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Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R, Alhawamdeh R. Role of gastrointestinal health in managing children with autism spectrum disorder. World J Clin Pediatr 2023; 12:171-196. [PMID: 37753490 PMCID: PMC10518744 DOI: 10.5409/wjcp.v12.i4.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
Children with autism spectrum disorders (ASD) or autism are more prone to gastrointestinal (GI) disorders than the general population. These disorders can significantly affect their health, learning, and development due to various factors such as genetics, environment, and behavior. The causes of GI disorders in children with ASD can include gut dysbiosis, immune dysfunction, food sensitivities, digestive enzyme deficiencies, and sensory processing differences. Many studies suggest that numerous children with ASD experience GI problems, and effective management is crucial. Diagnosing autism is typically done through genetic, neurological, functional, and behavioral assessments and observations, while GI tests are not consistently reliable. Some GI tests may increase the risk of developing ASD or exacerbating symptoms. Addressing GI issues in individuals with ASD can improve their overall well-being, leading to better behavior, cognitive function, and educational abilities. Proper management can improve digestion, nutrient absorption, and appetite by relieving physical discomfort and pain. Alleviating GI symptoms can improve sleep patterns, increase energy levels, and contribute to a general sense of well-being, ultimately leading to a better quality of life for the individual and improved family dynamics. The primary goal of GI interventions is to improve nutritional status, reduce symptom severity, promote a balanced mood, and increase patient independence.
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Affiliation(s)
- Mohammed Al-Beltagi
- Pediatric Department, Faculty of Medicine, Tanta University, Algharbia, Tanta 31511, Egypt
- Pediatrics, Univeristy Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Pathology Department, Salmaniya Medical Complex, Ministry of Health, Manama, Manama 12, Bahrain
- Medical Microbiology Section, Pathology Department, Irish Royal College of Surgeon, Bahrain, Muharraq, Busaiteen 15503, Bahrain
| | - Adel Salah Bediwy
- Pulmonology Department, Faculty of Medicine, Tanta University, Algharbia, Tanta 31527, Egypt
- Pulmonology Department, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama, Manama 26671, Bahrain
| | - Reem Elbeltagi
- Medicine, The Royal College of Surgeons in Ireland-Bahrain, Muharraq, Busiateen 15503, Bahrain
| | - Rawan Alhawamdeh
- Pediatrics Research, and Development Department, Genomics Creativity and Play Center, Manama, Manama 0000, Bahrain
- Pediatrics Research, and Development Department, SENSORYME Dubai 999041, United Arab Emirates
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2
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Lasheras I, Real-López M, Santabárbara J. Prevalence of gastrointestinal symptoms in autism spectrum disorder: A meta-analysis. An Pediatr (Barc) 2023; 99:102-110. [PMID: 37474417 DOI: 10.1016/j.anpede.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/22/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION A high prevalence of gastrointestinal (GI) symptoms has been described in children and adolescents with autism spectrum disorder (ASD). In addition, there is evidence that presence of GI symptoms is associated to greater severity of ASD. However, the frequency of GI symptoms in children and adolescents with ASD varies widely across studies, and their true prevalence is unknown. Therefore, the objective of this study was to estimate the prevalence of GI symptoms in children and adolescents with ASD. MATERIAL AND METHOD We conducted a meta-analysis following the PRISMA guidelines. We carried out a rapid systematic search for recent clinical and observational studies published from August 2012 in PubMed. The statistical analyses were performed with the software R. RESULTS Of 91 potentially eligible articles, only 8 met our inclusion criteria. The prevalence of GI symptoms ranged between 0% and 69%, with an estimated general prevalence of 33% (95% CI, 13%-57%), higher than that reported by a previous meta-analysis for the general paediatric population. This difference is even greater in the specific comparison of studies that applied the paediatric version of the ROME III questionnaire (QPGS-ROME III). CONCLUSIONS The results confirmed the hypothesis that there is a higher prevalence of functional GI symptoms in paediatric patients with ASD compared to their neurotypical peers.
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Affiliation(s)
- Isabel Lasheras
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain
| | - Matias Real-López
- Unidad Predepartamental de Medicina, Universitat Jaume I, Castellón, Spain; Programa de Trastorno Mental Grave de la Infancia y la Adolescencia, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain.
