A preliminary study on nutritional status and intake in Chinese children with autism

Sensory sensitivity and intelligence are correlated with nutrient deficiency in children with autism spectrum disorder and intellectual disability

BACKGROUND/OBJECTIVES

Relationship between dietary intake and sensory sensitivity and intelligence in autism spectrum disorder (ASD) is not well described. This study aims to investigate nutrition status in children with ASD and ID and its association with sensory sensitivity and intelligence.

SUBJECTS/METHODS

84 students (34 ASD and 48 ID) in a special education school were recruited. Dietary intakes were evaluated with 3-day food dairy. Sensory sensitivity was measured using short sensory profile (SSP). Wechsler IQ test were performed.

RESULTS

Two out of twenty-four investigated nutrients had an adequate intake rate of over 50%. Four out of ten investigated vitamins had an inadequate intake rate of over 90% and another two over 80%. 75.6% of participants had inadequate energy intake. After adjusting for age, ASD participants had a higher intake of all surveyed nutrients but only the intake of vitamin E and folate were statistically different (p < 0.05) along with a smaller number of inadequate nutrients (p < 0.001). Taste/smell sensitivity, movement sensitivity, underresponsive/seeks sensation, and total sensory sensitivity symptoms severity were slightly higher in ASD group than in ID group (all p < 0.05). After adjusting for IQ and sensory sensitivity score, difference of number of inadequate nutrients between ASD and ID group were not statistically significant (p = 0.193).

CONCLUSIONS

Individuals with ASD had better dietary intake but worse sensory sensitivity compared to those with ID. Sensory sensitivity and intelligence are correlated with nutritional status in individuals with neurodevelopmental disorder.

The role and impact of abnormal vitamin levels in autism spectrum disorders

The prevalence of autism spectrum disorder (ASD), a neurodevelopmental disorder with a predominance of social behavioral disorders, has increased dramatically in various countries in recent decades. The interplay between genetic and environmental factors is believed to underlie ASD pathogenesis. Recent analyses have shown that abnormal vitamin levels in early life are associated with an increased risk of autism. As essential substances for growth and development, vitamins have been shown to have significant benefits for the nervous and immune systems. However, it is unknown whether certain vitamin types influence the emergence or manifestation of ASD symptoms. Several studies have focused on vitamin levels in children with autism, and neurotypical children have provided different insights into the types of vitamins and their intake. Here, we review the mechanisms and significance of several vitamins (A, B, C, D, E, and K) that are closely associated with the development of ASD in order to prevent, mitigate, and treat ASD. Efforts have been made to discover and develop new indicators for nutritional assessment of children with ASD to play a greater role in the early detection of ASD and therapeutic remission after diagnosis.

Autism Spectrum Disorder and Eating Problems: The Imbalance of Gut Microbiota and the Gut-Brain Axis Hypothesis

This review explores the complexities of autism spectrum disorder (ASD), primarily focusing on the significant eating challenges faced by children and adolescents with this neurodevelopmental condition. It is common for individuals with ASD to exhibit heightened sensitivity to various sensory aspects of food such as taste, texture, smell, and visual appeal, leading to restricted and less diverse diets. These dietary limitations are believed to contribute to an imbalance in the gut microbiota. This review elaborates on how these eating problems, coupled with the distinctive characteristics of ASD, might be influenced by and, in turn, influence the gut-brain axis, a bidirectional communication system between the gastrointestinal tract and the brain. This discussion aims to shed light on the multifaceted interactions and potential implications of diet, gut health, and neurological development and function in children and adolescents with ASD.

Looking Beyond the Growth Curve: A Retrospective Study on Nutrient Deficient Diets in Children with Severe Food Selectivity

Severe food selectivity places children at risk for nutrient deficiencies and long-term medical complications, if unaddressed. However, poor nutrition in highly selective eaters is often overlooked when considering other behavioral or medical concerns. Additionally, studies regarding food selectivity are sparse and limited to children with developmental delays. This study further investigates the nutritional deficiencies and growth characteristics of children with severe food selectivity to assist pediatricians in the earlier identification of patients for nutrition screening. A retrospective chart review was completed for 13 patients admitted to a pediatric feeding program solely for table-textured food selectivity. Nutrition and anthropometric data from the medical record were analyzed. All patients were determined to be following an age-appropriate growth curve but had multiple micronutrient deficiencies. Additionally, 6 children were typically developing outside of the feeding context. Results suggest that children with food selectivity may require more intensive and earlier nutrition screening beyond their growth patterns.

Dietary pattern in autism increases the need for probiotic supplementation: A comprehensive narrative and systematic review on oxidative stress hypothesis

Autism spectrum disorders (ASDs) are associated with specific dietary habits, including limited food selection and gastrointestinal problems, resulting in an altered gut microbiota. Autistic patients have an elevated abundance of certain gut bacteria associated with increased oxidative stress in the gastrointestinal tract. Probiotic supplementation has been shown to decrease oxidative stress in a simulated gut model, but the antioxidant effects of probiotics on the oxidative stress of the gut in autistic patients have not been directly studied. However, it is speculated that probiotic supplementation may help decrease oxidative stress in the gastrointestinal tract of autistic patients due to their specific dietary habits altering the microbiota. PubMed, Scopus and Web of Science databases and Google Scholar were searched up to May 2023. This systematic-narrative review aims to present the latest evidence regarding the changes in eating habits of autistic children which may further increase the gut microbiota induced oxidative stress. Additionally, this review will assess the available literature on the effects of probiotic supplementation on oxidative stress parameters.

The use of data independent acquisition based proteomic analysis and machine learning to reveal potential biomarkers for autism spectrum disorder

