Dietary Supplementation in Children with Autism Spectrum Disorders
Parents with children on the autism spectrum want their child to be healthy, as all parents do. However, children with autism can have particular issues with food. Children with autism are more likely to use dietary supplements to meet perceived dietary shortfalls, according to recent research from Stewart and colleagues. The authors conducted dietary analyses in 292 children aged 2 to 11 years with autism spectrum disorders at various sites around the US. Caregivers completed three-day food records that included details dietary supplements taken, and were asked about mealtime behaviors and restrictive diets of the study subjects.
The authors found that around 60% children with autism take dietary supplements, which is higher than for nationally representative studies that estimate around 20-40% of children of the same age take dietary supplements (see Bailey et al.). There did not appear to be an influence of poor eating behaviors on supplementation use, however following a gluten-free casein-free diet increased the proportion of children supplemented to almost 80%. The most common type of supplement was a multi-vitamin/mineral supplement, presumably containing 3 or more vitamins and at least one mineral, using the definition from Bailey.
Intake was defined as “probably inadequate” (i.e. 40% of children did not meet the EAR/AI) for vitamins D and E, calcium, choline, potassium, and pantothenic acid, which agrees mostly with representative estimates for all children in the US, such as on the Micronutrient Calculator website. For the other 17 micronutrients, which the authors unfortunately to not list, intakes were considered to be adequate in general. Even so, over 30% of children had intakes above the upper level from food alone for preformed vitamin A, manganese, folic acid, copper and zinc, depending on age groups.
Use of supplements improved intakes of pantothenic acid, choline, manganese, vitamin E, copper, magnesium, and phosphorous. Vitamin D from supplements made a significant contribution to overall intakes and reduced the proportion of individuals below the EAR by three- to four-fold. Supplement users had intakes above the UL for vitamin C, in addition to those nutrients for which intakes were already excessive from the diet.
The authors conclude that the supplements that are given to children with an autism spectrum disorder do not match up well with the nutrients that children ingest inadequate amounts of. For the nutrients choline and potassium, this is understandable. Choline is not officially a vitamin and may not be included in supplements for this reason. Potassium intake recommendations for this age group are in the range of 3 to 4 grams per day, an impractical quantity to put in a tablet for children. Calcium intakes, around 0.5 to 1.3 grams for this age group, may also be left out of supplements for this reason. Pantothenic acid (vitamin B5) is not well known, and vitamin E is not well known for the age group: parents may not be aware of their importance in the diet. Vitamin D is a shortfall nutrient, and supplements did make a significant contribution to children meeting recommendations.
Dietary supplementation can be of use if the diet is inadequate. Children with autism may be particularly at risk due to unusual diets that result from their condition, or due to diets that parents try as an attempt to reduce potentially diet-related behavioral issues. While it is possible to make a guess about the adequacy of a child’s diet, a better option is to measure intakes. This can be done with the help of a registered dietitian. Keeping a food log at websites such as the USDA’s Supertracker can also be helpful for parents to identify whether their child has an inadequate diet. Knowledge is power.
Stewart PA, Hyman SL, Schmidt BL, Macklin EA, Reynolds A, Johnson CR, James SJ, Manning-Courtney P. Dietary Supplementation in Children with Autism Spectrum Disorders: Common, Insufficient, and Excessive. Journal of the Academy of Nutrition and Dietetics. http://www.andjrnl.org/article/S2212-2672(15)00390-1/abstract
Bailey RL, Gahche JJ, Lentino CV, Dwyer JT, Engel JS, Thomas PR, Betz JM, Sempos CT, Picciano MF. Dietary supplement use in the United States, 2003-2006. J Nutr. 2011 Feb;141(2):261-6. doi: 10.3945/jn.110.133025. Epub 2010 Dec 22. http://www.ncbi.nlm.nih.gov/pubmed/21178089
Hyman SL, Stewart PA, Schmidt B, Cain U, Lemcke N, Foley JT, Peck R, Clemons T, Reynolds A, Johnson C, Handen B, James SJ, Courtney PM, Molloy C, Ng PK. Nutrient intake from food in children with autism. Pediatrics. 2012 Nov;130 Suppl 2:S145-53. doi: 10.1542/peds.2012-0900L.