Elsevier

Nutrition

Volume 29, Issue 3, March 2013, Pages 537-541
Nutrition

Applied nutritional investigation
Low folate and vitamin B12 nourishment is common in Omani children with newly diagnosed autism

https://doi.org/10.1016/j.nut.2012.09.014Get rights and content

Abstract

Objective

Arab populations lack data related to nutritional assessment in children with autism spectrum disorders (ASDs), especially micronutrient deficiencies such as folate and vitamin B12.

Methods

To assess the dietary and serum folate and vitamin B12 statuses, a hospital-based case–control study was conducted in 80 Omani children (40 children with ASDs versus 40 controls).

Results

The ASD cases showed significantly lower levels of folate, vitamin B12, and related parameters in dietary intake and serum levels.

Conclusion

These data showed that Omani children with ASDs exhibit significant deficiencies in folate and vitamin B12 and call for increasing efforts to ensure sufficient intakes of essential nutrients by children with ASDs to minimize or reverse any ongoing impact of nutrient deficiencies.

Introduction

A survey of the available literature suggests that nutritional and dietary interventions are considered routine treatment for developmental disorders including autism [1], [2]. However, the study and implementation of such measures have been limited to the industrialized and affluent countries of North America and Western Europe, with few exceptions [3], [4]. Developing countries, and especially Arab countries, lack relevant data because autism is not a common theme of research [5].

Autism spectrum disorders (ASDs) are neurodevelopmental disorders commonly characterized by debilitating and intransigent symptoms in three categories: difficulties with reciprocal social interactions, impaired communication skills, and disturbed emotional functioning that often manifests as stereotypical and non-goal–directed behaviors [6].

Oman, an Arab country located on the southern tip of the Arabian Peninsula adjacent to the Asian and African continents with a population nearing 3.5 million, presents fertile ground to explore the nutritional and dietary deficits in children with developmental disorders [7]. In Oman, a preliminary epidemiologic survey has suggested that 0.14 per 1000 Omani children (0–14 y old) have ASDs [8].

Issues of child welfare are generally a significant concern for domestic social policy. Oman, like other emerging economies, is witnessing the co-occurrence of undernutrition and obesity in its population [9]. Evidence also suggests that the country has yet to overcome persistent malnutrition. Alasfoor et al. [10] reported that, nationwide, approximately 7% of children exhibit wasting, 11% exhibit stunting, and 18% were classified as underweight. A more recent study replicating that study has suggested that these indices of malnutrition may be even higher [11]. However, these studies limited their sample selection to preschool children in mainstream education. Thus, children with ASDs were unlikely to be accounted for by these assessments of malnutrition indices because such children are unlikely to be enrolled in mainstream schools in Oman [12]. To address the potential data gap regarding children with developmental disorders, Al-Farsi et al. [13] examined the nutritional status of 128 children with ASDs in Oman and found that approximately 9% of the participants were malnourished according to the indices of underweight, wasting, and stunting. There is evidence that the variation in levels of two important nutrients, folate and vitamin B12 [14], [15], [16], is strongly relevant for ASD. These two nutrients have been suggested to play a vital role in cognitive functions [17] similar to those often found to be disturbed in children with ASDs [14], [18], [19], [20].

Building on these emerging data showing that Arab populations tend to have folate and vitamin B12 deficiencies, we initially conducted a preliminary study on screening the folate and vitamin B12 status and we reported that a low status of these two vitamins was associated with hyperhomocysteinemia in Omani autistic children [21]. In the present study, we performed a more comprehensive investigation and compared dietary and serum folate and vitamin B12 statuses between children with ASDs and control subjects matched for age, gender, ethnicity, and sociodemographic status.

Section snippets

Materials and methods

The present case–control study was designed to determine the differential variation in folate or vitamin B12 levels in preschool-age Omani children (3–5 y old) with and without diagnosed ASDs. The study was conducted from December 2009 to August 2010 at Sultan Qaboos University Hospital (SQUH), the main referral hospital for all autism cases in Oman.

Results

Eighty children, including 40 cases and 40 controls, were analyzed. The age was identical in cases and controls. Selected sociodemographic characteristics of all subjects at the time of enrollment in the study are listed in Table 1. In the two groups, most participant families lived in urban areas. The groups were also comparable in the distribution of maternal age, mother's occupation, and family income. Compared with the control group, mothers of participants in the case group tended to have

Discussion

The present study shows that there is a differential variation in two nutrients, folate and vitamin B12, in Omani children with ASD compared to those defined as control subjects. A significant decrease was found in the mean values of dietary and serum levels of folate and vitamin B12 between children with and those without ASD. A decrease in the activity of methionine synthase, for which folate and vitamin B12 are required cofactors, was observed, indicating that their dietary and serum

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    This study was supported by the Internal Grant Fund (IG/AGR/Food/10/01) and His Majesty's Strategic Fund (SR/MED/FMCO/11/01), College of Medicine and Health Sciences, Sultan Qaboos University. A research grant from the Autism Research Institute provided partial support for this study.

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