Nutrient Intake and Supplement Use In Children with Autism Spectrum Disorders: Do Multivitamins Provide the Nutrients Consumed In Low Amounts?

Background: Children with autism spectrum disorders (ASD) often engage in selective eating patterns, yet little is known about the adequacy of nutrient intake since many foods consumed are highly fortified.  Additionally, children with ASD commonly take dietary supplements.  It is unknown whether these supplements enhance the nutrient profile or result in excessive intake.

Objectives:   To examine dietary intake and supplement use in children with autism to determine nutrients of concern and whether supplements enhance nutrient adequacy or result in excessive intake.

Methods:   NDSR© software was used to perform an interim analysis of nutrient intake and supplement use on 126 three day diet records of children with ASD aged 2-11 in a multicenter study of dietary behaviors and nutrition status.  Usual intake was compared to the IOM’s Dietary Reference Intakes (DRI) for age and gender.  The percentage of children meeting recommended nutrient intake levels and the percentage consuming nutrients above the Upper Limit (UL) from food alone were determined.  The UL is the highest intake level likely to pose no risk, above which the potential of adverse effects increases.  Nutrients provided by dietary supplements were assessed and compared to the nutrients low in the diet and to ULs for children.

Results: The chart below indicates DRIs were not met in many participants for vitamin D, choline, potassium, and fiber and UL was exceeded for sodium, niacin, and manganese from food alone.  Sixty-six percent of children were taking dietary supplements, compared to 32% in the general pediatric population   and 62% in other children with chronic diseases.  Multivitamin/minerals were the most common dietary supplements consumed followed by fatty acids and probiotics.   The supplement content was compared to dietary needs.  Ninety-seven % of the multivitamins used contained vitamin D, while only 37% contained choline, 11% vitamin K , 8% potassium and 0% fiber.  The amount of potassium and choline provided by supplements was far below the recommended intake levels.  Folate, niacin and vitamin A were nutrients in supplements most likely to exceed the UL even before including nutrients from food. 

 

Age	n	% Meeting DRI					% Exceeding UL
		Fiber	Potassium	Vitamin D	Choline	Vitamin K	Sodium	Niacin	Manganese
(1-3)	33	2	2	10	30	61	72	81	52
(4-8)	79	1	0	10	20	19	74	52	30
(9-13)	14	1	0	16	13	41	94	92	3

 

 

 

 

 

 

Conclusions :  Many children with ASD do not meet recommended intakes for nutrients.  Children who are selective eaters may be better served by consultation with dietitians to correct nutrient imbalances using food rather than with general multivitamin use. When indicated, targeted supplementation may avoid exceeding the UL while meeting the child’s nutritional needs.

Acknowledgements:  The data for the study were collected as part of the ATN, a program of Autism Speaks. Further support came from a cooperative agreement (UA3 MC 11054) from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program, to the Massachusetts General Hospital and supported by the National Center for Research Resources (NCRR) UL1RR024160