Study On The Association Of Micronutrients And Eating Behavior With Autism Spectrum Disorders

Objectives To understand the basic characteristics,eating behaviors and environmental exposures of children with autism spectrum disorder(ASD)and analyze their intrinsic association with the onset of autism,and to explore the relationship between eating behaviors,micronutrients and ASD.MethodsFrom December 2021 to December 2022,213 children aged 1-10 years who met the diagnostic criteria for ASD and 214 normal healthy children from Zilinshan Kindergarten in Longgang District,Shenzhen,who attended the Department of Child Rehabilitation and the Department of Pediatrics in Longgang District,Shenzhen,were selected as the study subjects,and the control group was 214 normal healthy children from Zilinshan Kindergarten in Longgang District,Shenzhen.A self-administered questionnaire one-to-one survey was used to investigate the basic characteristics and environmental exposure during pregnancy in children with ASD and normal children.The Preschooler’s Eating Behavior Questionnaire(PEBQ)was used to measure children’s eating status;the Autism Behavior Checklist(ABC)and the Childhood Autism Rating Scale(CABRS)were used to measure children’s eating status.The core symptoms of children with ASD were assessed using the Autism Behavior Checklist(ABC)and the Childhood Autism Rating Scale(CARS).111 children and 111 healthy children who voluntarily participated in blood sampling were tested for serum fatsoluble vitamins A,D and E using tandem mass spectrometry and whole blood zinc,copper,magnesium,iron,calcium,manganese and lead using inductively coupled plasma mass spectrometry.Result(1)To examine the effect of risk factors associated with the child with autism: gender female(OR=0.208,95%CI: 0.099-0.435),maternal education college or bachelor’s degree(OR=0.084,95%CI: 0.019-0.375)and high school or secondary school(OR=0.108,95%CI: 0.018-0.635),annual family income higher than $100,000,quiet living environment during mother’s pregnancy(OR=0.392,95%CI: 0.160-0.960),good mental health of mother during pregnancy(OR=0.333,95%CI: 0.186-0.597),no history of illness during mother’s pregnancy(OR=0.375,95%CI: 0.181-0.776)and history of medication use(OR= 0.359,95%CI: 0.165-0.793)were protective factors for ASD in children;rural household(OR=5.217,95%CI: 1.535-17.732),screen exposure for more than 2 hours(OR=18.094,95%CI: 4.710-69.511),and not washing hands before meals(OR=7.901,95%CI: 2.740-22.783),occasional(OR=3.599,95%CI: 1.804-7.179)and frequent constipation(OR=3.512,95%CI: 1.177-10.477),and mixed breast milk formula feeding(OR=2.212,95%CI: 1.064-4.599)were risk factors for ASD.(2)The score of food fussiness in ASD group was significantly higher than that in normal group;The scores of external eating and initiative eating were significantly lower than those of normal group(P<0.05).Correlation analysis of nutrient and dietary behavior scale scores in ASD children showed that manganese level was significantly negatively correlated with unhealthy eating habits and satiety responsiveness(r=-0.273,P<0.01;r=-0.246,P<0.05),was significantly positively correlated with initiative eating(r=0.255,P<0.05);Vitamin D level was positively correlated with satiety responsiveness and external eating(r=0.246,P<0.05;r=0.287,P<0.01),was significantly negatively correlated with emotional eating(r=-0.281,P<0.01).Vitamin E level was positively correlated with emotional eating and total scores(r=0.234,P< 0.05;r=0.243,P < 0.05).(3)The relationship between nutrient levels and childhood autism: children in the ASD group had significantly higher levels of manganese,calcium,and lead than normal children,while copper,zinc,and vitamin D levels were significantly lower than normal children(all P<0.05);Spearman correlation analysis between nutrients in children with ASD showed that iron levels were significantly positively correlated with zinc and magnesium levels(r=0.20,P<0.05;r=0.38,P<0.001),and a significant negative correlation with calcium levels(r=-0.39,P<0.001);lead levels were positively correlated with iron levels(r=0.23,P< 0.05);vitamin D levels were positively correlated with both copper and vitamin A levels(r=0.21,P<0.05;r=0.31,P<0.01);vitamin E levels were positively correlated with both calcium and vitamin D levels were positively correlated(r=0.35,P<0.001;r=0.23,P<0.05).(4)The correlation between core symptoms and nutrient levels of autism was divided into atypical group,mild-moderate group,and severe group according to the scores of CARS in children with ASD.The results showed that the nutrient levels of the three groups of children with ASD were not significantly different(P > 0.05).Spearman rank correlation analysis of nutrients and ABC scale scores in children with ASD showed that zinc level was significantly positively correlated with the score of sensory(r=0.208,P <0.05).Magnesium level was positively correlated with the score of relating(r=0.221,P <0.05).Vitamin A levels were negatively correlated with the score of sensory(r=-0.25,P <0.05)and positively correlated with the score of language(r=0.284,P < 0.01).Vitamin D levels were positively correlated with the score of language and self-help(r=0.212,P< 0.05;r=0.24,P < 0.05).(5)In the univariate model,calcium and manganese levels were positively associated with the risk of ASD,while copper,zinc,and vitamin D levels were negatively associated with the risk of ASD(P trend < 0.05).The results of the multifactorial model were generally consistent with the univariate model,with calcium and manganese levels positively associated with the risk of developing ASD,while copper and vitamin D levels were negatively associated with the risk of developing ASD(P trend < 0.05).ConclusionThe prevention of ASD children should pay attention to the exposure of related risk factors,attach importance to the cultivation of children’s personal living habits and dietary behaviors,ensure the quality of life of pregnant women and care for their mental health status.Nutrient levels in children with ASD are low,with copper,zinc,and vitamin D being the main nutrients that are low,and may be associated with the risk of developing ASD and the core symptoms of the disease,but this association needs to be studied in more depth in the future.More in-depth studies are needed.Considering the crucial role of nutrients in the neurodevelopment and symptoms of autistic children,micronutrient and vitamin levels in children with ASD should be monitored in a timely manner and the intake of relevant nutrient levels should be observed.