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Yuan JJ, Zhao YN, Lan XY, Zhang Y, Zhang R. Prenatal, perinatal and parental risk factors for autism spectrum disorder in China: a case- control study. BMC Psychiatry 2024; 24:219. [PMID: 38509469 PMCID: PMC10956196 DOI: 10.1186/s12888-024-05643-0] [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: 04/20/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is heritable neurodevelopmental disorders (NDDs), but environmental risk factors have also been suggested to a play a role in its development. Prenatal, perinatal and parental factors have been associated with an increased risk of ASD in children. The aim of the present study was to explore the prenatal, perinatal, and parenting risk factors in children with autism spectrum disorder (ASD) from Beijing, China by comparing them with typically developing (TD) children. METHODS A sample of 151 ASD children's parents who from rehabilitation institutions in Beijing were enrolled in this study, and an additional 151 children from kindergartens in Beijing were recruited as a control group (child age: mean = 4.4 years). TD children were matched according to age, sex and maternal education. We explored the maternal AQ (Autism Spectrum Quotient) scores (mean:19.40-19.71, no significant difference between two groups) to referring the genetic baseline. This study evaluated 17 factors with unadjusted and adjusted analyses. RESULTS Birth asphyxia was associated with a more than a thirteen-fold higher risk of ASD (adjusted odds ratio (AOR) = 13.42). Breastfeeding difficulties were associated with a higher risk of ASD(AOR = 3.46). Parenting influenced the risk of ASD, with low responding (LR) and harsh or neglectful parenting associated with a higher risk of ASD in offspring (AOR = 2.37 for LR, AOR = 3.42 for harsh parenting and AOR = 3.01 for neglectful parenting). Maternal fever during pregnancy was associated with a higher risk of ASD in offspring (AOR = 3.81). CONCLUSIONS Many factors were associated with ASD in offspring. Further assessment is needed to elucidate the role of modifiable environmental factors to inform prevention strategies.
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Affiliation(s)
- Jia-Jia Yuan
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Neuroscience Research Institute, Peking University, Beijing, China
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Beijing, China
- Autism Research Center of Peking University Health Science Center, Beijing, China
| | - Ya-Nan Zhao
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
- APEC Health Science Academy Peking Universities, Beijing, China
| | - Xing-Yu Lan
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Neuroscience Research Institute, Peking University, Beijing, China
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Beijing, China
- Autism Research Center of Peking University Health Science Center, Beijing, China
| | - Yong Zhang
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China
- Neuroscience Research Institute, Peking University, Beijing, China
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Beijing, China
- Autism Research Center of Peking University Health Science Center, Beijing, China
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Rong Zhang
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China.
- Neuroscience Research Institute, Peking University, Beijing, China.
- Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Beijing, China.
- Autism Research Center of Peking University Health Science Center, Beijing, China.
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China.
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Zhan XL, Pan N, Karatela S, Shi L, Wang X, Liu ZY, Jing J, Li XH, Cai L, Lin LZ. Infant feeding practices and autism spectrum disorder in US children aged 2-5 years: the national survey of children's health (NSCH) 2016-2020. Int Breastfeed J 2023; 18:41. [PMID: 37568201 PMCID: PMC10422796 DOI: 10.1186/s13006-023-00580-2] [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: 10/05/2022] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE To investigate the relationship between infant feeding practices and autism spectrum disorder (ASD) among children aged 2-5 years in the United States (US). METHODS Data from the 2016-2020 National Survey of Children's Health, a nationally representative cross-sectional survey, were utilized for this study. Questionnaires were administered to parents of children aged 2-5 years to gather information on ASD diagnosis, infant feeding practices, and demographic factors (e.g., child sex, ethnic group, and maternal age