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Morrill V, Benke K, Brinton J, Soke GN, Schieve LA, Fields V, Farzadegan H, Holingue C, Newschaffer CJ, Reynolds AM, Daniele Fallin M, Ladd-Acosta C. Genetic liability for gastrointestinal inflammation disorders and association with gastrointestinal symptoms in children with and without autism. Am J Med Genet B Neuropsychiatr Genet 2024; 195:e32952. [PMID: 37455590 PMCID: PMC10792104 DOI: 10.1002/ajmg.b.32952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Children with autism spectrum disorder (ASD) have a greater prevalence of gastrointestinal (GI) symptoms than children without ASD. We tested whether polygenic scores for each of three GI disorders (ulcerative colitis, inflammatory bowel disease, and Crohn's disease) were related to GI symptoms in children with and without ASD. Using genotyping data (564 ASD cases and 715 controls) and external genome-wide association study summary statistics, we computed GI polygenic scores for ulcerative colitis (UC-PGS), inflammatory bowel disease (IDB-PGS), and Crohn's disease (CD-PGS). Multivariable logistic regression models, adjusted for genetic ancestry, were used to estimate associations between each GI-PGS and (1) ASD case-control status, and (2) specific GI symptoms in neurotypical children and separately in ASD children. In children without ASD, polygenic scores for ulcerative colitis were significantly associated with experiencing any GI symptom (adjusted odds ratio (aOR) = 1.36, 95% confidence interval (CI) = 1.03-1.81, p = 0.03) and diarrhea specifically (aOR = 5.35, 95% CI = 1.77-26.20, p = 0.01). Among children without ASD, IBD-PGS, and Crohn's PGS were significantly associated with diarrhea (aOR = 3.55, 95% CI = 1.25-12.34, p = 0.02) and loose stools alternating with constipation (aOR = 2.57, 95% CI = 1.13-6.55, p = 0.03), respectively. However, the three PGS were not associated with GI symptoms in the ASD case group. Furthermore, polygenic scores for ulcerative colitis significantly interacted with ASD status on presentation of any GI symptom within a European ancestry subset (aOR = 0.42, 95% CI = 0.19-0.88, p = 0.02). Genetic risk factors for some GI symptoms differ between children with and without ASD. Furthermore, our finding that increased genetic risks for GI inflammatory disorders are associated with GI symptoms in children without ASD informs future work on the early detection of GI disorders.
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Affiliation(s)
- Valerie Morrill
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kelly Benke
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John Brinton
- Department of Pediatrics, School of Medicine, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Gnakub N. Soke
- Centers for Disease Control and Prevention, Division of Scientific Education and Professional Development, Epidemic Intelligence Service, Atlanta, Georgia, USA
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura A. Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Victoria Fields
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Homayoon Farzadegan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Calliope Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Craig J. Newschaffer
- AJ Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
- College of Health and Human Development, Pennsylvania State University, Pennsylvania, USA
| | - Ann M. Reynolds
- Department of Pediatrics, School of Medicine, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - M. Daniele Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christine Ladd-Acosta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Sánchez-Bonaste A, Merchante LFS, Gónzalez-Bravo C, Carnicero A. Systematic measuring cortical thickness in tibiae for bio-mechanical analysis. Comput Biol Med 2023; 163:107123. [PMID: 37343467 DOI: 10.1016/j.compbiomed.2023.107123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/08/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Measuring the thickness of cortical bone tissue helps diagnose bone diseases or monitor the progress of different treatments. This type of measurement can be performed visually from CAT images by a radiologist or by semi-automatic algorithms from Hounsfield values. This article proposes a mechanism capable of measuring thickness over the entire bone surface, aligning and orienting all the images in the same direction to have comparable references and reduce human intervention to a minimum. The objective is to batch process large numbers of patients' CAT images obtaining thicknesses profiles of their cortical tissue to be used in many applications. METHODS Classical morphological and Deep Learning segmentation is used to extract the area of interest, filtering and interpolation to clean the bones and contour detection and Signed Distance Functions to measure the cortical Thickness. The alignment of the set of bones is achieved by detecting their longitudinal direction, and the orientation is performed by computing their principal component of the center of mass slice. RESULTS The method processed in an unattended manner 67% of the patients in the first run and 100% in the second run. The difference in the thickness values between the values provided by the algorithm and the measures done by a radiologist was, on average, 0.25 millimetres with a standard deviation of 0.2. CONCLUSION Measuring the cortical thickness of a bone would allow us to prepare accurate traumatological surgeries or study their structural properties. Obtaining thickness profiles of an extensive set of patients opens the way for numerous studies to be carried out to find patterns between bone thickness and the patients' medical, social or demographic variables.
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Affiliation(s)
- Alberto Sánchez-Bonaste
- ICAI School of Engineering, Comillas Pontifical University, Alberto Aguilera 25, 28015, Madrid, Spain
| | - Luis F S Merchante
- MOBIOS Lab, Institute for Research in Technology, Comillas Pontifical University, Sta Cruz de Marcenado 26, 28015, Madrid, Spain
| | - Carlos Gónzalez-Bravo
- ICAI School of Engineering, Comillas Pontifical University, Alberto Aguilera 25, 28015, Madrid, Spain
| | - Alberto Carnicero
- MOBIOS Lab, Institute for Research in Technology, Comillas Pontifical University, Sta Cruz de Marcenado 26, 28015, Madrid, Spain.
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Zarezadeh M, Mahmoudinezhad M, Hosseini B, Khorraminezhad L, Razaghi M, Alvandi E, Saedisomeolia A. Dietary pattern in autism increases the need for probiotic supplementation: A comprehensive narrative and systematic review on oxidative stress hypothesis. Clin Nutr 2023; 42:1330-1358. [PMID: 37418842 DOI: 10.1016/j.clnu.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/15/2023] [Accepted: 06/11/2023] [Indexed: 07/09/2023]
Abstract
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.
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Affiliation(s)
- Meysam Zarezadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Banafshe Hosseini
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre, Montreal, QC H3T 1C5, Canada
| | - Leila Khorraminezhad
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada
| | - Maryam Razaghi
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ehsan Alvandi
- School of Medicine, Western Sydney University, NSW, Australia
| | - Ahmad Saedisomeolia
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Québec, Canada.
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4
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Islam N, Hathaway KL, Anderson BS, Sharp WG, Loechner KJ. Brief Report: Decreased Bone Health in Children with Autism Spectrum Disorder and Avoidant Restrictive Food Intake Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-05976-x. [PMID: 37179523 DOI: 10.1007/s10803-023-05976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Children with autism spectrum disorder (ASD) and food selectivity are at increased risk for nutritional deficiencies which could affect bone health. METHODS We report on four male patients with ASD and avoidant restrictive food intake disorder (ARFID) with significant bone conditions including rickets, vertebral compression fractures, osteopenia, and slipped capital femoral epiphyses. RESULTS Each patient was at risk for at least one nutritional deficiency. Two out of four patients had deficiencies in Vitamins A, B12, E, and zinc. Calcium and Vitamin D deficiency were noted in all four. Two out of four patients with Vitamin D deficiency developed rickets. CONCLUSION Provisional evidence suggests that children with ASD and ARFID are at elevated risk for serious adverse bone health outcomes.
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Affiliation(s)
- Noreen Islam
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA.
| | - Kristin L Hathaway
- Children's Multidisciplinary Feeding Program, Marcus Autism Center, 1920 Briarcliff Rd NE, Atlanta, GA, 30329, USA
| | - Brooke S Anderson
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - William G Sharp
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
- Children's Multidisciplinary Feeding Program, Marcus Autism Center, 1920 Briarcliff Rd NE, Atlanta, GA, 30329, USA
| | - Karen J Loechner
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
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5
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Proctor KB, Rodrick E, Belcher S, Sharp WG, Kindler JM. Bone health in avoidant/restrictive food intake disorder: a narrative review. J Eat Disord 2023; 11:44. [PMID: 36949522 PMCID: PMC10031860 DOI: 10.1186/s40337-023-00766-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/03/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) is an eating/feeding disturbance characterized by severe food avoidance or restriction that results in faltering growth, nutritional deficiencies, dependence on formula supplementation, and/or significant psychosocial impairment. Compared to other eating disorders, ARFID is observed to have an earlier childhood onset and chronic course without intervention. Childhood represents a sensitive period for longitudinal growth and bone accrual, setting the stage for long-term health outcomes associated with longevity and quality of life, including risk for fracture and osteoporosis. RESULTS This narrative review discusses published scientific literature on bone health in individuals with ARFID by describing the current understanding of ARFID's effect on bone health, how common dietary constraints characteristic of ARFID may present unique risks to bone health, and the current clinical recommendations for bone health assessment. Reviewing what is known of clinical data from anorexia nervosa (AN) and similar cohorts, the chronicity and etiology of dietary restriction observed in ARFID are hypothesized to compromise bone health significantly. Although limited, examination of bone health in ARFID patients suggests children with ARFID tend to have shorter stature compared to healthy reference datasets and have lower bone density compared to healthy individuals, similar to those with AN. There remains a substantial knowledge gap in how ARFID may interrupt bone accrual during childhood and adolescence, and subsequent impact on attainment of peak bone mass and peak bone strength. The longitudinal effects of ARFID may be subtle and overlooked clinically in the absence of severe weight loss or growth stunting. Early identification and remediation of threats to bone mass accrual have significant personal and population-level implications. CONCLUSION For patients with ARFID, delayed identification and intervention to address feeding disturbances may have a long-lasting impact on various body systems and processes, including those relating to longitudinal growth and bone mass accrual. Further research employing rigorous prospective observational and/or randomized study designs are required to clearly define effects of ARFID, as well as clinical interventions aimed at addressing ARFID-related feeding disturbances, on bone accrual.
