Nutritional Status and Symptoms in Preschool Children With Autism Spectrum Disorder: A Two-Center Comparative Study in Chongqing and Hainan Province, China

Abstract

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.

Serum Folate Status Is Primarily Associated With Neurodevelopment in Children With Autism Spectrum Disorders Aged Three and Under—A Multi-Center Study in China

“…Feeding problems, such as being a picky eater, lack of food variety, and resistance to new foods are more prevalent than in typically developing children. It is reported that children with ASD often prefer energy-dense foods such as meat, sugar-sweetened beverages, and snacks, and reject vegetables and fruits ( 34 , 35 ). In our study, children with ASD exhibited more picky eating, especially resistance to vegetables, as compared with TD children.…”

Association Between Peripheral Blood Levels of Vitamin A and Autism Spectrum Disorder in Children: A Meta-Analysis

“…Furthermore, thirteen of the remaining records were excluded through full-text reading (7 records with overlapping data, 1 record with insufficient data, 2 reviews, and 3 abstracts). The study conducted by Zhu et al reported the results in two different regions ( 27 ). We treated the report by Zhu et al as two different studies: Zhu 2020 (1) and Zhu 2020 (2).…”

“…We treated the report by Zhu et al as two different studies: Zhu 2020 (1) and Zhu 2020 (2). Finally, five records (6 studies) with 1,451 unique participants were included in our meta-analysis to evaluate the association between the concentration of vitamin A and ASD (27)(28)(29)(30)(31). The flow diagram is shown in Figure 1.…”

Research Progress in Vitamin A and Autism Spectrum Disorder

“…Multiple studies have shown that individuals with ASD have lower levels of VA compared to typically developing (TD) children or family members [17][18][19][20][21]. An assessment of nutritional intake for 3 consecutive days in 367 ASD children aged 2 to 11 years in the United States (National Health and Nutrition Examination Survey data and matched subsets based on age, sex, family income, and race/ethnicity (N = 252 analyzed food records)), using a developing country information system, found that ASD children aged 4 to 8 years had significantly lower VA intake than controls [22].…”

“…Previous studies were limited to the nutritional status of ASD children in a single region, but a recent study recruited 738 children with ASD and 302 TD children from Chongqing and Hainan (China) to compare their nutritional status and symptoms and analyze their response to nutritional levels and ASD symptoms [ 21 ]. They used the ABC, SRS, and CARS to evaluate the symptoms of ASD children and the GDS to assess neurodevelopment in ASD children.…”