Nutritional Deficiency Disease Secondary to ARFID Symptoms Associated with Autism and the Broad Autism Phenotype: A Qualitative Systematic Review of Case Reports and Case Series
Yule S, Wanik J, Holm E, Bruder M, Shanley E, Sherman C, Fitterman M, Lerner J, Marcello M, Parenchuck N, Roman-White C, Ziff M (2021) Journal of the Academy of Nutrition and Dietetics 121(3) 467-492 doi: 10.1016/j.jand.2020.10.017
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.
FAB RESEARCH COMMENT:
Overt nutritional deficiencies leading to serious health problems are extremely common in children on the Autism Spectrum who show features of Avoidant Restrictive Food Intake Disorder (ARFID), according to this new systematic review of published case reports and case series.Most cases involved multiple micronutrient deficiencies.
- Scurvy - the classic Vitamin C deficiency disease - was the essential nutrient deficiency most commonly reported.
- 'Eye disorders secondary to Vitamin A deficiency' were the second most commonly reported - and in some cases, this had progressed to the stage where the blindness was irreversible
Very importantly - despite having micornutrient malnutrition sever enough to cause serious health problems, the majority of children were not clinically underweight
This only highlights the seriously low nutrient density of the ultra-processed foods most favoured by the vast majority of children (and adults) with ASD and ARFID.
ARFID is a relatively newly classified form of eating disorder, involving highly selective and restrictive eating patterns that are primarily driven by anxiety and fear around food, rather than concerns over weight or body image.
Although by no means confined to individuals wityh Autistic Spectrum Disorders or related conditions, ARFID is extremely common in these groups - with some reports suggesting that this type of eating disorder may affect as many as 70% of autistic children.
These findings provide a very strong case for the proposal that regular screening for nutrient deficiencies should form part of the standard clinical care and management of all children with ARFID - and given its high prevalence in ASD and related conditions, should be actively considered by all health professionals involved in the care of such children.
Furthermore, the provision of dietary assessment and support - including supplementation where necessary to reverse clinical nutrient deficiencies - makes obvious sense, and given the serious consequences of leaving these untreated, very likely to prove cost-effective.
For further information on this topic please see:
And for further information on this topic, please see the following lists of articles, which are updated as new findings become available:
Food and Behaviour Research is a registered charity (No SC034604) and a company limited by guarantee (Co No SC 253448)
Newsletter Signup
Useful Links
Contact Us
FAB Research
23 Carlton Road
Oxford
OX2 7SA
Important Notice
Medical opinion and guidance should always be sought for any symptoms that might possibly reflect a known or suspected disease, disorder or medical condition. Information provided on this website (or by FAB Research via any other means) does not in any way constitute advice on the treatment of any medical condition formally diagnosed or otherwise.
Site by Redstone Websites. Easy to Use Web Content Management. 2025 © All Rights Reserved.