Relationship of Dietary Intake to Gastrointestinal Symptoms in Children with Autistic Spectrum Disorders

doi:10.1016/j.biopsych.2006.07.013

Biological Psychiatry

Volume 61, Issue 4, 15 February 2007, Pages 492-497

https://doi.org/10.1016/j.biopsych.2006.07.013 Get rights and content

Background

Gastrointestinal (GI) symptoms and abnormalities in stool consistency are frequently reported by parents of children with autism spectrum disorders (ASD). The purpose of this study was to 1) describe dietary intake of a cohort of children with ASD compared with normative data and 2) determine whether GI symptoms and stool consistency are related to dietary intake.

Methods

Data from diet diaries of children (3–8 years) with ASD (n = 62) were analyzed by a registered pediatric dietician to compare to RDA standards for total calories, protein, carbohydrate, and fat. Dietary intake was correlated with descriptors of stool consistency using cumulative logistic regression methods.

Results

Intake of calories, carbohydrates, and fat were in the average range; protein intake was increased (211% of RDA). Reported frequency of GI abnormalities, including abnormal stool consistency (e.g., bulky or loose), was increased (54%). No statistically significant relationships between stool consistency and dietary intake were observed.

Conclusions

In this sample, there was a high rate of reported gastrointestinal symptoms, despite lack of medical causes. Intake was adequate for calories and carbohydrates and increased for protein. The children did not exhibit excessive carbohydrate intake. There was no association of nutrient intake to changes in stool consistency.

Section snippets

Methods and Materials

This study was part of a larger double-blind, placebo-controlled crossover trial that examined the effect of human synthetic secretin (ChiRhoClin, Silver Spring, Maryland) on behavior in children with ASDs (Levy et al 2003). All parents were informed of the study protocol by the nurse coordinator, and written informed consent was obtained. The Institutional Review Board of The Children’s Hospital of Philadelphia approved the study.

In the earlier study, children were recruited from a sample of

Results

Records of 62 subjects who participated in the secretin trial (Levy et al 2003) were analyzed. All subjects had growth parameters, 52 subjects had complete diet histories, and 59 subjects had complete stool diaries. Subjects ranged from 44 to 104 months old, with a mean age of 73 months. The sample included 50 boys (89.6%) and was 90% Caucasian, 5% African American, and 5% Latino. No subjects had weight measurements below the 5th percentile. Six subjects (9.7%) had weight measurements over the

Discussion

There is anecdotal clinical evidence, reports from families, and some support in the literature of increased GI symptoms—in particular, loose stools—among children with ASD. From discussion with clinical colleagues with expertise in pediatric gastroenterology, the working theory was that children with ASD often had selective diets, with a predominance of carbohydrates (hence the term “great white diet”) and that this resulted in diarrhea because of the increased osmotic load (Hammer et al 1989

Conclusions

This study describes increased frequency of GI symptoms in a well-characterized cohort of children diagnosed with ASD. Results suggest that GI symptoms are not significantly related to abnormal patterns of dietary intake of macronutrients—specifically, carbohydrates, proteins, or fats. The GI symptom of abnormal stool pattern such as loose stools or bulky volume is unlikely due to other factors that include an intrinsic, as yet uncharacterized GI disease specific to autism spectrum disorder,

