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Rafi’i MR, Ja’afar MH, Abd Wahil MS, Md Hanif SA. Urine manganese, cadmium, lead, arsenic, and selenium among autism spectrum disorder children in Kuala Lumpur. PeerJ 2024; 12:e17660. [PMID: 38974411 PMCID: PMC11227810 DOI: 10.7717/peerj.17660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/08/2024] [Indexed: 07/09/2024] Open
Abstract
Background The development of autism spectrum disorder (ASD) may stem from exposure to environmental pollutants such as heavy metals. The primary objective of this study is to determine the role of heavy metals of concern such as manganese (Mn), cadmium (Cd), lead (Pb), arsenic (As), and essential trace element selenium (Se) among ASD children in Kuala Lumpur, Malaysia. Method A total of 155 preschoolers in Kuala Lumpur between the ages 3 to 6 participated in an unmatched case-control study, comprising ASD children (n = 81) recruited from an early intervention program for autism, and 74 children without autism who were recruited from public preschools. Urine samples were collected at home, delivered to the study site, and transported to the environmental lab within 24 hours. Inductively coupled plasma mass spectrometry (ICP-MS) was applied to measure the concentration of heavy metals in the samples. Data were analysed using bivariate statistical tests (Chi-square and T-test) and logistic regression models. Result This study demonstrated that Cd, Pb, and As urine levels were significantly greater in children without autism relative to those affected with ASD (p < 0.05). No significant difference was in the levels of Se (p = 0.659) and Mn (p = 0.875) between children with ASD and the control group. The majority of children in both groups have urine As, Pb, and Cd values lower than 15.1 µg/dL, 1.0 µg/dL, and 1.0 µg/dL, respectively which are the minimal risk values for noncarcinogenic detrimental human health effect due to the heavy metal's exposure . Factors associated with having an ASD child included being a firstborn, male, and higher parental education levels (adjusted odds ratios (aOR) > 1, p < 0.05). Conclusion Preschoolers in this study demonstrated low levels of heavy metals in their urine samples, which was relatively lower in ASD children compared to the healthy matched controls. These findings may arise from the diminished capacity to excrete heavy metals, especially among ASD children, thereby causing further accumulation of heavy metals in the body. These findings, including the factors associated with having an ASD child, may be considered by healthcare professionals involved in child development care, for early ASD detection. Further assessment of heavy metals among ASD children in the country and interventional studies to develop effective methods of addressing exposure to heavy metals will be beneficial for future reference.
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Affiliation(s)
- Muhammad Ridzwan Rafi’i
- Department of Public Health Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Hasni Ja’afar
- Department of Public Health Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Shahrol Abd Wahil
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia
| | - Shahrul Azhar Md Hanif
- Department of Public Health Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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Rozaini MAN, Sariman S, Abd Rashed A, Shari N. The association of screen time with physical activity and weight status of autistic children in Kuala Lumpur, Malaysia. NUTRITION & FOOD SCIENCE 2023; 53:549-563. [DOI: 10.1108/nfs-02-2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Purpose
The purpose of this study was to evaluate the screen time used by Autism Spectrum Disorder (ASD) children and its association with their physical activity and weight status.
Design/methodology/approach
This cross-sectional study was conducted among 100 purposive sampled children registered under the National Autism Society of Malaysia centres in Kuala Lumpur. Parents-administered questionnaire composed of socio-demographic, anthropometric data (height and weight of the children), Autism Severity Questionnaire, Screen Time Questionnaire and Physical Activity Questionnaire for Older Children (PAQ-C) was used in this study.
Findings
Respondents in this study were categorised as having mild ASD (55%). Most of the respondents had higher screen time (78%), with average (4.14 ± 3.19) h spent using the devices. The respondents had low physical activity level (54%), with average PAQ-C scores of (2.38 ± 0.79). Average BMI-for-age z-scores was 1.06 ± 2.15, which was in the normal category. Approximately, 34% of the respondents were overweight and obese. BMI-for-age was positively associated with screen time during weekdays (χ2 = 11.06; p < 0.05) but not during weekend (χ2 = 3.14; p > 0.05). Spearman correlation test showed negative relationships between screen time on weekdays (rs = −0.30 and p < 0.01) and weekend (rs = −0.21 and p < 0.05) with PAQ-C of this group of ASD children.
Practical implications
Screen time was directly associated with the BMI-for-age z-score but was inversely associated with physical activity. Future studies could implement a structured physical activity intervention among children with ASD, which may increase physical activity and decrease screen time behaviours while addressing the overweight/obesity and cognitive aspects of these ASD children.
Originality/value
This study measured the amount of screen time, level of physical activity and weight status but not dietary intake of autistic children.