| | - Javier Santabárbara
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Ministerio de Ciencia e Innovación, Madrid, Spain; Instituto de Investigación Sanitaria, IIS-Aragón, Zaragoza, Spain
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3
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Bresciani G, Da Lozzo P, Lega S, Bramuzzo M, Di Leo G, Dissegna A, Colonna V, Barbi E, Carrozzi M, Devescovi R. Gastrointestinal Disorders and Food Selectivity: Relationship with Sleep and Challenging Behavior in Children with Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020253. [PMID: 36832380 PMCID: PMC9955415 DOI: 10.3390/children10020253] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023]
Abstract
The aim of this study was to evaluate the interaction between gastrointestinal (GI) disorders, sleep problems, and challenging behaviors in children with a diagnosis of Autism Spectrum Disorder (ASD) and their effect on parental stress. The secondary objective was to assess the frequency and type of GI and feeding disorders in a sample of children with ASD through a multidisciplinary assessment and, finally, to investigate families' perceptions and satisfaction with the proposed multidisciplinary approach. All children underwent a comprehensive gastroenterological and neuropsychiatric evaluation supported by standardized questionnaires. Pediatric gastroenterologists, specifically trained in Applied Behavior Analysis (ABA), provided advice for parent-delivered behavioral intervention for food selectivity. Thirty-six children with an autism diagnosis (29 males, age 4.5 +/-2.2 years, mean +/- SD) were enrolled. A positive correlation between sleep problems and aggressive behavior was found, and this association was stronger in children experiencing more problematic mealtime behaviors (b = 0.788, p = 0.014). Sleep difficulties were associated with stereotyped behaviors and parent-perceived stress. Parents interviewed about the gastroenterology visit perceived this multidisciplinary approach as helpful in addressing food selectivity. This study shows that sleep and mealtime issues can have a synergistic negative impact on ASD symptoms. A multidisciplinary approach and an integrated assessment of GI, feeding problems, and sleep disorders could be helpful in diagnosing comorbidities and to provide targeted advice to parents.
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Affiliation(s)
- Giulia Bresciani
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Prisca Da Lozzo
- Department of Medical, Surgical and Health Sciences, University of Trieste, 38122 Trieste, Italy
| | - Sara Lega
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Matteo Bramuzzo
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Grazia Di Leo
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Andrea Dissegna
- Department of Life Sciences, University of Trieste, 38122 Trieste, Italy
- CIMeC Centre for Mind/Brain Sciences, University of Trento, 38122 Rovereto, Italy
| | - Vissia Colonna
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Egidio Barbi
- Department of Medical, Surgical and Health Sciences, University of Trieste, 38122 Trieste, Italy
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
- Correspondence:
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
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KULUSHTAYEVA B, NURYMKHAN G, TUMENOVA G, BAYAZITOVA K, IMANBAYEV A. Composite flour production and assessment of the safety quality of gluten-free bread. FOOD SCIENCE AND TECHNOLOGY 2023. [DOI: 10.1590/fst.56522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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5
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Yu Y, Huang J, Chen X, Fu J, Wang X, Pu L, Gu C, Cai C. Efficacy and Safety of Diet Therapies in Children With Autism Spectrum Disorder: A Systematic Literature Review and Meta-Analysis. Front Neurol 2022; 13:844117. [PMID: 35359629 PMCID: PMC8963985 DOI: 10.3389/fneur.2022.844117] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/07/2022] [Indexed: 12/27/2022] Open
Abstract
Objective Autism Spectrum Disorder is a neurodevelopmental disorder, with a rapid increase in recognition over the past decade. Interest in alternative therapies is growing annually, such as dietary therapies including gluten-free and/or casein-free diet, and the ketogenic diet. However, there is no consensus on the efficacy and safety of dietary therapy in children with ASD up to now. This study aimed to assess the efficacy and safety of these diet interventions for children with ASD based on a meta-analysis of global data. Methods Seven databases (Cochrane Library, PubMed, EMBASE, Web of Science, VIP, CNKI, and Wanfang) were searched according to the established inclusion criteria, from the inception of the databases to August 18, 2021. The Cochrane Bias risk assessment tool was intended to assess the quality of the included studies. Review Manager 5.4 software was used as an efficacy analysis tool of the included studies, taking the core autistic symptoms and scales of ASD as therapeutic efficacy evaluations. Results In total, 7 RCTs with 338 participants were finally obtained. All studies assessed the association between core autistic symptoms and therapeutic diet, showing a statistically significant effect (standard mean difference (SMD) of −0.51, 95% confidence interval (Cl): −0.81 to −0.21), in which two studies which followed the GFD diet reported significant reductions in social behaviors (SMD of−0.41, 95% Cl: −0.75 to −0.06), showing no correlation with the length of the interventions (P < 0.05). Two studies were performed in KD diet suggested a significant effect in core symptoms (SMD of −0.67, 95% Cl: −1.04 to −0.31). No statistically significant changes were observed in the GFCF diet, GFD diet, cognition, communication, and stereotypical behaviors subgroups (all P > 0.05). Conclusion The results of a meta-analysis suggest that diet therapies can significantly ameliorate core symptoms of ASD, and GFD diets are conducive to improving social behaviors. Although the results suggest the effectiveness of dietary therapy for ASD, limited by the small sample size of RCTs, more well-designed, and high-quality clinical trials are needed to validate the above conclusions. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021277565.
