Risk and Protective Factors in Autism Spectrum Disorders: A Case Control Study in the Lebanese Population

Abstract

Autism spectrum disorders (ASD) are among the most common childhood neurodevelopmental disorders. Identification of risk and protective factors are necessary to improve the guidance of prevention and intervention strategies. Our study aims to determine the potential risk and protective factors in ASD in the Lebanese population. Our case-control study included 100 ASD patients and 100 healthy matched controls recruited from all the Lebanese districts. The data collected from the questionnaires was analyzed using SPSS 23.0. Independent Student T-test and Chi-Square test were carried out for the bivariate analysis of the data. In addition, the variables revealing a p-value < 0.05 were used for the multivariate logistic regression analysis. Multivitamins intake, especially omega 3 and vitamin B (Odds Ratio (OR) = 0.257; 95% Confidence Interval (CI) [0.115–0.579]), rich cereal diet (OR = 0.212; 95% CI [0.089–0.510]), and supplementation in iron during pregnancy (OR = 0.229; 95% CI [0.083–0.627]) were identified as protective factors against ASD. On the other hand, stress during pregnancy (OR = 6.339; 95% CI [2.845–14.125]), the presence of ASD patients in the family (OR = 7.878; 95% CI [1.877–33.065]) and the presence of attention deficit hyperactivity disorder (ADHD) patients in the family (OR = 6.981; 95% CI [1.362–35.789]) were associated with ASD. This study shed light on risk and protective factors associated with ASD in the Lebanese population. Further rigorous research, taking into consideration these factors, is needed to assist in early detection, prevention and subsequent intervention targeting ASD and its associated comorbidities, given that our study is not experimental and does not prove causality.

Prenatal, perinatal and postnatal risk factors associated with autism spectrum disorder in Palestine: a case-control study

“…Our findings suggest that stressful life experiences during pregnancy may significantly increase the likelihood of having a child with ASD, which is consistent with the findings of other studies. (Gerges, et al 2020;Say, Karabekiroğlu, Babadağı, & Yüce, 2016;Varcin, Alvares, Uljarević, & Whitehouse, 2017). Stressful pregnancy events are thought to cause the hypothalamus to release the corticotropin-releasing hormone, which may set off a chain of events that allows autoantibodies and interleukins to enter and promote brain inflammation and the development of ASD.…”

“…A recent study explored the link between low nutritional status including vitamins A, D, B1, B2, B6, B12, folic acid, niacin, iron, and zinc of Palestinian pregnant, lactating mothers and children as a modifiable risk factor of ASD (Altamimi, 2018). Besides, multivitamins intake, especially omega 3 and vitamin B, a rich cereal diet, and iron supplementation during pregnancy were protective factors against ASD among Lebanese (Gerges, et al 2020). Another Palestinian study confirmed an association between autism, iron deficiency, and anemia.…”

Future Prospects for Epigenetics in Autism Spectrum Disorder

“…Perinatal exposure to some common environmental pollutants, such as air pollution [ 25 ], and pesticides [ 26 ] have also shown an association with increased ASD risk. Some differences in maternal nutrients, including maternal iron supplement consumption [ 27 ] and maternal use of folic acid and multivitamin supplements [ 28 ], have also been shown to have potential protective effects against ASD development. These environmental exposures are often hypothesized to act at least partially through epigenetic mechanisms [ 29 – 33 ], although the tissue-specific and temporally influenced nature of epigenetic modifications can make repeated observation of epigenetic markers of ASD difficult.…”

Body Composition and Anthropometric Measurements in Children and Adolescents with Autism Spectrum Disorder: A Case–Control Study in Lebanon

“…This rapid increase highlights the necessity for a deeper comprehension of the pathophysiology of this disorder, as the exact etiology of ASD is not yet clear. However, several studies have shown that it involves genetic, epigenetic, and environmental factors [ 6 , 7 , 8 , 9 ].…”