.

Discussion

For this sample too I have to say what I previously wrote on the sample of Down not treated by drugs (Cocchi, 1994).
Although a sample of 93 Down subjects out of 526 could be representative, the F/M ratio differs very much from the expected about 100/135. On the other hand, the distribution of the chromosomal anomalies does not totally match the Italian and International distributions. In our sample translocations' forms are over-represented. The 3 sub-samples add to these difficulties.
As for gender or chromosomal anomaly differences in foods' taste I did not find any of them both for sweets and meat broth or cube broth, in research on 460 Down subjects (Cocchi, 1990).
No information has been found on either gender or chromosomal differences in taste for the remaining sort of foods I have checked up, but I need to be cautious.
We can think this sample and these sub-samples only as a second term for comparison, the first one being that of the previous survey (Cocchi, 1994). In this way I can finish this study on food habits in Downs. Food habits regarding rice and eggs would have also been valuable, but I never asked for these.
As for the drugs I reported, they are not all of them every subject took, but only those he/she was taking when he/she came for the last checkup. The choice of the drugs has always been individually tailored.
The analysis of food habits I have done suggests that most drug treated Downs, since their 10-12 years show their taste for sweets, meat or cube broth, milk and dairy products, bread and pasta, meat, cooked vegetables and fruit. Unlike not-treated Downs, they have also stable taste for sweets and fruit. Under this viewpoint I maintain that drug treated Downs do not differ from normal people of comparable age.
The whole preference for meat or cube broth, and for fish seems age decreasing. The preference for cooked and raw vegetables goes down in 16 and more years sub-group. The rationale for these results is unclear. Chance and the reduced sub-groups' size could play a role on it.
Most drug treated Downs show a good feeding balance as for seven out of nine investigated fields except the taste for fish or cooked vegetables. Refusal or scarce preference for a certain kind of food differs from one food to another.
It goes from 5-10% for bread and pasta to nearly 50% for meat or cube broth. A strong refusal for a certain kind of food varies from 0.0% for meat to 12.90% for raw vegetables. It is to say that drug therapies significantly reduced the rates of refusal for all investigated foods (Tab. 12). The finding of refusal or scarce preference drives at problems of controlling precursors that these foods supply to the body.
As for example, when there is a refusal of milk and dairy products, we first ought to think about triptophan, the precursor of serotonin.
The taste for raw vegetables seems well established in about 47% of 10-12 years old Down and it progress until adult age. In spite of this, about 12% of drug treated Downs refuse raw vegetables. Surely the intake of folates and perhaps other vitamins does not match the body's needs. As referred by Lejeune et al., 1986, Downs requires more folates than normal individuals.
In my experience, other same age "normal" subjects refuse to eat raw vegetables, but I think they are less, and I have always seen them during consultation for mild psychiatric problems.
In a different way I can treat the preference for eating sweets, because I sat on it both in Down subjects (Cocchi, 1990) and in depressed children (Cocchi, 1980).
In this study 12 subjects aged 16 or more out of 21 (57.14%) refused or had scarce preference for sweet things. A hundred and four out of 460 Downs (78.46%) did the same in my previous research without age limits (Cocchi, 1990).
It seems that a biological limiting avoids the brain of Down individuals to have too much glucose, by acting on its intake. Glucose is a precursor of l-glutamic acid via the Krebs' cycle, and l-glutamic acid, in its turn, is the precursor of GABA.
The transformation of l-glutamic acid into GABA has been found reduced in a state of stress, and so an increasing amount of glutamate could be neurotoxic.
Should the reduced intake of sweets in many Down subjects be a compensation mechanism, a kind of self-medication that aims to lower the risk that glutamate becomes neurotoxic?
If this is true, drug therapies able to lower stress reactions could have modified the taste for sweets.The comparison between not-treated and drug treated Downs (Tab. 3bis, grades 5-6) strongly supports this opinion.
The taste for broth, when prepared by meat or by cube, looks rather different. This broth holds glutamine, glutamate or monosodium glutamate. Only glutamine, as second precursor of brain glutamate (Ward, Thanki & Bradford, 1983) can cross the blood-brain barrier, but blood glutamate can be transformed into glutamine (Meister 1956; Meister 1969).
Although a larger supply of glutamine can promote glutamate neurotoxicity, here to limit its intake works less.
About 68% of not-treated Downs have a liking for meat broth or cube broth and most of them since their 10-12 years (Cocchi, 1994).
In my previous research without age limits, 284 out of 460 Downs (61.74%, nearly same percentage) did not refuse it (Cocchi, 1990).
In drug treated Downs, about 67% again do not have a refusal for meat or cube broth, nearly the same rate found in not-treated Downs.
This fact could drive at some speculations on the different biological value of glucose and glutamine as precursors of brain glutamate and GABA.
If we watch out the last two grades of every comparison between not-treated and drug treated Downs, we can get a final outlook (Tab. 13). Drug treated Downs show increased preferences for sweets, broth, milk and dairy products, bread and pasta, and fruit. As for meat they have nearly the same as not-treated Downs.
Fish, cooked and raw vegetables are less preferred by drug treated Downs.