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Affiliation(s)
- Yuping Yu
- Graduate College of Tianjin Medical University, Tianjin, China.,Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Jinyue Huang
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China.,Tianjin Pediatric Research Institute, Tianjin, China
| | - Xiaofang Chen
- Graduate College of Tianjin Medical University, Tianjin, China.,Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Jia Fu
- Graduate College of Tianjin Medical University, Tianjin, China.,Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Xinhui Wang
- Graduate College of Tianjin Medical University, Tianjin, China.,Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Linjie Pu
- Graduate College of Tianjin Medical University, Tianjin, China.,Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Chunyu Gu
- Graduate College of Tianjin Medical University, Tianjin, China.,Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Chunquan Cai
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China.,Tianjin Pediatric Research Institute, Tianjin, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China.,Department of Neurosurgery, Tianjin Children's Hospital, Tianjin, China
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6
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de Sousa Franckilin LR, Dos Santos ACPM, Freitas FEDA, Vieira IG, de Freitas Jorge CE, Neri DG, de Abreu MVC, Fonseca JK, Loffi RG, Foureaux G. Gluten: do only celiac patients benefit from its removal from the diet? FOOD REVIEWS INTERNATIONAL 2022. [DOI: 10.1080/87559129.2021.2024566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Renato Guimarães Loffi
- Departamento de Ciência, Tecnologia e Inovação, Treini Biotecnologia Ltda, Belo Horizonte, Brazil
| | - Giselle Foureaux
- Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Nutrição, Angiogold: Medicina Integrativa, Belo Horizonte, Brazil
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7
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Öz S, Bayhan P. An investigation of the relationship between the eating behaviours of children with typical development and autism spectrum disorders and parent attitudes during mealtime eating behaviours and parent attitudes during mealtime. Child Care Health Dev 2021; 47:877-885. [PMID: 34273188 DOI: 10.1111/cch.12899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nutrition has significant importance in the course of growth and development in early childhood. Selective and fussy eating is prevalent among children with autism spectrum disorder and can have a profound impact on parents' mealtime actions. AIMS The study aimed to investigate the relationship between parental mealtime actions and the eating behaviours of children aged 3-5 years with typical development (TD) and autism spectrum disorder (ASD). METHODS A total of 180 parents of children between 3 and 5 years in Ankara participated in the study; 90 were parents of children with TD, and 90 were parents of children with ASD. We measured the variables using the Brief Assessment of Mealtime Behaviour in Children (BAMBIC), Children's Eating Behaviour Questionnaire (CEBQ), and Parent Mealtime Action Scale (PMAS). RESULTS The results revealed that food refusal, disruptive behaviours, and limited variety in TD children were related to parental actions, such as the use of rewards. We also found a negative correlation between enjoyment of food and the use of rewards. Children with ASD displayed differences concerning food refusal, and their parents were found to prepare more special meals for them compared with children with TD. CONCLUSION Despite differences, the eating behaviours of children with TD and ASD show similarities in some cases. If a child has a low interest in eating, then their parents tend to be more insistent, use more rewards, and offer special meals. On the contrary, a child's high interest in eating harms such parental behaviours. Because an acknowledgement that a relationship exists between the eating behaviours of children and parental actions would make intervening to shape parental attitudes easier, it is recommended that future studies should be carried out to respond to the eating problems of children by working with parents.
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Affiliation(s)
- Sena Öz
- Faculty of Health Sciences, Department of Child Development, Ankara University, Keçiören, Ankara, Turkey
| | - Pınar Bayhan
- Faculty of Health Sciences, Department of Child Development, Hacettepe University, Altındağ, Ankara, Turkey
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8
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Keklik D, Nazik E. Knowledge about childhood autism among nurses in Turkey: A cross-sectional descriptive study. Perspect Psychiatr Care 2021; 57:1637-1644. [PMID: 33484175 DOI: 10.1111/ppc.12729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to determine the level of knowledge that nurses possess about childhood autism. DESIGN AND METHODS This cross-sectional descriptive study was conducted among 278 nurses. A personal information form, which was created by the present researchers, and Knowledge about Childhood Autism among Health Workers questionnaire were used to collect data. FINDINGS The mean knowledge level was 12.29 ± 3.19. There was a significant difference in total scale scores as a function of participation in a training program on childhood autism and acquaintance with a person with autism. PRACTICE IMPLICATIONS Nurses play an important role in the early diagnosis of childhood autism. Therefore, they should be educated about childhood autism.
