A Case Control Study of Food Selectivity and Bone Health in Children with Autism Spectrum Disorder (ASD)

Introduction: Provisional evidence suggest that children with ASD are at risk for decreased bone mineral density (BMD) High prevalence of severe food selectivity (SFS) in ASD may contribute to reduced BMD;however, the consequences of restricted patterns of intake in ASD are not well understood In this case control pilot study, we applied a tiered framework to evaluate the relationship between food selectivity and BMD status Study Design: Recruitment of 30 boys (6-10 years of age) divided into 3 groups: (1) ASD and severe food selectivity (SFS) (n=10);(2) ASD with mild/no FS (NFS) (n=10);and (3) without ASD and NFS (n=10, controls) Clinical assessment/diagnostic testing confirmed ASD status Presence/absence of FS involved a FS screening tool supported by a nutrition evaluation of regular (3-day) dietary intake Exclusion criteria included (1) medical issues known to affect BMD (e g , glucocorticoids);(2) enteral feeding (suggesting feeding disturbance beyond SFS), and/or 3) eating disorder (e g , anorexia nervosa), which involves a different etiology Measurement Approach: Feasibility outcomes included recruitment, attrition, and successful collection of clinical, BMD, and serologic/urine laboratory assessments Study measures included radiological assessment involving DXA (TBLH, spine) Serologic/urine laboratory assessments included bone metabolism markers (25 OH vitamin D, PTH, Calcium, Magnesium, Phosphorus, and alkaline phosphatase (formation marker) and urine NTX (resorption marker), and markers of malabsorption included CRP and celiac screen Endocrine tests included thyroid, growth hormone indices and testosterone PreliminaryResults See Table 1: Enrollment thus far involves 23/30 boys (study held due to covid restrictions) Feasibility outcomes indicated high retention and completion of study measures (>90%) A trend to lower TBLH Z-score in SFS than NFS or controls is seen and indicates larger group sizes are needed Of note, no difference in vitamin D noted Conclusion: FS is a common problem for children with ASD These preliminary findings suggest that children with ASD and severe FS may be at risk for adverse health outcomes including decreased BMD Increased group numbers will provide greater power to see if these findings are significant Further study, in turn, directed to intervention models (feeding therapy;vitamin supplementation) would be indicated Abbreviations: DXA: dual energy absorptiometry, TBLH: total body less head;NTX: N-telopeptide;PTH: parathyroid hormone