at birth). Logistic regression with sample weights was employed to assess the association between infant feeding practices and ASD, while controlling for demographic variables. Polynomial regression models were used to examine trends in exclusive breastfeeding and ever breastfeeding rates among children with and without ASD. RESULTS A total of 35,050 children aged 2-5 years were analyzed, including 616 diagnosed with ASD, after excluding participants with missing information on breastfeeding and ASD diagnosis. Of these children with ASD, 76.6% (n = 472) had a breastfeeding history, with 67.5% (n = 416) engaged in partial breastfeeding and 9.1% (n = 56) exclusively breastfed. Adjusted odds ratios for each additional month of breastfeeding compared to never being breastfed were 0.98 (95% CI, 0.96-1.01). The adjusted odds ratios for breastfeeding durations of > 0-6 months, > 6-12 months, > 12-24 months, and > 24 months were 0.81 (95% CI, 0.50-1.31), 0.65 (95% CI, 0.36-1.18), 0.81 (95% CI, 0.44-1.49), and 0.48 (95% CI, 0.23-1.01), respectively. Compared to children who were never breastfed, the adjusted odds ratio for children who were ever breastfed was 0.74 (95% CI, 0.47-1.18). Among children with ASD, the proportion of ever breastfeeding declined from 82.0% in 2017 to 64.3% in 2020, while exclusive breastfeeding decreased from 12.0% in 2016 to 4.2% in 2020. CONCLUSIONS AND RELEVANCE Although no significant association was found between infant feeding practices and ASD among US children aged 2-5 years, the rates of breastfeeding, particularly exclusive breastfeeding, were suboptimal among children with ASD. This highlights the need for specific policies and practices to promote and support breastfeeding among parents of children with ASD or those at high risk of having a child with ASD.
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Affiliation(s)
- Xiao-Ling Zhan
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, China
| | - Ning Pan
- Key Laboratory of Brain, Cognition and Education Sciences, Institute for Brain Research and Rehabilitation, Ministry of Education, South China Normal University, 510631, Guangzhou, China
| | - Shamshad Karatela
- Faculty of Health and Behavioural Sciences, Pharmacy Australia Centre of Excellence, University of Queensland, Woolloongabba, QLD, Australia
- Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville, QLD, Australia
| | - Lei Shi
- JNU-HKUST Joint Laboratory for Neuroscience and Innovative Drug Research, College of Pharmacy, Jinan University, Guangzhou, 510632, Guangdong, China
| | - Xin Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Institute for Brain Research and Rehabilitation, Ministry of Education, South China Normal University, 510631, Guangzhou, China
| | - Zhao-Yan Liu
- Department of Nutrition, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, China
| | - Jin Jing
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, China
| | - Xiu-Hong Li
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, China
| | - Li Cai
- Research Center of Children and Adolescent Psychological and Behavioral Development, Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, China
| | - Li-Zi Lin
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Yuexiu District, 510080, Guangzhou, China.
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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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Vasilakis M, Polychronis K, Panagouli E, Tzila E, Papageorgiou A, Thomaidou L, Psaltopoulou T, Tsolia M, Sergentanis TN, Tsitsika AK. Food Difficulties in Infancy and ASD: A Literature Review. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010084. [PMID: 36670635 PMCID: PMC9857150 DOI: 10.3390/children10010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The aim of this literature review is to investigate the potential association between specific food difficulties and autism spectrum disorder (ASD) during the first two years of life. MATERIALS The search was conducted in PubMed, Google Scholar, Embase and PsycInfo databases. RESULTS Twenty-one studies were synthesized (3763 infants and children). Difficulties during breastfeeding, breast milk refusal and avoidance of taking solids have been linked to ASD. Infants with ASD have been referred to as picky eaters. Problematic mealtime behaviour during infancy has also been associated with ASD. CONCLUSIONS The present review highlights the association between food difficulties, including problematic mealtime behaviours, food selectivity, breastfeeding difficulties and food refusal during infancy and ASD early during life, including the first months.