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Affiliation(s)
- Kaitlin B. Proctor
- Emory University School of Medicine and Children’s Healthcare of Atlanta, Athens, GA USA
| | - Eugene Rodrick
- Department of Nutritional Sciences, University of Georgia, Room 279 Dawson Hall, 305 Sanford Drive, Athens, GA 30606 USA
| | - Staci Belcher
- Department of Nutritional Sciences, University of Georgia, Room 279 Dawson Hall, 305 Sanford Drive, Athens, GA 30606 USA
| | - William G. Sharp
- Emory University School of Medicine and Children’s Healthcare of Atlanta, Athens, GA USA
| | - Joseph M. Kindler
- Department of Nutritional Sciences, University of Georgia, Room 279 Dawson Hall, 305 Sanford Drive, Athens, GA 30606 USA
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Ganta A, Pillai SS, Fredette ME, Topor LS. Severe Vitamin D Deficiency in Youth with Autism Spectrum Disorder During the COVID-19 Pandemic. J Dev Behav Pediatr 2022; 43:461-464. [PMID: 35943373 DOI: 10.1097/dbp.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Decrease in sunlight exposure during periods of social distancing during the COVID-19 pandemic increased the risk of severe manifestations of vitamin D deficiency (VDD) in a particular "high-risk" population. Our objective was to highlight the importance of vitamin D screening in youth with autism spectrum disorder (ASD) and restrictive eating. CASE PRESENTATION We describe 3 adolescent male patients with ASD who developed severe manifestations of VDD and hypocalcemia in late 2020 during the COVID-19 pandemic. All spent less time outdoors than in prior years because of isolation at home during the pandemic. Presenting symptoms included seizures and atraumatic fractures. All 3 were found to have hypocalcemia and severe VDD. Limited sun exposure because of isolation indoors during the COVID-19 pandemic was a likely contributing factor to the severity of VDD. All 3 were treated with intravenous calcium acutely, followed by oral calcium and vitamin D. Laboratory tests performed post-treatment showed biochemical resolution of hypocalcemia and VDD. CONCLUSION These cases highlight the importance of screening "at-risk" youth for VDD. Clinicians should be cognizant that children and adolescents with ASD and restricted eating can have severe manifestations of hypocalcemia and VDD. Decreased sun exposure because of isolating indoors during the COVID-19 pandemic increased their risk for this.
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Affiliation(s)
- Avani Ganta
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, RI
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Sabitha S Pillai
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, RI
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Meghan E Fredette
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, RI
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Lisa Swartz Topor
- Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, RI
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
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Rokicki J, Kaufmann T, de Lange AMG, van der Meer D, Bahrami S, Sartorius AM, Haukvik UK, Steen NE, Schwarz E, Stein DJ, Nærland T, Andreassen OA, Westlye LT, Quintana DS. Oxytocin receptor expression patterns in the human brain across development. Neuropsychopharmacology 2022; 47:1550-1560. [PMID: 35347267 PMCID: PMC9205980 DOI: 10.1038/s41386-022-01305-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/04/2022] [Indexed: 12/31/2022]
Abstract
Oxytocin plays a vital role in social behavior and homeostatic processes, with animal models indicating that oxytocin receptor (OXTR) expression patterns in the brain influence behavior and physiology. However, the developmental trajectory of OXTR gene expression is unclear. By analyzing gene expression data in human post-mortem brain samples, from the prenatal period to late adulthood, we demonstrate distinct patterns of OXTR gene expression in the developing brain, with increasing OXTR expression along the course of the prenatal period culminating in a peak during early childhood. This early life OXTR expression peak pattern appears slightly earlier in a comparative macaque sample, which is consistent with the relative immaturity of the human brain during early life compared to macaques. We also show that a network of genes with strong spatiotemporal couplings with OXTR is enriched in several psychiatric illness and body composition phenotypes. Taken together, these results demonstrate that oxytocin signaling plays an important role in a diverse set of psychological and somatic processes across the lifespan.
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Affiliation(s)
- Jaroslav Rokicki
- grid.5510.10000 0004 1936 8921NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Tobias Kaufmann
- grid.5510.10000 0004 1936 8921NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway ,grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Ann-Marie G. de Lange
- grid.5510.10000 0004 1936 8921NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway ,grid.9851.50000 0001 2165 4204LREN, Centre for Research in Neurosciences - Department of Clinical Neurosciences, CHUV and University of Lausanne, Lausanne, Switzerland ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Dennis van der Meer
- grid.5510.10000 0004 1936 8921NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway ,grid.5012.60000 0001 0481 6099School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Shahram Bahrami
- grid.5510.10000 0004 1936 8921NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Oslo, Norway
| | - Alina M. Sartorius
- grid.5510.10000 0004 1936 8921NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Oslo, Norway
| | - Unn K. Haukvik
- grid.5510.10000 0004 1936 8921NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway ,grid.55325.340000 0004 0389 8485Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Nils Eiel Steen
- grid.5510.10000 0004 1936 8921NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Emanuel Schwarz
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dan J. Stein
- grid.7836.a0000 0004 1937 1151SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Terje Nærland
- grid.55325.340000 0004 0389 8485NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Ole A. Andreassen
- grid.5510.10000 0004 1936 8921NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Lars T. Westlye
- grid.5510.10000 0004 1936 8921NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Oslo, Norway ,grid.5510.10000 0004 1936 8921KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Daniel S. Quintana
- grid.5510.10000 0004 1936 8921NORMENT Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
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Quan L, Xu X, Cui Y, Han H, Hendren RL, Zhao L, You X. A systematic review and meta-analysis of the benefits of a gluten-free diet and/or casein-free diet for children with autism spectrum disorder. Nutr Rev 2021; 80:1237-1246. [PMID: 34617108 PMCID: PMC8990762 DOI: 10.1093/nutrit/nuab073] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
CONTEXT It has been suggested that a gluten-free and casein-free (GFCF) diet may alleviate the symptoms of autism spectrum disorder (ASD) and facilitate neurodevelopment of children with ASD. Studies to date have been inconclusive. OBJECTIVE This study aimed to evaluate (through quantitative meta-analysis) the efficacy and safety of a GFCF diet for children with ASD. To our knowledge, this is the first time such an analysis has been carried out. DATA SOURCES Eight electronic databases were searched, from the establishment of each database up to March 27, 2020: PubMed, Web of Science, Embase (Ovid), PsycINFO (Ovid), Cochrane Library, CNKI, Wanfang, and VIP databases. DATA EXTRACTION Two authors independently performed the data extraction and risk-of-bias assessment. DATA ANALYSIS A quantitative meta-analysis was performed with standard procedures by using Stata SE 15 software. Within the total of 8 studies, with 297 participants, 5 studies reported significant reductions in stereotypical behaviors [standard mean difference (SMD) = -0.41, 95% confidence interval (CI): -0.68 to -0.15], and 3 studies reported improvements in cognition (SMD = -0.46, 95% CI: -0.91 to -0.01) following GFCF dietary intervention. No statistically significant changes were observed in other symptomatic categories (all P > 0.05). CONCLUSION The current meta-analysis showed that a GFCF diet can reduce stereotypical behaviors and improve the cognition of children with ASD. Though most of the included studies were single-blind, the benefits of a GFCF diet that have been indicated are promising. Additional studies on a larger scale are warranted. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020177619.
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Affiliation(s)
- Liuliu Quan
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Xinjie Xu
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Yonghong Cui
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Heze Han
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Robert L Hendren
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Lidan Zhao
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Xin You
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
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9
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Rostami Haji Abadi M, Neumeyer A, Misra M, Kontulainen S. Bone health in children and youth with ASD: a systematic review and meta-analysis. Osteoporos Int 2021; 32:1679-1691. [PMID: 33928402 DOI: 10.1007/s00198-021-05931-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
Higher risk of fracture reported in individuals with autism spectrum disorder (ASD) might be linked to poor bone health and development in childhood. This study aimed to systematically review studies comparing imaged bone outcomes between children with ASD and typically developing children (TDC) or reference data, and to perform a meta-analysis comparing commonly reported bone outcomes. We searched articles published since August 2020 from PubMed, Cochrane Library, Web of Science, EMBASE, and Scopus databases. We included studies comparing areal bone mineral density (aBMD) between children with ASD and TDC in the qualitative analysis (meta-analysis), and evaluated other imaged bone outcomes qualitatively. Seven publications were identified for the systematic review, and four studies were included in the meta-analysis. The meta-analysis indicated lower aBMD at the total body (standardized mean difference = - 0.77; 95% CI, - 1.26 to - 0.28), lumbar spine (- 0.69; - 1.00 to - 0.39), total hip (- 1.00; - 1.82 to - 0.17), and femoral neck (- 1.07; - 1.54 to - 0.60) in children with ASD compared to TDC. Based on our qualitative review, limited evidence suggested 13% lower bone mineral content at the total body and 10-20% lower cortical area, cortical and trabecular thickness, and bone strength at the distal radius and tibia in children with ASD. Children with ASD have lower aBMD at the total body, lumbar spine, and hip and femoral neck compared to TDC. Limited evidence also suggests deficits in bone mineral content, micro-architecture, and strength in children with ASD.
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Affiliation(s)
| | - A Neumeyer
- Lurie Center for Autism, Department of Pediatrics, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA
| | - M Misra
- Division of Pediatric Endocrinology Department of Pediatrics, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA
| | - S Kontulainen
- University of Saskatchewan College of Kinesiology, Saskatoon, Canada.
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10
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The role of microbiota-gut-brain axis in neuropsychiatric and neurological disorders. Pharmacol Res 2021; 172:105840. [PMID: 34450312 DOI: 10.1016/j.phrs.2021.105840] [Citation(s) in RCA: 253] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022]
Abstract
Emerging evidence indicates that the gut microbiota play a crucial role in the bidirectional communication between the gut and the brain suggesting that the gut microbes may shape neural development, modulate neurotransmission and affect behavior, and thereby contribute to the pathogenesis and/or progression of many neurodevelopmental, neuropsychiatric, and neurological conditions. This review summarizes recent data on the role of microbiota-gut-brain axis in the pathophysiology of neuropsychiatric and neurological disorders including depression, anxiety, schizophrenia, autism spectrum disorders, Parkinson's disease, migraine, and epilepsy. Also, the involvement of microbiota in gut disorders co-existing with neuropsychiatric conditions is highlighted. We discuss data from both in vivo preclinical experiments and clinical reports including: (1) studies in germ-free animals, (2) studies exploring the gut microbiota composition in animal models of diseases or in humans, (3) studies evaluating the effects of probiotic, prebiotic or antibiotic treatment as well as (4) the effects of fecal microbiota transplantation.
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11
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Abstract
OBJECTIVE To document the clinical presentation of scurvy in children with autism spectrum disorder (ASD) and summarize the contemporary approaches to assessment and management in this population. Scurvy is a disease caused by vitamin C deficiency most often detected in populations at high risk for nutrition insufficiency (e.g., extreme poverty). Children with ASD and severe food selectivity consistent with avoidant-restrictive food intake disorder may also be at risk for scurvy. METHOD We searched MEDLINE, CINAHL, and PsycINFO databases (1990-2018) in peer-reviewed journals for studies of children with ASD and scurvy. Inclusion criteria required confirmed diagnosis of ASD and scurvy in children (birth to 18 years) with a clear description of restrictive dietary patterns. Cases of scurvy due to other causes were excluded. We used a standardized protocol to independently code information; agreement between coders was high. RESULTS The systematic search identified 20 case reports involving 24 children (mean age = 9 ± 3.5; 22 boys/2 girls). The eventual diagnosis of scurvy followed a wide range of negative diagnostic testing; treatment with ascorbic acid and/or a multivitamin resulted in rapid improvement. CONCLUSIONS Symptoms of scurvy mimic other pediatric conditions (e.g., cancer). The range of diagnostic testing increased costs and healthcare risks (radiation, sedation) and delayed the diagnosis of scurvy. In children with ASD and severe food selectivity, a nutrition evaluation and laboratory testing are warranted before a more elaborate testing.