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Zulkifli MN, Kadar M, Hamzaid NH. Weight Status and Associated Risk Factors of Mealtime Behaviours among Children with Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070927. [PMID: 35883911 PMCID: PMC9316127 DOI: 10.3390/children9070927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
Abstract
Atypical mealtime behaviours in children with autism spectrum disorder (ASD) have been linked with oral sensory hypersensitivity that may contribute to food selectivity and weight issues. This cross-sectional study aims to determine the association between atypical mealtime behaviours and associated risk factors besides exploring the prevalence of overweight and obesity among Malaysian children with ASD in community settings. A total of 150 children with ASD aged 3−11 years participated in this study. A self-administered questionnaire on sociodemographic variables, mealtime behaviours and oral sensory processing was completed by the caregivers. The prevalence of overweight in the study samples was 18.5%, whereas obesity was 20.0%. In a multivariate analysis model, oral sensory processing (B = 0.608, 95% CI = 0.493, 0.722, p < 0.001), severity of autism symptoms (moderate and severe) (B = 2.585, 95% CI = 0.722, 4.448, p = 0.007) and younger children with ASD (B = −0.694, 95% CI = −1.189, −0.199, p = 0.006) were found as independent predictors of atypical mealtime behaviours. Children with ASD aged 3−11 years old have a higher prevalence of being overweight and obese, thus requiring regular anthropometric screening in community settings by relevant healthcare professionals. Furthermore, a relationship was found between oral sensory difficulties and atypical mealtime behaviours in children with ASD. A multidisciplinary approach is crucial in the overall management of food selectivity in this population.
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Affiliation(s)
- Maizatul Naqiah Zulkifli
- Dietetics Programme, Centre for Rehabilitation and Special Needs (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
- Department of Dietetics and Food Services, Sungai Buloh Hospital, Ministry of Health, Jalan Hospital, Sungai Buloh 47000, Malaysia
| | - Masne Kadar
- Occupational Therapy Programme, Centre for Rehabilitation and Special Needs (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Nur Hana Hamzaid
- Dietetics Programme, Centre for Rehabilitation and Special Needs (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
- Department of Dietetics and Food Services, UKM Specialist Children’s Hospital, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia
- Correspondence: ; Tel.: +60-3-92897511 (ext. 7080)
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Kang YQ, Teo CM, Tan ML, Aw MM, Chan YH, Chong SC. Feeding difficulties in Asian children with autism spectrum disorder. Pediatr Neonatol 2022; 63:48-56. [PMID: 34538733 DOI: 10.1016/j.pedneo.2021.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To characterize the nature and severity of feeding difficulties in Asian young children with Autism Spectrum Disorders (ASD) and identify potential predictors of poorer feeding outcomes. METHODS Cross sectional study of children aged 1-7 years with ASD. Parents completed the following: demographic information, brief autism mealtime behavior inventory, aberrant behavior checklist (ABC), behavioral pediatrics feeding assessment scale (BPFAS) and caregiver feeding style questionnaire. Additional information (medical data, cognitive and developmental assessment results, e.g., Autism Diagnostic Observation Schedule Second Edition, Autism Diagnostic Interview, Revised, Vineland Adaptive Behaviour Scales, etc.) were subsequently obtained from electronic medical records retrospectively by one of the study team members. RESULTS Of the 67 children, 28.4% had feeding difficulties (high BPFAS total frequency score). Caregiver feeding styles were authoritarian (34.8%) or indulgent (39.4%). Child characteristics did not significantly predict for the severity of feeding difficulties. Univariate analysis revealed that authoritarian feeding style (p = 0.001) and ABC hyperactivity score (p = 0.006) were significantly associated with BPFAS severity score. Multivariate analysis revealed that ABC hyperactivity score remained significantly associated with BPFAS severity score after controlling for all other ABC subscale scores. A final regression model including all child characteristics and ABC scores did not reveal any significant predictors of BPFAS total frequency score (R2 = 0.557). CONCLUSION Our findings suggest an association between hyperactivity, authoritarian feeding style and feeding difficulties. Children with ASD who have significant hyperactivity behaviors in the context of parents with an authoritarian feeding style should be actively screened for problematic feeding behaviors.