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Affiliation(s)
- Marios Vasilakis
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Konstantinos Polychronis
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Eleni Panagouli
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Efthalia Tzila
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Alexia Papageorgiou
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Loretta Thomaidou
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Theodora Psaltopoulou
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Department of Clinical Therapeutics, “Alexandra” Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Maria Tsolia
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Theodoros N. Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 115 21 Athens, Greece
| | - Artemis K. Tsitsika
- MSc Program “Strategies of Developmental and Adolescent Health”, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Correspondence: ; Tel.: +30-216-0033-788
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Huang S, Wang X, Sun T, Yu H, Liao Y, Cao M, Cai L, Li X, Lin L, Su X, Jing J. Association of Breastfeeding for the First Six Months of Life and Autism Spectrum Disorders: A National Multi-Center Study in China. Nutrients 2021; 14:45. [PMID: 35010918 PMCID: PMC8746572 DOI: 10.3390/nu14010045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 12/23/2022] Open
Abstract
Previous studies have shown that exclusive breastfeeding is associated with lower odds of having autism spectrum disorders (ASD) in children, but data are lacking in Asian countries, especially China. This cross-sectional study of seven cities in China collected data from August 2016 to March 2017 from 6049 toddlers aged 16-30 months and their parents who responded to questionnaires. The breastfeeding status was collected via questionnaires based on recommendations from the World Health Organization. The standard procedure for screening and diagnosis was applied to identify toddlers with ASD. Among the 6049 toddlers (3364 boys [55.6%]; mean [SD] age, 22.7 [4.1] months), 71 toddlers (1.2%) were identified as ASD. The prevalence of exclusive breastfeeding, partial breastfeeding, and not breastfeeding was 48.8%, 42.2%, and 9.1%, respectively. Compared to toddlers with exclusive breastfeeding, toddlers with partial breastfeeding or without breastfeeding had higher odds of having ASD (odd ratios [OR]: 1.55, 95% confidence interval [CI]: 0.90-2.74; OR: 2.34, 95% CI: 1.10-4.82). We did not find significant modification of demographic characteristics on the associations. The results remained robust in multiple sensitivity analyses. Toddlers without breastfeeding for the first six months of life had higher odds of having ASD, and our findings shed light on the necessity of strengthening public health efforts to increase exclusive breastfeeding in China.
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Affiliation(s)
- Saijun Huang
- Department of Child Healthcare, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan 528000, China; (S.H.); (T.S.); (H.Y.); (Y.L.)
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510280, China
| | - Xin Wang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (X.W.); (M.C.); (L.C.); (X.L.)
| | - Tao Sun
- Department of Child Healthcare, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan 528000, China; (S.H.); (T.S.); (H.Y.); (Y.L.)
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510280, China
| | - Hong Yu
- Department of Child Healthcare, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan 528000, China; (S.H.); (T.S.); (H.Y.); (Y.L.)
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510280, China
| | - Yanwei Liao
- Department of Child Healthcare, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan 528000, China; (S.H.); (T.S.); (H.Y.); (Y.L.)
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510280, China
| | - Muqing Cao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (X.W.); (M.C.); (L.C.); (X.L.)
| | - Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (X.W.); (M.C.); (L.C.); (X.L.)
| | - Xiuhong Li
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (X.W.); (M.C.); (L.C.); (X.L.)
| | - Lizi Lin
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China;
| | - Xi Su
- Department of Child Healthcare, Affiliated Foshan Maternity and Child Healthcare Hospital, Southern Medical University, Foshan 528000, China; (S.H.); (T.S.); (H.Y.); (Y.L.)
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510280, China
| | - Jin Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (X.W.); (M.C.); (L.C.); (X.L.)
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Krishnan V, Krishnakumar P, Gireeshan VK, George B, Basheer S. Early Social Experience and Digital-Media Exposure in Children with Autism Spectrum Disorder. Indian J Pediatr 2021; 88:793-799. [PMID: 33471317 DOI: 10.1007/s12098-021-03666-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the early social experience and digital media exposure in children with autism spectrum disorder (ASD) in comparison with typically developed children. METHODS Details of digital-media exposure and early social experience in 65 children with ASD were compared with those in a control group of equal number of typically developed children, matched for age and gender. Prenatal and perinatal factors were also studied. The diagnosis of ASD was based on the International Clinical Epidemiology Network (INCLEN) diagnostic tool and Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria. Variables which were biologically relevant and has a P value of < 0.05 in the univariate analysis were analyzed by logistic regression to obtain the adjusted effect measures. RESULTS Children with ASD were exposed to digital media at an earlier age and spent significantly more time with digital media and less time with their mothers, compared to typically developed children. Exposure to digital media before 21 mo was associated with risk of ASD and the risk increased when mothers spent less than 6.5 h per day with the baby. Family history of epilepsy and developmental delay, maternal stress during the antenatal period, and absence of exclusive breastfeeding during the first 6 mo were significantly more in children with ASD. CONCLUSION There are significant differences in the early life social experience and digital-media exposure in children with ASD compared to typically developed counterparts. Given the reported rise in prevalence of ASD, these findings stress the need for further prospective studies to explore these potentially modifiable risk factors.
