What are common nutritional deficiencies in autistic pediatric patients?

Common Nutritional Deficiencies in Autistic Pediatric Patients

Vitamin D, vitamin A, B-vitamins, calcium, and iron are the most frequently reported micronutrient deficiencies in autistic pediatric patients, with food selectivity being the primary contributing factor. 1

Prevalence and Risk Factors

• Children with autism spectrum disorder (ASD) have a fivefold elevated risk of developing eating problems compared to typically developing children, predisposing them to nutritional deficiencies 2
• Food selectivity and restrictive eating patterns are the primary contributors to nutritional deficiencies in this population 1
• Body mass indices are below the 5th percentile in 20% of ASD children versus 8.85% of typically developing children, indicating potential undernutrition 3
• Deficiencies can occur despite normal growth parameters in some children, highlighting the importance of comprehensive nutritional assessment beyond anthropometric measurements 1

Most Common Nutritional Deficiencies

Vitamins

• Vitamin D (25.0% of cases) - most frequently reported deficiency 1
• Vitamin A (24.8% of cases) - second most common deficiency, can lead to xerophthalmia in severe cases 1
• B-vitamins (18.0% of cases) - including B1, B6, and B12 4, 1
• Vitamin E - higher intake reported in some studies but deficiency noted in others 3, 1

Minerals

• Calcium (10.8% of cases) - often associated with vitamin D deficiency 1
• Iron (9.6% of cases) - can lead to iron deficiency anemia that is challenging to treat due to food aversions 1, 5
• Zinc - less commonly reported but still significant 1
• Fluoride - lower intake compared to typically developing children 3
• Magnesium - very highly inadequate intake reported 2

Macronutrient Concerns

• Protein - higher intake in primary school children with ASD compared to typically developing children 2
• Monounsaturated fatty acids (MUFA) - lower intake in preschool children with ASD 2
• All children (with and without ASD) show high intake of sugars, fats, and saturated fatty acids, but children with ASD tend to have poorer quality diets overall 2

Clinical Implications

• Co-occurring deficiencies are present in 70% of cases, complicating treatment approaches 1
• Nutritional deficiencies can lead to clinical manifestations including:
  • Rickets (vitamin D deficiency) 1
  • Xerophthalmia (vitamin A deficiency) 1
  • Iron deficiency anemia that is often resistant to standard treatments 5
  • Growth failure in some cases, though not universal 1

Assessment and Monitoring Recommendations

• Regular nutritional screening should be incorporated into routine care for all children with ASD 3
• Assessment should include:
  • Detailed dietary intake records (3-day food diaries are recommended) 3
  • Anthropometric measurements (weight, height, BMI) 3
  • Laboratory testing for micronutrient status, particularly for vitamins D, A, B12, iron, and calcium 1
• Special attention should be paid to food variety and selectivity patterns 3
• Even children with normal growth parameters should be assessed for potential micronutrient deficiencies 1

Treatment Considerations

• Standard supplementation approaches may be challenging due to sensory issues and medication aversions 5
• Alternative delivery methods for supplements may need to be considered (liquid forms, flavored options, etc.) 5
• A multidisciplinary approach involving pediatricians, dietitians, and behavioral specialists is often necessary 1
• Behavioral interventions to address food selectivity should be implemented alongside nutritional supplementation 1

Prevention Strategies

• Early dietary intervention and monitoring before deficiencies become severe 1
• Education for caregivers about creative ways to incorporate nutrient-dense foods into acceptable food options 1
• Regular reassessment of nutritional status as dietary preferences may change over time 3