Abstract
Objective
To compare parent reported feeding difficulties and nutritional adequacy of children with Autism Spectrum Disorders (ASD) to an age and socio-economically matched group of typically developing children.
Methods
The scores on Children’s Eating Behavior Inventory (CEBI), three-day food records, anthropometric measures and adequacy of micro- and macro- nutrients were compared for 63 children diagnosed with ASD and 50 typically developing children enrolled from the department of pediatrics of a tertiary care teaching hospital from North India.
Results
The majority (79%) of the parents of ASD children reported some concern regarding their feeding behavior as compared to 64% of the parents of typically developing children. As compared to controls, ASD children had significantly higher CEBI scores (97.28 vs. 89.48, t = 3.15, P = 0.002) and more feeding problems (6.42 vs. 2.70, t = 3.74, P = 0.001). Relative to controls, ASD children consumed fewer number of food items (P = 0.022), particularly fruits (P = 0.004), vegetables (P = 0.011), and proteins (P = 0.015); had significantly lower daily intake of potassium (P = 0.001), copper (P = 0.007), and folate (P = 0.001). Although children with autism did not differ significantly from controls on intake of calories, height, weight, or body mass index, significantly greater proportion of ASD children failed to meet the estimated average requirement of thiamine (P = 0.039), vitamin C (P = 0.013), and copper (P = 0.005).
Conclusions
The findings underscore the need for comprehensive assessment and empirically-supported interventions for eating problems and dietary deficiencies found in ASD children.
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References
Schreck KA, Williams K, Smith AFA. Comparison of eating behaviors between children with and without autism. J Autism Dev Disord. 2004;34:433–8.
Schmitt L, Heiss CJ, Campbell EEA. Comparison of nutrient intake and eating behavior of boys with and without autism. Top Clin Nutr. 2008;23:23–31.
Nadon G, Feldman DE, Dunn W, Gisel E. Mealtime problems in children with autism spectrum disorder and their typically developing siblings. A comparison study. Autism. 2011;15:98–113.
Postorino V, Sanges V, Giovagnoli G, et al. Clinical differences in children with autism spectrum disorder with and without food selectivity. Appetite. 2015;92:126–32.
Aponte CA, Romanczykb RG. Assessment of feeding problems in children with autism spectrum disorder. Res Autism Spectr Disord. 2016;21:61–72.
Sharp WG, Berry RC, McCracken C, et al. Feeding problems and nutrient intake in children with autism spectrum disorders: meta-analysis and comprehensive review of the literature. J Autism Dev Disord. 2013;43:2159–73.
Dovey TM, Farrow CV, Martin CI, Isherwood E, Halford JCG. When does food refusal require professional intervention? Curr Nutr Food Sci. 2009;5:160–71.
Micali N, Rask CU, Olsen EM, Skovgaard AM. Early predictors of childhood restrictive eating: a population-based study. J Dev Behav Pediatr. 2016;37:314–21.
Cermak SA, Curtin C, Bandini LG. Food selectivity and sensory sensitivity in children with autism spectrum disorders. J Acad Nutr Dietetics. 2010;110:238–46.
Archer LA, Rosenbaum PL, Streiner DL. The children’s eating behavior inventory. J Pediatr Psychol. 1991;16:629–42.
Kaur G. Dietcal - a tool for dietary assessment and planning. New Delhi: Profound Tech Solutions; 2015.
Institute of Medicine Dietary Reference Intakes: Applications and Dietary Assessment. Washington, DC: National Academy Press; 2000.
Ledford JR, Gast DL. Feeding problems in children with autism spectrum disorders: a review. Focus Autism Other Dev Disabl. 2006;21:153–66.
Bandini LG, Anderson SE, Curtin C, et al. Food selectivity in children with autism spectrum disorders and typically developing children. J Pediatr. 2010;157:259–64.
Wright CM, Parkinson KN, Shipton D, Drewett RF. How do toddler eating problems relate to their eating behavior, food preferences, and growth? Pediatrics. 2007;120:e1069–75.
Emond A, Emmett P, Steer C, Golding J. Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics. 2010;126:337–42.
Evans EW, Must A, Anderson SE, et al. Dietary patterns and body mass index in children with autism and typically developing children. Res Autism Spectr Disord. 2012;6:399–405.
Graf-Myles J, Farmer C, Thurm A, et al. Dietary adequacy of children with autism compared with controls and the impact of restricted diet. J Dev Behav Pediatr. 2013;34:449–59.
Liu X, Liu J, Xiong X, et al. Correlation between nutrition and symptoms: nutritional survey of children with autism spectrum disorder in Chongqing, China. Nutrients. 2016;8:294.
Hubbard KL, Anderson SE, Curtin C, Must A, Bandini LG. A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children. J Acad Nutr Diet. 2014;114:1981–7.
Mazurek MO, Vasa RA, Kalb LG, et al. Anxiety, sensory over-responsivity, and gastrointestinal problems in children with autism spectrum disorders. J Abnorm Child Psychol. 2013;41:165–76.
Johnson CR, Turner K, Stewart PA, et al. Relationships between feeding problems, behavioral characteristics and nutritional quality in children with ASD. J Autism Dev Disord. 2014;44:2175–84.
Vissoker RE, Latzer Y, Gal E. Eating and feeding problems and gastrointestinal dysfunction in autism spectrum disorders. Res Autism Spectr Disord. 2015;12:10–21.
Xia W, Zhou Y, Sun C, Wang J, Wu LA. Preliminary study on nutritional status and intake in Chinese children with autism. Eur J Pediatr. 2010;169:1201–6.
Bicer AH, Alsaffar AA. Body mass index, dietary intake and feeding problems of Turkish children with autism spectrum disorder (ASD). Res Dev Disabil. 2013;34:3978–87.
Meguid N, Anwar M, Zaki S, Kandeel W, Ahmed N, Tewfik I. Dietary patterns of children with autism spectrum disorder: a study based in Egypt. Open Access Maced J Med Sci. 2015;3:262–7.
Sahu SK, Kumar SG, Bhat BV, et al. Malnutrition among under-five children in India and strategies for control. J Nat Sci Biol Med. 2015;6:18–23.
Marí-Bauset S, Llopis-González A, Zazpe I, Marí-Sanchis A, Suárez-Varela MM. Comparison of nutritional status between children with autism spectrum disorder and typically developing children in the Mediterranean region (Valencia, Spain). Autism. 2016; doi:10.1177/1362361316636976.
Williams-Hooker R, George EO, Levy M, Morgan C, Smith TL, Bittle JB. Calcium and vitamin D intake of boys who have autism. Child Obesity Nutr. 2013;5:113–7.
Stewart PA, Hyman SL, Schmidt BL, et al. Dietary supplementation in children with autism spectrum disorders: common, insufficient and excessive. J Acad Nutr Diet. 2015;115:1237–48.
Contributions
PM, BB, and PS designed the study. PM and PS jointly made the diagnosis of ASD. PM wrote the manuscript. BB analyzed the nutrition data. LV collected the data and helped in the analysis. All the authors approved the manuscript. PM will act as guarantor for the paper.
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Malhi, P., Venkatesh, L., Bharti, B. et al. Feeding Problems and Nutrient Intake in Children with and without Autism: A Comparative Study. Indian J Pediatr 84, 283–288 (2017). https://doi.org/10.1007/s12098-016-2285-x
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DOI: https://doi.org/10.1007/s12098-016-2285-x