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Affiliation(s)
- Vaisakh Krishnan
- Department of Pediatrics, Government Medical College, Kozhikode, Kerala, India
| | | | - V K Gireeshan
- Department of Pediatrics, Government Medical College, Manjeri, Kerala, India
| | - Biju George
- Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India
| | - Salah Basheer
- Institute of Mental Health and Neurosciences (IMHANS), Kozhikode, Kerala, India
- Department of Child Psychiatry, IQRAA International Hospital and Research Centre, Kozhikode, Kerala, India
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Associations between Prenatal Education, Breastfeeding and Autistic-Like Behaviors in Pre-Schoolers. CHILDREN-BASEL 2021; 8:children8020124. [PMID: 33572414 PMCID: PMC7916179 DOI: 10.3390/children8020124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
Abstract
This study aimed to investigate the association between prenatal education and autistic-like behaviors of preschoolers as well as the mediating role of breastfeeding in their associations. A cross-sectional study via a structured questionnaire was conducted with 67,578 preschool children and parents from Longhua District of Shenzhen, China. Hierarchical logistic regression models were performed to explore the associations between maternal participation in prenatal education and autistic-like behaviors in preschoolers, as well as the mediating effect of breastfeeding in the associations. After controlling for potential confounders, logistic regression analysis indicated that maternal participation in prenatal education could significantly increase the prevalence of breastfeeding, and the strength of the association was enhanced with the increase frequency of prenatal education visits (ORs ranging from 1.191 to 1.899). While both maternal participation in prenatal education (ORs ranging from 0.732 to 0.798) and breastfeeding (OR = 0.773) were significantly associated with the lower presence of autistic-like behaviors in preschoolers. The crossover analysis indicated that children with both maternal prenatal education and breastfeeding had the lower risk of presence of autistics-like behaviors (OR = 0.569). Furthermore, mediation analysis illustrated that breastfeeding mediated the association between maternal participation in prenatal education and the presence of autistic-like behaviors in preschoolers, with a mediating effect of approximately 14.3%. Our findings suggest that maternal participation in prenatal education is significantly associated with a decreased risk of autistic-like behaviors in preschool children through increased breastfeeding in the mothers who attended prenatal education.
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Abstract
Autism is a grand challenge in global mental health to be dealt with on a priority basis. Phenotypic knowledge, biological understanding, and evidence-based intervention studies are all from western countries. We know very little about autism in the low- and middle-income countries (LMIC). Lack of infrastructure and difficulties in operationalizing research has widened the knowledge gap. We performed a comprehensive scoping review of research in Autism Spectrum Disorder in India to have an overall impression, identify gaps, and formulate evidence-based recommendations for further study. We searched PubMed, SCOPUS, and Cochrane Library to identify relevant Indian studies. A hundred and fifty-nine publications met the inclusion criteria. Most of the research contribution in autism is from few tertiary care medical centres, technological institutes, and not-for-profit organizations. We identified various themes of research like clinical profile, interventions, biomarkers, psychological, social, epidemiological, and risk factors. Evidence-based intervention studies, translation and adaptation of standard diagnostic instruments, and qualitative research on the experience of autism appeared to be state of the art. However, epidemiological studies, biomarkers identification, risk assessment studies were of low quality. There is a need for nationwide studies with representative sampling on epidemiology, biomarkers, and risk factors for a complete evaluation of the actual burden and biology of autism in India. Also, there is a need to design implementation research to evaluate the effectiveness of evidence-based interventions in routine healthcare settings. We recommend that future research should fill these gaps in understanding autism and improving its outcome in India.