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Affiliation(s)
- Dilara Keklik
- Faculty of Health Sciences, Çukurova University, Adana, Turkey
| | - Evşen Nazik
- Faculty of Health Sciences, Çukurova University, Adana, Turkey
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9
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Nadeem MS, Murtaza BN, Al-Ghamdi MA, Ali A, Zamzami MA, Khan JA, Ahmad A, Rehman MU, Kazmi I. Autism - A Comprehensive Array of Prominent Signs and Symptoms. Curr Pharm Des 2021; 27:1418-1433. [PMID: 33494665 DOI: 10.2174/1381612827666210120095829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a multifaceted neurodevelopmental condition characterized by multiple psychological and physiological impairments in young children. According to the recent reports, 1 out of every 58 newly-born children is suffering from autism. The aetiology of the disorder is complex and poorly understood, hindering the adaptation of targeted and effective therapies. There are no well- established diagnostic biomarkers for autism. Hence the analysis of symptoms by the pediatricians plays a critical role in the early intervention. METHODS In the present report, we have emphasized 24 behavioral, psychological and clinical symptoms of autism. RESULTS Impaired social interaction, restrictive and narrow interests, anxiety, depression; aggressive, repetitive, rigid and self-injurious behavior, lack of consistency, short attention span, fear, shyness and phobias, hypersensitivity and rapid mood alterations, high level of food and toy selectivity; inability to establish friendships or follow the instructions; fascination by round spinning objects and eating non-food materials are common psychological characteristics of autism. Speech or hearing impairments, poor cognitive function, gastrointestinal problems, weak immunity, disturbed sleep and circadian rhythms, weak motor neuromuscular interaction, lower level of serotonin and neurotransmitters, headache and body pain are common physiological symptoms. CONCLUSION A variable qualitative and quantitative impact of this wide range of symptoms is perceived in each autistic individual, making him/her distinct, incomparable and exceptional. Selection and application of highly personalized medical and psychological therapies are therefore recommended for the management and treatment of autism.
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Affiliation(s)
- Muhammad Shahid Nadeem
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Bibi Nazia Murtaza
- Department of Zoology, Abbottabad University of Science and Technology (AUST), Abbottabad, Pakistan
| | - Maryam A Al-Ghamdi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Akbar Ali
- College of Pharmacy, Northern Border University Rafha 1321, Saudi Arabia
| | - Mazin A Zamzami
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Jalaluddin A Khan
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Aftab Ahmad
- College of Pharmacy, Northern Border University Rafha 1321, Saudi Arabia
| | - Mujaddad Ur Rehman
- Department of Zoology, Abbottabad University of Science and Technology (AUST), Abbottabad, Pakistan
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Thorsteinsdottir S, Olsen A, Olafsdottir AS. Fussy Eating among Children and Their Parents: Associations in Parent-Child Dyads, in a Sample of Children with and without Neurodevelopmental Disorders. Nutrients 2021; 13:2196. [PMID: 34202394 PMCID: PMC8308294 DOI: 10.3390/nu13072196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Parents are important agents in shaping children's eating habits. However, the associations between children's and parents' eating behaviors are complex and may be convoluted for various reasons, such as parenting feeding styles, stressful mealtimes, and children's neurodevelopmental disorders (ND), such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). The purpose of this study was to analyze associations between parents and their children's fussy eating, in a cross-sectional sample of children, with and without ND. Ninety-seven parents answered screening questionnaires prior to an intervention study. Associations were investigated using two-way ANOVAs and chi-square analyses. Overall, children with ND accepted fewer food items and consumed unhealthier foods more frequently than children without ND. Fussy eating parents had children who accepted fewer food items and consumed unhealthier foods more frequently than children whose parents were not fussy eaters. Interaction effects were not significant. A higher proportion of fussy eating parents, than non-fussy eating parents, had children who had difficulties with combined foods and hidden ingredients. The findings highlight the need for further investigation into the relationships between parents' influence on their children's eating behavior and food consumption, as well as possible reciprocal impacts.
