1. Nutritional status of children with Autism Spectrum Disorder
Zazpe I1,2, Mari-Bauset S3, Bes-Rastrollo M1, de la Fuente C1, Mari-Sanchis A4, Morales Suárez-Varela MM5
1Department. of Preventive Medicine and Public Health, University of Navarra, Spain. CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain. 2Department of Nutrition and Food Sciences and Physiology, University of Navarra, Spain. 3Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Spain; Biomedical Research Centre Network on Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Spain. 4 Clinical Nutrition and Dietetics Unit, Navarra Hospital Complex, Spain. 5Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain, Biomedical Research Centre Network on Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Spain; Center for Public Health Research (CSISP), Spain.
Introduction
Autism spectrum disorder (ASD) comprises a complex set of behaviorally defined neurodevelopmental abnormalities in two core areas: deficits in social communication and fixated or restricted, repetitive or stereotyped behaviors and interests, including food
Selectivity. Atypical feeding behaviors, the adoption of gluten-free casein-free (GFCF) diets, and aberrant behavior patterns (with different levels of physical activity as well as idiosyncratic social skills and poor social interaction) are factors that imply risks of both excessive and insufficient intake.
Objectives
To evaluate nutrient intakes and Healthy Eating Index (HEI) scores comparing children with autism spectrum disorder (ASD) with typically developing (TD) children and the intakes of both groups with dietary reference intakes, given that previous research has suggested that the diet of children with ASD may not meet recommendations.
Participants and Methods
A matched case-control study was conducted using 3-day food diaries completed by 105 ASD (93 boys and 12 girls) and 495 TD (266 boys and 229 girls) children between 6 and 9 years old in Valencia (Spain). The Children were recruited from the same area and similar socioeconomic backgrounds. The probability of intake adequacy was assessed using the estimated average requirement cut-point method and a probabilistic approach. Student´s t-tests and χ2 tests were used to assess the statistical significance of the differences between means and proportions, respectively. Linear regression was applied to compare the two groups and logistic regression to assess the results with respect to Spanish dietary recommendations. Multivariable-adjusted models were fitted to control for potentials confounders.
All statistical tests were two tailed and alpha was set at 0.05
Autism spectrum disorder (ASD) comprises a complex set of
behaviorally defined neurodevelopmental abnormalities in two core
areas: deficits in social communication and fixated or restricted,
repetitive or stereotyped behaviors and interests, including food
Selectivity. Atypical feeding behaviors, the adoption of gluten-free
casein-free (GFCF) diets, and aberrant behavior patterns (with
different levels of physical activity as well as idiosyncratic social
skills and poor social interaction) are factors that imply risks of both
excessive and insufficient intake.
Results
We observed no significant differences between the two groups in age (93.7 vs months, p=0.22), HEI score (65.32 vs , p=0.43), total dietary intake (1955 vs. 1961, p=0.86) or food variety score (3.72 vs. 3.53, p= 0.45). Linear regression showed that ASD children had a lower intake of cereals and dairy products and higher intake of legumes and vegetables (β=-20.1, 95% CI: to -9.58; β=-40.8, 95%CI: to -3.22; β=21.2, 95%CI: 4.98, 37.36; β=22.5, 95%CI 4.77, respectively). This is consistent with higher intakes of fibre, folate, vitamins B6, E, and K, magnesium and zinc, but lower intakes of calcium and sodium in these children. Logistic regression analysis showed that adherence to recommendations was greater for fibre (OR=0.28, 95%CI 0.09, 0.82) and vitamin E (OR=0.42, 95%CI 0.22, 0.82), and poorer for riboflavin (OR=13.08, 95%CI 1.04, ) and vitamin C (OR=2.60, 95%CI 1.12, 6.03) in ASD than TD children. Overall, however, many children in both ASD and TD groups did not consume the recommended amounts of certain nutrients.
Conclusions
These results suggest that dietary assessment and recommendations should be made on a case-by-case basis. The findings should be used to guide future clinical and research activities in this area. More research is needed to corroborate our results.
Declaration of Conflicting Interests
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
We observed no significant differences between the two groups in age
(93.7 vs months, p=0.22), HEI score (65.32 vs , p=0.43),
total dietary intake (1955 vs. 1961, p=0.86) or food variety score (3.72
vs. 3.53, p= 0.45). Linear regression showed that ASD children had a
lower intake of cereals and dairy products and higher intake of legumes
and vegetables (β=-20.1, 95% CI: to -9.58; β=-40.8, 95%CI:
to -3.22; β=21.2, 95%CI: 4.98, 37.36; β=22.5, 95%CI 4.77,
40.28 respectively). This is consistent with higher intakes of fibre,
folate, vitamins B6, E, and K, magnesium and zinc, but lower intakes of
calcium and sodium in these children. Logistic regression analysis
showed that adherence to recommendations was greater for fibre
(OR=0.28, 95%CI 0.09, 0.82) and vitamin E (OR=0.42, 95%CI 0.22,
0.82), and poorer for riboflavin (OR=13.08, 95%CI 1.04, ) and
vitamin C (OR=2.60, 95%CI 1.12, 6.03) in ASD than TD children.
Overall, however, many children in both ASD and TD groups did not
consume the recommended amounts of certain nutrients.
To evaluate nutrient intakes and Healthy Eating Index (HEI) scores
comparing children with autism spectrum disorder with typically
developing (TD) children and the intakes of both groups
with dietary reference intakes, given that previous research has
suggested that the diet of children with ASD may not meet
recommendations.
These results suggest that dietary assessment and recommendations
should be made on a case-by-case basis. The findings should be used to
guide future clinical and research activities in this area. More research is
needed to corroborate our results.
A matched case-control study was conducted using 3-day food diaries
completed by 105 ASD (93 boys and 12 girls) and 495 TD (266 boys
and 229 girls) children between 6 and 9 years old in Valencia (Spain).
The children were recruited from the same area and similar
socioeconomic backgrounds. The probability of intake adequacy was
assessed using the estimated average requirement cut-point method
and a probabilistic approach. Student´s t-tests and χ2 tests were used
to assess the statistical significance of the differences between means
and proportions, respectively. Linear regression was applied to
compare the two groups and logistic regression to assess the results
with respect to Spanish dietary recommendations. Multivariable-
adjusted models were fitted to control for potentials confounders.
All statistical tests were two tailed and alpha was set at 0.05.
The authors declare no potential conflicts of interest with respect to the
research, authorship, and/or publication of this article.