Autism spectrum disorder (ASD) is a complex neurological developmental disorder in children, and is associated with social isolation and restricted interests. The etiology of this disorder is still unknown. There is neither any confirmed laboratory test nor any effective therapeutic strategy to diagnose or cure it. We performed data independent acquisition (DIA) and multiple reaction monitoring (MRM) analysis of plasma from children with ASD and controls. The result showed that 45 differentially expressed proteins (DEPs) were identified between autistic subjects and controls. Among these, only one DEP was down-regulated in ASD; other DEPs were up-regulated in ASD children's plasma. These proteins are found associated with complement and coagulation cascades, vitamin digestion and absorption, cholesterol metabolism, platelet degranulation, selenium micronutrient network, extracellular matrix organization and inflammatory pathway, which have been reported to be related to ASD. After MRM verification, five key proteins in complement pathway (PLG, SERPINC1, and A2M) and inflammatory pathway (CD5L, ATRN, SERPINC1, and A2M) were confirmed to be significantly up-regulated in ASD group. Through the screening of machine learning model and MRM verification, we found that two proteins (biotinidase and carbonic anhydrase 1) can be used as early diagnostic markers of ASD (AUC = 0.8, p = 0.0001). SIGNIFICANCE: ASD is the fastest growing neurodevelopmental disorder in the world and has become a major public health problem worldwide. Its prevalence has been steadily increasing, with a global prevalence rate of 1%. Early diagnosis and intervention can achieve better prognosis. In this study, data independent acquisition (DIA) and multiple reaction monitoring (MRM) analysis was applied to analyze the plasma proteome of ASD patients (31 (±5) months old), and 378 proteins were quantified. 45 differentially expressed proteins (DEPs) were identified between the ASD group and the control group. They mainly were associated with platelet degranulation, ECM proteoglycar, complement and coagulation cascades, selenium micronutrient network, regulation of insulin-like growth factor (IGF) transport and uptake by insulin-like growth factor binding proteins (IGFBPs), cholesterol metabolism, vitamin metabolism, and inflammatory pathway. Through the integrated machine learning methods and the MRM verification of independent samples, it is considered that biotinidase and carbon anhydrase 1 have the potential to become biomarkers for the early diagnosis of ASD. These results complement proteomics database of the ASD patients, broaden our understanding of ASD, and provide a panel of biomarkers for the early diagnosis of ASD.

Nutrient intake and adequacy in children with autism spectrum disorder: EPINED epidemiological study

LAY ABSTRACT

Children with autism spectrum disorder (ASD) have a fivefold elevated risk of developing eating problems, which predisposes them to nutritional deficiencies. This study assesses nutritional intake and adequacy in children with ASD, subdiagnostic autistic symptoms and typically developing (TD) children. Preschool children with ASD and subdiagnostic symptoms had slightly lower intake of monounsaturated fatty acids (MUFA), vitamin D and vitamin B12. Primary school children with ASD and subdiagnostic symptoms had slightly higher intake of protein, cholesterol, thiamine and niacin, and a higher percentage of obesity than children with TD. All children had a high intake in sugars, fats and saturated fatty acids; a very highly inadequate intake of vitamins (vitamins D and E), fibre, b-carotene, calcium and magnesium; and a moderately inadequate intake of vitamin C, folate and iron. However, although all children need nutrition advice, children with ASD and subdiagnostic autistic symptoms had a poorer quality diet than those with TD.

Nutritional Status and Feeding Behavior of Children with Autism Spectrum Disorder in the Middle East and North Africa Region: A Systematic Review

Autism spectrum disorder (ASD) in children is associated with increased risks of overweight/obesity and underweight, altered nutrient profile, and abnormal feeding behaviors. This systematic review aimed to elucidate the literature on the nutritional status of children with ASD in the Middle East North Africa (MENA) region, by providing a summary and assessment of the body of evidence. A systematic review of English and Arabic publications up to November 2020 was conducted of five databases in addition to the grey literature, which include a nutrition-related parameter, from both experimental and observational study designs. Children with ASD (ASD-C) between 2 and 19 years in the MENA Region were the target population. For risk of bias, the Academy of Nutrition and Dietetics' Quality Criteria Checklist (QCC) was adopted. The number of published articles was grossly limited. Forty-three articles were included, of which only four articles reported a low risk of bias; therefore, the results were interpreted in light of methodological limitations. Both overweight and underweight were common in ASD-C, although not consistently different than typically developing children. Nutrient inadequacies of energy, protein, omega-3, and others; deficiencies in serum iron indicators and calcium, as well as vitamins B12, B9, and D levels; and higher levels of homocysteine and omega-6/omega-3 ratios were reported. Feeding behavior problems were also common in ASD-C. Understanding nutritional requirements and food preferences can guide the planning of the appropriate comprehensive interventions for ASD-C. Various nutritional and behavioral concerns were identified in the included studies; however, they were subject to methodological weaknesses, which limited the generalizability of these results. Future research is warranted that must be directed to finding strong evidence using robust study designs on nutritional status and feeding behaviors of ASD-C, with a particular emphasis on the MENA Region.

The Rationale for Vitamin, Mineral, and Cofactor Treatment in the Precision Medical Care of Autism Spectrum Disorder

Children with autism spectrum disorder may exhibit nutritional deficiencies due to reduced intake, genetic variants, autoantibodies interfering with vitamin transport, and the accumulation of toxic compounds that consume vitamins. Importantly, vitamins and metal ions are essential for several metabolic pathways and for neurotransmitter functioning. The therapeutic benefits of supplementing vitamins, minerals (Zinc, Magnesium, Molybdenum, and Selenium), and other cofactors (coenzyme Q10, alpha-lipoic acid, and tetrahydrobiopterin) are mediated through their cofactor as well as non-cofactor functions. Interestingly, some vitamins can be safely administered at levels far above the dose typically used to correct the deficiency and exert effects beyond their functional role as enzyme cofactors. Moreover, the interrelationships between these nutrients can be leveraged to obtain synergistic effects using combinations. The present review discusses the current evidence for using vitamins, minerals, and cofactors in autism spectrum disorder, the rationale behind their use, and the prospects for future use.

Weight Status and Associated Risk Factors of Mealtime Behaviours among Children with Autism Spectrum Disorder

Atypical mealtime behaviours in children with autism spectrum disorder (ASD) have been linked with oral sensory hypersensitivity that may contribute to food selectivity and weight issues. This cross-sectional study aims to determine the association between atypical mealtime behaviours and associated risk factors besides exploring the prevalence of overweight and obesity among Malaysian children with ASD in community settings. A total of 150 children with ASD aged 3−11 years participated in this study. A self-administered questionnaire on sociodemographic variables, mealtime behaviours and oral sensory processing was completed by the caregivers. The prevalence of overweight in the study samples was 18.5%, whereas obesity was 20.0%. In a multivariate analysis model, oral sensory processing (B = 0.608, 95% CI = 0.493, 0.722, p < 0.001), severity of autism symptoms (moderate and severe) (B = 2.585, 95% CI = 0.722, 4.448, p = 0.007) and younger children with ASD (B = −0.694, 95% CI = −1.189, −0.199, p = 0.006) were found as independent predictors of atypical mealtime behaviours. Children with ASD aged 3−11 years old have a higher prevalence of being overweight and obese, thus requiring regular anthropometric screening in community settings by relevant healthcare professionals. Furthermore, a relationship was found between oral sensory difficulties and atypical mealtime behaviours in children with ASD. A multidisciplinary approach is crucial in the overall management of food selectivity in this population.

Lessons in Adapting a Family-Based Nutrition Program for Children With Autism

OBJECTIVE

To evaluate the adaptation and implementation of an existing, evidence-based nutrition program for children with autism and their parents.

