Abstract
Background
Little is known about the effect on dietary adequacy of supplements given to children
with autism spectrum disorder (ASD).
Objective
This cross-sectional study examines dietary supplement use and micronutrient intake
in children with ASD.
Design
Three-day diet/supplement records and use of a gluten/casein-free diet (GFCF) were
documented. Estimates of usual intake of micronutrients from food and supplements
were compared with the Dietary Reference Intakes.
Participants
Children aged 2 to 11 years (N=288) with ASD from five Autism Treatment Network sites
from 2009-2011.
Main outcome measures
Percentage of children meeting or exceeding upper limits of micronutrient intake with
or without supplements and relative to GFCF diet status.
Statistical analysis
Micronutrient intake from food and supplements was compared by Spearman rank correlation.
Usual intake was estimated by the National Cancer Institute method adjusted for age,
sex, supplement use, and GFCF diet. Adequacy of intake was compared between supplement
use status and between food and total intake in supplement users relative to Dietary
Reference Intakes limits.
Results
Dietary supplements, especially multivitamin/minerals, were used by 56% of children
with ASD. The most common micronutrient deficits were not corrected (vitamin D, calcium,
potassium, pantothenic acid, and choline) by supplements. Almost one-third of children
remained deficient for vitamin D and up to 54% for calcium. Children receiving GFCF
diets had similar micronutrient intake but were more likely to use supplements (78%
vs 56%; P=0.01). Supplementation led to excess vitamin A, folate, and zinc intake across the
sample, vitamin C, and copper among children aged 2 to 3 years, and manganese and
copper for children aged 4 to 8 years.
Conclusions
Few children with ASD need most of the micronutrients they are commonly given as supplements,
which often leads to excess intake. Even when supplements are used, careful attention
should be given to adequacy of vitamin D and calcium intake.
Keywords
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Biography
P. A. Stewart is an assistant professor of pediatrics, Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
Biography
S. L. Hyman is a professor of pediatrics, Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
Biography
B. L. Schmidt is a clinical nutrition specialist, Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.
Biography
E. A. Macklin is an instructor in medicine, Massachusetts General Hospital Biostatistics Center, Boston, MA.
Biography
A. Reynolds is an associate professor of pediatrics, Child Development Unit, University of Colorado Denver and Children’s Hospital Colorado, Aurora.
Biography
C. R. Johnson is a board-certified behavior analyst–doctoral and an associate professor, Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville.
Biography
S. J. James is a professor of pediatrics, University of Arkansas for Medical Sciences Children’s Hospital Research Institute, Little Rock.
Biography
P. Manning-Courtney is a professor of pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Article info
Publication history
Published online: June 04, 2015
Accepted:
March 27,
2015
Received:
August 13,
2014
Footnotes
Supplementary materials: Podcast available at www.andjrnl.org/content/podcast
STATEMENT OF POTENTIAL CONFLICT OF INTEREST B. Schmidt reports receiving financial remuneration from Nutricia North America, Inc, for participating in a focus group/round table discussion regarding her knowledge and experience with gastrointestinal issues in children with autism. No potential conflict of interest was reported by the other authors.
FUNDING/SUPPORT This study was funded by Autism Speaks, the Health Resources and Services Administration, and the National Institutes of Health. Additional support came from a cooperative agreement (no. UA3 MC 11054) from the US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program, to the Massachusetts General Hospital. The project was also supported by the University of Rochester Clinical Translational Science Award (no. UL1 TR000042) from the National Center for Advancing Translational Sciences of the National Institutes of Health, and from the Harvard NeuroDiscovery Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Autism Speaks Autism Treatment Network or the National Institutes of Health.
Identification
Copyright
© 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
