Abstract
Background
The demographics, weight statuses, and dietary patterns of people with autism or the
broad autism phenotype who experience a severe nutrient deficiency disease due to
symptoms of avoidant/restrictive food intake disorder have not been well established.
Objective
The primary objective of this review was to examine the relationship between the demographics,
weight statuses, dietary patterns, and nutrient deficiency diseases that characterize
the most severe manifestations of avoidant/restrictive food intake disorder symptomology
associated with autism or the broad autism phenotype.
Methods
A systematic review of English and non-English articles published up to August 29,
2019, on the Scopus, PubMed, and Cumulative Index to Nursing and Allied Health Literature
Plus electronic databases was conducted. Additional cases were identified through
the reference list of all included articles. The search terms used were “autis∗ AND (deficiency OR scurvy)”. Only case reports or case series in which a person of
any age who had been identified as having a formal diagnosis of autism or autism symptoms
and a disease of nutritional deficiency due to self-imposed dietary restrictions were
included. Data were independently extracted by 8 authors using predefined data fields.
Results
A total of 76 cases (patients were aged 2.5 to 17 years) from 63 articles that were
published from 1993 through 2019 were found. More than 85% cases (65 of 76 patients)
were from articles published in the past 10 years. The largest percentage of published
cases (69.7% [53 of 76]) involved scurvy, a vitamin C deficiency. The second-largest
percentage of published cases (17.1% [13 of 76]) involved eye disorders secondary
to vitamin A deficiency. Other primary nutrient deficiencies reported were thiamin,
vitamin B-12, and vitamin D. In 62.9% (22 of 35) of the patients for which a body
mass index or a weight percentile for age was provided, the patient was within normal
weight parameters, per Centers for Disease Control weight status categories.
Conclusions
Based on the 63 articles extracted for this systematic review, nutritional deficiency
diseases related to inadequate intakes of vitamin A, thiamin, vitamin B-12, vitamin
C, and vitamin D were found in individuals with autism and the broad autism phenotype
who had severe self-imposed dietary restrictions. When weight information was provided,
most of the youth in these cases were not reported to be underweight. Individuals
of any weight who present with symptoms of avoidant/restrictive food intake disorder
can benefit from early and frequent screening for adequacy of micronutrient intake,
regardless of whether they have a clinical diagnosis of autism.
Keywords
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Biography
S. Yule is an independent researcher, Summer Yule Nutrition, Avon, CT.
Biography
J. Wanik is an assistant professor in residence, dietetics program, University of Connecticut, Storrs, CT.
Biography
E. M. Holm is a registered dietitian and nutritionist, Holm Nutrition Counseling, Alexandria, VA.
Biography
M. B. Bruder is a professor, pediatrics, child and family studies, University of Connecticut Health Center, Farmington, CT.
Biography
E. Shanley is a dietetics director, Department of Allied Health Sciences, University of Connecticut, Storrs, CT.
Biography
C. Q. Sherman is an educator, and therapist (licensed graduate professional counselor), St Coletta of Greater Washington Public Charter School, Washington, DC.
Biography
M. Fitterman is a dietetics intern, Department of Allied Health Sciences, University of Connecticut, Storrs, CT.
Biography
J. Lerner is a dietetics intern, Department of Allied Health Sciences, University of Connecticut, Storrs, CT.
Biography
M. Marcello is a dietetics intern, Department of Allied Health Sciences, University of Connecticut, Storrs, CT.
Biography
N. Parenchuck is a dietetics intern, Department of Allied Health Sciences, University of Connecticut, Storrs, CT.
Biography
C. Roman-White is a dietetics intern, Department of Allied Health Sciences, University of Connecticut, Storrs, CT.
Biography
M. Ziff is a dietetics intern, Department of Allied Health Sciences, University of Connecticut, Storrs, CT.
Article Info
Publication History
Published online: November 19, 2020
Accepted:
October 14,
2020
Received:
June 27,
2019
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding to disclose.
AUTHOR CONTRIBUTIONS S. Yule performed the eligibility assessment and S. Yule, J. Wanik, M. Fitterman, J. Lerner, M. Marcello, N. Parenchuck, C. Roman-White, and M. Ziff extracted the data. S. Yule wrote the first draft with contributions from J. Wanik, M. B. Bruder, and E. Shanley. S. Yule, J. Wanik, E. M. Holm, M. B. Bruder, E. Shanley, and C. Q. Sherman reviewed and commented on subsequent drafts of the manuscript.
Identification
Copyright
© 2021 Published by Elsevier Inc on behalf of the Academy of Nutrition and Dietetics.