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12
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Turgeon S, Lanovaz MJ. Perceptions of Behavior Analysis in France: Accuracy and Tone of Posts in an Internet Forum on Autism. BEHAVIOR AND SOCIAL ISSUES 2021. [DOI: 10.1007/s42822-021-00057-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Nayda C, Gould J, Roberts RM. Psychologist attitudes, self-reported competence and practices associated with the use of dietary interventions for children presenting for psychological treatment. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1944788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Cary Nayda
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Jacqueline Gould
- School of Psychology, University of Adelaide, Adelaide, Australia
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
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14
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Pecorelli A, Cordone V, Schiavone ML, Caffarelli C, Cervellati C, Cerbone G, Gonnelli S, Hayek J, Valacchi G. Altered Bone Status in Rett Syndrome. Life (Basel) 2021; 11:life11060521. [PMID: 34205017 PMCID: PMC8230033 DOI: 10.3390/life11060521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
Rett syndrome (RTT) is a monogenic neurodevelopmental disorder primarily caused by mutations in X-linked MECP2 gene, encoding for methyl-CpG binding protein 2 (MeCP2), a multifaceted modulator of gene expression and chromatin organization. Based on the type of mutation, RTT patients exhibit a broad spectrum of clinical phenotypes with various degrees of severity. In addition, as a complex multisystem disease, RTT shows several clinical manifestations ranging from neurological to non-neurological symptoms. The most common non-neurological comorbidities include, among others, orthopedic complications, mainly scoliosis but also early osteopenia/osteoporosis and a high frequency of fractures. A characteristic low bone mineral density dependent on a slow rate of bone formation due to dysfunctional osteoblast activity rather than an increase in bone resorption is at the root of these complications. Evidence from human and animal studies supports the idea that MECP2 mutation could be associated with altered epigenetic regulation of bone-related factors and signaling pathways, including SFRP4/WNT/β-catenin axis and RANKL/RANK/OPG system. More research is needed to better understand the role of MeCP2 in bone homeostasis. Indeed, uncovering the molecular mechanisms underlying RTT bone problems could reveal new potential pharmacological targets for the treatment of these complications that adversely affect the quality of life of RTT patients for whom the only therapeutic approaches currently available include bisphosphonates, dietary supplements, and physical activity.
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Affiliation(s)
- Alessandra Pecorelli
- Animal Science Department, Plants for Human Health Institute, North Carolina State University, Kannapolis, NC 28081, USA;
- Correspondence: (A.P.); (G.V.)
| | - Valeria Cordone
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy;
| | - Maria Lucia Schiavone
- Animal Science Department, Plants for Human Health Institute, North Carolina State University, Kannapolis, NC 28081, USA;
| | - Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy; (C.C.); (S.G.)
| | - Carlo Cervellati
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy;
| | - Gaetana Cerbone
- Division of Medical Genetics, “S.G. Moscati” Hospital, 74100 Avellino, Italy;
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy; (C.C.); (S.G.)
| | - Joussef Hayek
- Toscana Life Sciences Foundation, 53100 Siena, Italy;
| | - Giuseppe Valacchi
- Animal Science Department, Plants for Human Health Institute, North Carolina State University, Kannapolis, NC 28081, USA;
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy;
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea
- Correspondence: (A.P.); (G.V.)
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15
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Yang F, Liu Y, Chen S, Dai Z, Yang D, Gao D, Shao J, Wang Y, Wang T, Zhang Z, Zhang L, Lu WW, Li Y, Wang L. A GABAergic neural circuit in the ventromedial hypothalamus mediates chronic stress-induced bone loss. J Clin Invest 2021; 130:6539-6554. [PMID: 32910804 DOI: 10.1172/jci136105] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 08/26/2020] [Indexed: 12/25/2022] Open
Abstract
Homeostasis of bone metabolism is regulated by the central nervous system, and mood disorders such as anxiety are associated with bone metabolism abnormalities, yet our understanding of the central neural circuits regulating bone metabolism is limited. Here, we demonstrate that chronic stress in crewmembers resulted in decreased bone density and elevated anxiety in an isolated habitat mimicking a space station. We then used a mouse model to demonstrate that GABAergic neural circuitry in the ventromedial hypothalamus (VMH) mediates chronic stress-induced bone loss. We show that GABAergic inputs in the dorsomedial VMH arise from a specific group of somatostatin neurons in the posterior region of the bed nucleus of the stria terminalis, which is indispensable for stress-induced bone loss and is able to trigger bone loss in the absence of stressors. In addition, the sympathetic system and glutamatergic neurons in the nucleus tractus solitarius were employed to regulate stress-induced bone loss. Our study has therefore identified the central neural mechanism by which chronic stress-induced mood disorders, such as anxiety, influence bone metabolism.
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Affiliation(s)
- Fan Yang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yunhui Liu
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Shanping Chen
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zhongquan Dai
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Dazhi Yang
- Department of Orthopedics, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
| | - Dashuang Gao
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jie Shao
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yuyao Wang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - Ting Wang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - Zhijian Zhang
- Center for Brain Science, Key Laboratory of Magnetic Resonance in Biological Systems and State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, CAS, Wuhan, China.,Center for Excellence in Brain Science and Intelligence Technology, CAS, Shanghai, China
| | - Lu Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - William W Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Yinghui Li
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Liping Wang
- Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (CAS).,CAS Key Laboratory of Brain Connectome and Manipulation.,Guangdong Provincial Key Laboratory of Brain Connectome and Behavior.,Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China
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16
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Panossian C, Lyons-Wall P, Whitehouse A, Oddy WH, Lo J, Scott J, O'Sullivan TA. Young Adults with High Autistic-Like Traits Displayed Lower Food Variety and Diet Quality in Childhood. J Autism Dev Disord 2021; 51:685-696. [PMID: 32617793 PMCID: PMC7835288 DOI: 10.1007/s10803-020-04567-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study explored the association between autistic-like traits in young adults and dietary intake in early childhood in the Gen2 Raine Study cohort. Data were available from 811 participants at years 1, 2 and 3 for the assessment of dietary intake, and at year 20 for measurement of autistic-like traits. Results showed as autistic-like traits increased, total food variety, core food variety and dairy variety decreased (p < 0.05), with a lower consumption of citrus fruits and yoghurt (both p = 0.04). As autistic-like traits increased, diet quality decreased, this trend was significant at 2 years (p = 0.024). Our results suggest that young adults with higher autistic-like traits were more likely to have had lower food variety and diet quality in early childhood.
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Affiliation(s)
- Catherine Panossian
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Philippa Lyons-Wall
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth Children's Hospital, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Wendy H Oddy
- Menzies Institute for Medical Research, University of Tasmania, Churchill Avenue, Hobart, TAS, 7005, Australia
| | - Johnny Lo
- School of Science, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Jane Scott
- School of Public Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Therese A O'Sullivan
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
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17
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Hartman JS, Silver AH. Nutritional Rickets Due to Severe Food Selectivity in Autism Spectrum Disorder. J Dev Behav Pediatr 2021; 42:66-72. [PMID: 32890122 DOI: 10.1097/dbp.0000000000000856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Studies have detected differences in various measures of bone health between individuals with autism spectrum disorder (ASD) and their peers. However, these measures do not amount to direct clinical evidence of increased orthopedic pathology in this population. Some of the most compelling evidence to this effect comes from case reports of nutritional rickets in children with ASD. We report on 1 such case that, to our knowledge, is the first report of nutritional rickets in ASD necessitating corrective surgery. METHODS Case report, review of relevant literature, and implications for further research. RESULTS An 11-year-old girl with ASD was admitted for postoperative medical comanagement after successful repair of bilateral genu valgum (knock knees). On admission, the patient's mother reported that the patient was a "picky eater." No cause had been determined preoperatively, although the deformity had developed at 10 years of age, thereby qualifying as pathologic. The medical team considered rickets because of the patient's limited diet. Subsequent laboratory work demonstrated hypocalcemia, vitamin D deficiency, and secondary hyperparathyroidism. The patient was diagnosed with nutritional rickets due to inadequate vitamin D intake, a consequence of severe food selectivity associated with ASD. CONCLUSION This case exemplifies the extreme orthopedic and metabolic complications that can result from food selectivity in children with ASD, pointing to the need for further research into the prevalence and causes of orthopedic pathology and nutritional rickets in this population. The case also underscores the need for evidence-based guidelines to prevent orthopedic pathology in children with ASD.
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Affiliation(s)
- Jacob S Hartman
- Albert Einstein College of Medicine, Bronx, NY
- Montefiore Medical Center, Bronx, NY
| | - Alyssa H Silver
- Albert Einstein College of Medicine, Bronx, NY
- Children's Hospital at Montefiore, Bronx, NY
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18
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Li YJ, Xie XN, Lei X, Li YM, Lei X. Global prevalence of obesity, overweight and underweight in children, adolescents and adults with autism spectrum disorder, attention-deficit hyperactivity disorder: A systematic review and meta-analysis. Obes Rev 2020; 21:e13123. [PMID: 32783349 DOI: 10.1111/obr.13123] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022]
Abstract
Individuals with autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD) may have unhealthy bodyweight. This meta-analysis was performed to understand the weight status in individuals with ASD or ADHD. PubMed, Embase, Cochrane and ISI Web of Science databases were searched from inception until June 2020 to identify relevant studies. Prevalence estimates and their 95% confidence intervals (CIs) of obesity, overweight and underweight were separately pooled using random-effects models. A total of 95 studies were included in the meta-analysis. The pooled estimates of the prevalence of obesity, overweight and underweight were 21.8%, 19.8% and 6.4% in individuals with ASD and 14.7%, 20.9% and 4.0% in individuals with ADHD. In subgroup analyses, an increasing trend in the prevalence of unhealthy weight was observed from children aged 2 to 5 years to adults with ASD (obesity: from 16.7% to 31.3%, overweight: from 16.2% to 27.2%, underweight from 5.3% to 8.6%) and from children aged 6 to 12 years to adults with ADHD (obesity: from 13.5% to 19.3%, overweight: from 18.8% to 31.2%). The worrisome epidemic of obesity and overweight in individuals with ASD, ADHD highlighted the need for weight management.