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Affiliation(s)
- Sigrun Thorsteinsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, School of Education, University of Iceland, 105 Reykjavík, Iceland;
| | - Annemarie Olsen
- Department of Food Science, University of Copenhagen, 1958 Copenhagen, Denmark;
| | - Anna S. Olafsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, School of Education, University of Iceland, 105 Reykjavík, Iceland;
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11
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Al-Beltagi M. Autism medical comorbidities. World J Clin Pediatr 2021; 10:15-28. [PMID: 33972922 PMCID: PMC8085719 DOI: 10.5409/wjcp.v10.i3.15] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/12/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023] Open
Abstract
Medical comorbidities are more common in children with autism spectrum disorders (ASD) than in the general population. Some genetic disorders are more common in children with ASD such as Fragile X syndrome, Down syndrome, Duchenne muscular dystrophy, neurofibromatosis type I, and tuberous sclerosis complex. Children with autism are also more prone to a variety of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headaches, and congenital abnormalities of the nervous system. Besides, sleep disorders are a significant problem in individuals with autism, occurring in about 80% of them. Gastrointestinal (GI) disorders are significantly more common in children with ASD; they occur in 46% to 84% of them. The most common GI problems observed in children with ASD are chronic constipation, chronic diarrhoea, gastroesophageal reflux and/or disease, nausea and/or vomiting, flatulence, chronic bloating, abdominal discomfort, ulcers, colitis, inflammatory bowel disease, food intolerance, and/or failure to thrive. Several categories of inborn-errors of metabolism have been observed in some patients with autism including mitochondrial disorders, disorders of creatine metabolism, selected amino acid disorders, disorders of folate or B12 metabolism, and selected lysosomal storage disorders. A significant proportion of children with ASD have evidence of persistent neuroinflammation, altered inflammatory responses, and immune abnormalities. Anti-brain antibodies may play an important pathoplastic mechanism in autism. Allergic disorders are significantly more common in individuals with ASD from all age groups. They influence the development and severity of symptoms. They could cause problematic behaviours in at least a significant subset of affected children. Therefore, it is important to consider the child with autism as a whole and not overlook possible symptoms as part of autism. The physician should rule out the presence of a medical condition before moving on to other interventions or therapies. Children who enjoy good health have a better chance of learning. This can apply to all children including those with autism.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama P.O. Box 26671, Bahrain, Bahrain
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 0000000, Al Gharbia, Egypt
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12
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Al-Beltagi M. Autism medical comorbidities. World J Clin Pediatr 2021. [PMID: 33972922 DOI: 10.5409/wjcp.v10.i3.15.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Medical comorbidities are more common in children with autism spectrum disorders (ASD) than in the general population. Some genetic disorders are more common in children with ASD such as Fragile X syndrome, Down syndrome, Duchenne muscular dystrophy, neurofibromatosis type I, and tuberous sclerosis complex. Children with autism are also more prone to a variety of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headaches, and congenital abnormalities of the nervous system. Besides, sleep disorders are a significant problem in individuals with autism, occurring in about 80% of them. Gastrointestinal (GI) disorders are significantly more common in children with ASD; they occur in 46% to 84% of them. The most common GI problems observed in children with ASD are chronic constipation, chronic diarrhoea, gastroesophageal reflux and/or disease, nausea and/or vomiting, flatulence, chronic bloating, abdominal discomfort, ulcers, colitis, inflammatory bowel disease, food intolerance, and/or failure to thrive. Several categories of inborn-errors of metabolism have been observed in some patients with autism including mitochondrial disorders, disorders of creatine metabolism, selected amino acid disorders, disorders of folate or B12 metabolism, and selected lysosomal storage disorders. A significant proportion of children with ASD have evidence of persistent neuroinflammation, altered inflammatory responses, and immune abnormalities. Anti-brain antibodies may play an important pathoplastic mechanism in autism. Allergic disorders are significantly more common in individuals with ASD from all age groups. They influence the development and severity of symptoms. They could cause problematic behaviours in at least a significant subset of affected children. Therefore, it is important to consider the child with autism as a whole and not overlook possible symptoms as part of autism. The physician should rule out the presence of a medical condition before moving on to other interventions or therapies. Children who enjoy good health have a better chance of learning. This can apply to all children including those with autism.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama P.O. Box 26671, Bahrain, Bahrain
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13
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Gluten and Autism Spectrum Disorder. Nutrients 2021; 13:nu13020572. [PMID: 33572226 PMCID: PMC7915454 DOI: 10.3390/nu13020572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/15/2021] [Accepted: 01/27/2021] [Indexed: 12/14/2022] Open
Abstract
An expanding body of literature is examining connections between Autism Spectrum Disorder (ASD) and dietary interventions. While a number of specialist diets have been suggested as beneficial in ASD, gluten has received particularly close attention as a potentially exacerbating factor. Reports exist suggesting a beneficial effect of the gluten-free diet (GFD) in ameliorating behavioural and intellectual problems associated with ASD, while epidemiological research has also shown a comorbidity between ASD and coeliac disease. However, both caregivers and clinicians have expressed an uncertainty of the value of people with ASD going gluten-free, and as the GFD otherwise receives considerable public attention a discussion which focuses specifically on the interaction between ASD and gluten is warranted. In this review we discuss the historical context of ASD and gluten-related studies, and expand this to include an overview of epidemiological links, hypotheses of shared pathological mechanisms, and ultimately the evidence around the use and adoption of the GFD in people with ASD.
