International Meeting for Autism Research: Nutrient Intake, Gastrointestinal Symptoms and Intestinal Microflora in Children with Autism Spectrum Disorder

Nutrient Intake, Gastrointestinal Symptoms and Intestinal Microflora in Children with Autism Spectrum Disorder

Friday, May 21, 2010
Franklin Hall B Level 4 (Philadelphia Marriott Downtown)
2:00 PM
M. Geraghty , Medical Dietetics, The Ohio State University, Columbus, OH
A. E. Lane , Occupational Therapy, The Ohio State University, Columbus, OH
L. Wang , Animal Science-Molecular Lab, The Ohio State University, Columbus, OH
J. E. Wall , Medical Dietetics, The Ohio State University, Columbus, OH
J. Altenburger , Medical Dietetics, The Ohio State University, Columbus, OH
K. Klug , Medical Dietetics, The Ohio State University, Columbus, OH
Background: Although the etiology of ASD has yet to be fully elucidated, a variety of gastrointestinal (GI) symptoms have been described in this population. Nutrient intake is often compromised in children with autism, for a myriad of reasons. The incidence of gastrointestinal problems has been documented  as 30-40% and in some studies up to 80%.  Abnormal intestinal microflora has been reported in some children with ASD.  Is it possible  there is a clinical “gastrointestinal phenotype” to be described in these children?

Objectives: The objectives of this study were to:  Indentify nutrient intake deficiencies in children with ASD; Describe gastrointestinal symptoms in children with ASD; Characterize (via molecular techniques) the stool microflora (beneficial and pathogenic) in children with ASD; and Analyze for relationships among these three variables to explore trends for a possible  clinical phenotype for further hypothesis testing.  

Methods: Twenty-four children with ASD and 12 typical children were recruited for this pilot study. Nutrient Intake, Gastrointestinal Symptoms, and stool microflora were measured in the ASD children. Stool samples from children with ASD were age and gender-matched with  samples from typical children. Three day food records were collected and analyzed using the Food Processor Nutrient Analysis Software, 2009 (ESHA Research, Salem, OR). The degree to which the children experienced the various symptoms (bloating, flatulence, abdominal pain, diarrhea, headache) was recorded  by placing an “X” on a 5 cm. line numbered 0-5 on a record sheet, with 0= none and 5 = severe. Stool was collected and handled as described in a recently published OSU protocol which demonstrated improved PCR—Polymerase chain reaction - quality community DNA extraction.  The DNA extraction called for the repeated bead-beating plus column (RBB+C) method. For Bifidobacteria, Lactobacilli, and Clostridia, the specific primers for each real-time PCR assay were used.

Results:  A deficient nutrient intake was considered as such for <80% of the Dietary Reference Intake (DRI) of the specific vitamin or mineral. Following is the percentage of the children for who had deficient intakes for each nutrient: Vitamin A- 67%; Biotin- 63%;Calcium 37%; Choline-96%; Folic acid- 25%)Vitamin D, 54%; Vitamin E- 67%, Vitamin K-92%; Magnesium-42%; Manganese-63%; and  Potassium-71%. Forty-six percent (11/24) of the children regularly experienced at least one gastrointestinal symptom, with Bloating, Flatulence, and Constipation being reported more frequently as 2.5-4.0 (moderately severe), and Abdominal Pain and Diarrhea reported as mild (1.0-2.0). Preliminary molecular characterization of stool reveals a statistically significant lower count of Lactobacilli  (P= 0.0081) in the children with ASD vs. typical children, and no difference in  the Bifidobacteria enumeration. Pathogenic bacteria are currently being analyzed. Relationships among the variables will be statistically tested.

Conclusions: The majority of children with ASD have compromised nutrient intakes. Half of the children regularly experience gastrointestinal symptoms, with bloating, flatulence, and constipation being the most severe.  The beneficial bacteria, Lactobacilli, is significantly lower in the gastrointestinal tracts of children with autism in this study. Relationships among the variables, implications, and preliminary discussions regarding  possible clinical phenotypes will be further explored.

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