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Affiliation(s)
- Yong-Jiang Li
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xue-Ni Xie
- Shuda College, Hunan Normal University, Changsha, China
| | - Xue Lei
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Ya-Min Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xianyang Lei
- Office of the President, Central South University, Changsha, China
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19
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Mawson AR, Croft AM. Multiple Vaccinations and the Enigma of Vaccine Injury. Vaccines (Basel) 2020; 8:E676. [PMID: 33198395 PMCID: PMC7712358 DOI: 10.3390/vaccines8040676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022] Open
Abstract
A growing number of vaccines are administered at the same time or in close succession, increasing the complexity of assessing vaccine safety. Individual vaccines are assumed to have no other effect than protection against the targeted pathogen, but vaccines also have nonspecific and interactive effects, the outcomes of which can be beneficial or harmful. To date, no controlled trials and very few observational studies have determined the impact of vaccination schedules on overall health. The balance of the risks and benefits from mass vaccination therefore remains uncertain. Recent studies worryingly suggest links between multiple vaccinations and increased risks of diverse multisystem health problems, including allergies, infections, and neuropsychiatric or neurodevelopmental disorders. Here, we propose that, in susceptible persons, multiple vaccinations activate the retinoid cascade and trigger apoptotic hepatitis, leading to cholestatic liver dysfunction, in which stored vitamin A compounds (retinyl esters and retinoic acid) enter the circulation in toxic concentrations; this induces endogenous forms of hypervitaminosis A, with the severity of adverse outcomes being directly proportional to the concentration of circulating retinoids. In very low concentrations, vitamin A and its major metabolite retinoic acid contribute to immune function and to the process of immunization, whereas excess vitamin A increases the risk of adverse events, including common "side-effects" as well as chronic adverse outcomes. The increasing rates of allergy, ear infections, and neurodevelopmental disorders (NDDs) in countries with high rates of vaccination could be related to mass vaccination and to its impact on liver function and vitamin A metabolism, collectively representing endogenous manifestations of hypervitaminosis A. Further studies of health outcomes in vaccinated and unvaccinated groups are urgently needed, to increase understanding of the pathophysiology and treatment of vaccine injury, to identify the risk factors and screen for vaccine injury, to inform public health policy on potential hazards related to vaccination schedules, and to optimize the safety and benefits of vaccines.
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Affiliation(s)
- Anthony R. Mawson
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Jackson State University, Jackson, MS 39213, USA
| | - Ashley M. Croft
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, White Swan Road, Portsmouth PO1 2DT, UK;
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20
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Baspinar B, Yardimci H. Gluten-Free Casein-Free Diet for Autism Spectrum Disorders: Can It Be Effective in Solving Behavioural and Gastrointestinal Problems? Eurasian J Med 2020; 52:292-297. [PMID: 33209084 PMCID: PMC7651765 DOI: 10.5152/eurasianjmed.2020.19230] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/23/2019] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder [ASD] is characterized by deficits in communication and social interactions combined with repetitive and restricted patterns of behaviors. Bidirectional changes in brain-gut microbiota are known to be responsible for the pathophysiology of many brain-related disorders, such as autism, as well as well-known gastrointestinal diseases, including gut disorders. Imbalance in the composition of gut microbiota is frequently observed in individuals with ASD. It is therefore believed that this imbalance is significant in the frequent occurrence of gastrointestinal symptoms. The integrity of the intestinal barrier and the blood-brain barrier [BBB] in individuals with ASD is affected. Incompletely digested peptides, toxins, and proinflammatory cytokines cross the BBB by entering the bloodstream and reach the central nervous system. As a result of the accumulation of these elements, brain function is adversely affected. It is hypothesized that incompletely digested peptides acting as opioid agonists reduce pain sensitivity and increase the severity of autism-specific behaviors. However, it is not known exactly how opioid peptides trigger ASD symptoms after they reach the brain. Diet therapies, especially elimination diets, are considered to be an alternative treatment to prevent this condition. Gluten-free casein-free [GFCF] diet is an elimination diet that involves the removal of certain proteins from the normal diet, such as gluten and casein. However, studies that demonstrate the beneficial effects of the GFCF diet on ASD patients and explain its mechanism is limited, which supports the opioid theory. This review aims to investigate the gastrointestinal and behavioral problems that are frequently observed in ASD, the possible action mechanisms of GFCF diets, and the efficacy of these elimination diets.
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Affiliation(s)
- Busra Baspinar
- Department of Nutrition and Dietetics, Ankara University Faculty of Health Sciences, Ankara, Turkey
| | - Hulya Yardimci
- Department of Nutrition and Dietetics, Ankara University Faculty of Health Sciences, Ankara, Turkey
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21
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Leader G, Tuohy E, Chen JL, Mannion A, Gilroy SP. Feeding Problems, Gastrointestinal Symptoms, Challenging Behavior and Sensory Issues in Children and Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2020; 50:1401-1410. [PMID: 31955310 DOI: 10.1007/s10803-019-04357-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Frequency of feeding problems, gastrointestinal (GI) symptoms, challenging behavior, sensory problems and comorbid psychopathology were assessed using the following questionnaires: Screening Tool for Feeding Problems for Children, GI Symptoms Inventory, Behavior Problems Inventory Short Form, Short Sensory Profile, and Autism Spectrum Disorder-Comorbidity Child (ASD-CC) in 136 children and adolescents with ASD. Eighty-four percent had food selectivity, followed by food refusal (78.7%), rapid eating (76.5%), chewing problems (60.3%), food stealing (49.3%) and vomiting (19.1%). Higher rates of GI symptoms, challenging behavior, and sensory issues were found in those who presented with rapid eating, food refusal and food stealing than those without these problems. Comorbid psychopathology predicted rapid eating, food selectivity and food refusal.
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Affiliation(s)
- Geraldine Leader
- Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland.
| | - Elaine Tuohy
- Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - June L Chen
- Department of Special Education, Faculty of Education, East China Normal University, Shanghai, China
| | - Arlene Mannion
- Irish Centre for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
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22
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González-Domenech PJ, Díaz Atienza F, García Pablos C, Fernández Soto ML, Martínez-Ortega JM, Gutiérrez-Rojas L. Influence of a Combined Gluten-Free and Casein-Free Diet on Behavior Disorders in Children and Adolescents Diagnosed with Autism Spectrum Disorder: A 12-Month Follow-Up Clinical Trial. J Autism Dev Disord 2020; 50:935-948. [PMID: 31813108 DOI: 10.1007/s10803-019-04333-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The use of alternative interventions, such as gluten-free and casein-free (GFCF) diets, is frequent due to limited therapies for Autism Spectrum Disorder (ASD). Our aims were to determine the influence of a GFCF diet on behavior disorders in children and adolescents diagnosed with ASD and the potential association with urinary beta-casomorphin concentrations. Thirty-seven patients were recruited for this crossover trial. Each patient consumed a normal diet (including gluten and casein) for 6 months and a GFCF diet for another 6 months. The order of the intervention (beginning with normal diet or with GFCF diet) was assigned randomly. Patients were evaluated at three time-points (at the beginning of the study, after normal diet and after GFCF diet). Questionnaires regarding behavior and autism and dietary adherence were completed and urinary beta-casomorphin concentrations were determined at each time-point. No significant behavioral changes and no association with urinary beta-casomorphin concentrations were found after GFCF diet. A 6-month GFCF diet do not induce significant changes in behavioral symptoms of autism and urinary beta-casomorphin concentrations. Further studies with a long follow-up period similar to ours and including placebo and blinding elements are needed to identify better those respondents to GFCF diets.
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Affiliation(s)
- Pablo José González-Domenech
- Child and Adolescent Mental Health Unit, Virgen de las Nieves University Hospital, Granada, Spain.,Department of Psychiatry, University of Granada, Granada, Spain
| | - Francisco Díaz Atienza
- Child and Adolescent Mental Health Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - Carlos García Pablos
- Child and Adolescent Mental Health Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | | | | | - Luis Gutiérrez-Rojas
- Department of Psychiatry, University of Granada, Granada, Spain. .,Psychiatry Service, Hospital Clínico San Cecilio, Granada, Spain. .,CTS-549 Research Group, Institute of Neuroscience, Granada, Spain.
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23
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Banire B, Khowaja K, Mansoor B, Qaraqe M, Al Thani D. Reality-Based Technologies for Children with Autism Spectrum Disorder: A Recommendation for Food Intake Intervention. ADVANCES IN NEUROBIOLOGY 2020; 24:679-693. [PMID: 32006380 DOI: 10.1007/978-3-030-30402-7_26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Food selectivity by children with autism spectrum disorder (ASD) is relatively high as compared to typical children and consequently puts them at risk of nutritional inadequacies. Thus, there is a need to educate children with ASD on food types and their benefits in a simple and interesting manner that will encourage food acceptance and enable a move toward healthy living. The use of technological intervention has proven to be an effective tool for educating children with ASD in maintaining attention and mastering new skills as compared to traditional methods. Some of the popularly used technologies are computer-based intervention and robotics which do not support ecological validity (i.e., mimicking natural scenario). Consideration of natural factors is essential for better learning outcomes and generalized skills which can easily be incorporated into reality-based technologies such as virtual reality, augmented reality, and mixed reality. These technologies provide evidence-based support for ecological validation of intervention and sustaining the attention of children with ASD. The main objective of this study is to review existing reality-based technology intervention for children with ASD and investigate the following: (1) commonly used reality-based technology, (2) types of intervention targeted with reality-based technology, and (3) what subjects' inclusion types are used in the reality-based interventions. These objective statements have guided our recommendation of reality-based technology that can support ecological validity of food intake intervention.
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Affiliation(s)
- Bilikis Banire
- Department of Information, and Computing Technology, Hamad Bin Khalifa University, Doha, Qatar
| | - Kamran Khowaja
- Department of Information, and Computing Technology, Hamad Bin Khalifa University, Doha, Qatar
| | - Bilal Mansoor
- Mechanical Engineering Program, Texas A&M University at Doha, Doha, Qatar
| | - Marwa Qaraqe
- Department of Information, and Computing Technology, Hamad Bin Khalifa University, Doha, Qatar
| | - Dena Al Thani
- Department of Information, and Computing Technology, Hamad Bin Khalifa University, Doha, Qatar.