Conclusion

This research on feeding habits in Downs aged 10 and more, and treated at least for two years by drug therapies brought to light some interesting results.
Ten-twelve years, as lower age limit, seem a good choice to avoid the effects of social learning in food taste.
Although we must view this sample of Downs as not representative, the rates of refusal for all the investigated foods decreased, as compared to same age not-treated Downs. I think it relevant, and I maintain it related to the anti-hyponeophagic effect of the therapies, as mainly anti-stress therapies. On the other side, the increasing in food preferences seems to get drug treated Downs closer to same age feeding in normals. But then, to support such hypotheses, I have not data to compare.

References

Cocchi R.: Greediness for sweet things in children as a symptom of antidepressive homeostatic compensation: 41 cases. Acta Paedopsychiat. 1980, 45: 293-300.
Cocchi R.: Precursori dell'ac. glutammico e del GABA e abitudini alimentari nei Down: Indagine epidemiologica su 460 soggetti. Riv. Ital. Disturbo Intellet. 1990, 3: 307-312.
Cocchi R.: Drug therapy in Down's syndrome: A theoretical context. It. J. Intellect. Impair. 1993, 6: 143-154.
Cocchi R.: Food habits in Down of 10 years or more. It. J. Intellect. Impair. 1994, 7: 149-157.
Fernstrom J.D.: Effects of the diet on brain neurotransmitters. Metabolism 1977, 26: 207-213.
Growdon J.H., Wurtman R.G.: Dietary influences on the synthesis of neurotransmitters in the brain. Nutr. Rev. 1979, 37: 129-136.
Lejeune J., Rethoré M.O., DeBlois M.C., Mannoury-Burolla C. et al.: Metabolisme des monocarbones et trisomie 21: sensibilité au MTX. Ann. Genet. 1986, 29: 16-19.
Meister A.: Metabolism of Glutamine. Physiol. Rev. 1956, 36: 103-127.
Meister A.: On the synthesis and utilisation of glutamine. Harvey Lect. 1969, 63: 139-168.
Ward H.K., Thanki C.M., Bradford H.F.: Glutamine and glucose as precursors of transmitters aminoacids: Ex vivo studies. J. Neurochem. 1983, 40: 855-860.