METHODS

Children aged 7-12 years with autism and their parent participated in 6 weekly sessions. Recruitment, intervention, and data collection took place in a community health center in an urban area.

RESULTS

Of the 50 referred participants, 38% attended the first classes, and 26% completed the program. Families and staff expressed satisfaction; parents reported increased physical activity, fruit, and vegetable intake in their children. Parents also desired continued learning and individualized recommendations.

CONCLUSIONS AND IMPLICATIONS

Adapting family-centered nutrition programs can positively influence diet behaviors in children with autism. As many children with autism battle with obesity, the findings from this pilot provide important insight into supporting these families and can further inform the development of evidence-based practices currently lacking for children with autism and their families.

Eating Behaviors and Diet Quality in Chinese Preschoolers with and without Autism Spectrum Disorder: A Case-Control Study

OBJECTIVES

To compare mealtime behaviors and diet quality in Chinese preschoolers with autism spectrum disorder (ASD) and typically developing preschoolers in Hong Kong.

STUDY DESIGN

This case-control study included a community sample of 65 families with preschoolers with ASD aged 3-6 years and 65 families with typically developing preschoolers matched for age and sex. Preschoolers' eating behaviors were assessed using the Brief Autism Mealtime Behaviour Inventory and the Preschoolers' Eating Behaviour Questionnaire (CPEBQ). Preschoolers' usual diet and nutrient intake were assessed using a validated food frequency questionnaire. Diet quality and diversity were generated using the Chinese Children Dietary Index total score and diet variety score. Between-group differences in various scales and dietary variables were examined using multivariate linear or logistics regression models adjusting for baseline demographic differences.

RESULTS

Compared with the typically developing group, the ASD group had greater scores in the Brief Autism Mealtime Behaviour Inventory food refusal domain (P < .001), the CPEBQ food fussiness (P = .001) and eating habit (P = .001) domains, and lower CPEBQ exogenous eating score (P = .003) and initiative eating score (P < .001). The Chinese Children Dietary Index total score (P = .001) and diet variety score (P = .005) and intake of soy and soy products (P = .001) were lower in the ASD group compared with the typically developing group.

CONCLUSIONS

Preschoolers with ASD showed more eating and mealtime problems, and lower diet quality and diversity than their typically developing counterparts. Our findings highlight the need for regular monitor and early identification of mealtime behavioral and nutrition problems among preschoolers with ASD.

The Effect of the Low FODMAP Diet on Gastrointestinal Symptoms, Behavioral Problems and Nutrient Intake in Children with Autism Spectrum Disorder: A Randomized Controlled Pilot Trial

Some research suggests that GI symptoms seen in children with ASD may relate to behavior problems. The objective of this pilot study was to assess the effect of the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet on GI and behavioral problems in children with ASD. At follow-up, the low FODMAP diet group had significant relief in some GI problems compared with both baseline in the group and control group. At baseline and at follow-up, there were no significant differences in behavioral problems between the low FODMAP diet group and the control group. Randomized controlled studies including larger sample sizes are needed to confirm the effects of low FODMAP diets in children with autism who have gastrointestinal problems.

The prevalence and risk factors for overweight/obesity among Turkish children with neurodevelopmental disorders

OBJECTIVE

To compare the prevalence and correlates of overweight (OW) and obesity (OB) between autism spectrum disorder (ASD), intellectual disability (ID), and attention deficit-hyperactivity disorder (ADHD) and to investigate which variables significantly contribute to OW/OB in each group.

METHODS

Of 267 cases (96 with ASD, 80 with ID, and 91 with ADHD) aged 2-18 years, body mass index (BMI) percentiles, birth weight, food reward usage, weekly screen and physical activity time, and psychotropics used were recorded.

RESULTS

OB (OB + OW) prevalence was 22.9 % (36.4 %) in ASD; 22.5 % (40 %) in ID; and 17.6 % (27.5 %) in ADHD. Although the ADHD group had the highest rate of stimulant usage (χ2 = 69.605, p < 0.001), physical activity attendance (χ2 = 49.751, p < 0.001), and the lowest anti-psychotic (χ2 = 69.142, p < 0.001), and anti-depressant usage (χ2 = 7.219, p < 0.001) than ID/DD or ASD, BMI percentile of the participants did not differ between the groups (H(2) = 1.652, p = 0.43). In hierarchical logistic regression analysis, in ASD, food reward (OR = 4.65, 95 %Cl = 1.25-17.19) and the number of psychotropics used (OR = 2.168, 95 %Cl = 1.07-4.36) were significantly related to the risk of OW/OB. In ADHD, each drugs administered and a 1-kilogram elevation in birth weight was associated with a 4.09 and 2.82 increased risk for OW/OB.

CONCLUSION

OW/OB is prevalent in children with neurodevelopmental disorders regardless of their diagnosis. Our findings showed that food rewards put a higher risk for OW/OB in ASD than administering a psychotropic. It could be better to use other positive reinforcements other than edible ones to prevent OW/OB in these children.

Does severity of intellectual disability affect the nutritional status of intellectually disabled children and adolescents?

Background: Balanced and adequate nutrition is important to improve the quality of life of children with intellectual disability but most of these children are negatively affected by nutritional problems. Objective: This study was conducted to determine the nutritional status and effect of the severity of intellectual disability on nutritional status of children and adolescents with intellectual disabilities. Methods: One hundred twenty-two intellectually disabled children aged 4-18 years from five different special education and rehabilitation centers were included in the study. Their socio-demographic characteristics, body weight, height, body mass index (BMI), mid-upper arm circumference (MUAC), and skinfold thickness were examined, and their three-day food consumption record was taken. Results: Anthropometric scores did not differ significantly according to the severity of intellectual disability. According to evaluations made based on the World Health Organization's 2007 percentile curves, 61.4% of the subjects with mild intellectual disability (MID), 57.1% of those with moderate intellectual disability (MOID), and 53.3% of those with severe intellectual disability (SID) were within the normal BMI range for their age. Conclusion: Rates of malnutrition and shortness in children and adolescents with SID were found to be higher than among children with MID and MOID, though the differences were not statistically significant.

Relationship between Autistic Traits and Nutrient Intake among Japanese Children and Adolescents

Increased food selectivity among children with autism spectrum disorder (ASD) may lead to nutritional inadequacy. The present study examined differences in nutrient intake between children and adolescents with and without ASD. We utilized cross-sectional data from the ongoing population Shika Town rural Japanese study. The participants were 1276 Japanese pupils and students aged between 7 and 15 years. ASD traits were evaluated using the Autism Spectrum Screening Questionnaire (ASSQ). Nutrient intake was assessed using a food frequency questionnaire. A one-way analysis of covariance (one-way ANCOVA) was performed to compare the mean nutrient intakes between participants with and without ASD traits. A two-way ANCOVA was conducted to compare the mean nutrient intakes among participants with and without ASD traits in different age groups (children and adolescents). The results obtained showed that the intake of carbohydrates and slightly lower intakes of protein, fat, calcium, magnesium, phosphorus, iron, zinc, retinol, vitamin B2, vitamin B12, folic acid, and pantothenic acid were higher among children and adolescents with ASD than among those without ASD. No interactions were observed between the autistic groups and age groups, excluding energy intakes. The present results indicate the importance of screening the nutrient intakes of ASD children and adolescents.