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Nutrient intake profile, growth patterns and hemoglobin levels in children with ASD – A case control study in Mysuru, India
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Citation Excerpt :
Diet-related issues which mainly include feeding problems, limited nutrient intakes, food refusal, restricted diets are frequently associated with ASD children as reported by their parents (Bandini, Anderson, Curtin, Cermak, & Evans, 2010; Ledford & Gast, 2006). Along with these, gastro-intestinal discomfort, acid reflux, leaky guts, diarrhea and constipation are nutritional-related medical issues commonly exhibited by ASD (Ahearn, Casinte, Nault, & Green, 2001; Buie et al., 2010; Cornish, 1998; Field, Garland, & Williams, 2003; Klein & Nowak, 1999; Levy et al., 2007; McElhanon, McCracken, Karpen, & Sharp, 2014; Sowmyanath, 2014; Whiteley, Rodgers, & Shattock, 2000). There is substantial research carried out worldwide on nutritional aspects among ASD children.
Research evidence suggests that the prevalence rate of Autism Spectrum Disorder (ASD) is increasing in India. In addition to socio-behavioral problems, diet-related issues are common and recurrent problems experienced by children with ASD. As there is only minimal research work done on these aspects, the present study is carried out as a case control snapshot to investigate the nutrient intakes of ASD children (n = 104) residing in the Mysore region, India. This data is compared with the nutrient intakes of Typically Developing (TD) controls (n = 121).
We evaluated ASD severity using Indian Scale for assessment of autism (ISAA). All the children aged (2–15 years) were examined for anthropometric measurements and hemoglobin levels. Dietary intakes and mealtime behavior problems were assessed using three-day food records and food frequency questionnaires.
Significantly (p< = 0.05) lower Z_HA, Z_WA, Z_BMIA values among ASD children were observed. Limited food variety and inadequacy of micronutrient intakes were observed and the ORs of ASD children were at 3.57-fold higher risk for failing to meet the recommendations for calcium. Their risk was 2.17-fold higher for iron, 3.06-fold for zinc, 2.92–fold for folate and 1.87-fold higher for vitamin C compared with the TD children. Overall, mealtime behavior issues and eating problems were higher (28.66%) among ASD than TD (10.51 %).Hemoglobin levels of ASD were significantly (p< = 0.05) lower than TD children. There was a negative partial correlation between Hb levels (8.97 ± 0.91 g/dL) and micronutrients viz., Iron (5.14 ± 2.83 mg), Calcium (2.52 ± 1.41 mg), Zn (2.81 ± 1.90 mg),Folate (83.48 ± 52.57 mg) and Vitamin B6 (0.47 ± 0.29 mg). We found that while controlling the ISSA scores (1.94 ± 0.62), there was no significant difference. Thus signifying ISSA score has strong influence on controlling the relationship between Hb levels and selected micronutrients.
Observations strongly indicate that well-timed nutritional screening and personalized dietary interventions can prevent/manage the nutritional deficiencies prevalent among ASD children of this region.
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Autism spectrum disorder (ASD) is an umbrella term for several neurodevelopmental disorders, all of which are characterized by deficits in social communication and social interactions, accompanied by restricted and repetitive patterns of behaviors, interests, and/or activities. Because each patient with ASD exhibits a broad spectrum of communicative and behavioral problems, no therapy has proved effective on its own. Current mainstream interventions for improving ASD patients' communication and social behaviors include psychosocial and educational strategies, speech therapies, behavioral interventions, developmental therapies, and parenting skills training programs. Altered gut microbiota in patients with ASD has been reported, and the use of probiotics to benefit children with ASD investigated in several clinical trials. This review article summarizes the existing literature on gut microbiota in ASD patients, as well as clinical trials using probiotics as an intervention with such patients, and discusses the altered taxa.
Gastrointestinal alterations in autism spectrum disorder: What do we know?
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There is an emerging body of evidence associating children having autism spectrum disorder (ASD) with gastrointestinal (GI) symptoms, such as abdominal pain, chronic diarrhea, constipation, vomiting, gastroesophageal reflux, intestinal infections, and increased intestinal permeability. Moreover, in many studies, large differences in the composition of intestinal microbiota and metabolic products between ASD patients and controls were reported. Deepening the role and the biology of the gut microbiome may be fundamental to elucidate the onset of GI symptoms in ASD individuals and their etiopathogenetic causes. The gut-brain axis may affect brain development and behaviors through the neuroendocrine, neuroimmune, and autonomic nervous systems.