Cocchi R.: Food habits in Downs of 10 years or more. It. J. Intellect. Impair. 1994, 7: 149-157


Any type of food had its rating scale, as it follows.
Sweets: 0 = no information; 1 = refuses any type of sweet thing; 2 = the subject eats some ice-cream or some chocolate; 3 = eats ice-creams and chocolate; 4 = eats sweets in a normal way; 5 = likes sweets; 6 = is very fond of sweets:
Meat broth or cube broth: 0 = no information; 1 = refuses any food cooked in broth; 2 = tastes only pasta cooked in it; 3 = eats it in a normal way; 4 = likes broth; 5 = asks for having broth.
Milk and derivatives: 0 = no information; 1 = refuses milk and derivatives: 2 = drinks some milk only at breakfast; 3 = drinks milk and eats derivatives in a normal way; 4 = likes milk also in the evening; 5 = seeks milk (usually directly from the fridge) and drinks about a litre every day.
Bread and pasta: 0 = no information; 1 = eats bread and pasta in a normal way; 2 = likes bread and pasta; 3 = eats much bread and asks for pasta twice a day.
Meat: 0 = no information; 1 = refuses any type of meat; 2 = eats some meat, usually ham; 3 = eats meat in a normal way; 4 = likes to eat meat.
Fish: 0 = no information; 1 = refuses any fish; 2 = tastes some fish; 3 = eats fish in a normal way; 4 = likes to eat fish.
Cooked vegetables (except potatoes): 0 = no information; 1 = refuses any vegetable; 2 = eats some vegetables, mainly as vegetable soup; 3 = eats cooked vegetables in a normal way; 4 = likes to eat cooked vegetables.
Raw vegetables: 0 = no information; 1 = refuses any raw vegetable; 2 = eats some salad leaves, only because forced by the parents; 3 = eats some vegetable, usually tomatoes; 4 = eats raw vegetables in a normal way; 5 = likes to eat raw vegetables.
Fruit: 0 = no information; 1 = refuses any fruit, also fruit juices; 2 = eats some fruit, usually fruit juices or bananas; 3 = eats fruit in quite normal way.
Tables present whole sample and subsample 1 (10-12 years) distributions.

Table 2: Liking sweets (Sample and Sub-Sample 1)
Grade Sample % Sub-S.1% %
0 10 9.90 6 10.91
1 13 12.88 10 18.18
2 27 26.73 21 38.18
3 22 21.78 9 16.36
4 19 18.81 7 12.73
5 10 9.90 2 3.64
6 0 0.00 0 0.00
Total 101 100.00 55 100.00

Table 3: liking for meat broth or cube broth
Grade Sample % Sub-S.1% %
0 5 4.95 1 1.82
1 16 15.84 11 20.00
2 14 13.86 11 20.00
3 53 52.48 26 47.27
4 12 11.88 6 10.91
5 1 0.99 0 0.00
Total 101 100.00 55 100.00

Table 4: liking for milk and derivatives
Grade Sample % Sub-S.1% %
1 2 1.98 1 1.82
2 17 16.83 10 18.18
3 9 8.91 4 7.42
4 61 60.41 34 61.82
5 11 10.89 5 9.09
6 1 1.98 1 1.82
Total 101 100.00 55 100.00

Table 5: liking for bread and pasta
Grade Sample % Sub-S.1% %
1 20 19.80 8 14.55
2 50 49.50 34 61.81
3 21 20.79 13 23.64
Total 101 100.00 55 100.00

Table 6: liking for meat
Grade Sample % Sub-S.1% %
0 6 5.94 4 7.27
1 3 2.97 2 3.64
2 5 4.95 4 7.27
3 82 81.19 42 76.37
4 5 4.95 3 5.45
Total 101 100.00 55 100.00

Table 7: liking for fish
Grade Sample % Sub-S.1% %
0 34 33.66 23 41.82
1 6 5.94 5 9.09
2 1 0.99 0 0.00
3 57 56.44 25 45.45
4 3 2.97 2 3.64
Total 101 100.00 55 100.00

Table 8: liking for cooked vegetables (except potatoes)
Grade Sample % Sub-S.1% %
1 16 15.84 9 16.36
2 11 10.89 7 12.73
3 73 72.28 39 70.91
4 1 0.99 0 0.00
Total 101 100.00 55 100.00

Table 9: liking for raw vegetables
Grade Sample % Sub-S.1% %
0 3 2.97 1 1.82
1 45 45.56 26 47.26
2 2 1.98 1 1.82
3 9 8.91 7 12.73
4 40 39.60 19 34.55
5 2 1.98 1 1.82
Total 101 100.00 55 100.00