Oxidative Stress in Autism Spectrum Disorder

According to the United States Centers for Disease Control and Prevention (CDC), as of July 11, 2016, the reported average incidence of children diagnosed with an autism spectrum disorder (ASD) was 1 in 68 (1.46%) among 8-year-old children born in 2004 and living within the 11 monitoring sites' surveillance areas in the United States of America (USA) in 2012. ASD is a multifaceted neurodevelopmental disorder that is also considered a hidden disability, as, for the most part; there are no apparent morphological differences between children with ASD and typically developing children. ASD is diagnosed based upon a triad of features including impairment in socialization, impairment in language, and repetitive and stereotypic behaviors. The increasing incidence of ASD in the pediatric population and the lack of successful curative therapies make ASD one of the most challenging disorders for medicine. ASD neurobiology is thought to be associated with oxidative stress, as shown by increased levels of reactive oxygen species and increased lipid peroxidation, as well as an increase in other indicators of oxidative stress. Children with ASD diagnosis are considered more vulnerable to oxidative stress because of their imbalance in intracellular and extracellular glutathione levels and decreased glutathione reserve capacity. Several studies have suggested that the redox imbalance and oxidative stress are integral parts of ASD pathophysiology. As such, early assessment and treatment of antioxidant status may result in a better prognosis as it could decrease the oxidative stress in the brain before it can induce more irreversible brain damage. In this review, many aspects of the role of oxidative stress in ASD are discussed, taking into account that the process of oxidative stress may be a target for therapeutic interventions.

Exergames for Children and Adolescents with Autism Spectrum Disorder: An Overview

Autistic Spectrum Disorder (ASD) is a complex neurodevelopmental disorder associated with various etiologies and characterized by deficits in social interaction, emotional reciprocity, communication, motor skills and cognitive functions. Studies have proposed that limited levels of physical activity and late motor skills and fitness, particularly in children and adolescents with ASD, may accentuate social and emotional deficits. In view of this, exergames, which are active video-games, can be considered a low-cost and safe type of exercise for children and adolescents with ASD, since they are more enjoyable than ordinary physical activities, influencing on treatment adherence. Thus, our study aims to evidence the effects of exergames on physical fitness, cognitive functions, and repetitive behaviors in children and adolescents with ASD. Despite the small number of studies investigating the effects of exergames as new strategy in children and adolescents with ASD, results suggest exergames as potential tool for the treatment of children and adolescents with ASD for improvement in physical fitness, cognitive functions and repetitive behavior. Our review pointed towards the importance of exergames for children and adolescents with ASD. Despite few studies conducted about this issue, we can consider exergames a potential tool to increase physical fitness, cognitive functions and to decrease repetitive behavior in children and adolescents with ASD. Moreover, health professionals should be careful when attempting to help this population, because the current literature is unclear yet about the improvement of ASD features through exergames.

The Prevalence of Insomnia and the Link between Iron Metabolism Genes Polymorphisms, TF rs1049296 C>T, TF rs3811647 G>A, TFR rs7385804 A>C, HAMP rs10421768 A>G and Sleep Disorders in Polish Individuals with ASD

Iron deficiency have been found to be linked to sleep disorders. Both genetic and environmental factors are risk factors for skewed iron metabolism, thus sleep disruptions in autism spectrum disorders (ASD). The aim of our study was to assess the prevalence of single nucleotide polymorphisms (SNPs) within transferrin gene (TF) rs1049296 C>T, rs3811647 G>A, transferrin receptor gene (TFR) rs7385804 A>C, and hepcidin antimicrobial peptide gene (HAMP) rs10421768 A>G in Polish individuals with ASD and their impact on sleep pattern. There were 61 Caucasian participants with ASD and 57 non-ASD controls enrolled. Genotypes were determined by real-time PCR using TaqMan SNP assays. The Athens Insomnia Scale (AIS) was used to identify sleep disruptions. There were 32 cases (57.14%) with insomnia identified. In the ASD group, the defined counts of genotypes were as follows: TF rs1049296, C/C n = 41 and C/T n = 20; TF rs3811647, G/G n = 22, G/A n = 34, and A/A n = 5; TFR rs7385804, A/A n = 22, A/C n = 29, and C/C n = 10; and HAMP rs10421768, A/A n = 34, A/G n = 23, and G/G n = 4. There were no homozygous carriers of the TF rs1049296 C>T minor allele in the ASD group. All analyzed SNPs were not found to be linked to insomnia. The investigated polymorphisms are not predictors of sleep disorders in the analyzed cohort of individuals with ASD.

Nutritional Status and Symptoms in Preschool Children With Autism Spectrum Disorder: A Two-Center Comparative Study in Chongqing and Hainan Province, China

Objective: The study aimed to compare the nutritional status and symptoms of preschool children with autism spectrum disorder (ASD) from two regions of China, and to analyze the association between nutritional status and symptoms of ASD. Methods: In this cross-sectional study, 738 ASD children and 302 typically developing children (TD) were recruited from Chongqing and Hainan of China. Symptoms of ASD children were evaluated with the Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS), and Childhood Autism Rating Scale (CARS). Neurodevelopment of ASD children was assessed with the Gesell Developmental Scale (GDS). Nutritional status was evaluated by anthropometric measures, biochemical detection of micronutrients, and providing questionnaire and food frequency questionnaire (FFQ) to caregivers. Results: Comparing ASD children with local TD children, ASD children consumed fewer whole grains, milk and dairy products, beans and soy products, vegetables, and fruits than local TD children in both regions. The serum concentrations of folate, vitamin B12 (VB12), and vitamin D (VD) were consistently lower in ASD children in both regions. Comparing the ASD children between the two regions, the ASD children in Chongqing had significantly higher mean scores of CARS, SRS, and ABC than those in Hainan. The ASD children in Chongqing consumed fewer whole grains, seafood, and fruits than those in Hainan. The serum concentrations of ferritin, vitamin A (VA), VB12, and VD were reduced in the ASD children of Chongqing than those in Hainan, and the ASD children in Chongqing had higher deficiency rates of zinc, ferritin, VA, and VD than those in Hainan. The serum levels of VA, VD, and folate showed a negative association with symptom scores of ASD children. VD and zinc levels had a positive association with the GDS scores of ASD children. Conclusions: ASD children exhibit a higher risk of nutrient deficiencies than neurotypical children, and there are regional differences in the nutritional status of ASD children. Micronutrients VA, VD, folate, and zinc levels were correlated with symptoms and development of ASD children. Therefore, it is essential to provide detailed nutrition evaluation and individualized nutrition interventions for ASD children from different backgrounds.