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Gut microbiota has been implicated in many disorders including Autism Spectrum Disorder (ASD). ASD is a neurodevelopmental brain disorder affecting individuals leading to restricted and repetitive pattern of behaviour and disruption of communication and social interactions. Altered microbiome and the presence or absence of key species capable of affecting specific responses in levels of their fermentation products are reflected in the urinary metabolite profile of patients. The aim of our study is to develop an improvised method for the detection and quantification of urinary p-cresol levels which could serve as an indicator for GI microbial dysbiosis. The p-cresol analysis was achieved using HPLC by a reverse phase C18 column with mobile phase composition of Acetonitrile/water/formic acid (10:90:0.05, v/v/v) in an isocratic mode of elution with a flow rate of 1.0 mL/min. The mass analysis of p-cresol was performed using LC-MS [Triple Quadrupole Liquid Chromatography Mass Spectrometer] in negative ESI mode with electron multiplier detector. p-cresol was eluted at a retention time of approximately 3.4 min. The standard calibration curves had a superior regression coefficient of greater than 0.99 (R² > 0.99) and were linear over a range from 0.0005 mg/mL to 0.015 mg/mL. The method was validated by analysis of six replicates with 0.08% relative standard deviation and method detection and quantification limits were 20 ng/mL and 50 ng/mL respectively. Further validation of method on real urine samples from two groups of children (Control population:< 10 years of age; 5M: 3F and ASD individuals: <10 years of age; All males) showed that detection was effective over a wide range of metabolite at levels as high as 149.73 μg/mL to as low as 0.897 μg/mL. This study reports a rapid, validated and sensitive method for the detection of p-cresol in urine samples.
Constipation in Children with Autism Spectrum Disorder Associated with Increased Emergency Department Visits and Inpatient Admissions
2018, Journal of Pediatrics
Citation Excerpt :
Oral sensory issues in children with ASD is often associated with picky eating and restrictive dietary intake, which has been proposed as a contributing factor to the increased rates of constipation in children with ASD.1,16 However, other studies have indicated that a restrictive dietary intake is not the primary cause of constipation, with no association found between dietary intake and constipation in those with ASD.13,17 Further studies are needed to determine just what role dietary intake plays in constipation in the ASD population.
To evaluate whether constipation in children with autism spectrum disorder (ASD) is associated with increased emergency department (ED) visits and inpatient admissions compared with constipation in children without ASD.
The Nationwide Emergency Department Sample was used to retrospectively examine demographic data, clinical characteristics, and outcomes of children with ASD and children without ASD who visited the ED for constipation between 2006 and 2014.
ED visits by children with ASD were more likely to be constipation-related compared with visits by children with other chronic conditions or children with no chronic conditions (1.9% vs 0.6% vs 0.9%; P < .001). Children with ASD were more likely than children with other chronic conditions or no chronic conditions to be admitted to the hospital after an ED visit for constipation (15.0% vs 10.6% vs 1.2%; P < .001). Hospital charges were higher in children with ASD than in those without chronic conditions.
Constipation is responsible for a large proportion of ED visits and more inpatient admissions resulting from these ED visits. These findings suggest a need for developing more effective outpatient therapies for constipation in children with ASD.
Dietary status and nutrient intake of children with autism spectrum disorder: A case-control study
2018, Research in Autism Spectrum Disorders
Citation Excerpt :
Decreased intake of calcium and vitamin D appear to be one of the most consistent findings in children with ASD (Cornish, 1998; Hediger et al., 2008; Herndon et al., 2009; Sadowska & Cierebiej, 2011; Xia, Zhou, Sun, Wang, & Wu, 2010; Zimmer et al., 2012). While the intake of B vitamins, magnesium, iron, vitamin A, vitamin C, and folic acid also appears to be inadequate in some studies, the nutritional requirements in these children in terms of energy and macronutrients seems to be satisfied (Emond et al., 2010; Hyman et al., 2012; Levy et al., 2007; Xia et al., 2010). Given the limited amount of studies available regarding this topic and the mixed results reported to date (Cermak, Curtin, & Bandini, 2010; Mari-Bauset et al., 2014a; Sharp et al., 2013), this aim of this study was to compare dietary intake in 2-to-8-year-old US children with and without an ASD diagnosis.
Parents and caregivers of children with Autism Spectrum Disorders (ASD) often report that their children are picky or problem eaters. Additionally, it has been reported that children with ASD often experience gastrointestinal problems such as constipation, diarrhea, flatulence, cramping, bloating, and pain. These factors raise concerns for the nutritional status of children with ASD, given that refusal to consume particular foods coupled with the inability to tolerate, digest, and/or absorb these foods can compromise overall nutritional status.
This case-control study investigated dietary intake of 86 children with ASD aged 2–8 years and 57 age-matched peers without ASD. Caregivers of participants who met inclusion criteria completed a health history questionnaire, provided information on dietary intake and feeding behavior, and completed a nutrition physical.
The majority of participants (both with and without ASD) met or exceeded macronutrient intake recommendations and dietary percentages for total energy, protein, carbohydrate, and fat consumption. Approximately 25% of participants consumed an inadequate or borderline amount of total calories per day based on Dietary Reference Intake (DRI) guidelines created by US Institute of Medicine (IOM). The majority of participants consumed inadequate amounts of vitamins A, D, E, folic acid and calcium. Furthermore, children with ASD consumed lower levels of protein and calcium, and were deficient in a number of B vitamins, including B1, B2, B3, B6, and folate, compared to similarly-aged children without ASD.
Given the impact of nutrition on growth and health status, a formal dietary assessment for all children with ASD is recommended.

