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To supplement or not to supplement – Is nutrition supplementation appropriate for children with ASD?
Children with Autism Spectrum Disorder (ASD) are often picky eaters, which can lead to concern that they may not be getting adequate amounts of vitamins and minerals, and may suggest to their carers a need for nutritional supplements. However, little is known about the effect of supplements on the dietary adequacy of children with ASD.
A study published last week in the Journal of the Academy of Nutrition and Dietetics looked at nutrition supplement use and total micronutrient intake (i.e. vitamin and mineral intake from diet and supplements) in 288 US children aged 2-11 years with ASD, including children with autistic disorder, Asperger's disorder and pervasive developmental disorder. The children’s micronutrient intake was calculated using detailed 3 day food diaries which assessed all food, beverages and nutritional supplements consumed over the time period, and were completed by their caregivers after training from a dietitian.
Nutrition supplements were not found to correct inadequate intakes of calcium and vitamin D
Over half (56 per cent) of the children used nutrition supplements, especially multivitamin/mineral formulations, making use more common than reported amongst children in the general population. The study though suggested that supplements did not correct the most common micronutrient deficits seen in the children with ASD, particularly those of vitamin D and calcium. Despite the relatively common practice of taking supplements, almost a third of the children had inadequate intake for vitamin D, and up to half of them for calcium. The reverse problem was also observed because the study found excessive intakes as a result of the use of supplements. Across all ages of children, supplementation led to excess intakes of vitamin A, folic acid and zinc.
Higher supplement use in children using GFCF diets
The study also looked specifically at children on gluten and casein free diets (GFCF), a dietary regimen commonly tried in an attempt to improve symptoms. Interestingly children receiving GFCF diets had similar micronutrient intakes but were more likely to use supplements, perhaps because of the perception that a restrictive diet is more likely to be nutritionally inadequate.
Ironically, it was found that the children who were more likely to be consuming more micronutrients in adequate amounts from food alone were also more likely to be taking supplements. Furthermore the micronutrients most likely to be consumed in adequate amounts in the diet were also the micronutrients most commonly found in multivitamins. Conversely, the micronutrients most likely to be consumed in inadequate amounts were infrequently included in nutritional supplements.
Excess intake from supplements reported
This particular study then found that 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.
The important point perhaps is that each child’s diet should be looked at for potential nutrient deficiencies or excess, and that again looking at diet in terms of individual needs and preferences is an important part of care. If there is concern with regards to the nutritional adequacy of children with ASD who are fussy or picky eaters, or a decision has been made to try a diet such as GFCF, professional dietary advice should be sought as an assessment of each individual’s diet can be carried out rather than reliance on ad hoc supplementation with micronutrient supplements.
Ayela Spiro, British Nutrition Foundation – QCS Expert Nutrition Contributor