Dietary Approaches to the Management of Autism Spectrum Disorders

This chapter reviews the literature surrounding autism spectrum disorders (ASD) and their relation to gastrointestinal (GI), behavioral, neurological, and immunological functioning. Individuals with ASD often have poor GI health, including bowel motility issues, autoimmune and/or other adverse responses to certain foods, and lack of necessary nutrient absorption. These issues may be caused or exacerbated by restrictive behavioral patterns (e.g., preference for sweet and salty foods and/or refusal of healthy foods). Those individuals with GI issues tend to demonstrate more behavioral deficits (e.g., irritability, agitation, hyperactivity) and also tend to have an imbalance in overall gut microbiome composition, thus corroborating several studies that have implicated brain-gut pathways as potential mediators of behavioral dysfunction.We examine the literature regarding dietary approaches to managing ASDs, including elimination diets for gluten, casein, or complex carbohydrates, a ketogenic diet, and a low oxalate diet. We also explore the research examining dietary supplements such as fatty acids, pro- and prebiotics, vitamins, minerals, glutathione, phytochemicals, and hormones. The research on dietary approaches to managing ASDs is limited and the results are mixed. However, a few approaches, such as the gluten-free/casein-free diet, fatty acid supplementation, and pre/probiotics have generally demonstrated improved GI and associated behavioral symptoms. Given that GI issues seem to be overrepresented in ASD populations, and that GI issues have been associated with a number behavioral and neurological deficits, dietary manipulation may offer a cheap and easily implemented approach to improve the lives of those with ASD.

Importance of Nutrition Intervention in Autistic Patients

Along with the issues of inflated social and financial burden associated with autism spectrum disorder (ASD), specific treatment for this disorder has also not been developed. Having a thorough look at previous trials done to treat autism, we find that nutrition intervention had been used frequently as a complementary form of therapy. Indeed, an early diagnosis of nutrition deficiency and metabolic disorders done concomitantly with accurate therapeutic interventions can be a cornerstone for improving cognitive and behavioral aptitudes of people with autism. Several studies have showed that increasing the intake of specific nutrients can reduce the symptoms and comorbidities associated with autism. Consequently, nutrition intervention and appropriate supplementation can be crucial in managing and treating autism. This paper will discuss recent literature on the significance of metabolic aspects in autistic disorder and highlight the influence of nutrition intervention on the symptoms of autism.

The risk of overweight and obesity in children with autism spectrum disorders: A systematic review and meta-analysis

Multiple studies have suggested that autism spectrum disorders seem to increase the risk of overweight and obesity. We examined the pooled prevalence and relative risk of developing overweight or obesity among children with autism spectrum disorders in a systematic review and meta-analysis. We searched PubMed, Scopus, ProQuest, and Web of Science databases and subsequently screened the records to identify studies that reported prevalence of overweight and/or obesity in children with ASD and matched groups of neurotypical children. DerSimonian-Laird random-effects meta-analyses were performed to examine pooled prevalence and relative risk of obesity in children with autism spectrum disorders using the "meta" package in R software. Among children with autism spectrum disorders, the prevalence of obesity was 22.2%. Children with ASD had a 41.1% greater risk (P = .018) of development of obesity. Non-Caucasian race, increasing age, female sex, and living in the United States emerged as positive moderators of the association between autism spectrum disorders and prevalence of overweight or obesity. Autism spectrum disorders seem to increase the risk of childhood obesity. Increased awareness of this association may allow the implementation of early interventions to reduce obesity and prevent potential deterioration of quality-of-life in this population.

Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions

Autism spectrum disorder (ASD) is a complex behavioral syndrome that is characterized by speech and language disorders, intellectual impairment, learning and motor dysfunctions. Several genetic and environmental factors are suspected to affect the ASD phenotype including air pollution, exposure to pesticides, maternal infections, inflammatory conditions, dietary factors or consumption of antibiotics during pregnancy. Many children with ASD shows abnormalities in gastrointestinal (GI) physiology, including increased intestinal permeability, overall microbiota alterations, and gut infection. Moreover, they are "picky eaters" and the existence of specific sensory patterns in ASD patients could represent one of the main aspects in hampering feeding. GI disorders are associated with an altered composition of the gut microbiota. Gut microbiome is able to communicate with brain activities through microbiota-derived signaling molecules, immune mediators, gut hormones as well as vagal and spinal afferent neurons. Since the diet induces changes in the intestinal microbiota and in the production of molecules, such as the SCFA, we wanted to investigate the role that nutritional intervention can have on GI microbiota composition and thus on its influence on behavior, GI symptoms and microbiota composition and report which are the beneficial effect on ASD conditions.

Evaluation of Whole Blood Trace Element Levels in Chinese Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder, which has increased markedly during the last decades. Essential trace elements play an important role in neurological function and their imbalances are common in children with ASD. The objective of the present study was to investigate whole blood levels of trace elements including zinc (Zn), copper (Cu), iron (Fe), and magnesium (Mg) in Chinese children with ASD. In total, 113 children diagnosed with ASD and 141 age-matched and gender-matched neurotypical children, divided into two gender and age groups of preschool age (2-5 years old) and school (6-10 years old) age, were examined. The quantitative analyses of whole blood trace element contents were performed by using flame atomic absorption spectroscopy. In the present study, the children with ASD generally had lower whole blood levels of Zn than the neurotypical controls. No significant differences in the whole blood Cu, Zn/Cu ratio, Fe, or Mg was detected between the ASD group and the control group. It is notable that whole blood Fe level in boys with ASD was significantly higher than in girls with ASD, and was nearly significant when compared with the control level of boys. After stratification for age, a significant 6% decrease in whole blood Zn levels was detected in preschool-aged children with ASD as compared to the control values. However, this significant ASD-related change was not detected in school-aged children. The whole blood Zn level and Zn/Cu ratio were significantly increased in school-aged children than in preschool-aged children in both ASD and control group. In addition, school-aged children with ASD had a significantly higher level of whole blood Fe than preschool-aged children with ASD. The results of the present study suggest an association between whole blood levels of Zn in Chinese children with ASD.