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Affiliation(s)
- Suravi Patra
- Department of Psychiatry, All India Institute of Medical Sciences Bhubaneswar, Odisha, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
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Virolainen S, Hussien W, Dalibalta S. Autism spectrum disorder in the United Arab Emirates: potential environmental links. REVIEWS ON ENVIRONMENTAL HEALTH 2020; 35:359-369. [PMID: 32663174 DOI: 10.1515/reveh-2020-0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
Autism spectrum disorder (ASD) has been experiencing an increase in global prevalence in recent decades. While many factors could account for this reality, certain environmental links have been shown to contribute to ASD development and etiology. The Middle East has had relatively little published research on ASD etiology although statistics indicate that ASD affects 1 in 146 births in the United Arab Emirates (UAE). This review therefore aims to examine potential causes of ASD within the UAE specifically, focusing on environmental links that may contribute to the rise in ASD cases in this population. Significantly, suboptimal breastfeeding practices, high levels of vitamin D deficiency, increased exposure to pollution, pesticides and heavy metals within the UAE may all be potentially important contributing factors to ASD in this population. Our findings support the notion that there are key links between various environmental factors and ASD prevalence in the UAE. The lack of knowledge and much research on ASD within the UAE deeply necessitates further studies on its etiology as it poses a serious public health challenge in the region and globally.
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Affiliation(s)
| | - Wejdan Hussien
- Department of Biology, Chemistry & Environmental Sciences, American University of Sharjah, P.O. Box 26666, Sharjah, United Arab Emirates
| | - Sarah Dalibalta
- Department of Biology, Chemistry & Environmental Sciences, American University of Sharjah, P.O. Box 26666, Sharjah, United Arab Emirates
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Margari L, Marzulli L, Gabellone A, de Giambattista C. Eating and Mealtime Behaviors in Patients with Autism Spectrum Disorder: Current Perspectives. Neuropsychiatr Dis Treat 2020; 16:2083-2102. [PMID: 32982247 PMCID: PMC7504729 DOI: 10.2147/ndt.s224779] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired social and communication skills and repetitive and restrictive behaviors. Children and adolescents with ASD are more likely to present feeding problems than their typically developing peers are. The present narrative review of literature aims to highlight the most recent evidence about epidemiology and presentations of eating and mealtime behavioral abnormalities in ASD from infancy to adolescence. Abnormalities in breastfeeding and acceptance of complementary foods have been described by most of the studies evaluating ASD early feeding history. Among the various eating and mealtime behaviors identified in ASD children and adolescents, the most common was food selectivity. The present review also provides brief overviews of the various aspects of food that may influence food acceptance by ASD patients and of the correlation between eating problems and ASD core symptoms, as well as with cognitive level, language skills, and family environment. However, studies evaluating eating problems in ASD children and adolescents are very heterogeneous and they show methodological differences. Moreover, the absence of unique definitions of eating and mealtime behaviors in ASD further limits the comparability of studies.
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Affiliation(s)
- Lucia Margari
- Child Neuropsychiatric Unit, University of Bari Aldo Moro, Bari, Italy
| | - Lucia Marzulli
- Child Neuropsychiatric Unit, University of Bari Aldo Moro, Bari, Italy
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Muhammad A, Shafiq Y, Nisar MI, Baloch B, Yazdani AT, Yazdani N, Jehan F. Nutritional support for lactating women with or without azithromycin for infants compared to breastfeeding counseling alone in improving the 6-month growth outcomes among infants of peri-urban slums in Karachi, Pakistan-the protocol for a multiarm assessor-blinded randomized controlled trial (Mumta LW trial). Trials 2020; 21:756. [PMID: 32873314 PMCID: PMC7465410 DOI: 10.1186/s13063-020-04662-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/07/2020] [Indexed: 12/03/2022] Open
Abstract
Background Globally, 45% of under-five deaths are either directly or indirectly attributable to malnutrition, and most of these deaths are in low- and middle-income countries (LMICs). Children are particularly vulnerable in the first 6 months of life. An estimated 4.7 million infants under the age of 6 months are moderately wasted, whereas 3.8 million are severely wasted. Although the children of malnourished women have an increased risk of stunting and wasting, there is little information on this issue. Methods This is a community-based, open-label, multiarm randomized controlled trial that will include parallel group assignments with a 1:1:1 allocation ratio in low-income squatter settlements in urban Karachi, Pakistan. The women in the control group (control arm) will receive standard counseling only, whereas the lactating women in the first intervention group (intervention arm 1) will receive two sachets of balanced energy protein (BEP) supplementation per day from enrollment until the infant reaches 6 months of age. The lactating women in the second intervention group (intervention arm 2) will receive the same BEP supplementation as those in intervention arm 1 while their babies will also receive a single stat dose (20 mg/kg orally) of azithromycin at 42 days. The primary outcome will be the relative length velocity from 0 to 6 months by intervention arm. The primary analysis will be intention-to-treat analysis. Trial registration ClinicalTrials.gov NCT03564652. Registered on 21 June 2018
