Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults

BACKGROUND

The poorer physical health of autistic adults compared to non-autistic adults has been highlighted by several epidemiological studies. However, research has so far been limited to specific geographical areas and has primarily focused on young autistic individuals (aged 35 years and younger). Recent studies indicate a higher rate of mortality in autistic people, as well as poorer quality of self-reported healthcare interactions. This study aims to determine, first, whether autistic people experience greater levels of non-communicable health conditions and second, whether these are explained by differences in demographics (i.e. sex, country of residence, ethnicity, education level), alcohol use, smoking, body mass index (BMI), or family history of medical conditions.

METHOD

We employed a cross-sectional, convenience-sampling study via an anonymous, online survey of autistic and non-autistic adults (n = 2305, mean age = 41.6, 65.9% female, 49% autistic). The survey asked participants to self-report information about their demographics, autism diagnosis, diet, exercise, sleep, sexual health, substance use, personal medical history, and family medical history (for all first-degree, biological relatives). Binomial logistic regression across four iterative models of increasing complexity was applied to assess rates of physical health conditions. The Benjamini-Hochberg correction was used to account for multiple testing, and only physical health conditions that achieved at least 1% endorsement within the overall sample (n > 22) were included in the analysis to reduce risk of Type I errors. We also used novel network analysis methods to test whether there are increased levels of multimorbidity between autistic and non-autistic people.

RESULTS

There were significantly elevated rates of non-communicable conditions across all organ systems in autistic people, including gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and haematological conditions. We confirmed previous findings by showing highly significant differences in rates of neurological and gastrointestinal symptoms (p < 0.0001). In addition, we established in the largest sample to date that Ehler-Danlos Syndrome (EDS) was more likely to occur among autistic females compared to non-autistic females. Finally, we found a higher prevalence of Coeliac's disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, but these results became non-significant after accounting for family history.

LIMITATIONS

Our study is biased towards females, white individuals, highly educated people, and UK residents, likely due to sampling biases. Our self-report study design may also exclude those who lack access to computers, or those with intellectual disability. Our network analysis is also limited in size.

CONCLUSIONS

This study provides evidence of widespread, physical health comorbidity that spans nearly all major organ systems in autistic adults compared to non-autistic adults, using both binary logistic regression and network models. Healthcare professionals must be made aware of the range of co-occurring physical health conditions that may be more common among autistic people. However, our findings also point towards potential avenues requiring further exploration, such as the association of autism with both Coeliac's disease and EDS.

Encapsulation of probiotic Lactobacillus acidophilus ATCC 4356 in alginate-galbanum (Ferula Gummosa Boiss) gum microspheres and evaluation of the survival in simulated gastrointestinal conditions in probiotic Tahini halva

One of the famous traditional confectionery products is Tahini halva. The aim of this study was the production of probiotic halva using free Lactobacillus acidophilus (FLA) and microencapsulated Lactobacillus acidophilus (MLA) with sodium alginate and galbanum gum as the second layer. The survival rate of MLA and FLA during heat stress, storage time, and simulation gastrointestinal condition in Tahini halva was assessed. The survival rates of MLA and FLA under heat stress were 50.13% and 34.6% respectively. During storage in Tahini halva, the cell viability loss was 3.25 Log CFU g-1 and 6.94 Log CFU g-1 for MLA and FLA, separately. Around 3.58 and 4.77 Log CFU g-1 bacteria were reduced after 6 h of exposure in simulated gastrointestinal conditions, for MLA and FLA respectively. These results suggest that the use of alginate and galbanum gum is a promising approach to protecting L. acidophilus against harsh environmental conditions.

Study of growth kinetic and gastrointestinal stability of acid-bile resistant Lactobacillus plantarum strains isolated from Siahmazgi traditional cheese

In this study, 22 Lactobacillus plantarum strains isolated from Siahmazgi traditional cheese were evaluated using different tests including resistance to low pH (1.50 and 2.50) and bile salt (0.50 and 1.00%), growth kinetic at low pH values and survival under simulated gastric and intestinal fluids. All the strains retained their viability at pH 2.50. However, the survival of all of the isolates was decreased at pH 1.50. Ten out of 22 strains which were able to tolerate low pH were selected for further investigations. All the selected isolates were able to grow at low pH. Strain F2 showed the highest specific growth rate. Five out of 10 isolates showed a significant decrease in bacterial count varied from 2.00 to 7.00 log CFU mL^-1 during 3 hr exposure to 0.50% bile salt, while five isolates represented resistance to 0.50% bile during 3 hr. A significant reduction was observed in survival of all of the isolate at 1.00% bile salt concentration. Furthermore, viability of the selected isolates was lowered during 1 hr incubation under gastric conditions, while it remained unchanged within next 2 hr. Although, no significant changes were seen in bacterial count of the selected isolates during 1 hr of exposure to simulated intestinal condition, the survival of the isolates was relatively reduced after 3 hr. In conclusion, five out of 22 examined L. plantarum isolates showed appropriate resistance properties, therefore, could be good candidates for further examinations including functional and safety evaluation supporting their use as probiotics.