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24
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Kahathuduwa CN, West BD, Blume J, Dharavath N, Moustaid-Moussa N, Mastergeorge A. The risk of overweight and obesity in children with autism spectrum disorders: A systematic review and meta-analysis. Obes Rev 2019; 20:1667-1679. [PMID: 31595678 DOI: 10.1111/obr.12933] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Chanaka N Kahathuduwa
- Department of Human Development and Family Studies, Texas Tech University, Lubbock, Texas, USA.,Department of Laboratory Sciences and Primary Care, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.,Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.,Obesity Research Institute, Texas Tech University, Lubbock, Texas, USA
| | - Blake D West
- Department of Human Development and Family Studies, Texas Tech University, Lubbock, Texas, USA.,The Burkhart Center for Autism Education and Research, Texas Tech University, Lubbock, Texas, USA
| | - Jessica Blume
- Department of Human Development and Family Studies, Texas Tech University, Lubbock, Texas, USA.,The Burkhart Center for Autism Education and Research, Texas Tech University, Lubbock, Texas, USA
| | - Nagaraju Dharavath
- Department of Human Development and Family Studies, Texas Tech University, Lubbock, Texas, USA
| | - Naima Moustaid-Moussa
- Obesity Research Institute, Texas Tech University, Lubbock, Texas, USA.,Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA.,Department of Plant and Soil Science, Texas Tech University, Lubbock, Texas, USA
| | - Ann Mastergeorge
- Department of Human Development and Family Studies, Texas Tech University, Lubbock, Texas, USA.,The Burkhart Center for Autism Education and Research, Texas Tech University, Lubbock, Texas, USA
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25
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Bone Health and BMD Research in Pediatric and Adolescent Individuals with ASD: Current Data, Evaluation, and Next Steps. Clin Rev Bone Miner Metab 2019. [DOI: 10.1007/s12018-019-09268-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Mu C, Corley MJ, Lee RWY, Wong M, Pang A, Arakaki G, Miyamoto R, Rho JM, Mickiewicz B, Dowlatabadi R, Vogel HJ, Korchemagin Y, Shearer J. Metabolic Framework for the Improvement of Autism Spectrum Disorders by a Modified Ketogenic Diet: A Pilot Study. J Proteome Res 2019; 19:382-390. [PMID: 31696714 DOI: 10.1021/acs.jproteome.9b00581] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The ketogenic diet (KD) can improve the core features of autism spectrum disorders (ASD) in some children, but the effects on the overall metabolism remain unclear. This pilot study investigated the behavioral parameters in relation to blood metabolites and trace elements in a cohort of 10 typically developed controls (TC) and 17 children with ASD at baseline and following 3 months of treatment with a modified KD regimen. A nontargeted, multiplatform metabolomic approach was employed, including gas chromatography-mass spectrometry, 1H nuclear magnetic resonance spectroscopy, and inductively coupled plasma-mass spectrometry. The associations among plasma metabolites, trace elements, and behavior scores were investigated. Employing a combination of metabolomic platforms, 118 named metabolites and 73 trace elements were assessed. Relative to TC, a combination of glutamate, galactonate, and glycerol discriminated ASD with 88% accuracy. ASD had higher concentrations of galactose intermediates, gut microbe-derived trimethylamine N-oxide and N-acetylserotonin, and lower concentrations of 3-hydroxybutyrate and selenium at baseline. Following 3 months of KD intervention, the levels of circulating ketones and acetylcarnitine were increased. KD restored lower selenium levels in ASD to that of controls, and correlation analysis identified a novel negative correlation between the changes in selenium and behavior scores. Based on the different behavior responses to KD, we found that high responders had greater concentrations of 3-hydroxybutyrate and ornithine, with lower galactose. These findings enhance our current understanding of the metabolic derangements present in ASD and may be of utility in predicting favorable responses to KD intervention.
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Affiliation(s)
| | - Michael J Corley
- John A. Burns School of Medicine, Department of Native Hawaiian Health , University of Hawaii , Honolulu , Hawaii 96822 , United States
| | - Ryan W Y Lee
- Shriners Hospitals for Children , Honolulu , Hawaii 96826 , United States
| | - Miki Wong
- Shriners Hospitals for Children , Honolulu , Hawaii 96826 , United States
| | - Alina Pang
- John A. Burns School of Medicine, Department of Native Hawaiian Health , University of Hawaii , Honolulu , Hawaii 96822 , United States
| | - Gaye Arakaki
- Shriners Hospitals for Children , Honolulu , Hawaii 96826 , United States
| | - Rob Miyamoto
- Shriners Hospitals for Children , Honolulu , Hawaii 96826 , United States
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27
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Ristori MV, Quagliariello A, Reddel S, Ianiro G, Vicari S, Gasbarrini A, Putignani L. Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions. Nutrients 2019; 11:nu11112812. [PMID: 31752095 PMCID: PMC6893818 DOI: 10.3390/nu11112812] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Maria Vittoria Ristori
- Unit of Human Microbiome, Children’s Hospital and Research Institute “Bambino Gesù”, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (M.V.R.); (A.Q.); (S.R.)
| | - Andrea Quagliariello
- Unit of Human Microbiome, Children’s Hospital and Research Institute “Bambino Gesù”, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (M.V.R.); (A.Q.); (S.R.)
| | - Sofia Reddel
- Unit of Human Microbiome, Children’s Hospital and Research Institute “Bambino Gesù”, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (M.V.R.); (A.Q.); (S.R.)
| | - Gianluca Ianiro
- Dipartimento di Gastroenterologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy;
| | - Stefano Vicari
- Neuropsichiatria dell’infanzia e dell’adolescenza, Children’s Hospital and Research Institute “Bambino Gesù”, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy;
| | - Antonio Gasbarrini
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Medicina Interna e Gastroenterologia, Area Gastroenterologia ed Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: (A.G.); (L.P.); Tel.: +39-0668-59-4127 (L.P.)
| | - Lorenza Putignani
- Units of Parasitology and Human Microbiome, Children’s Hospital and Research Institute “Bambino Gesù”, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
- Correspondence: (A.G.); (L.P.); Tel.: +39-0668-59-4127 (L.P.)
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28
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Marsden REF, Francis J, Garner I. Use of GFCF Diets in Children with ASD. An Investigation into Parents' Beliefs Using the Theory of Planned Behaviour. J Autism Dev Disord 2019; 49:3716-3731. [PMID: 31165958 PMCID: PMC6667690 DOI: 10.1007/s10803-019-04035-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Gluten free/Casein free (GFCF) diets are one of the most common types of Complementary and Alternative Medicines (CAM) used in Autism Spectrum Disorders (ASD) despite little evidence to support positive effects. There has been no theory driven literature that has investigated parent’s reasons for their use. The Theory of Planned Behaviour (TPB) was used to examine parent’s intentions to use GFCF diets for their child with an ASD. Treatment and causal beliefs were also examined. Parents (n = 33, children aged 3–17 years) were influenced by anticipated regret, positive outcomes and attitude. Future interventions should provide information to parents and health professionals about the possible causes of ASD and therapy options which are in line with current recommendations.
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Affiliation(s)
- Rachel E F Marsden
- Department of Psychology, Sheffield Hallam University, Heart of the Campus, Collegiate Crescent, Sheffield, S10 2BP, England, UK.
| | - John Francis
- Sheffield Hallam University, Unit 2 Science Park, City Campus, Sheffield, S1 1WB, England, UK
| | - Iain Garner
- Sheffield Institute of Education, Sheffield Hallam University, Charles Street Building, Sheffield, England, UK
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29
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Chawner LR, Blundell-Birtill P, Hetherington MM. Interventions for Increasing Acceptance of New Foods Among Children and Adults with Developmental Disorders: A Systematic Review. J Autism Dev Disord 2019; 49:3504-3525. [PMID: 31124025 PMCID: PMC6667424 DOI: 10.1007/s10803-019-04075-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
People with developmental disorders (DD) often display high levels of selective eating, which can result in micronutrient deficiencies. It is therefore essential to explore ways to increase dietary variety in this population. To identify different types of interventions promoting increased acceptance of new foods or dietary variety for DD populations and to determine their effectiveness. Thirty-six studies met criteria for inclusion in the review. Twenty-two types of intervention were identified with 34 studies being reported as effective and 33 of these incorporating components drawn from learning theory. Multi-component interventions centred on operant conditioning, systematic desensitisation and changes to environment and familial practices were reported as effective for individuals.
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Affiliation(s)
- L R Chawner
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
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30
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The Autism Managing Eating Aversions and Limited Variety Plan vs Parent Education: A Randomized Clinical Trial. J Pediatr 2019; 211:185-192.e1. [PMID: 31056202 PMCID: PMC6661002 DOI: 10.1016/j.jpeds.2019.03.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the feasibility and initial efficacy of a structured parent training program for children with autism spectrum disorder and moderate food selectivity. STUDY DESIGN This 16-week randomized trial compared the Managing Eating Aversions and Limited variety (MEAL) Plan with parent education. MEAL Plan (10 core and 3 booster sessions) provided parents with nutrition education and strategies to structure meals and expand the child's diet. Parent education (10 sessions) provided information about autism without guidance on nutrition, meal structure, or diet. In addition to feasibility outcomes, primary efficacy outcomes included the Clinical Global Impression - Improvement scale and the Brief Autism Mealtime Behaviors Inventory. Grams consumed during a meal observation served as a secondary outcome. RESULTS There were 38 eligible children (19 per group, 32 males). For MEAL Plan, attrition was <10% and attendance >80%. Therapists achieved >90% fidelity. At week 16, positive response rates on the Clinical Global Impression - Improvement scale were 47.4% for the MEAL Plan and 5.3% for parent education (P < .05). The adjusted mean difference (SE) on Brief Autism Mealtime Behaviors Inventory at week 16 was 7.04 (2.71) points (P = .01) in favor of MEAL Plan. For grams consumed, the adjusted standard mean difference (SE) was 30.76 (6.75), also in favor of MEAL Plan (P = .001). CONCLUSIONS The MEAL Plan seems to be feasible, and preliminary efficacy results are encouraging. If further study replicates these results, the MEAL Plan could expand treatment options for children with autism spectrum disorder and moderate food selectivity. TRIAL REGISTRATION Clinicaltrials.gov: NCT02712281.
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31
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Bjørklund G, Waly MI, Al-Farsi Y, Saad K, Dadar M, Rahman MM, Elhoufey A, Chirumbolo S, Jóźwik-Pruska J, Kałużna-Czaplińska J. The Role of Vitamins in Autism Spectrum Disorder: What Do We Know? J Mol Neurosci 2019; 67:373-387. [PMID: 30607900 DOI: 10.1007/s12031-018-1237-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/29/2018] [Indexed: 02/08/2023]
Abstract
Vitamin or mineral supplementation is considered to be the most commonly used medical treatment for autism spectrum disorder (ASD), in addition to other interventions such as neurological and psychological interventions. There is not much evidence of therapeutic efficacy between vitamin and mineral supplementation and improvements in ASD. However, several researchers have noted that patients with ASD have various metabolic and nutritional abnormalities including issues with sulfation, methylation, glutathione redox imbalances, oxidative stress, and mitochondrial dysfunction. There is some evidence that vitamin and mineral supplementation may support these basic physiologic processes. Recently, the nutritional status of ASD patients has been gaining focus in this particular area. Pointing out the nutritional status as a potential etiological factor for attention/communication disorders, more importance has been given to this particular point. Moreover, autistic specific considerations like the feature and behavior of ASD might be increased or at least fall in the higher risk due to the sub-optimal nutritional status.
