Research
Original Research
Dietary Supplementation in Children with Autism Spectrum Disorders: Common, Insufficient, and Excessive

https://doi.org/10.1016/j.jand.2015.03.026Get rights and content

Abstract

Background

Little is known about the effect on dietary adequacy of supplements given to children with autism spectrum disorder (ASD).

Objective

This cross-sectional study examines dietary supplement use and micronutrient intake in children with ASD.

Design

Three-day diet/supplement records and use of a gluten/casein-free diet (GFCF) were documented. Estimates of usual intake of micronutrients from food and supplements were compared with the Dietary Reference Intakes.

Participants

Children aged 2 to 11 years (N=288) with ASD from five Autism Treatment Network sites from 2009-2011.

Main outcome measures

Percentage of children meeting or exceeding upper limits of micronutrient intake with or without supplements and relative to GFCF diet status.

Statistical analysis

Micronutrient intake from food and supplements was compared by Spearman rank correlation. Usual intake was estimated by the National Cancer Institute method adjusted for age, sex, supplement use, and GFCF diet. Adequacy of intake was compared between supplement use status and between food and total intake in supplement users relative to Dietary Reference Intakes limits.

Results

Dietary supplements, especially multivitamin/minerals, were used by 56% of children with ASD. The most common micronutrient deficits were not corrected (vitamin D, calcium, potassium, pantothenic acid, and choline) by supplements. Almost one-third of children remained deficient for vitamin D and up to 54% for calcium. Children receiving GFCF diets had similar micronutrient intake but were more likely to use supplements (78% vs 56%; P=0.01). Supplementation led to excess vitamin A, folate, and zinc intake across the sample, vitamin C, and copper among children aged 2 to 3 years, and manganese and copper for children aged 4 to 8 years.

Conclusions

Few children with ASD need most of the micronutrients they are commonly given as supplements, which often leads to excess intake. Even when supplements are used, careful attention should be given to adequacy of vitamin D and calcium intake.

Section snippets

Sample

Children aged 2 to 11 years with ASD were recruited from five participating AS ATN sites between 2009 and 2011.1 AS ATN is a network funded by Autism Speaks to promote research and a standard of care regarding health conditions associated with ASD. All children entering or previously enrolled in the AS ATN who met the age requirement and consumed food by mouth were eligible for participation in this study. The five participating AS ATN sites in this study were Cincinnati Children’s Hospital,

Study Cohort

A total of 1418 children with ASD were eligible for the study based on age, ASD diagnosis, and enrollment at a participating AS ATN site, of whom 368 consented to the study. The proportion enrolling did not differ by age, sex, or ethnicity, but African Americans and mixed-race children were less likely to enroll. Of those who enrolled in this study, 292 completed 3-DFRs with the following distribution among DRI age- and sex-specific groups: 74 (26%) boys or girls aged 2 to 3 years, 177 (61%)

Discussion

This is the first article to examine micronutrient intake from both food and supplements using current nutrition research methods in a large, well-characterized sample of children with ASD. The effect of vitamin and mineral supplementation has previously been examined in the general pediatric population,3, 5 revealing that supplementation often does not correct for micronutrient inadequacies and can lead to excessive intake. In this study, similar results were found in children with ASD who

Conclusions

MVM supplements are the most common nutritional supplements given to children to ensure nutrient adequacy. However, most MVM supplements do not provide sufficient amounts of the micronutrients typically consumed in inadequate amounts by children with and without ASD. Instead, they often provide more of the micronutrients already consumed in sufficient amounts. This can lead to excessive intake that may place children at risk for adverse effects. Two of the micronutrients of greatest concern in

Acknowledgements

The authors thank the Autism Speaks Autism Treatment Network for use of the data. The authors also thank Jennifer Foley, Robin Peck, Nicole Quataert, and Nellie Wixom. Without their hard work, dedication, and attention to detail this work would not have been possible.

P. A. Stewart is an assistant professor of pediatrics, Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.

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  • Cited by (0)

    P. A. Stewart is an assistant professor of pediatrics, Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.

    S. L. Hyman is a professor of pediatrics, Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.

    B. L. Schmidt is a clinical nutrition specialist, Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY.

    E. A. Macklin is an instructor in medicine, Massachusetts General Hospital Biostatistics Center, Boston, MA.

    A. Reynolds is an associate professor of pediatrics, Child Development Unit, University of Colorado Denver and Children’s Hospital Colorado, Aurora.

    C. R. Johnson is a board-certified behavior analyst–doctoral and an associate professor, Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville.

    S. J. James is a professor of pediatrics, University of Arkansas for Medical Sciences Children’s Hospital Research Institute, Little Rock.

    P. Manning-Courtney is a professor of pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

    Supplementary materials: Podcast available at www.andjrnl.org/content/podcast

    STATEMENT OF POTENTIAL CONFLICT OF INTEREST B. Schmidt reports receiving financial remuneration from Nutricia North America, Inc, for participating in a focus group/round table discussion regarding her knowledge and experience with gastrointestinal issues in children with autism. No potential conflict of interest was reported by the other authors.

    FUNDING/SUPPORT This study was funded by Autism Speaks, the Health Resources and Services Administration, and the National Institutes of Health. Additional support came from a cooperative agreement (no. UA3 MC 11054) from the US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program, to the Massachusetts General Hospital. The project was also supported by the University of Rochester Clinical Translational Science Award (no. UL1 TR000042) from the National Center for Advancing Translational Sciences of the National Institutes of Health, and from the Harvard NeuroDiscovery Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Autism Speaks Autism Treatment Network or the National Institutes of Health.

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