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Affiliation(s)
| | | | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Benazir Baloch
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Early environmental risk factors for neurodevelopmental disorders - a systematic review of twin and sibling studies. Dev Psychopathol 2020; 33:1448-1495. [PMID: 32703331 PMCID: PMC8564717 DOI: 10.1017/s0954579420000620] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
While neurodevelopmental disorders (NDDs) are highly heritable, several environmental risk factors have also been suggested. However, the role of familial confounding is unclear. To shed more light on this, we reviewed the evidence from twin and sibling studies. A systematic review was performed on case control and cohort studies including a twin or sibling within-pair comparison of neurodevelopmental outcomes, with environmental exposures until the sixth birthday. From 7,315 screened abstracts, 140 eligible articles were identified. After adjustment for familial confounding advanced paternal age, low birth weight, birth defects, and perinatal hypoxia and respiratory stress were associated with autism spectrum disorder (ASD), and low birth weight, gestational age and family income were associated with attention-deficit/hyperactivity disorder (ADHD), categorically and dimensionally. Several previously suspected factors, including pregnancy-related factors, were deemed due to familial confounding. Most studies were conducted in North America and Scandinavia, pointing to a global research bias. Moreover, most studies focused on ASD and ADHD. This genetically informed review showed evidence for a range of environmental factors of potential casual significance in NDDs, but also points to a critical need of more genetically informed studies of good quality in the quest of the environmental causes of NDDs.
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Douglas PS. Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation. Front Integr Neurosci 2019; 13:66. [PMID: 31798425 PMCID: PMC6877903 DOI: 10.3389/fnint.2019.00066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/04/2019] [Indexed: 12/28/2022] Open
Abstract
Autism spectrum disorders (ASD) are an emergent public health problem, placing significant burden upon the individual, family and health system. ASD are polygenetic spectrum disorders of neural connectome development, in which one or more feedback loops amplify small genetic, structural, or functional variations in the very early development of motor and sensory-motor pathways. These perturbations trigger a 'butterfly effect' of unpredictable cascades of structural and functional imbalances in the global neuronal workspace, resulting in atypical behaviors, social communication, and cognition long-term. The first 100 days post-term are critically neuroplastic and comprise an injury-sensitive developmental window, characterized by a neural biomarker, the persistence of the cortical subplate, and a behavioral biomarker, the crying diathesis. By the time potential diagnostic signs are identified, from 6 months of age, ASD neuropathy is already entrenched. The International Society for Autism Research Special Interest Group has called for pre-emptive intervention, based upon rigorous theoretical frames, and real world translation and evaluation. This paper responds to that call. It synthesizes heterogenous evidence concerning ASD etiologies from both psychosocial and biological research literatures with complexity science and evolutionary biology, to propose a theoretical framework for pre-emptive intervention. This paper hypothesizes that environmental factors resulting from a mismatch between environment of evolutionary adaptedness and culture initiate or perpetuate early motor and sensory-motor lesions, triggering a butterfly effect of multi-directional cascades of atypical developmental in the complex adaptive system of the parent and ASD-susceptible infant. Chronic sympathetic nervous system/hypothalamic-pituitary-adrenal axis hyperarousal and disrupted parent-infant biobehavioral synchrony are the key biologic and behavioral mechanisms perpetuating these atypical developmental cascades. A clinical translation of this evidence is proposed, for application antenatally and in the first 6 months of life, as pre-emptive intervention for ASD.
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Affiliation(s)
- Pamela S. Douglas
- Transforming Maternity Care Collaborative, Griffith University, Brisbane, QLD, Australia
- Discipline of General Practice, The University of Queensland, Brisbane, QLD, Australia
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