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Association of food hypersensitivity in children with the risk of autism spectrum disorder: a meta-analysis

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Abstract

This meta-analysis was performed to clarify the association between food hypersensitivity in children and autism spectrum disorder (ASD) in detail. Relevant studies published in 8 databases before March 2020 were retrieved and screened according to established inclusion criteria. The odds ratio (OR) with the 95% confidence interval (CI) was pooled to estimate the effect. Subgroup analyses were performed in terms of publication year, study design, location, sample size, definition of food hypersensitivity, definition of ASD, and study quality score. Furthermore, we stratified studies by participant sex and age to perform a more detailed analysis. This meta-analysis included 12 published articles with 434,809 subjects. A significant association was observed between food hypersensitivity and the risk of ASD (OR = 2.792, 95% CI: 2.081–3.746). The risk of ASD among girls and subjects younger than 12 with food hypersensitivity may be greater than that among boys and those older than 12. The results of sensitivity analysis and publication bias analysis show that the association is relatively stable.

Conclusion: Our results showed a positive association between food hypersensitivity and autism spectrum disorder, and girls and subjects younger than 12 may be more sensitive to this association. The role of food hypersensitivity in the onset of ASD deserves more attention.

What is Known:

• Food hypersensitivity is a term used to describe food allergies and food intolerance.

• ASD is a group of neurodevelopmental disorders that are characterized by deficits in social interaction, repetitive or stereotypic behavior, and verbal communication disorder.

• The prevalence rates of ASD and food hypersensitivity in the developed world are increasing.

What is New:

• In this work, we reviewed and analyzed the available data and studies and found a positive association between food hypersensitivity and ASD.

• Girls and children younger than 12 may be more sensitive to have ASD than boys and children older than 12.

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Abbreviations

AHRQ:

Agency for Healthcare Research and Quality

ABC:

Autism Behavior Checklist

ADI:

Autism Diagnostic Interview

ADI-R:

Autism Diagnostic Interview-Revised

ADOS:

Autism Diagnostic Observation Schedule

ASD:

Autism spectrum disorder

CARS:

Childhood Autism Rating Scale

CBM:

China Biology Medicine disc/Sinomed

CNKI:

China National Knowledge Infrastructure

CCMD:

Chinese diagnostic criteria for mental disorders

CIs:

Confidence intervals

DSM:

Diagnostic and Statistical Manual of Mental Disorders

FEM:

Fixed effects model

HRs:

Hazard ratios

IL:

Interleukin

ICD:

International Statistical Classification of Diseases

NHIS:

National Health Interview Survey

NOS:

Newcastle-Ottawa Scale

ORs:

Odds ratios

PRISMA:

Preferred Reporting Items for Systematic Review and Meta-Analyses

PRs:

Prevalence ratios

REM:

Random effects model

RRs:

Relative risks

TNF:

Tumor necrosis factor

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Funding

This study was funded by National Natural Science Foundation of China (grant number: 81872704).

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Author notes

  1. Hong Li and Haixia Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Rehabilitation Medicine, Anhui Provincial Children’s Hospital/Children’s Hospital of Anhui Medical University, Hefei, 230051, Anhui, China

    Hong Li & Guanglei Tong

  2. Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China

    Haixia Liu, Xin Chen, Jian Zhang & Yehuan Sun

  3. Department of Neonatology, Anhui Provincial Children’s Hospital/Children’s Hospital of Anhui Medical University, Hefei, 230051, Anhui, China

    Jian Zhang

  4. Center for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China

    Yehuan Sun

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  1. Hong Li
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  2. Haixia Liu
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  3. Xin Chen
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  4. Jian Zhang
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Contributions

Hong Li, Haixia Liu, and Yehuan Sun designed the research; Hong Li, Haixia Liu, and Xin Chen conducted the research; Hong Li, Haixia Liu, and Jian Zhang analyzed the data; Hong Li and Haixia Liu, and Xin Chen wrote the paper. Yehuan Sun mainly reviewed the paper and Guanglei Tong assisted. Hong Li and Haixia Liu had primary responsibility for the final content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yehuan Sun.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Communicated by Gregorio Paolo Milani

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Li, H., Liu, H., Chen, X. et al. Association of food hypersensitivity in children with the risk of autism spectrum disorder: a meta-analysis. Eur J Pediatr 180, 999–1008 (2021). https://doi.org/10.1007/s00431-020-03826-x

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