Stability of human salivary extracellular vesicles containing dipeptidyl peptidase IV under simulated gastrointestinal tract conditions

Background

Extracellular vesicles (EVs) have been isolated from various sources, including primary and cultured cell lines and body fluids. Previous studies, including those conducted in our laboratory, have reported the stability of EVs under various storage conditions.

Methods

EVs from human whole saliva were separated via size-exclusion chromatography. To simulate the effects of gastric or intestinal fluids on the stability of EVs, pepsin or pancreatin was added to the samples. Additionally, to determine the effect of bile acids, sodium cholate was added. The samples were then subjected to western blotting, dynamic light scattering, and transmission electron microscopy analyses. In addition, the activity of dipeptidyl peptidase (DPP) IV retained in the samples was examined to monitor the stability of EVs.

Results

Under acidic conditions, with pepsin mimicking the milieu of the stomach, the EVs remained stable. However, they partially lost their membrane integrity in the presence of pancreatin and sodium cholate, indicating that they may be destabilized after passing through the duodenum. Although several associated proteins, such as mucin 5B and CD9 were degraded, DPP IV was stable, and its activity was retained under the simulated gastrointestinal conditions.

Conclusion

Our data indicate that although EVs can pass through the stomach without undergoing significant damage, they may be disrupted in the intestine to release their contents. The consistent delivery of active components such as DPP IV from EVs into the intestine might play a role in the efficient modulation of homeostasis of the signal transduction pathways occurring in the gastrointestinal tract.

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The morphology of EVs was retained after enzyme or sodium cholate treatment.

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Although EVs could pass through the stomach, they were disrupted in the intestine.

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DPP IV of EVs may remain intact following digestion and solubilization in the gastrointestinal tract.

Selenium release kinetics and mechanism from Cordyceps sinensis exopolysaccharide-selenium composite nanoparticles in simulated gastrointestinal conditions

This work investigated selenium (Se) release kinetics and mechanism from exopolysaccharide-selenium nanoparticles (EPS-SeNPs, Se/EPS = 1/20, 1/1 and 4/3) in simulated gastric (SGF) and intestinal fluids (SIF) using kinetics models of Zero order, First order, Higuchi, Hixson-Crowell and Korsmeyer-Peppas. EPS-SeNPs showed an increase in size from 80-125 nm to 250-320 nm and more ambiguous boundary after gastrointestinal digestion. Se/EPS ratio and pH had significant influence on Se release. Se release kinetics from EPS-SeNPs (Se/EPS = 1/1 and 4/3 in SGF) followed a classical Fickian diffusion, in contrast to an erosion governed by macromolecular chains relaxation for Se/EPS = 1/20 in SIF. Se release from EPS-SeNPs (Se/EPS = 1/1 and 4/3 in SIF) was well-fitted to Korsmeyer-Peppas model and followed a non-Fickian mechanism controlled by both diffusion and erosion. Additionally, EPS-SeNPs (Se/EPS = 1/20) showed a low Se release after SGF digestion, but a high release after SIF digestion, suggesting its application in controlled release of Se-enriched supplements for Se-deficiency treatment.

Relationship between blood ammonia levels and gastrointestinal condition in patients with cirrhosis

AIM: To investigate the relationship between gastrointestinal condition and blood ammonia levels in cirrhotic patients to provide a basis for reducing the intestinal absorption of ammonia and lowering blood ammonia in the clinical setting.

METHODS: Patients with simple cirrhosis, cirrhosis with gastrointestinal bleeding, liver cirrhosis with constipation, simple intestinal obstruction, or simple gastrointestinal bleeding treated at our hospital from January 2011 to December 2012 were studied. Healthy subjects were also included as controls. The changes in ammonia in each group, and ammonia changes in cirrhotic patients with gastrointestinal disorders before and after treatment were compared.

RESULTS: Blood ammonia was significantly higher in patients with simple cirrhosis than in those with simple gastrointestinal bleeding or intestinal obstruction and normal subjects (t = 6.251, 6.802, 7.328, P < 0.05), in cirrhotic patients with gastrointestinal bleeding than in those with simple gastrointestinal bleeding or simple intestinal obstruction and normal subjects (t = 5.152, 5.738, 6.173, P < 0.05), in cirrhotic patients with constipation than in those with simple gastrointestinal bleeding or simple intestinal obstruction and normal objects (t = 8.402, 8.477, 9.132, P < 0.05 ), and in cirrhotic patients with gastrointestinal bleeding or constipation than in those with simple cirrhosis (t = 7.241, 11.374, P < 0.05). In 42 cirrhotic patients with gastrointestinal bleeding or constipation, blood ammonia levels after acidification treatment were significantly lower than those before treatment (51.4 μmol/L ± 18.5 μmol/L vs 85.3 μmol/L ± 33.7 μmol/L, t = 21.402, P < 0.05).

CONCLUSION: The gastrointestinal condition has a close relationship with blood ammonia levels in patients with cirrhosis. Cirrhotic patients with intestinal disorders have significantly increased blood ammonia levels. Acidification treatment can effectively reduce intestinal ammonia levels and prevent hepatic encephalopathy.