Dietary Patterns and Anthropometric Measures of Indian Children with Autism Spectrum Disorder

Research literature on dietary patterns & eating habits of children with Autism Spectrum Disorder (ASD) in India is limited. To explore this, a pilot study (n = 53) which included 45 boys and 8 girls (age group of 2-13 years) was conducted. Three day food records, Food Frequency Questionnaire and Children Eating Behavior Inventory were used to assess the dietary intakes and mealtime behavior problems respectively. Findings revealed lower intake of fruits and vegetables which reflected on their micronutrient status which was significantly (p ≤ 0.05) in lower amounts predominantly B-Complex, Calcium and Iron. The study has suggested a strong need for future implementation of nutritional intervention programs at the earliest to expand food variety among children with ASD of this region.

Relationship in Quality of Diet, Food Habit and Feeding Practice in Children with Pervasive Developmental Disorder and Their Caregiver

This study aimed to assess the dietary quality and food habits in children with pervasive developmental disorder (PDD) and to evaluate the relationship between diet quality of children with PDDs and their caregivers' feeding practice and nutritional perceptions. Twenty-one pairs of caregivers and their children with PDD were surveyed. The caregivers completed surveys regarding their children's weight status, food habits, and dietary quality and their food habits, nutritional perceptions, knowledge, and feeding practices. Dietary quality was assessed as mean adequacy ratio, dietary diversity score (DDS), dietary variety score (DVS), and Index of Nutritional Quality (INQ). The children were in the normal ranges of body mass index (BMI) and Röhrer index. Having three times a meal, regular meal time, salty taste of the caregiver were related to those of the children with PDD (β = 0.533, 0.447, and 0.886, respectively; p < 0.05). Child control, food as reward, involvement, pressure, and restriction for the health of the caregiver were positively related to DDS, DVS, and INQ of the children with PDD (p < 0.05). High feeding stress and nutritional knowledge of the caregiver were related to the high BMI of the children with PDD (β = 0.445 and 0.602, respectively; p < 0.05), whereas emotion regulation, encourage balance and variety, and involvement of caregiver were negatively related to BMI (β = −0.426, −0.430, and −0.388, respectively; p < 0.05). In conclusion, food habits of children with PDD were closely related to those of caregiver. To improve nutritional status, more insightful understand will be required by considering their developmental differences in this population.

Highly Selective Eating in Autism Spectrum Disorder Leading to Scurvy: A Series of Three Patients

BACKGROUND

Some children with autism spectrum disorder (ASD) have highly specific food selectivity and therefore are prone to nutritional deficiencies of different kinds.

PATIENTS

We document three children with ASD who presented with refusal to walk and gingivitis who underwent comprehensive evaluations before establishing the diagnosis of vitamin C deficiency (scurvy). The symptoms resolved after treatment with vitamin C.

CONCLUSIONS

Prevention of nutritional deficiencies in children with ASD is essential, and providing multivitamin supplementation whenever high food selectivity is noted may prevent significant morbidity.

The Levels of Vitamin D, Vitamin D Receptor, Homocysteine and Complex B Vitamin in Children with Autism Spectrum Disorders

Objective

Autism spectrum disorder (ASD) is a complex neurodevelopmental syndrome with an increasingly prevalent etiology, yet not fully understood. It has been thought that vitamin D, complex B vitamin levels and homocysteine are associated with environmental factors and are important in ASD. The aim of this study was to examine serum vitamin D, vitamin D receptor (VDR), homocysteine, vitamin B6, vitamin B12 and folate levels in ASD.

Methods

In this study, serum vitamin D and VDR, homocysteine, vitamins B6, B12 and folate levels were determined in 60 patients with ASD (aged 3 to 12 years) and in 45 age-gender matched healthy controls. In addition, calcium, phosphorus and alkaline phosphatase, which are associated with vitamin D metabolism, were measured from serum in both groups. ASD severity was evaluted by the Childhood Autism Rating Scale (CARS).

Results

Serum vitamin D and VDR were substantially reduced in patients with ASD in comparision to control group. However, homocysteine level was significantly higher and vitamin B6, vitamin B12 and folate were also reduced in patients with ASD. Total CARS score showed a positive association with homocysteine and a negative correlation with vitamins D,B6, B12, folate and VDR.

Conclusion

This comprehensive study, which examines many parameters has shown that low serum levels of vitamins D, B6, B12, folate and VDR as well as high homocysteine are important in the etiopathogenesis of ASD. However, further studies are required to define the precise mechanism(s) of these parameters and their contributions to the etiology and treatment of ASD.

Intervención en un niño con autismo mediante el juego

Introducción. El autismo es una alteración en el neurodesarrollo en la que se compromete el desarrollo comunicativo, emocional y simbólico del niño, así como la capacidad de establecer relaciones con el adulto y los objetos.Objetivo. Identificar el impacto del juego en el desarrollo comunicativo, emocional y simbólico de un niño con autismo de 3 años y 6 meses.Materiales y métodos. Se hizo una entrevista a los padres del niño y una observación a este en el contexto educativo y clínico. Se aplicó una evaluación del desarrollo infantil antes y después de realizar una intervención en la que se empleó el método experimental formativo propuesto por Vigotsky. La investigación fue de carácter cualitativo de tipo descriptivo. La intervención se diseñó considerando las necesidades de desarrollo psicológico del niño en lo que se refiere a la actividad rectora de juego.Resultados. El juego es un medio efectivo que contribuye con el desarrollo de habilidades comunicativas, emocionales y simbólicas en casos de autismo.Conclusión. La intervención clínica desde la aproximación psicológica histórico-cultural y la teoría de la actividad tiene impacto positivo en el desarrollo psicológico del niño, se propone de manera intencional y promueve el desarrollo de habilidades de corregulación social que facilitan la interacción comunicativa en casos de autismo.

Iron and vitamin D levels among autism spectrum disorders children

Aim:

The aim of this study was to investigate iron deficiency anemia and Vitamin D deficiency among autism children and to assess the importance of risk factors (determinants).

Subjects and Methods:

This was a case–control study conducted among children suffering from autism at the Hamad Medical Corporation in Qatar. A total of 308 cases and equal number of controls were enrolled. The Autism Diagnostic Observation Schedule-Generic was the instrument used for diagnosis of Autism.

Results:

The mean age (±standard deviation, in years) for autistic versus control children was 5.39 ± 1.66 versus 5.62 ± 1.81, respectively. The mean value of serum iron levels in autistic children was severely reduced and significantly lower than in control children (74.13 ± 21.61 μg/dL with a median 74 in autistic children 87.59 ± 23.36 μg/dL in controls) (P = 0.003). Similarly, the study revealed that Vitamin D deficiency was considerably more common among autistic children (18.79 ± 8.35 ng/mL) as compared to healthy children (22.18 ± 9.00 ng/mL) (P = 0.004). Finally, mean values of hemoglobin, ferritin, magnesium; potassium, calcium; phosphorous; glucose, alkaline phosphate, hematocrit, white blood cell, and mean corpuscular volume were all statistically significantly higher in healthy control children as compared to autistic children (P < 0.001). Multivariate logistic regression analysis revealed that serum iron deficiency, serum calcium levels, serum Vitamin D levels; ferritin, reduced physical activity; child order, body mass index percentiles, and parental consanguinity can all be considered strong predictors and major factors associated with autism spectrum disorders.