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Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Toften 24, 8610, Mo i Rana, Norway.
| | - Mostafa I Waly
- Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Oman
| | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman
| | - Khaled Saad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
- CONEM Upper Egypt Pediatric Research Group, Assiut University, Assiut, Egypt
| | - Maryam Dadar
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Md Mostafizur Rahman
- Department of Environmental Sciences, Jahangirnagar University, Dhaka, Bangladesh
- Graduate School of Environmental Science, Hokkaido University, Sapporo, Japan
| | - Amira Elhoufey
- CONEM Upper Egypt Pediatric Research Group, Assiut University, Assiut, Egypt
- Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- CONEM Scientific Secretary, Verona, Italy
| | - Jagoda Jóźwik-Pruska
- Institute of General and Ecological Chemistry, Department of Chemistry, Technical University of Lodz, Lodz, Poland
- CONEM Poland Chemistry and Nutrition Research Group, Lodz University of Technology, Lodz, Poland
| | - Joanna Kałużna-Czaplińska
- Institute of General and Ecological Chemistry, Department of Chemistry, Technical University of Lodz, Lodz, Poland
- CONEM Poland Chemistry and Nutrition Research Group, Lodz University of Technology, Lodz, Poland
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32
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Fetissov SO, Averina OV, Danilenko VN. Neuropeptides in the microbiota-brain axis and feeding behavior in autism spectrum disorder. Nutrition 2018; 61:43-48. [PMID: 30684851 DOI: 10.1016/j.nut.2018.10.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/24/2018] [Indexed: 12/26/2022]
Abstract
A combination of altered social and feeding behaviors is common in children with autism spectrum disorder (ASD); however, the underlying mechanisms are unknown. Nevertheless, it has been established that several specific neuropeptides are critically involved in the regulation of both feeding and social behavior, such as α-melanocyte-stimulating hormone (α-MSH) and oxytocin, respectively. Moreover, recent data implicated gut microbiota in regulation of host feeding and emotion and revealed its dysbiosis in ASD, suggesting a mechanistic role of altered microbiota-brain axis in ASD. In this review, we discuss how gut microbiota dysbiosis may alter hunger and satiety peptide hormones as well as brain peptidergic pathways involved in the regulation of host feeding and social behaviors and hence may contribute to the ASD pathophysiology. In particular, we show that interactions between α-MSH and oxytocin systems in the brain can provide clues for better understanding of the mechanisms underlying altered feeding and social behaviors in ASD and that the origin of such alterations can be linked to gut microbiota.
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Affiliation(s)
- Sergueï O Fetissov
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Mont-Saint-Aignan, France; University of Rouen Normandy, Institute for Research and Innovation in Biomedicine, Rouen, France.
| | - Olga V Averina
- Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - Valery N Danilenko
- Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow, Russia
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33
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Dietary interventions for autism spectrum disorder: New perspectives from the gut-brain axis. Physiol Behav 2018; 194:577-582. [PMID: 30036560 DOI: 10.1016/j.physbeh.2018.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/12/2018] [Accepted: 07/18/2018] [Indexed: 02/06/2023]
Abstract
There is still controversy surrounding the effectiveness of dietary interventions for autism spectrum disorder (ASD), namely the gluten-free/casein free diet and the ketogenic diet. Additionally, as studies mainly investigated their impact on ASD symptoms and behaviors, much remains unknown about their mechanisms of action and physiological effects. Given the recent surge of global interest in the gut-brain axis and its involvement in ASD, we underline the importance of understanding the physiological effects of such restrictive diets that remove certain nutritional items from one's diet. Some evidence has emerged with findings of the gut-microbial, inflammatory, and neuronal effects of these diets. We propose probiotics as a potential alternative that can serve similar biological purposes as these elimination diets and outline different physiological routes whereby probiotics can lead to improvements for individuals with ASD. We hope that future research can delineate the complete physiological effects of these diets. Such knowledge can guide the creation of more informed interventions, which conserve the components resulting in positive behavioral change while being less restrictive and devoid of the harmful effects of limiting certain nutrients.
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34
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Sharp WG, Postorino V, McCracken CE, Berry RC, Criado KK, Burrell TL, Scahill L. Dietary Intake, Nutrient Status, and Growth Parameters in Children with Autism Spectrum Disorder and Severe Food Selectivity: An Electronic Medical Record Review. J Acad Nutr Diet 2018; 118:1943-1950. [PMID: 30005820 DOI: 10.1016/j.jand.2018.05.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 05/02/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Food selectivity is common in children with autism spectrum disorder (ASD). The clinical characteristics, however, of severe food selectivity in children with ASD is not well documented. OBJECTIVE This study examined the demographic characteristics, anthropometric parameters, risk of nutritional inadequacy, dietary variety, and problematic mealtime behaviors in a sample of children with ASD with severe food selectivity. DESIGN The study involved a cross-sectional electronic medical record review. Data extraction followed a systematic protocol for data extraction. PARTICIPANTS/SETTING Children (age 2 to 17 years) with ASD, severe food selectivity, and complete nutritional data who received a multidisciplinary evaluation at a specialty feeding clinic in the southeastern United States between January 2014 and January 2016. Criteria for severe food selectivity used in this clinical practice required complete omission of one or more food groups (eg, fruit, vegetable, protein, grain, dairy) or consuming a narrow range of items on a weekly basis (eg, five or fewer total food items). MAIN OUTCOME MEASURES Analyses examined demographic characteristics, dietary preferences, risk for nutritional inadequacies, anthropometric parameters, and problematic mealtime behaviors. RESULTS Of the 279 patients evaluated during the 24-month period, 70 children with ASD and severe food selectivity met inclusion criteria. Caregivers reported 67% of the sample (n=47) omitted vegetables and 27% omitted fruits (n=19). Seventy-eight percent consumed a diet at risk for five or more inadequacies. Risk for specific inadequacies included vitamin D (97% of the sample), fiber (91%) vitamin E (83%), and calcium (71%). Children with five or more nutritional inadequacies (n=55) were more likely to make negative statements during meals (P<0.05). Severe food selectivity was not associated with compromised growth or obesity. CONCLUSION Children with ASD and severe food selectivity may be at increased risk for nutritional inadequacies. Future research should examine causes, consequences, and remediation of severe food selectivity in this population.
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Prosperi M, Santocchi E, Balboni G, Narzisi A, Bozza M, Fulceri F, Apicella F, Igliozzi R, Cosenza A, Tancredi R, Calderoni S, Muratori F. Behavioral Phenotype of ASD Preschoolers with Gastrointestinal Symptoms or Food Selectivity. J Autism Dev Disord 2018; 47:3574-3588. [PMID: 28861653 DOI: 10.1007/s10803-017-3271-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study investigated the prevalence and type of gastrointestinal (GI) and food selectivity (FS) symptoms in 163 preschoolers with ASD, and their possible links with core ASD features and emotional/behavioural problems. 40.5% of children with ASD had at least one severe GI symptom or FS. Preschoolers with and without GI symptoms and with and without FS were significantly different on several emotional/behavioural problems and restrictive/repetitive behaviours, whereas they did not differ significantly on performance IQ and autistic severity. The GI plus FS group presented with Sleep Problems, Self-injurious Behaviors and Anxiety Problems. Results indicated the need for early identification of GI disturbances and FS in order to design tailored intervention for these symptoms frequently associated to challenging behaviours in ASD.
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Affiliation(s)
- Margherita Prosperi
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Elisa Santocchi
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Giulia Balboni
- University of Perugia, Piazza G. Ermini, 1, 06123, Perugia, Italy
| | - Antonio Narzisi
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | | | - Francesca Fulceri
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Fabio Apicella
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Roberta Igliozzi
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Angela Cosenza
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Raffaella Tancredi
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
| | - Sara Calderoni
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Filippo Muratori
- IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56018, Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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36
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Bone Mineral Density in Boys Diagnosed with Autism Spectrum Disorder: A Case-Control Study. J Autism Dev Disord 2018; 47:3608-3619. [PMID: 28861640 DOI: 10.1007/s10803-017-3277-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study compared bone mineral density (BMD) of the spine obtained by dual-energy X-ray absorptiometry (DEXA), nutritional status, biochemical markers, and gastrointestinal (GI) symptoms in 4-8 year old boys with Autism Spectrum Disorder (ASD) with a group of age-matched, healthy boys without ASD. Boys with ASD had significantly lower spine BMD compared to controls but this was not correlated with any biochemical markers, dietary intake of calcium and vitamin D, elimination diet status, or GI symptomology. Reduced BMD in 4-8 year old boys with ASD appears to involve factors other than nutrient intake and GI status, and requires further study.
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Neumeyer AM, Cano Sokoloff N, McDonnell EI, Macklin EA, McDougle CJ, Holmes TM, Hubbard JL, Misra M. Nutrition and Bone Density in Boys with Autism Spectrum Disorder. J Acad Nutr Diet 2018; 118:865-877. [PMID: 29409733 DOI: 10.1016/j.jand.2017.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/07/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Boys with autism spectrum disorder (ASD) have lower bone mineral density (BMD) than typically developing controls. Differences in diet and exercise may contribute to low BMD. OBJECTIVE Our aim was to examine macro- and micronutrient intakes and self-reported physical activity in boys with ASD compared to TDC and the relationship of these variables with BMD. DESIGN/METHODS We conducted a cross-sectional study of 49 boys (25 ASD, 24 typically developing controls) assessed for 3-day food records and physical activity records, and BMD of the whole body less head, hip, and spine using dual-energy x-ray absorptiometry. Fasting levels of 25(OH) vitamin D and calcium were obtained. PARTICIPANTS Participants were adolescent boys, aged 8 to 17 years, recruited from a clinic population (ASD) or community advertisements (ASD and typically developing controls) matched for age. RESULTS ASD participants were approximately 9 months younger than typically developing control participants on average. Body mass index and serum vitamin D and calcium levels were similar. Boys with ASD consumed 16% fewer calories, with a larger percentage obtained from carbohydrates, and 37% less animal protein and 20% less fat than typically developing controls. A lower proportion of ASD participants were categorized as "very physically active" (27% vs 79%; P<0.001). BMD z scores were 0.7 to 1.2 standard deviations lower in ASD than typically developing controls at all locations. Higher animal protein, calcium, and phosphorus intakes were associated positively with bone density measures in boys with ASD. CONCLUSIONS Compared to typically developing controls, boys with ASD had lower protein, calcium, and phosphorus intakes, activity levels, and BMD z scores at the lumbar spine, femoral neck, total hip, and whole body less head. Protein, calcium, and phosphorus intakes were associated positively with BMD.
