Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders

FAB RESEARCH COMMENT:

This study reports that from 6 months of age, the 79 children in this large birth cohort study formally diagnosed with autistic spectum disorder (ASD) before age 4.5years showed significantly more feeding problems, 'fussy' or selective eating, and issues with food allergy or intolerance than the almost 13,000 typically developing children with whom they were compared.

Unfortunately, little or no other useful information can be obtained from this report, owing to serious methodological issues; and the main conclusion is likely to be highly misleading, if not harmful. 

That potential for harm is very clearly and forcefully expressed in this article - written by a dietitian experienced in working with children with ASD:

• Pediatrics: Nutrition Doesn't Matter For Kids?

As that article provides a comprehensive critique of the many methodological and other issues raised by this article, only a few main points are made here.

First, the prevalence of ASD is hugely higher than the 0.006% implied by these numbers. The fact that only 79 children from this large population-based sample of 13,000 appear to have received a formal ASD diagnosis indicates that a very much larger number of such children had not (yet) been identified, and hence were classified within the control group.

Second, no useful data on the actual dietary intakes of these children are provided, or their actual nutrient intakes. 

Most concerning, however is the superficial - and seemingly reassuring - conclusion that "energy intake and growth were not impaired" in this small ASD sample vs controls.

This blithe statement is all too easily interpreted as 'Oh well - so there's no real problem, then, is there'.

Such an interpretation is compltely unjustified given the (lack of) data presented on the actual nutritional status of these children - which impacts on  BRAIN HEALTH in particular (and therefore the difficulties with mood, behaviour and learning that led to their ASD diagnosis) - but is also a key factor determining their physical health 

• Neither calorie consumption nor PHYSICAL GROWTH can possibly reveal whether these children were receiving enough of the key nutrients most critical for normal BRAIN development and function - or the physical health and development of their gut, immune and other bodily systems that have powerful influences on this.

Unfortunately, the nutritional requirements of the brain are still completely ignored in both dietary guidelines and most clinical practice in nutrition and dietetics (let alone public health) the omission here of any consideration of these children's actual nutritional status is perhaps not surprising.

Serious nutritional deficiencies are almost always associated with the well-documented feeding difficulties, selective / restrictive eating patterns and other forms of eating disorder that are typical of children with ASD-type difficulties. Higher rates of such difficulties are noted in the tiny group of 79 children identified here, but their nutritional implications are completely ignored.

The complete failure even to allude to nutrition in relation to the brain-based behavioural difficulties involved in ASD represents a serious missed opportunity.