| ObjectiveTo explore the relationship between food intolerance(FI)and the behavior of children with autism spectrum disorder(ASD)by detecting the level of serum intolerant food;By avoiding intolerant food,the difference of intestinal flora and serum IL-1 β,IL-6 before and after the intervention were compared,so as to explore the possible mechanism of the influence of FI on the behavior of ASD,and to provide a new idea for the rehabilitation intervention of clinical ASD children.MethodFrom January 2018 to June 2019,146 ASD children aged 2-6 years were included.All ASD children meet the ASD diagnostic criteria in DSM-5.According to the characteristics of children’s daily food in this area,14 kinds of serum food specific Ig G were detected by enzyme linked immunosorbent assay(ELISA),and the level of FI was evaluated according to the detection level of serum food specific Ig G antibody.According to the results of FI test,ASD children were divided into FI group(n= 94)and non-FI group(n= 50).Both two groups of children were divided into intervention group and control group by the method of judgment sampling,FI intervention group were asked to avoid intolerant food,FI control group had conventional diet;non-FI intervention group were give balanced diet recommendations,non-FI control group had conventional diet.The levels of serum cytokines(IL-1 β,IL-6)were detected by ELISA before and after intervention;Children’s gastrointestinal(GI)symptoms,eating behavior problems,sleep problems were assessed by the self-designed ASD children’s general behavior and gastrointestinal symptoms assessment questionnaire,which included 29 items,using Liket five-level scoring method;The core symptoms of ASD children were assessed by Autism Rating Scale(cars).There were 15 feces samples in each of FI group and non-FI group being collected before food intervention.The distribution of intestinal flora was detected by 16 S r RNA gene sequencing,and the information of intestinal flora was analyzed by Chao1 index,Shannon index and species composition analysis.Follow up observation for 3 months,during which all cases included had rehabilitation training under the guidance of therapists.This study was approved by the hospital ethics committee.Results(1)The detection rate of FI in ASD children was 65.3%,and children with 2 to 3types of FI accounted for the most(68%).The top five rates of intolerant food were milk(76.6%),egg(72.3%),shrimp(72.3%),wheat(44.7%)and COD(40.4%).The degree of intolerance was mainly mild and moderate.(2)The levels of IL-1β and IL-6 in the FI group were significantly higher than those in the FI group[(2.39 ± 0.18)ng/L vs.(2.28 ± 0.14)ng/L;(2.51 ± 0.18)ng/L vs.(2.38 ±0.13)ng/L,both P<0.001].Besides,the relative abundance of intestinal bifidobacteria,enterobacteriaceae,and lactobacilli in FI group were relatively high,while that of Bacteroides was relatively low.(3)The total score of CARS,GI,and sleep of FI group before food intervention were significantly higher than those of non-FI group [(34.31 ± 2.25)vs.(33.02 ± 2.18);(20.78± 2.30)vs.(19.28 ± 2.20);(17.18 ± 2.72)vs.(16.14 ± 2.41),all P<0.05].The severity of FI was correlated with IL-1 β,IL-6,the total scor of CARS,GI and sleep problems(r=0.218,0.340,0.369,0.403,0.435,respectively,all P< 0.05).(4)After food intervention,the levels of IL-1β and IL-6 in FI intervention group were significantly decrease than those in FI control group [(2.34±0.20)ng/L vs.(2.43±0.19)ng/L;(2.41±0.24)ng/L vs.(2.51±0.20)ng/L].Decrease(both P <0.05);what’s more,the total score of CARS,GI and sleep in FI control group were all improved compared with FI control group [(28.70±2.17)vs.(29.85±1.88);(16.32±3.58)vs.(17.98±2.39);(12.79±2.14)vs.(13.85±2.06),all P<0.05].Conclusion(1)Children with ASD aged 2 to 6 years have a high prevalence of FI.Milk,eggs,and shrimp are the most common intolerant foods for children in this study.FI is closely related to ASD children’s autism symptoms,GI symptoms and some sleep problems.For ASD children with GI and sleep problems,attention should be paid to FI,and the relationship between FI and related symptoms should be evaluated.(2)FI children have more obvious intestinal flora disorder,which are manifested by the increased of the abundance of intestinal flora;the dominant of Bifidobacteria,lactobacilli and enterobacilli;and the decreased of Bacteroides in the relative abundance.(3)The serum levels of pro-inflammatory cytokines of IL-1 β and IL-6 in ASD with FI increased significantly.(4)Avoidance of intolerant food may improve autism behavior and gastrointestinal function by reducing the levels of serum pro-inflammatory factors of IL-1 β and IL-6. |
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