Conclusion:

This study suggests that deficiency of iron and Vitamin D as well as anemia were more common in autistic compared to control children.

Iron deficiency parameters in autism spectrum disorder: clinical correlates and associated factors

Background

High prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) has been reported in children with autism spectrum disorder (ASD). However, there is a limited number of studies about the association between iron deficiency parameters and clinical symptoms of ASD. This study aims to compare hemoglobin, hematocrit, iron, ferritin, MCV, and RDW levels between ASD patients and healthy controls and to investigate the correlation between these values and clinical symptoms of ASD.

Methods

The sample consisted of 100 children in ASD patient group and 100 healthy controls, with an age range of 2–18 years. We used ferritin cutoff of < 10 ng/mL for preschoolers (< 6 years) and < 12 ng/mL for school-aged (> 6 years) children to evaluate ID. Anemia was defined as hemoglobin < 11.0 g/dL for preschoolers and < 12.0 g/dL for school-aged children. Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (AuBC), and Aberrant Behavior Checklist (AbBC) were used to evaluate the severity of autistic symptoms and behavioral problems. Categorical variables were compared by using chi-square test. Normally distributed parametric variables were compared between groups by using Independent Samples t test. Pearson’s correlation analysis was used in order to examine the correlations. The p value < 0.05 was accepted to be statistically significant.

Results

Hemoglobin, hematocrit, iron, and MCV (p < 0.05) levels of children with ASD were lower than healthy controls. Hemoglobin, hematocrit, and MCV (p < 0.05) levels were found to be significantly lower in preschool ASD patients. Hemoglobin and hematocrit (p < 0.05) levels were significantly lower in ASD patients with intellectual disability. Hemoglobin (p < 0.05) levels were lower in patients with severe ASD. There was a significant negative correlation between hematocrit levels of children with ASD and CARS, AuBC, and AbBC total scores (p < 0.05).

Conclusions

Hemoglobin levels of children with ASD were lower than healthy children, but this was not sufficient to result in anemia. IDA in children with ASD might be associated with intellectual disability instead of ASD symptom severity.

Dietary adequacy of Egyptian children with autism spectrum disorder compared to healthy developing children

Although the etiology and pathology of autism spectrum disorder (ASD) is still poorly understood, a number of environmental, anthropological, neurobiological and genetic factors have been related to the pathophysiology of ASD, even the impact of oxidative stress response related to the environment and nutrition intake. Usual recommended dietary habits are based on the combination of behavioral and dietary or nutraceutical interventions together with pharmacotherapy. Investigations about a reliable relationship between diet and ASD are still lacking. The present study aimed at comparing dietary regimens and habits of normally developing apparently healthy children, without diagnosed ASD, with a pediatric population of individuals affected by autistic disorder. Assessments of nutritional and anthropometric data, in addition to biochemical evaluation for nutrient deficiencies, were performed. A total of 80 children with autistic disorder and 80 healthy, normally developing pediatric individuals were enrolled in the study. Parents were asked to complete the standardized questionnaire regarding the different types of food and the proportion of a serving for their children. Biochemical analysis of micro- and macronutrients were also done. Plotting on the Egyptian sex-specific anthropometric growth (auximetric) chart, absolute weights as well as weight-related for age classes, were significantly higher in cases than healthy controls. No differences between groups were observed in regard to total kilocalories (kcal), carbohydrates, and fat intake. A total of 23.8% of children with autistic disorder vs. 11.3% in the healthy control group had a nutrient intake with features below the Recommended Dietary Allowance (RDA) of protein. Children with autistic disorder showed low dietary intake of some micronutrients; calcium (Ca), magnesium (Mg), iron (Fe), selenium (Se) and sodium (Na), also they had significantly high intake of potassium (K) and vitamin C compared to healthy controls. Serum Mg, Fe, Ca, folate and vitamin B12 in children with autistic disorder were significantly low compared with healthy children. Significant positive correlations between serum Mg, Fe, Ca, vitamin B12 and folate and their levels in food were present. These results confirmed that different nutritional inadequacy was observed in Egyptian children with autistic disorder. The evidence reported in the present study should recommend screening of the nutritional status of ASD children for nutrient adequacy to reduce these deficiencies by dietary means or by administering appropriate vitamin and mineral supplements. Nutritional intervention plan should be tailored to address specific needs.

Feeding Problems and Nutrient Intake in Children with and without Autism: A Comparative Study

OBJECTIVE

To compare parent reported feeding difficulties and nutritional adequacy of children with Autism Spectrum Disorders (ASD) to an age and socio-economically matched group of typically developing children.

METHODS

The scores on Children's Eating Behavior Inventory (CEBI), three-day food records, anthropometric measures and adequacy of micro- and macro- nutrients were compared for 63 children diagnosed with ASD and 50 typically developing children enrolled from the department of pediatrics of a tertiary care teaching hospital from North India.

RESULTS

The majority (79%) of the parents of ASD children reported some concern regarding their feeding behavior as compared to 64% of the parents of typically developing children. As compared to controls, ASD children had significantly higher CEBI scores (97.28 vs. 89.48, t = 3.15, P = 0.002) and more feeding problems (6.42 vs. 2.70, t = 3.74, P = 0.001). Relative to controls, ASD children consumed fewer number of food items (P = 0.022), particularly fruits (P = 0.004), vegetables (P = 0.011), and proteins (P = 0.015); had significantly lower daily intake of potassium (P = 0.001), copper (P = 0.007), and folate (P = 0.001). Although children with autism did not differ significantly from controls on intake of calories, height, weight, or body mass index, significantly greater proportion of ASD children failed to meet the estimated average requirement of thiamine (P = 0.039), vitamin C (P = 0.013), and copper (P = 0.005).

CONCLUSIONS

The findings underscore the need for comprehensive assessment and empirically-supported interventions for eating problems and dietary deficiencies found in ASD children.

Assessment of plasma amino acid profile in autism using cation-exchange chromatography with postcolumn derivatization by ninhydrin

BACKGROUND/AIM

Autism is a heterogeneous neurodevelopmental disorder. This study aimed to assess the clinical significance of amino acid profile assay in autism using cation-exchange chromatography with ninhydrin postcolumn derivatization.