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Tan C, Frewer V, Cox G, Williams K, Ure A. Prevalence and Age of Onset of Regression in Children with Autism Spectrum Disorder: A Systematic Review and Meta-analytical Update. Autism Res 2021; 14:582-598. [PMID: 33491292 DOI: 10.1002/aur.2463] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/10/2020] [Accepted: 12/05/2020] [Indexed: 01/22/2023]
Abstract
A systematic review published in 2013 reported 32% of children on the autism spectrum experience skill loss, known as autistic regression. However, the frequency varied depending on definition and measures used to capture skills. Retrospective parent report and prospective observation indicate loss of language and/or social skills, with motor skills typically unaffected. Our aim was to update the prevalence and age of onset of autistic regression through a meta-analysis of the literature to understand if there have been changes to the reported onset and prevalence since 2010. A systematic literature search was conducted using Medline, Embase, PsycINFO, and the Cochrane Library databases and included studies published from 2010 onward. Risk of bias assessment was performed on included studies. A random effects model was used to calculate the pooled prevalence and age of onset of autistic regression. Ninety-seven studies were included in the systematic review, of which 75 studies involving 33,014 participants had sufficient data for meta-analytic syntheses. The pooled proportion of autistic regression was 30% (95% confidence interval [CI]: 27-32%) but heterogeneity was high (I2 = 96.91) and did not reduce with sensitivity or subgroup analyses based on study design or clinical differences, respectively. Prevalence varied according to risk of bias (low: 27%) and definition of regression (language: 20%, language/social: 40%, mixed: 30%, and unspecified: 27%). Weighted average age of onset was 19.8 months. Findings from this meta-analysis highlight the importance of developing a standardized definition of autistic regression, and tools to measure this at multiple time points during early childhood development. LAY SUMMARY: About a third of children with Autism Spectrum Disorder experience loss of skills, which is also known as autistic regression. This paper provides an update of the rate of autistic regression in children and the age when they first experience loss of skills, based on current studies. The findings from this review contribute to our understanding of the onset patterns of autistic regression. Unfortunately, studies are not sufficiently similar, making it difficult to provide clear answers on the exact timing or type of regression seen in different children.
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Affiliation(s)
- Christine Tan
- Department of Paediatrics and Melbourne School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Veronica Frewer
- Department of Paediatrics and Melbourne School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Georgina Cox
- Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics & Education Research, Monash University, Clayton, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics and Melbourne School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics & Education Research, Monash University, Clayton, Victoria, Australia.,Developmental Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Alexandra Ure
- Department of Paediatrics and Melbourne School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics & Education Research, Monash University, Clayton, Victoria, Australia.,Developmental Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
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15
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Longitudinal Epidemiological Study of Autism Subgroups Using Autism Treatment Evaluation Checklist (ATEC) Score. J Autism Dev Disord 2020; 50:1497-1508. [PMID: 30062397 PMCID: PMC7211200 DOI: 10.1007/s10803-018-3699-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Here we report the results of the subgroup analyses of an observational cohort of children whose parents completed the Autism Treatment Evaluation Checklist (ATEC) over the period of several years. A linear mixed effects model was used to evaluate longitudinal changes in ATEC scores within different patient subgroups. All groups decreased their mean ATEC score over time indicating improvement of symptoms, however there were significant differences between the groups. Younger children improved more than the older children. Children with milder ASD improved more than children with more severe ASD in the Communication subscale. There was no difference in improvement between females vs. males. One surprising finding was that children from developed English-speaking countries improved less than children from non-English-speaking countries.
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16
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González-Domenech PJ, Díaz Atienza F, García Pablos C, Fernández Soto ML, Martínez-Ortega JM, Gutiérrez-Rojas L. Influence of a Combined Gluten-Free and Casein-Free Diet on Behavior Disorders in Children and Adolescents Diagnosed with Autism Spectrum Disorder: A 12-Month Follow-Up Clinical Trial. J Autism Dev Disord 2020; 50:935-948. [PMID: 31813108 DOI: 10.1007/s10803-019-04333-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The use of alternative interventions, such as gluten-free and casein-free (GFCF) diets, is frequent due to limited therapies for Autism Spectrum Disorder (ASD). Our aims were to determine the influence of a GFCF diet on behavior disorders in children and adolescents diagnosed with ASD and the potential association with urinary beta-casomorphin concentrations. Thirty-seven patients were recruited for this crossover trial. Each patient consumed a normal diet (including gluten and casein) for 6 months and a GFCF diet for another 6 months. The order of the intervention (beginning with normal diet or with GFCF diet) was assigned randomly. Patients were evaluated at three time-points (at the beginning of the study, after normal diet and after GFCF diet). Questionnaires regarding behavior and autism and dietary adherence were completed and urinary beta-casomorphin concentrations were determined at each time-point. No significant behavioral changes and no association with urinary beta-casomorphin concentrations were found after GFCF diet. A 6-month GFCF diet do not induce significant changes in behavioral symptoms of autism and urinary beta-casomorphin concentrations. Further studies with a long follow-up period similar to ours and including placebo and blinding elements are needed to identify better those respondents to GFCF diets.