Table 10: liking for fruit
Grade Sample % Sub-S.1% %
0 6 5.94 3 5.45
1 31 30.69 21 38.18
2 20 19.80 12 21.82
3 44 43.56 19 34.55
Total 101 100.00 55 100.00

Discussion

We can think this sample and these sub-samples only as good points of departure to study food habits in Downs. Food habits regarding rice and eggs would have also been valuable, but I never asked for these.
The analysis of food habits I have done suggests that Downs, since their 10-12 years do not vary their taste for milk and derivatives, bread and pasta, meat and cooked vegetables. Most Downs prefer these foods and, in this respect, I think that Downs do not differ from same age normals. The finding of the contrary drives at problems of controlling precursors that these foods supply to the body. As for example, when there is a refusal of milk and derivatives, we first ought to think about triptophan, the precursor of serotonin.
From 10-12 years Downs increase their taste for fish and about 70% of them like it since their 13-15 years. There is not any refusal in our sample after 15 years. For this food too, the data suggest a normal development of this preference.
The taste for raw vegetables seems well established in about 47% of 10-12 years old Down and it progress until adult age. In spite of this about 24% of 16 or more years Down refuse raw vegetables or eat them in very small amount. Surely the intake of folates and perhaps other vitamins, does not match the body's needs. As referred by Lejeune et al., 1986, Downs requires more folates than normal individuals.
In my experience, other same age "normal" subjects refuse to eat raw vegetables, but I think they are less, and I have always seen them during consultation for mild psychiatric problems. As for these subjects, three points arise:
  1. Have they a hyponeophagic habit, symptom of a long lasting state of masked stress?
  2. Could some reduced supply partly be the cause of present psychiatric troubles?
  3. If points (i) and (ii) were both true, could they have a negative synergic action? Moreover, I do not know if there is or there is not a lucky fate for truly normal subjects refusing to eat raw vegetables, because they do not ask for my psychiatric help.
We can use the same ways of reasoning, with suitable adaptation, for about 10% of Down aged 16 or more who refuse to eat fruit.
In a quite different way I can treat the preference for eating sweets because I sat on it both in Down subjects (Cocchi, 1990) and in depressed children (Cocchi, 1980). While in this study 12 subjects aged 16 or more out of 21 (57.14%) refused or had scarce preference for sweet things, 204 out of 460 Downs (78.46%) did the same in my previous research without age limits (Cocchi, 1990).
It seems that a biological limiting avoids the brain of Down individuals to have too much glucose, by acting on its intake. Glucose is a precursor of l-glutamic acid via the Krebs' cycle, and l-glutamic acid, in its turn, is the precursor of GABA.
The transformation of l-glutamic acid into GABA has been found reduced in a state of stress, and so an increasing amount of glutamate could be neurotoxic.
Should the reduced intake of sweets in many Down subjects a compensation mechanism, a kind of self-medication that aims to lower the risk that glutamate becomes neurotoxic?
If this is true, drug therapies able to lower stress reactions ought to modify the taste for sweets. In my experience it seems to happen so, but I have to bear it out by a special study.
The tasting for broth, when prepared by meat or by cube, looks rather different.
This broth holds glutamine, glutamate or monosodium glutamate. Only glutamine, as second precursor of brain glutamate (Ward, Thanki & Bradford, 1983) can cross the blood-brain barrier, but blood glutamate can be transformed into glutamine (Meister 1956; Meister 1969).
Although a larger supply of glutamine can promote glutamate neurotoxicity, here the limiting of its intake works less.
About 65% of these Downs have a liking for meat broth or cube broth and most of them since their 10-12 years.
In my previous research without age limits 284 out of 460 Downs (61.74%, nearly same percentage) did not refuse it.
This fact could drive at some speculations on the different biological value of glucose and glutamine as precursors of brain glutamate and GABA.
Revised: February 22, 1998.