Nutritional Status and Feeding Behavior of Children with Autism Spectrum Disorder in the Middle East and North Africa Region: A Systematic Review

Abstract

Autism spectrum disorder (ASD) in children is associated with increased risks of overweight/obesity and underweight, altered nutrient profile, and abnormal feeding behaviors. This systematic review aimed to elucidate the literature on the nutritional status of children with ASD in the Middle East North Africa (MENA) region, by providing a summary and assessment of the body of evidence. A systematic review of English and Arabic publications up to November 2020 was conducted of five databases in addition to the grey literature, which include a nutrition-related parameter, from both experimental and observational study designs. Children with ASD (ASD-C) between 2 and 19 years in the MENA Region were the target population. For risk of bias, the Academy of Nutrition and Dietetics’ Quality Criteria Checklist (QCC) was adopted. The number of published articles was grossly limited. Forty-three articles were included, of which only four articles reported a low risk of bias; therefore, the results were interpreted in light of methodological limitations. Both overweight and underweight were common in ASD-C, although not consistently different than typically developing children. Nutrient inadequacies of energy, protein, omega-3, and others; deficiencies in serum iron indicators and calcium, as well as vitamins B12, B9, and D levels; and higher levels of homocysteine and omega-6/omega-3 ratios were reported. Feeding behavior problems were also common in ASD-C. Understanding nutritional requirements and food preferences can guide the planning of the appropriate comprehensive interventions for ASD-C. Various nutritional and behavioral concerns were identified in the included studies; however, they were subject to methodological weaknesses, which limited the generalizability of these results. Future research is warranted that must be directed to finding strong evidence using robust study designs on nutritional status and feeding behaviors of ASD-C, with a particular emphasis on the MENA Region.

Micronutrient deficiency and supplements in schoolchildren and teenagers

“…The autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects several areas of mental development: uncertainty persists as to the efficacy of therapeutic diets [42]. Nevertheless, a retrospective survey of consumers who purchased Autism Nutrition Research Center products (ANRC-EP), a multi-micronutrient product for children or adults with ASD, enrolled 211 people including 85 children aged 5--15 years.…”

Anthropometric Profile, Overweight/Obesity Prevalence, and Socioeconomic Impact in Moroccan Children Aged 6–12 Years Old with Autism Spectrum Disorder

“…Particularly in emerging countries such as Morocco, data on ASD children remain scarce [3,10,[20][21][22]. While there are available data on ASD obesity among young Moroccan children under the age of 12 residing abroad [23,24], the prevalence of ASD within Morocco itself remains elusive.…”

“…However, the presence of significant disparities across regions highlights the need for a nuanced understanding of the specific profile of affected populations. Notably, data concerning children with ASD remain scarce in emerging countries [ 3 ].…”

“…Children with ASD face a multitude of consequences from obesity, with one of the most significant being the premature development of metabolic syndrome. This complex condition is characterized by a set of risk factors that dramatically increase susceptibility to cardiovascular diseases, type 2 diabetes, high blood pressure, high cholesterol, and other metabolic disorders [ 3 , 4 , 9 ]. Moreover, obesity can also exacerbate the symptoms associated with ASD.…”

Anthropometric measurements and food intake questionnairesas assessment tools for nutritional status in children with autism spectrum disorders

“…Growth and Development Monitoring: Anthropometric measurements, such as height, weight, and head circumference, are essential tools for tracking the growth and development of children with both typical development (TD) and ASD. These measurements can help identification of potential growth-related issues, such as growth delays or abnormalities in head size, which may be indicative of underlying medical conditions (14).…”