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Affiliation(s)
- Pablo José González-Domenech
- Child and Adolescent Mental Health Unit, Virgen de las Nieves University Hospital, Granada, Spain.,Department of Psychiatry, University of Granada, Granada, Spain
| | - Francisco Díaz Atienza
- Child and Adolescent Mental Health Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - Carlos García Pablos
- Child and Adolescent Mental Health Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | | | | | - Luis Gutiérrez-Rojas
- Department of Psychiatry, University of Granada, Granada, Spain. .,Psychiatry Service, Hospital Clínico San Cecilio, Granada, Spain. .,CTS-549 Research Group, Institute of Neuroscience, Granada, Spain.
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17
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Gluten-Free Diet in Children with Autism Spectrum Disorders: A Randomized, Controlled, Single-Blinded Trial. J Autism Dev Disord 2020; 50:482-490. [PMID: 31659595 DOI: 10.1007/s10803-019-04266-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
To determine whether a gluten-free diet (GFD) compared with a gluten-containing diet (GD) influences functioning of children with autism spectrum disorders (ASD), we performed a randomized, controlled, single-blinded trial. Sixty-six children (36-69 months) with ASD, within the normal IQ (> 70) range, who had been on a GFD for at least 8 weeks before enrollment were eligible for inclusion. After an 8-week run-in period on a GFD, the GFD group continued this diet and the GD group consumed at least one normal meal containing gluten per day for 6 months. There were no differences between groups in autistic symptoms, maladaptive behaviors, or intellectual abilities after the intervention. A GFD compared with a GD did not affect functioning of children with ASD.Trial registration ClinicalTrials.gov, number NCT02280746.
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18
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Rubenstein E, Croen L, Lee LC, Moody E, Schieve LA, Soke GN, Thomas K, Wiggins L, Daniels J. Community-based service use in preschool children with autism spectrum disorder and associations with insurance status. RESEARCH IN AUTISM SPECTRUM DISORDERS 2019; 66:101410. [PMID: 32831903 PMCID: PMC7430759 DOI: 10.1016/j.rasd.2019.101410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND ASD-related services can improve outcomes for children, but less is known about service outside of school settings during preschool age. We aimed to describe amount and category of community-based service use among 3-5-year-old children with ASD and examine differences by health insurance. METHODS We used cross-sectional data on 792 children with ASD diagnoses in the Study to Explore Early Development, a community-based study of neurodevelopment with enrollment between 2012-2016. Mothers reported current child service use and insurance status at study entry. We used log-Poisson and logistic regression to compare service use by insurance group. RESULTS Nearly 40% of children were not receiving community-based services at study entry. Children with public insurance had fewer total services than children with private or both insurances. After adjustment for sociodemographic confounders, insurance status was not associated with types of different categories of community-based services. However, children with public insurance alone were least likely to receive community-based behavioral therapy and most likely to receive psychotropic medication compared to other insurances. CONCLUSION Many preschool-aged children do not receive community-based services, with receipt associated with insurance type. Increasing access and availability for evidence-based service, especially for beneficiaries of public insurance, may improve service use and outcomes.
