Introduction

Nutrition is what we get from food we eat. It’s that part of food that gives our bodies what they need to function- to live and movearound, to think and breathe, play and work. Without nutrition wecould not survive for very long [1].

The science of nutrition helps us to improve our food choices byidentifying and amount of nutrition we need, the best source of thosenutrients and the other components in foods that may be helpful orharmful [2].

Good nutrition is of paramount importance for both infants andchildren [3].

Optimum nutrition is important during childhood for threemajor reasons:

• It allows the child to grow and develop and reach its geneticpotential for physical size and intelligence.

• Childhood offers an important opportunity to establishhealthy eating patterns and food preferences. Diet habitslearned during this period often become lifelong habits.

• A poor quality diet can increase risk of chronic disease laterin life [2].

Malnutrition includes both under and over nutrition. Indeveloping countries under nutrition is a major public healthproblem. Under nutrition which is better understood than intelligencebehavior or cognition is defined as a state wherein adequate nutrientsare not delivered to the cells to provide the substrate for optimalfunctioning [4].

A diet survey provided information about dietary intake patternsof specific food consumed and estimated nutrients intakes. Itindicates relative dietary inadequacies, which is helpful in planninghealth education activities. Diet history are the diet recalls, generallycovering 24 hours. It can be easily elicited from most subjects. 3days food records provided a reasonable way to obtain a qualitativeestimate of nutrient intakes. Food record maintained by subjects for 1to 7 days can be used to know the diet history.

In 24 hours diet recall method, a set of standardized cups suited tolocal conditions are used. Information on the total cooked amount ofeach preparations is noted in terms of standardized cups. The intakeof each food items by specific individual in the family such as thepre school child, adolescent girl or pregnant or lactating woman isassessed by using cups [5].

In 24 hours diet recall method, dietary data is obtained from therespondent through an oral questionnaire of diet survey using a set ofstandardized cups suited to local conditions [6].

24 hours diet recall method is also a report of daily habits, butinterviewed or written information about the previous day’s intake.The participants has to remember the actual food consumed andgive information on portion weights from memory. The respondentsburden for a single 24 hour recall is less than for several days for foodrecords and the method is typically used for determining averageusual intake of a large population / group [7].

The term Autism Spectrum disorder (ASD) refers to range of neurodevelopmental disorders that include the more specific diagnoses ofautism, Asperger syndrome, and pervasive developmental disordernot otherwise specified [8]. The defining features of ASD includeimpairments in social interaction, communication, imagination,restricted interest, and stereotypic behaviours. These symptomsrange in severity from mild to debilitating and usually persistthroughout the lifespan [9]. In addition to the symptoms used indiagnosis, several serious co morbid conditions are also commonlyassociated with ASD including intellectual disability, depression, andepilepsy [10]. Current estimates suggest that the prevalence of ASD isapproximately 6.7 cases per 1000 children or approximately 1 in every150 children [11].

While the etiology of ASD remains unknown, emerging evidencesuggests multiple gene defects may be involved in tandem with anenvironmental catalyst [12]. The ongoing confusion regarding theetiology of ASD has lead to the consideration of many possible causes.Often these potential causes are translated into treatments andthen propagated to the public before sufficient evidence regardingeffectiveness or safety exists [13].

Food preferences are shaped by a combination of geneticand environmental factors. The development of children’s foodpreferences involves a complex interplay of genetic, familial andenvironmental factors. There is evidence of a strong genetic influenceon appetite traits in children, but environment plays an important inmodelling children’s eating behaviour. Satiety is closely related to dietcomposition, and foods with low energy density contribute to preventovereating. Food preferences are the product of an interplay betweengenetic and environmental factors that result in substantial individualdifferences in the extent to which children are suspicious and fussyabout food in general and their likes and dislikes for specific foods.To encourage a healthy attitude to food and prevent overweight, oneshould monitor children’s growth, dietary habits and life style andparents strategies (control or disinhibition). A child’s dietary practiceshould be investigated at different ages with particular attention tothe overall diet quality (how many times, the variety of foods) and selfregulation [14].

The purpose of this study was to ascertain, if there is any statisticalco relation between the macronutrients intake of calories and proteinin ASD and normal children of same age group. The focus of thisstudy is to explore these macronutrient deficiencies in these childrenin Indian set up as there are literally very few studies done on it. Thiswill help in turn give an insight of their dietary patterns and helpidentify malnutrition if any and thus will help care givers and parentsto these ASD children to overcome it.

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Methods

The study was approved by Ethics Committee. 40 diagnosed casesof ASD children from the age group of 2-6 years of age were includedin the study. The normal subjects/ control (n=40) were selected fromthe school randomly. Questionnaire and was designed to collect datafrom mothers. Consent from mothers were taken prior to the survey.After preparing the questionnaire and validating it with a pilot study,the survey was carried out to collect information. The data wascollected in one to one process by speaking to mothers of each child.24 hours diet recall was taken from mothers in order to calculateon energy and protein intake of children. Cups and glasses werestandardized and were used for collecting information accurately.The data was analysed statistically using SPSS Version 20.0. The meanstandard deviation of macronutrients (calories and proteins) wascalculated. Each of them were further subjected to “t” test to see thesignificance (p < 0.05).

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Results and Discussion

Table 1 shows the mean standard distribution of energy andprotein intake of ASD and normal children. The mean of energywas found to be significantly on the lower side compared to normalchildren of the same age group. The mean (s.d) of daily energy intakewas 895.00 (147.54) and 1388.75 (149.13) for cases and control grouprespectively.

Table 1: Distribution of Energy and Protein Intake in Cases and Control ( n=40in each group).

Similarly, the intake of protein was also calculated and the mean(s.d) was found to be 20 (8.5) and 35.13 (8.2) in cases and controlgroup children.

Parents of children with ASD commonly report concerns regarding feeding difficulties and poor nutrition. Feeding difficulties,in the form of undesirable mealtime behaviours and/or skill deficits,can cause parental concern and impact on family dynamics. Poornutrition can have an impact on development and health issues [15].

Figure 1 and Figure 2 depicts the energy and protein intake within two groups.

Figure 1: Mean Score of Energy Intake in Cases and Control.

Figure 2 : Mean Score of Protein intake in Cases and Control.

The data collected was further analysed using “t” test. Table 2 andTable 3 represents the energy and protein intake of children of bothgroups. These macronutrients intake were found to be statisticallysignificant.

Table 2: Energy Intake in Cases and Control ( n=40 in each group).

Table 3: Protein Intake in Cases and Control ( n=40 in each group).

(p< 0.05) thus proving to malnutrition in ASD children.

Inadequate nutrient intake of children with autism spectrumdisorder (ASD) have been reported. The study examined thenutritional statuses of children with ASD and nutritional intake.These children consumed significantly fewer macronutrientscompared with children without ASD. Thus results suggests thatreduced macronutrient intake are quite common among childrenwith ASD [16].

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Conclusion

Over all, according to the study there seems to be existingsignificant difference between the macronutrient intake of AutismSpectrum Disorder and normal children within the same agegroup in Indian children. Further research can be conducted to seeother nutrient intake and there deficiencies in the ASD children inIndia. Apart from it, the parents and care givers should be givenregular counseling/ training sessions by health professionals whichwill educate them regarding healthy eating habits to overcomemalnutrition within these children.

This article is for Phd study

There is no conflict of interest to be declared

This is a self funded study

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