شیوع سوء تغذیه و اضافه وزن در بین کودکانی با اختلال طیف اوتیسم

• Children with ASD present feeding difficulties which affect nutritional status and growth indices.• Average intake, in this population, does not consistently reflect the nutritional risk.• The use of calculated sum of nutritional deficiencies reveals the nutritional risk.• ASD is a risk factor for overweight in children.• Total nutrition and its components should be thoroughly evaluated in ASD children.Children with autism spectrum disorder (ASD) are at risk of developing nutritional deviations. Three to six year old children with ASD were compared to their typically developing siblings and to a typically developing age and gender matched control group, in order to evaluate their intake and body mass index.Nutrient intake was compared to the Dietary Reference Intake using three-day diet diaries completed by the parents. The sum percentage of nutritional deficiencies in the ASD group compared to the typical development group was 342.5% (±122.9%) vs. 275.9% (±106.8%), respectively (P = 0.026). A trend toward higher deficiency in the ASD group was observed as compared to the sibling group 363% (±122.9%) vs. 283.2% (±94.7%) (P = 0.071). A higher body mass index was found in the ASD group compared to their counterparts, despite their nutritional deficiencies. In conclusion, children with ASD are more likely to suffer from nutritional deficiencies despite higher body mass index.

Dietary habits and preferences of children with Autism Spectrum Disorder (ASD) have been investigated in recent years and have become a recognized clue for diagnosis (American Psychiatric Association, 2013). Most studies support the presence of feeding difficulties in ASD children and the additional challenges these difficulties add to the familial burden of care. These difficulties often include: nutritional consumption lower than the recommendations (Zimmer et al., 2012 and Lockner et al., 2008) and food refusal (Cornish, 1998), pica disorder (Emond et al., 2010) a limited variety, not using specific utensils (Schreck, Williams, & Smith, 2004), variance in amounts consumed from different food groups, such as less dairy products and more protein-rich products (Herndon, DiGuiseppi, Johnson, Leiferman, & Reynolds, 2009), throwing food, rejecting or preferring foods according to texture, color or temperature (Johnson et al., 2008 and Ahearn et al., 2001) and oral motor impairments (Williams, Gibbons, & Schreck, 2005). There are several case reports of children with ASD who suffered from various unrecognized nutrient deficiencies, with a degree of severity to subsequently cause health risks such as scurvy (Niwa et al., 2012, Cole et al., 2011 and Duggan et al., 2007), rickets, and vitamin A deficiency related ophthalmological conditions (Clark et al., 1993 and Steinemann and Christiansen, 1998). In previous studies, the average nutrient consumption was used to calculate deficiencies: Johnson et al. (2008) found that children with ASD had a lower average vitamin K consumption as compared to children with typical development, (6.8 mg/day vs. 8.9 mg/day, respectively P < 0.025). However, more children with typical developmental did not meet the recommended dietary intake (RDA) for magnesium, (using average intake) compared to ASD children (53% vs. 6%, respectively, P < 0.025). Herndon et al. (2009) found children with ASD had a lower average calcium consumption (747 mg/day vs. 894 mg/day, respectively P < 0.05), a higher average vitamin B6 consumption (1.5 g/day vs. 1.2 g/day, respectively P < 0.05) and a higher average vitamin E consumption (8 mg/day vs. 4 mg/day, respectively P < 0.05) as compared to their counterparts. Emond et al. (2010) also analyzed average nutrients’ consumption. Compared with controls, children with ASD consumed less vitamin C (P = .007) and vitamin D (P = .004) and more iodine (P = .01). Zimmer et al. (2012) found lower consumption of protein (72.77 g/day vs. 92.64, respectively P < 0.05), calcium (945.18 mg/day vs. 1221.98 mg/day P < 0.05), magnesium (314.89 mg/day vs. 265.93 mg/day, respectively P < 0.05), vitamin B12 (4.69 μg/day vs. 6.66 μg/day, respectively P < 0.05), and vitamin D (198.62 IU/day vs. 319.86 IU/day, respectively P < 0.05). Therefore, there is paucity of evidence-based data to establish recommendations and guidelines for treatment ( Raiten and Massaro, 1986, Schreck et al., 2004, Schmitt et al., 2008, Lockner et al., 2008 and Bandini et al., 2010). In the current analysis we investigated the nutritional status of 3–6 year old children with ASD and herein report our preliminary findings. We addressed the nutritional assessment using a different approach which may better reflect the nutritional status of these children.

The current study shows that although children with ASD had a higher Z-score for weight and BMI, they had more nutritional deficiencies than children with typical development. In the current analysis, children with ASD are more susceptible for various nutritional deficiencies as compared to a typical developed child and each child with ASD may have different deficiencies as compared to other ASD children. We recommend that feeding problems in children with ASD should be addressed by individual assessment and a trained multidisciplinary team.