Possible Factors Associated with High Prevalence of Overweight and Obesity in Toddlers with Autistic Spectrum Disorder

Background:

Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interaction along with restricted and repetitive behaviors. In addition, abnormal sensory processing and difficulties with oral motor skills are more common in children with ASD. These challenges, play an important role in eating patterns and dietary consumption. Food aversion/refusal or food selectivity is common. These feeding difficulties, may lead to inadequate nutritional intake and impaired growth parameters in children.

Objectives:

This study examined the incidence of overweight and obesity among toddlers diagnosed with ASD, and its relation to demographic and clinical parameters, as well as the severity of the core symptoms.

Methods:

Toddlers 1-3 years of age, with ASD who were enrolled in the 2015 or 2016 school year –in one of 11 different Early Intervention Day Care Centers (EIDCC) participated in the study. All of the toddlers were diagnosed with ASD based on DSM - 5 criteria. Demographic, parental and clinical data were collected. Weight and Height were measured and age and gender specific z-scores were determined according to the World Health Organization (WHO) child growth standards. Social and communication performance was evaluated using the Social Communication Questionnaire (SCQ). Exclusion criteria included genetic syndromes, chronic diseases and endocrine abnormalities. Statistical analyses were performed utilizing SPSS.

Results:

The study participants (n=142) included 98 males (69%), and 44 females (31%), aged 2.5±0.4 years. Of prenatal data that were available from 118-122 participants, 18 (15.3%) were born after IVF treatment and 51 (42.9%%) by Caesarean section, 15 (12.7%) are one of twins. Higher incidence of birth weight classified as large for gestational age (LGA) was noted (n=27): 22.3% versus 10%, as expected when compared to the general population (p<0.05). Total SCQ score ranged from 5 to 32 (n=133). Height – z scores corresponded to international averages with mean of -0.06±1.34 versus 0, p>0.05. In contrast, significantly increased BMI-z scores were found : 0.65±1.21 versus 0, p<0.05. Fifty- two participants had BMI z sore >1 SD and classified as overweight (13.4%) or obese (23.2%), while only one toddler presented underweight. In order to find which parameters may be related to overweight/obesity, comparisons were made between those with high z-scores versus those with normal BMI (n=89). No statistical differences were noted in age, gender distribution, height-z scores, parent's age and education, any of the prenatal and perinatal factors, nor SCQ scores (p>0.05).

Conclusions:

Our results from a multi-center sample of toddlers with ASD, suggest that there is an elevated risk for unhealthy weight status, which presents at a very young age. Since no associations were found with ASD symptoms severity, perinatal history or demographic parameters, it may be concluded that the tendency to obesity is related to eating habits and possibly low physical activity. This study emphasizes the importance of increasing awareness and providing education for caregivers and developing intervention strategies to prevent early – onset obesity that has known deleterious consequences on health over the lifespan.