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38
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Moro C, Covino J. Nutrition and growth: assessing the impact of regional nutritional intake on childhood development and metacarpal parameters. Anat Cell Biol 2018; 51:31-40. [PMID: 29644108 PMCID: PMC5890015 DOI: 10.5115/acb.2018.51.1.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022] Open
Abstract
Measuring skeletal development throughout juvenile growth can provide a greater understanding into the health, hormonal function and genetics of children. The metacarpals have been of interest for their potential to provide insights into healthy juvenile skeletal development. This study investigated the growth patterns of developing females from isolated communities who had varied diets. Anthropometrical measurements and hand-wrist X-rays were taken of 353 juvenile females from three populations: Pari Coastal Village and Bundi Highlands Village, Papua New Guinea (PNG); and Brisbane, Australia between 1968 to 1983. Radiographs were digitized, and the length and width of the second and third metacarpals compared to each subject's height and weight. As subject heights increased, metacarpal length and width increased. However, stature and second metacarpal length indicated the strongest correlation (P<0.01), compared to third metacarpal length (P<0.01) or width. From 11 to 13 years of age, Brisbane subjects were significantly heavier and taller in comparison to subjects from PNG, and coastal females were heavier and taller than the highland females. A prominent difference between the two PNG populations was the regional intake of protein in their diets. The second metacarpal presents particularly accurate measurements when determining the height or development of a child. Nutritional intake appears to have a major influence normal childhood growth, with a potential for protein deficiency to strongly inhibit growth. Any delayed growth is particularly evident in the child's stature, as well as in the development of the metacarpal long bones of the hand.
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Affiliation(s)
- Christian Moro
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Jessica Covino
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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39
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Tye C, Runicles AK, Whitehouse AJO, Alvares GA. Characterizing the Interplay Between Autism Spectrum Disorder and Comorbid Medical Conditions: An Integrative Review. Front Psychiatry 2018; 9:751. [PMID: 30733689 PMCID: PMC6354568 DOI: 10.3389/fpsyt.2018.00751] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/19/2018] [Indexed: 12/18/2022] Open
Abstract
Co-occurring medical disorders and associated physiological abnormalities in individuals with autism spectrum disorder (ASD) may provide insight into causal pathways or underlying biological mechanisms. Here, we review medical conditions that have been repeatedly highlighted as sharing the strongest associations with ASD-epilepsy, sleep, as well as gastrointestinal and immune functioning. We describe within each condition their prevalence, associations with behavior, and evidence for successful treatment. We additionally discuss research aiming to uncover potential aetiological mechanisms. We then consider the potential interaction between each group of conditions and ASD and, based on the available evidence, propose a model that integrates these medical comorbidities in relation to potential shared aetiological mechanisms. Future research should aim to systematically examine the interactions between these physiological systems, rather than considering these in isolation, using robust and sensitive biomarkers across an individual's development. A consideration of the overlap between medical conditions and ASD may aid in defining biological subtypes within ASD and in the development of specific targeted interventions.
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Affiliation(s)
- Charlotte Tye
- Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Abigail K Runicles
- Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Andrew J O Whitehouse
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia
| | - Gail A Alvares
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia
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Abstract
To examine bone mass in children and adolescents with autism spectrum disorders (ASD). Risperidone-treated 5 to 17 year-old males underwent anthropometric and bone measurements, using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Multivariable linear regression analysis models examined whether skeletal outcomes differed among participants with (n = 30) versus without ASD (n = 156). After adjusting for potential covariates, having ASD was associated with significantly lower trabecular bone mineral density and bone strength at the radius, and with marginally lower total body less head bone mineral content (p < 0.09). No differences at the lumbar spine were observed. ASD are associated with lower bone mass. Future studies should investigate interventions to optimize skeletal health in ASD.
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Affiliation(s)
- Chadi A Calarge
- Menninger Department of Psychiatry and Behavioral Science and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 1102 Bates Ave, Suite 790, Houston, TX, 77030, USA.
| | - Janet A Schlechte
- Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, 52242, IA, USA
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41
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Ekhlaspour L, Baskaran C, Campoverde KJ, Sokoloff NC, Neumeyer AM, Misra M. Bone Density in Adolescents and Young Adults with Autism Spectrum Disorders. J Autism Dev Disord 2017; 46:3387-3391. [PMID: 27491424 DOI: 10.1007/s10803-016-2871-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patients with autism spectrum disorder (ASD) are at increased risk for fracture, and peri-pubertal boys with ASD have lower bone mineral density (BMD) than controls. Data are lacking regarding BMD in older adolescents with ASD. We compared BMD using dual-energy X-ray absorptiometry in 9 adolescents/young adults with ASD against 9 typically developing matched controls. Patients with ASD and controls were excluded if they had other underlying conditions that may affect bone. Compared to controls, patients with ASD had (i) lower femoral neck and hip BMD Z-scores, and (ii) lower spine, femoral neck and hip height adjusted BMD Z-scores even after controlling for BMI. Understanding the underlying pathophysiology will be key to developing therapies to improve BMD and reduce fracture risk.
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Affiliation(s)
- Laya Ekhlaspour
- Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, 55 Fruit Street, Yawkey 6c, Boston, MA, 02114, USA.
| | - Charumathi Baskaran
- Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, 55 Fruit Street, Yawkey 6c, Boston, MA, 02114, USA
| | - Karen Joanie Campoverde
- Neuroendocrine Unit, Massachusetts General Hospital, 101 Merrimac St, 6th Floor, Office 615, Boston, MA, 02114, USA
| | - Natalia Cano Sokoloff
- Neuroendocrine Unit, Massachusetts General Hospital, 101 Merrimac St, 6th Floor, Office 615, Boston, MA, 02114, USA
| | - Ann M Neumeyer
- Lurie Center for Autism, Massachusetts General Hospital and Harvard Medical School, One Maguire Road, Lexington, MA, 02421, USA
| | - Madhusmita Misra
- Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, 55 Fruit Street, Yawkey 6c, Boston, MA, 02114, USA
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42
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Ly V, Bottelier M, Hoekstra PJ, Arias Vasquez A, Buitelaar JK, Rommelse NN. Elimination diets' efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. Eur Child Adolesc Psychiatry 2017; 26:1067-1079. [PMID: 28190137 PMCID: PMC5591346 DOI: 10.1007/s00787-017-0959-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/31/2017] [Indexed: 12/22/2022]
Abstract
Nutrition plays an important role in neurodevelopment. This insight has led to increasing research into the efficacy of nutrition-related interventions for treating neurodevelopmental disorders. This review discusses an elimination diet as a treatment for attention deficit hyperactivity disorder and autism spectrum disorder, with a focus on the efficacy of the food additives exclusion diet, gluten-free/casein-free diet and oligoantigenic diet. Furthermore, we discuss the potential mechanisms of elimination diets' effects in these neurodevelopmental disorders. The main candidate mechanism is the microbiome-gut-brain axis possibly involving complex interactions between multiple systems, including the metabolic, immune, endocrine, and neural system. We conclude with practical implications and future directions into the investigation of an elimination diet's efficacy in the treatment of attention deficit hyperactivity disorder and autism spectrum disorder.
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Affiliation(s)
- Verena Ly
- Karakter, Child and Adolescents Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.
- Department of Cognitive Neuroscience and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Leiden University, Institute of Psychology and Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Marco Bottelier
- Triversum, Child and Adolescent Psychiatry, Alkmaar, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alejandro Arias Vasquez
- Department of Cognitive Neuroscience and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Psychiatry and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Human Genetics and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter, Child and Adolescents Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nanda N Rommelse
- Karakter, Child and Adolescents Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
- Department of Psychiatry and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
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43
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Lewis KE, Sharan K, Takumi T, Yadav VK. Skeletal Site-specific Changes in Bone Mass in a Genetic Mouse Model for Human 15q11-13 Duplication Seen in Autism. Sci Rep 2017; 7:9902. [PMID: 28851986 PMCID: PMC5575059 DOI: 10.1038/s41598-017-09921-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/01/2017] [Indexed: 12/13/2022] Open
Abstract
Children suffering from autism have been reported to have low bone mineral density and increased risk for fracture, yet the cellular origin of the bone phenotype remains unknown. Here we have utilized a mouse model of autism that duplicates 6.3 Mb region of chromosome 7 (Dp/+) corresponding to a region of chromosome 15q11-13, duplication of which is recurrent in humans to characterize the bone phenotype. Paternally inherited Dp/+ (patDp/+) mice showed expected increases in the gene expression in bone, normal postnatal growth and body weight acquisition compared to the littermate controls. Four weeks-old patDp/+ mice develop a low bone mass phenotype in the appendicular but not the axial skeleton compared to the littermate controls. This low bone mass in the mutant mice was secondary to a decrease in the number of osteoblasts and bone formation rate while the osteoclasts remained relatively unaffected. Further in vitro cell culture experiments and gene expression analysis revealed a major defect in the proliferation, differentiation and mineralization abilities of patDp/+ osteoblasts while osteoclast differentiation remained unchanged compared to controls. This study therefore characterizes the structural and cellular bone phenotype in a mouse model of autism that can be further utilized to investigate therapeutic avenues to treat bone fractures in children with autism.
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Affiliation(s)
- Kirsty E Lewis
- Department of Mouse and Zebrafish Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, United Kingdom.,Department of Physiology, Pharmacology, Neuroscience, University of Bristol, Bristol, BS8 1TD, United Kingdom
| | - Kunal Sharan
- Department of Mouse and Zebrafish Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, United Kingdom.,Department of Molecular Nutrition, CSIR-Central Food Technological Research Institute, Mysore, India
| | - Toru Takumi
- RIKEN Brain Science Institute (BSI), Wako, Saitama, Japan.,Graduate School of Biomedical Sciences, Hiroshima University, Minami, Hiroshima, Japan
| | - Vijay K Yadav
- Department of Mouse and Zebrafish Genetics, Wellcome Trust Sanger Institute, Cambridge, CB10 1SA, United Kingdom. .,Metabolic Research Laboratory, National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, 110067, India.
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44
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Cekici H, Sanlier N. Current nutritional approaches in managing autism spectrum disorder: A review. Nutr Neurosci 2017; 22:145-155. [PMID: 28762296 DOI: 10.1080/1028415x.2017.1358481] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The link between nutrition and autism spectrum disorder (ASD), which is a complex developmental disorder manifesting itself in significant delays or deviation in interaction and communication, has provided a fresh point of view and signals that nutrition may have a role in the aetiology of ASD, as well as play an active role in treatment by alleviating symptoms. OBJECTIVE In this review study aimed at evaluating, with scientific and concrete proof, the current medical nutrition implementations on ASD, existing medical nutrition therapies have been addressed and their effects on ASD symptoms have been discussed in light of current research. METHODS We reviewed articles regarding the medical nutritional therapy of autism on current nutritional approaches selected from PubMed, Science Direct, EBSCO, and databases about autism and nutrition. RESULTS The research put forward that in individuals with ASD, while gluten-free/casein-free and ketogenic diets, camel milk, curcumin, probiotics, and fermentable foods can play a role in alleviating ASD symptoms, consumption of sugar, additives, pesticides, genetically modified organisms, inorganic processed foods, and hard-to-digest starches may aggravate symptoms. DISCUSSION Further prospective controlled trials with large sample sizes are needed before recommendations can be made regarding the ideal ASD diet. This review emphasizes the value of identifying current nutritional approaches specific to individuals with ASD and integrating their effects on symptoms to the conversation and presents suggestions for future research designed to identify medical nutrition therapies targeting this population to better understand the link between ASD and nutrition.