MATERIALS AND METHODS

This study included 42 autistic children and 26 apparently healthy children. All participants were subjected to the assay of plasma amino acids (essential, nonessential, and nonstandard) using cation-exchange chromatography with postcolumn derivatization by ninhydrin.

RESULTS

The levels of most of the essential amino acids were significantly lower in autistic children than controls. As regards nonessential amino acids, significantly lower levels for plasma cysteine, tyrosine, and serine and significantly higher levels for plasma glutamic acid were recorded in autistic children than controls. Finally, the autistic group demonstrated significantly lower levels of α-aminoadipic acid, carnosine, and β-alanine and significantly higher levels of hydroxyproline, phosphoserine, β-amino-isobutyric acid, and ammonia as compared to controls.

CONCLUSION

The study revealed that autistic children exhibit distinct alterations in the plasma levels of some amino acids, which can in turn participate in the disease etiology and can be applied as a diagnostic tool for early detection of autism.

New Perspective on Impact of Folic Acid Supplementation during Pregnancy on Neurodevelopment/Autism in the Offspring Children - A Systematic Review

It has been conclusively established that folic acid supplementation prior to and during early pregnancy (up to 12 weeks of gestation) can prevent neural tube defects (NTDs). We hypothesized that folate effects may extend from neuro-structural defects to alterations in neuro-behavioural and emotional skills including autism spectrum disorders (ASDs) and other developmental disorders. The objective of this review was to comprehensively evaluate evidence on the impact of folic acid on neurodevelopment other than NTDs. We conducted an online search of relevant literature compiled by the National Library of Medicine from Medline and EMBASE (searched on Dec 31, 2014: http://www.ncbi.nlm.nih.gov/entrez/query/fcgi and http://www.elsevier.com/online-tools/embase). We first created 3 files (search restricted to English literature) using the following key words: 1) folate or folic acid (171322 papers identified by this search); 2) maternal or pregnancy or pregnant or gestation or gestational or prenatal or antenatal or periconception or periconceptional (1349219 papers identified by this search); and 3) autism or autism spectrum disorders or developmental delay or development or neurodevelopment or mental or cognitive or language or personal-social or gross motor or fine motor or behaviour or intellectual or intelligence or Bayley Scale (8268145 papers identified by this search). We then merged the 3 files and reviewed the papers that addressed these three issues simultaneously. A total of 22 original papers that examined the association between folic acid supplementation in human pregnancy and neurodevelopment/autism were identified after the screening, with 15 studies showing a beneficial effect of folic acid supplementation on neurodevelopment/autism, 6 studies showed no statistically significant difference, while one study showed a harmful effect in > 5 mg folic acid supplementation/day during pregnancy. Folic acid supplementation in pregnancy may have beneficial effects on the neurodevelopment of children beyond its proven effect on NTDs.

Comparison of nutritional status between children with autism spectrum disorder and typically developing children in the Mediterranean Region (Valencia, Spain)

This case-control study investigated nutrient intake, healthy eating index with 10 items on foods and nutrients, on 3-day food diaries and anthropometric measurements in 105 children with autism spectrum disorder and 495 typically developing children (6-9 years) in Valencia (Spain). Children with autism spectrum disorder were at a higher risk for underweight, eating more legumes, vegetables, fiber, and some micronutrients (traditional Mediterranean diet) but fewer dairy and cereal products, and less iodine, sodium, and calcium than their typically developing peers. Differences existed in total energy intake but healthy eating index and food variety score differences were not significant. Autism spectrum disorder group failed to meet dietary recommendations for thiamin, riboflavin, vitamin C, or calcium. Risk of inadequate intake of fiber, vitamin E, and sodium was lower in children with autism spectrum disorder than typically developing children. Results suggest that (1) risk of inadequate intake of some micronutrients in children with autism spectrum disorder and (2) cultural patterns and environment may influence food intake and anthropometric characteristics in autism spectrum disorder. Primary care should include anthropometric and nutritional surveillance in this population to identify intervention on a case-by-case basis. Future research should explore dietary patterns and anthropometric characteristics in different autism spectrum disorder populations in other countries, enhancing our understanding of the disorder's impact.

Correlation between Nutrition and Symptoms: Nutritional Survey of Children with Autism Spectrum Disorder in Chongqing, China

Restricted diets and inadequate nutrient intake of children with autism spectrum disorder (ASD) have been reported. This study examined the nutritional statuses of children with ASD and the relationships between their behaviors and nutritional intake. A total of 154 children with ASD (age = 5.21 ± 1.83 years) and 73 typically-developing (TD) children (age = 4.83 ± 0.84 years) from Chongqing, China, were enrolled. The severity of ASD was evaluated using the Childhood Autism Rating Scale (CARS). The serum ferritin, folate, vitamin B12, 25(OH) vitamin D, and vitamin A concentrations in the children with ASD were determined. All participants underwent anthropometric examinations, dietary assessments, and questionnaire assessments about their feeding behaviors, and gastrointestinal symptoms. The ZHA, ZWA, and ZBMIA were found to be significantly lower in the children with ASD compared with those without ASD. In addition, the percentages of children exhibiting severe picky eating and severe resistance to new foods, as well as those with a reported general impression of severe eating problems and constipation, were higher among the children with ASD. These children consumed significantly fewer macronutrients compared with the children without ASD. In addition, the children with ASD had the highest rate of vitamin A deficiency, followed by iron deficiency. After adjusting for sex, the vitamin A concentration was found to be negatively correlated with the CARS score (rs = -0.222, p = 0.021). No correlation between the ferritin, folate, vitamin D, or vitamin B12 concentration and the CARS score was found. These results suggest that reduced macronutrient intakes, severe feeding behavior issues, constipation, and vitamin A deficiency are quite common among children with ASD. Further, a low serum vitamin A level may be a risk factor for symptoms of ASD. However, the underlying mechanism should be further studied.

Behavioral and Physiological Factors Associated With Selective Eating in Children With Autism Spectrum Disorder

Selective eating is common in children with autism spectrum disorder (ASD), but it is not yet well understood. The objectives of this study were to examine a new definition of selective eating, compare behavioral measures between children with ASD and selective eating and those without selective eating, and determine relationships among behavioral measures and measures of selective eating. Participants were assigned to groups on the basis of number of foods eaten compared with a population-based sample. Results of one-way multivariate analysis of variance indicated no overall effect of group for challenging behaviors, sensory reactivity, or repetitive behaviors. Between-participant tests indicated that scores for compulsive behaviors were significantly lower (p = .036) for the selective eating group. Correlations were moderately strong among variables relating to food intake and behavioral variables, but were not significant between selective eating and behavioral variables. Further research is needed to validate the definition of selective eating and to identify targets for intervention.