Dietary Influences on BMI in Children with Autism Spectrum Disorders

Background: The prevalence of childhood obesity has increased over the past two decades in the United States. Children with autism spectrum disorders (ASD) may have a similar or greater prevalence of obesity due to selective eating and mealtime behaviors which may alter risk factors

Objectives: Known dietary risk factors (points of intervention) for overweight/obesity in the general population will be analyzed for children with ASD.  Children with ASD with and without overweight/obesity will be compared on the following factors: 1) food categories contributing the most calorie per day 2) caloric intake from sugar sweetened beverages (SSB); 3) servings of fruits and vegetables consumed 4) number of eating occasions/day; and 5) breakfast consumption.

Methods: Children (n=292) with ASD (2-11 years) from five Autism Speaks Autism Treatment Network (AS ATN) sites (Rochester, Pittsburgh, Cincinnati, Little Rock, Denver) participated in an AIRP study of dietary intake (2010-11). They were characterized per the AS ATN registry protocol for diagnosis and demographics.  Prospective three day diet diaries were collected and analyzed using Nutrition Database Research Studies software. BMI (Body Mass Index) was calculated.  In addition to the above, data analysis includes food category comparison to the National Health and Nutrition Examination Survey (NHANES 2005-06 for ages 2-13 years), descriptive statistics, t-test and chi square.  

Results: The mean age of respondents was 5.2 years, 84% were male.  Only the 4-8 year old age group in both the ASD and NHANES groups were similar in the top ten food categories relative to calorie intake: grain based desserts, yeast breads, pizza, pasta and pasta dishes and reduced fat milk.  The top foods that contributed to caloric intake were different in children (2-3, 8-11 years) with ASD compared to the NHANES sample.  SSB contributed fewer calories (% kcal/day) for children with ASD compared to the NHANES sample (2-3 years: 0.7% v.s. 1.5%; 4-8 years:  1.8% v.s 2.8%, 9-11 ASD: 1.8% v.s 9-13 NHANES: 2.8%). Within the top ten calorie contributing food categories, 100% fruit juice (not orange or grapefruit) (2-3 years 5.3%; 4-8years 3.2%) and fried white potatoes (3.0%) were the only fruit or vegetable that were ranked. Children with ASD had eating occasions on average of 18/3 days (5.9 SD). More than 95% of children with ASD consumed breakfast on all three days across BMI groups. Relationships of these feeding behaviors with BMI will be further examined.

Conclusions: As in the general population, addressing eating behaviors is an important behavioral target for overweight/obesity prevention and management in children with ASD. Targeting SSB and breakfast consumption may have less impact on obesity management.  Additional modifications to the current approach of promoting healthy weight may be necessary for children with ASD.