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Affiliation(s)
- Hande Cekici
- a Department of Nutrition and Dietetics , College of Health, Recep Tayyip Erdoğan University , Merkez , Rize , Turkey
| | - Nevin Sanlier
- b Faculty of Health Science, Department of Nutrition and Dietetics , Biruni University , Zeytinburnu , İstanbul , Turkey
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45
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Abstract
Feeding disorders often present in children with complex medical histories as well as those with neurodevelopmental disabilities. If untreated, feeding problems will likely persist and may lead to additional developmental and medical complications. Treatment of pediatric feeding disorders should involve an interdisciplinary team, but the core intervention should include behavioral feeding techniques as they are the only empirically supported therapy for feeding disorders.
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46
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Gillberg C, Fernell E, Kočovská E, Minnis H, Bourgeron T, Thompson L, Allely CS. The role of cholesterol metabolism and various steroid abnormalities in autism spectrum disorders: A hypothesis paper. Autism Res 2017; 10:1022-1044. [PMID: 28401679 PMCID: PMC5485071 DOI: 10.1002/aur.1777] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 12/15/2016] [Accepted: 01/30/2017] [Indexed: 01/25/2023]
Abstract
Based on evidence from the relevant research literature, we present a hypothesis that there may be a link between cholesterol, vitamin D, and steroid hormones which subsequently impacts on the development of at least some of the "autisms" [Coleman & Gillberg]. Our hypothesis, driven by the peer reviewed literature, posits that there may be links between cholesterol metabolism, which we will refer to as "steroid metabolism" and findings of steroid abnormalities of various kinds (cortisol, testosterone, estrogens, progesterone, vitamin D) in autism spectrum disorder (ASD). Further research investigating these potential links is warranted to further our understanding of the biological mechanisms underlying ASD. Autism Res 2017. © 2017 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research. Autism Res 2017, 10: 1022-1044. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Eva Kočovská
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Barts and London School of Medicine, Queen Mary University of London, Blizard Institute58 Turner StreetE1 2ABLondon
| | - Helen Minnis
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Institute of Health and Wellbeing, University of Glasgow, RHSC YorkhillGlasgowScotlandG3 8SJUnited Kingdom
| | - Thomas Bourgeron
- Institut Pasteur, Human Genetics and Cognitive Functions UnitParisFrance
- CNRS UMR 3571: Genes, Synapses and Cognition, Institut PasteurParisFrance
- Université Paris Diderot, Sorbonne Paris CitéHuman Genetics and Cognitive FunctionsParisFrance
- FondaMental FoundationCréteilFrance
| | - Lucy Thompson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Institute of Health and Wellbeing, University of Glasgow, RHSC YorkhillGlasgowScotlandG3 8SJUnited Kingdom
| | - Clare S. Allely
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- School of Health SciencesUniversity of SalfordManchesterEngland
- Honorary Research Fellow in the College of MedicalVeterinary and Life Sciences affiliated to the Institute of Health and Wellbeing at the University of Glasgow
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47
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Neumeyer AM, Cano Sokoloff N, McDonnell E, Macklin EA, McDougle CJ, Misra M. Bone microarchitecture in adolescent boys with autism spectrum disorder. Bone 2017; 97:139-146. [PMID: 28088646 PMCID: PMC6309443 DOI: 10.1016/j.bone.2017.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/07/2017] [Accepted: 01/10/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Boys with autism spectrum disorder (ASD) have lower areal bone mineral density (aBMD) than typically developing controls (TDC). Studies of volumetric BMD (vBMD) and bone microarchitecture provide information about fracture risk beyond that provided by aBMD but are currently lacking in ASD. OBJECTIVES To assess ultradistal radius and distal tibia vBMD, bone microarchitecture and strength estimates in adolescent boys with ASD compared to TDC. DESIGN/METHODS Cross-sectional study of 34 boys (16 ASD, 18 TDC) that assessed (i) aBMD at the whole body (WB), WB less head (WBLH), hip and spine using dual X-ray absorptiometry (DXA), (ii) vBMD and bone microarchitecture at the ultradistal radius and distal tibia using high-resolution peripheral quantitative CT (HRpQCT), and (iii) bone strength estimates (stiffness and failure load) using micro-finite element analysis (FEA). We controlled for age in all groupwise comparisons of HRpQCT and FEA measures. Activity questionnaires, food records, physical exam, and fasting levels of 25(OH) vitamin D and bone markers (C-terminal collagen crosslinks and N-terminal telopeptide (CTX and NTX) for bone resorption, N-terminal propeptide of Type 1 procollagen (P1NP) for bone formation) were obtained. RESULTS ASD participants were slightly younger than TDC participants (13.6 vs. 14.2years, p=0.44). Tanner stage, height Z-scores and fasting serum bone marker levels did not differ between groups. ASD participants had higher BMI Z-scores, percent body fat, IGF-1 Z-scores, and lower lean mass and aBMD Z-scores than TDC at the WB, WBLH, and femoral neck (P<0.1). At the radius, ASD participants had lower trabecular thickness (0.063 vs. 0.070mm, p=0.004), compressive stiffness (56.7 vs. 69.7kN/mm, p=0.030) and failure load (3.0 vs. 3.7kN, p=0.031) than TDC. ASD participants also had 61% smaller cortical area (6.6 vs. 16.4mm2, p=0.051) and thickness (0.08 vs. 0.22mm, p=0.054) compared to TDC. At the tibia, ASD participants had lower compressive stiffness (183 vs. 210kN/mm, p=0.048) and failure load (9.4 vs. 10.8kN, p=0.043) and 23% smaller cortical area (60.3 vs. 81.5mm2, p=0.078) compared to TDC. A lower proportion of ASD participants were categorized as "very physically active" (20% vs. 72%, p=0.005). Differences in physical activity, calcium intake and IGF-1 responsiveness may contribute to group differences in stiffness and failure load. CONCLUSION Bone microarchitectural parameters are impaired in ASD, with reductions in bone strength estimates (stiffness and failure load) at the ultradistal radius and distal tibia. This may result from lower physical activity and calcium intake, and decreased IGF-1 responsiveness.
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Affiliation(s)
- Ann M Neumeyer
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA 02421, United States; Harvard Medical School, Boston, MA 02115, United States.
| | - Natalia Cano Sokoloff
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA 02421, United States
| | - Erin McDonnell
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Eric A Macklin
- Harvard Medical School, Boston, MA 02115, United States; Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Christopher J McDougle
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA 02421, United States; Harvard Medical School, Boston, MA 02115, United States
| | - Madhusmita Misra
- Harvard Medical School, Boston, MA 02115, United States; Pediatric Endocrine and Neuroendocrine Units, Massachusetts General Hospital, Boston, MA 02114, United States
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Bone Accrual in Males with Autism Spectrum Disorder. J Pediatr 2017; 181:195-201.e6. [PMID: 27887681 PMCID: PMC5274559 DOI: 10.1016/j.jpeds.2016.10.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/20/2016] [Accepted: 10/26/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To test the hypothesis that bone accrual over a 4-year period is reduced in boys with autism spectrum disorder (ASD) compared with typically developing controls. STUDY DESIGN Twenty-five boys with ASD and 24 controls were assessed for bone outcomes. Fourteen boys with ASD and 11 controls were assessed both at baseline and after 4 years. The mean subject age was 11.0 ± 1.6 years at study initiation and 14.9 ± 1.6 years at follow-up. Bone mineral density (BMD) was measured at the spine, hip, and whole body using dual-energy X-ray absorptiometry and normalized for age, race, and sex (BMD z-scores). Height adjustments were performed as well. We assessed medical history, physical activity using questionnaires, vitamin D and calcium intake using food records, and serum calcium, phosphorus, 25(OH)-vitamin D, and pubertal hormone levels. RESULTS Boys with ASD had lower spine, hip, and whole body BMD z-scores compared with controls. In those subjects assessed both at baseline and after 4 years, bone accrual rates did not differ between the 2 groups; however, spine and hip BMD z-scores remained lower in the boys with ASD than in controls at follow-up. Notably, the ASD group was less physically active at both time points. CONCLUSION Although pubertal bone accrual was similar to that in controls, BMD in children with ASD remained low over a 4-year follow-up period, suggesting that low BMD is a consequence of prepubertal factors, such as low physical activity. Studies are needed to investigate the causes and consequences of decreased BMD, to assess BMD in females and adults with ASD, and to evaluate therapeutic interventions.
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Nutritional Impact of a Gluten-Free Casein-Free Diet in Children with Autism Spectrum Disorder. J Autism Dev Disord 2016; 46:673-84. [PMID: 26428353 DOI: 10.1007/s10803-015-2582-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We compared anthropometric values, nutrient intake, the Healthy Eating Index and food variety in children with autism spectrum disorder (ASD), 20 on a gluten-free casein-free (GFCF) diet and 85 on a regular diet in Valencia (Spain) using 3-days food diaries. Those on the GFCF diet had a lower weight, body mass index, and total energy, pantothenic acid, calcium, phosphorus and sodium intake, but a higher intake of fiber, legumes, and vegetables. Further, the GFCF diet group had a better quality of fat intake, but needed supplementation with vitamin D. Randomized controlled trials are required to explore long-term effects of this diet on anthropometric and nutritional status (the focus of our study), but also behavioral symptoms, in children with ASD.
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Marí-Bauset S, Llopis-González A, Zazpe I, Marí-Sanchis A, Morales Suárez-Varela M. Comparison of nutritional status between children with autism spectrum disorder and typically developing children in the Mediterranean Region (Valencia, Spain). AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:310-322. [PMID: 27132010 DOI: 10.1177/1362361316636976] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
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.
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Affiliation(s)
- Salvador Marí-Bauset
- 1 University of Valencia, Spain.,2 CIBERESP, Institute of Health Carlos III, Spain
| | - Agustín Llopis-González
- 1 University of Valencia, Spain.,2 CIBERESP, Institute of Health Carlos III, Spain.,3 Center for Public Health Research (CSISP-FISABIO), Spain
| | - Itziar Zazpe
- 4 University of Navarre, Spain.,5 CIBERobn, Institute of Health Carlos III, Spain
| | | | - Maria Morales Suárez-Varela
- 1 University of Valencia, Spain.,2 CIBERESP, Institute of Health Carlos III, Spain.,3 Center for Public Health Research (CSISP-FISABIO), Spain
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