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Affiliation(s)
- Eric Rubenstein
- University of Wisconsin Madison, Waisman Center, 1500 Highland Ave, Madison WI, 53705
| | - Lisa Croen
- Division of Research, Kaiser Permanente of Northern California, 2000 Broadway, Oakland, CA 94612
| | - Li-Ching Lee
- Bloomberg School of Public Health, Johns Hopkins University, 315 N Wolfe St, Baltimore, MD 21231
| | - Eric Moody
- Wyoming Institute of Disabilities, University of Wyoming, 1000 E. University Ave. Laramie, WY 82071
| | - Laura A. Schieve
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA 30329
| | - Gnakub N. Soke
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA 30329
| | - Kathleen Thomas
- Cecil G. Sheps Center for Health Services Research, University of North Carolina Chapel Hill, 725 Martin Luther King Jr. Blvd. Chapel Hill, NC 27599-7590
| | - Lisa Wiggins
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 1600 Clifton Road, Atlanta, GA 30329
| | - Julie Daniels
- University of North Carolina Gillings School of Global Public Health, Department of Biostatistics, 137 East Franklin Street Room 6702 CB# 8030 Chapel Hill, NC 27514
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19
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Höfer J, Bachmann C, Kamp-Becker I, Poustka L, Roessner V, Stroth S, Wolff N, Hoffmann F. Willingness to try and lifetime use of complementary and alternative medicine in children and adolescents with autism spectrum disorder in Germany: A survey of parents. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1865-1870. [DOI: 10.1177/1362361318823545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Regardless of their limited evidence and potential adverse effects, use of complementary and alternative medicine is common in children with autism spectrum disorder. Nevertheless, data on complementary and alternative medicine use in children with autism spectrum disorder in Germany are lacking. Therefore, a questionnaire survey on the use of complementary and alternative medicine was distributed to parents of children with autism spectrum disorder from three academic autism spectrum disorder outpatient clinics in Germany. Of 211 respondents, 46% stated that their child currently used or had ever used some form of complementary and alternative medicine in their life. The complementary and alternative medicine modalities most frequently used were manipulative and body-based methods (e.g. craniosacral therapy). And 18% of caregivers expressed willingness to try complementary and alternative medicine treatments for their child with autism spectrum disorder in the future, with mind–body interventions predominating. Health professionals should be aware of the considerable complementary and alternative medicine use prevalence among children with autism spectrum disorder and offer parents information about its effectiveness and potential side effects.
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20
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Ferguson BJ, Dovgan K, Severns D, Martin S, Marler S, Gross Margolis K, Bauman ML, Veenstra-VanderWeele J, Sohl K, Beversdorf DQ. Lack of Associations Between Dietary Intake and Gastrointestinal Symptoms in Autism Spectrum Disorder. Front Psychiatry 2019; 10:528. [PMID: 31402878 PMCID: PMC6669230 DOI: 10.3389/fpsyt.2019.00528] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Many individuals with autism spectrum disorder (ASD) have significant gastrointestinal (GI) symptoms, but their etiology is currently unknown. Dietary interventions are common in children and adolescents with ASD, including diets with increased omega-3 fatty acids or diets free of gluten and/or casein, which may also impact GI symptoms and nutrition. However, little is known about the relationship between nutritional intake and GI symptomatology in ASD. The objective of this study was to assess the relationships between GI symptoms, omega-3 intake, micronutrients, and macronutrients in children with ASD. Methods: A total of 120 children diagnosed with ASD participated in this multisite study. A food frequency questionnaire was completed by the patient's caretaker. The USDA Food Composition Database was utilized to provide nutritional data for the food items consumed by each participant. GI symptomatology was assessed using a validated questionnaire on pediatric gastrointestinal symptoms. Results: There were no significant associations between GI symptoms and the amount of omega-3 fatty acids and/or other micro- and macronutrients contained in the diet. Conclusions: This study suggests that dietary variations do not appear to drive GI symptoms, nor do GI symptoms drive dietary variations in those with ASD, although causation cannot be determined with this observational assessment. Furthermore, there may be other factors associated with lower GI tract symptoms in ASD, such as increased stress response.
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Affiliation(s)
- Bradley J Ferguson
- Department of Health Psychology, School of Health Professions, University of Missouri, Columbia, MO, United States.,Thompson Center for Autism & Neurodevelopmental Disorders, Columbia, MO, United States.,Department of Radiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Kristen Dovgan
- Department of Psychology, Marist College, Poughkeepsie, NY, United States
| | - Danielle Severns
- School of Medicine, University of Missouri, Columbia, MO, United States
| | - Shannon Martin
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
| | - Sarah Marler
- Medical Exploration of Neurodevelopmental Disorders Clinic (MEND), Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kara Gross Margolis
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, & Nutrition & Morgan Stanley Children's Hospital, Columbia University Medical Center, Columbia, MO, United States
| | - Margaret L Bauman
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States
| | | | - Kristin Sohl
- Thompson Center for Autism & Neurodevelopmental Disorders, Columbia, MO, United States.,Department of Child Health, University of Missouri, Columbia, MO, United States
| | - David Q Beversdorf
- Thompson Center for Autism & Neurodevelopmental Disorders, Columbia, MO, United States.,Department of Radiology, University of Missouri School of Medicine, Columbia, MO, United States.,Departments of Neurology & Psychological Sciences, William and Nancy Thompson Endowed Chair in Radiology, University of Missouri, Columbia, MO, United States
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21
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Lambert J, Mejia S, Vojdani A. Plant and human aquaporins: pathogenesis from gut to brain. Immunol Res 2018; 67:12-20. [DOI: 10.1007/s12026-018-9046-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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22
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Brief Report: Implementation of a Specific Carbohydrate Diet for a Child with Autism Spectrum Disorder and Fragile X Syndrome. J Autism Dev Disord 2018; 50:1800-1808. [DOI: 10.1007/s10803-018-3704-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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