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Affiliation(s)
- Ying Qi Kang
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Charmaine Min Teo
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Michelle Ln Tan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Paediatric Gastroenterology, Nutrition, Hepatology and Liver Transplantation, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Marion M Aw
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Paediatric Gastroenterology, Nutrition, Hepatology and Liver Transplantation, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University, Singapore
| | - Shang Chee Chong
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abd Wahil MS, Ja’afar MH, Md Isa Z. Assessment of Urinary Lead (Pb) and Essential Trace Elements in Autism Spectrum Disorder: a Case-Control Study Among Preschool Children in Malaysia. Biol Trace Elem Res 2022; 200:97-121. [PMID: 33661472 PMCID: PMC7930527 DOI: 10.1007/s12011-021-02654-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 12/27/2022]
Abstract
Lead (Pb) is a heavy metal which is abundant in the environment and known to cause neurotoxicity in children even at minute concentration. However, the trace elements calcium (Ca), magnesium (Mg), zinc (Zn) and iron (Fe) are essential to children due to its protective effect on neurodevelopment. The primary objective of this study was to assess the role of Pb and trace elements in the development of autism spectrum disorder (ASD) among preschool children. A total of 81 ASD children and 74 typically developed (TD) children aged between 3 and 6 years participated in the study. Self-administered online questionnaires were completed by the parents. A first-morning urine sample was collected in a sterile polyethene urine container and assayed for Pb, Ca, Mg, Zn and Fe using an inductively coupled plasma mass spectrometry (ICP-MS). Comparisons between groups revealed that the urinary Pb, Mg, Zn and Fe levels in ASD children were significantly lower than TD children. The odds of ASD reduced significantly by 5.0% and 23.0% with an increment of every 1.0 μg/dL urinary Zn and Fe, respectively. Post interaction analysis showed that the odds of ASD reduced significantly by 11.0% and 0.1% with an increment of every 1.0 μg/dL urinary Zn and Pb, respectively. A significantly lower urinary Pb level in ASD children than TD children may be due to their poor detoxifying mechanism. Also, the significantly lower urinary Zn and Fe levels in ASD children may augment the neurotoxic effect of Pb.
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Affiliation(s)
- Mohd Shahrol Abd Wahil
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Hasni Ja’afar
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Zaleha Md Isa
- Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Bacherini A, Igliozzi R, Cagiano R, Mancini A, Tancredi R, Muratori F, Balboni G. Behavioral and emotional problems of toddlers with autism spectrum disorder: Effects of parents' sociocultural level and individual factors. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104106. [PMID: 34656889 DOI: 10.1016/j.ridd.2021.104106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Toddlers with autism spectrum disorder (ASD) show higher prevalence and severity of Behavioral and Emotional Problems (BEP) than their peers without ASD. AIMS Investigating the effects of parental factors, i.e., mothers' and fathers' age and Sociocultural Level (Socioeconomic Status, Cultural Capital, and Social Capital), and individual factors, i.e., toddles' age, birth order, general development, autism symptom severity, and adaptive behavior, on the expression of BEP in toddlers with ASD. METHODS Participants were 148 toddlers with ASD (aged 18-37 months) and both their parents. BEP were measured with the Child Behavior Checklist 1½-5 (CBCL) Syndrome and Pervasive developmental problems (PDD) DSM-oriented scales, general development with the Griffiths Mental Development Scales (GMDS), autism symptom severity with the Autism Diagnostic Observation Schedule-2 (ADOS-2), and adaptive behavior with the Vineland-II Adaptive behavior composite. RESULTS Vineland-IIAdaptive behavior composite was negatively associated with the majority of the CBCL scales. In contrast, the ADOS-2 Restrictive and repetitive behavior was negatively and the ADOS-2 Social affect, toddlers' age, and birth order were positively associated with only a few of the CBCL scales (e.g., PDD). GMDS scores were not associated with any CBCL scales. Mothers' age and fathers' Cultural Capital and Social Capital dimensions were negatively associated with specific CBCL scales, even when considered in addition to individuals' factors. CONCLUSIONS Individual and parental factors simultaneously affect the expression of BEP and should be considered for clinical decisions.
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Affiliation(s)
- Alice Bacherini
- Department of Philosophy, Social Sciences and Education, University of Perugia, Piazza G. Ermini, 1, 06123, Perugia, Italy
| | - Roberta Igliozzi
- IRCCS Stella Maris Foundation - Pisa, Italy, Viale del Tirreno 331, 56128, Calambrone
| | - Romina Cagiano
- IRCCS Stella Maris Foundation - Pisa, Italy, Viale del Tirreno 331, 56128, Calambrone
| | - Alice Mancini
- IRCCS Stella Maris Foundation - Pisa, Italy, Viale del Tirreno 331, 56128, Calambrone
| | - Raffaella Tancredi
- IRCCS Stella Maris Foundation - Pisa, Italy, Viale del Tirreno 331, 56128, Calambrone
| | - Filippo Muratori
- IRCCS Stella Maris Foundation - Pisa, Italy, Viale del Tirreno 331, 56128, Calambrone; Department of Clinical and Experimental Medicine, University of Pisa, Viale del Tirreno 331, 56128, Calambrone, Pisa, Italy
| | - Giulia Balboni
- Department of Philosophy, Social Sciences and Education, University of Perugia, Piazza G. Ermini, 1, 06123, Perugia, Italy.
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