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Original articleRelationship of Dietary Intake to Gastrointestinal Symptoms in Children with Autistic Spectrum Disorders

Background

Methods

Results

Conclusions

Section snippets

Methods and Materials

Results

Discussion

Conclusions

Gastroenterology

Am J Gastroenterol

J Pediatr

Trends Neurosci

Am J Gastroenterol

Res Dev Disabil

Lancet Neurol

Lancet

Constipation with acquired megarectum in children with autism

Pediatrics

An assessment of food acceptance in children with autism or pervasive developmental disorder—not otherwise specified

J Autism Dev Disord

Plasma amino acids profiles in children with autism: Potential risk of nutritional deficiencies

J Autism Dev Disord

Diagnostic and Statistical Manual of Mental Disorders

How commonly are known medical conditions associated with autism?

J Autism Dev Disord

Relation of childhood gastrointestinal disorders to autism: Nested case–control study using data from the UK General Practice Research Database

BMJ

An audit of referrals of children with autistic spectrum disorder to the dietetic service

J Hum Nutr Diet

24-hour dietary recall and food record methods

Educating Children with Autism

Abnormal intestinal permeability in children with autism

Acta Paediatr

Gastrointestinal factors in autistic disorder: A critical review

J Autism Dev Disord

Correlates of specific childhood feeding problems

J Paediatr Child Health

No evidence for a new variant of measles-mumps-rubella-induced autism

Pediatrics

Evaluation of nutrient intakes and diets

Autism and medical disorders: A review of the literature

Dev Med Child Neurol

Malabsorption and cerebral dysfunction: A multivariate and comparative study of autistic children

J Autism Child Schizophr

Studies of osmotic diarrheas induced in normal subjects by ingestion of polyethylene glycol and lactulose

J Clin Invest

Infectious and immune factors in the pathogenesis of neurodevelopmental disorders: Epidemiology, hypotheses, and animal models

Ment Retard Dev Disabil Res Rev

Autism and gastrointestinal symptoms

Curr Gastroenterol Rep

Areas of agreement about effective practices among programs serving young children with autism spectrum disorders

Infants Young Child

The gluten connection: The association between schizophrenia and celiac disease

Acta Psychiatr Scand

Original article
Relationship of Dietary Intake to Gastrointestinal Symptoms in Children with Autistic Spectrum Disorders