Abstract
Objective: The study aimed to compare the nutritional status and symptoms of preschool children with autism spectrum disorder (ASD) from two regions of China, and to analyze the association between nutritional status and symptoms of ASD.Methods: In this cross-sectional study, 738 ASD children and 302 typically developing children (TD) were recruited from Chongqing and Hainan of China. Symptoms of ASD children were evaluated with the Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS), and Childhood Autism Rating Scale (CARS). Neurodevelopment of ASD children was assessed with the Gesell Developmental Scale (GDS). Nutritional status was evaluated by anthropometric measures, biochemical detection of micronutrients, and providing questionnaire and food frequency questionnaire (FFQ) to caregivers.Results: Comparing ASD children with local TD children, ASD children consumed fewer whole grains, milk and dairy products, beans and soy products, vegetables, and fruits than local TD children in both regions. The serum concentrations of folate, vitamin B12 (VB12), and vitamin D (VD) were consistently lower in ASD children in both regions. Comparing the ASD children between the two regions, the ASD children in Chongqing had significantly higher mean scores of CARS, SRS, and ABC than those in Hainan. The ASD children in Chongqing consumed fewer whole grains, seafood, and fruits than those in Hainan. The serum concentrations of ferritin, vitamin A (VA), VB12, and VD were reduced in the ASD children of Chongqing than those in Hainan, and the ASD children in Chongqing had higher deficiency rates of zinc, ferritin, VA, and VD than those in Hainan. The serum levels of VA, VD, and folate showed a negative association with symptom scores of ASD children. VD and zinc levels had a positive association with the GDS scores of ASD children.Conclusions: ASD children exhibit a higher risk of nutrient deficiencies than neurotypical children, and there are regional differences in the nutritional status of ASD children. Micronutrients VA, VD, folate, and zinc levels were correlated with symptoms and development of ASD children. Therefore, it is essential to provide detailed nutrition evaluation and individualized nutrition interventions for ASD children from different backgrounds.
Highlights
Autism spectrum disorders (ASDs) are wide-spectrum neurodevelopmental disorders characterized by early appearing social communication deficits and repetitive sensory motor behaviors [1]
There were 738 ASD children and 302 typically developing (TD) children recruited between August 2016 and October 2018
They were assigned to four groups: ASD children in Chongqing (379 boys and 66 girls, aged 4.39 ± 1.25 years), TD children in Chongqing (102 boys and 99 girls, aged 4.44 ± 0.82 years), ASD children in Hainan province (250 boys and 43 girls, aged 4.28 ± 1.37 years), and TD children in Hainan province (50 boys and 51 girls, aged 4.35 ± 1.18 years)
Summary
Autism spectrum disorders (ASDs) are wide-spectrum neurodevelopmental disorders characterized by early appearing social communication deficits and repetitive sensory motor behaviors [1]. Studies reported decreased dietary intake and serum concentrations likely below the reference range or lower than neurotypical controls of folate [7], vitamin B12 (VB12) [7, 8], vitamin D (VD) [9, 10], vitamin A [11, 12], iron [13], and zinc [12] in children with autism. Ugur [16] found that serum VD and folate levels of ASD children were not significantly different from those of neurotypical controls. Hope et al [17] found that patients with neurodevelopmental disorders (including ASD) have a significantly higher serum level of VB12 than neurotypical children. Whether ASD children present malnutrition or more frequently than typical children is inconclusive because the nutritional status of an individual is a consequence of complex mechanisms and interactions, which could be affected
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