Vitamin A and vitamin D deficiencies exacerbate symptoms in children with autism spectrum disorders

Objectives: This study was designed to investigate the vitamin A (VA) and vitamin D (VD) levels in children with autism spectrum disorders (ASD) and to determine whether co-deficiency of VA and VD exacerbates clinical symptoms in autistic children.

Methods: The Autism Behavior Checklist, Childhood Autism Rating Scale (CARS), and Social Responsiveness Scale (SRS) were used to assess the symptoms of 332 children diagnosed as ASD. And the Gesell Developmental Scale (GDS) was used to evaluate neurodevelopment in children with ASD. Anthropometric measurement and questionnaire results were compared for all autistic children and 197 age- and gender-matched control children. Serum retinol levels were detected with high-performance liquid chromatography, and serum levels of 25-OH vitamin D were measured with an immunoassay method in the two groups.

Results: The Z_HA, Z_WA, and Z_BMIA of the children with ASD were significantly lower than those of the control children. Furthermore, higher proportions of children with picky eating, resistance to new foods, and eating problems were observed in the ASD group when compared with the control group. Serum retinol and 25-OH vitamin D levels in autistic children were significantly lower than those in the control children. Additionally, VA and VD co-deficiency impacts more on the symptoms and development in autistic children.

Conclusions: We found that children with autism have more VA and VD deficiencies than control children, and VA and VD co-deficiency may exacerbate the symptoms of children with ASD.     

Evaluation of a Diet Containing Probiotics and Zinc for the Treatment of Mild Diarrheal Illness in Children Younger Than One Year of Age

Objectives: Supplementation of probiotics and supplementation of zinc during acute gastroenteritis in children have been shown to exert positive effects on diarrhea duration and severity. Our aim was to evaluate a new diet enriched with zinc and probiotic bacteria in the treatment of acute gastroenteritis in young children.

Methods: In a double blind prospective study, 65 children aged 6–12 months were randomized to receive 6 × 10⁹ colony forming units of Streptococcus thermophilus, Bifidobacterium lactis, Lactobacillus acidophilus (2 × 10⁹ of each strain), 10 mg of zinc/day, and 0.3 grams of fructo-oligosaccharides in the supplemented group (n = 33) or placebo (n = 32), given in a soy protein based rice cereal. For each child, age, sex, weight, degree of dehydration, the presence of fever or vomiting, stool frequency and consistency were recorded daily until diarrhea resolution.

Results: Diarrhea resolution occurred after 1.43 ± 0.71 days in the supplemented group vs. 1.96 ± 1.24 in the control group (p = 0.017). In the subset of children who presented with vomiting, time to vomiting resolution was 0.27 ± 0.59 vs. 0.81 ± 0.91 days in the supplemented and control groups, respectively (p = 0.06). On day 3, there was only 1 child with watery stools in the supplemented group versus 10 children in the control group (p = 0.02).

Conclusions: In our series, the feeding of a cereal containing Streptococcus thermophilus, Bifidobacterium lactis, Lactobacillus acidophilus and zinc, reduced the severity and duration of acute gastroenteritis in young children. However, whether this combination is better than either the addition of probiotics or zinc alone is yet to be determined.     

Probiotic mixture containing Lactobacillus spp. and Bifidobacterium spp. attenuates 5-fluorouracil-induced intestinal mucositis in mice

Abstract

Lactobacillus spp. and Bifidobacterium spp. was used to protect against gastrointestinal disorders. The present study evaluated the effects of probiotic mixture (PM) containing Lactobacillus spp. and Bifidobacterium spp. on intestinal mucositis induced by 5-fluorouracil (5-FU). Swiss male mice (25–30?g) were treated with 5-FU (450?mg/kg, ip) and were orally administered (PM). Probiotic mixture 1 (PM-1) is a mixture of two probiotics (Lactobacillus acidophilus and Bifidobacterium lactis) and probiotic mixture 2 (PM-2) is a mixture of four probiotics (Lactobacillus acidophilus, Lactobacillus paracasei, Lactobacillus rhamnosus, and Bifidobacterium lactis). PM-1 and PM-2 decreased histopathological scores in the duodenum and jejunum after mucositis. PM-2 attenuated 5-FU-induced weight loss. On the other hand, PM-1 did not exert a significant effect on weight loss. Both probiotics mixture increased the villus/crypt ratio in all intestinal segments, increased GSH levels in the duodenum and jejunum, and reduced the MDA, MPO, TNF-α, and IL-6 levels in the duodenum, jejunum, and ileum. PM-2 attenuated the delay in gastric emptying. PM-1 and PM-2 prevented epithelial injury in intestinal mucositis by 5-FU, demonstrating the potential use of these probiotics as therapeutic agents against intestinal mucositis.     

Lactobacillus plantarum PS128 and Other Probiotics in Children and Adolescents with Autism Spectrum Disorder: A Real-World Experience

Autism Spectrum Disorder is a neurodevelopmental disorder. Recent data suggest that probiotics can reduce some symptoms of this disorder and Lactobacillus plantarum PS128 has been reported to be especially useful. We recruited a sample of 131 autistic children and adolescents (M:F = 122:19; age: 86.1 ± 41.1 months) and evaluated their changes after use of probiotics by mean of CGI. We found some significant improvements with very few side effects; these positive effects were more evident in younger children. Patients taking Lactobacillus plantarum PS128 had greater improvements and fewer side effects than those taking other probiotics. Our real-life data are consistent with existing literature showing a specific effect of Lactobacillus plantarum PS128 in Autism Spectrum Disorder.     

Role of mycotoxins in the pathobiology of autism: A first evidence

Objectives: Gene–environment interaction is an emerging hypothesis to expound not only the autism pathogenesis but also the increased incidence of neurodevelopmental disorders (such as autistic spectrum disorder, attention-deficit, hyperactivity disorder). Among xenobiotics, mycotoxins are worldwide contaminants of food that provoke toxicological effects, crucially resembling several symptoms associated with autism such as oxidative stress, intestinal permeability, and inflammation. Here, we focused on a group of mycotoxins to test their role in the manifestation of autism, try to explain their mechanism of action, and discuss possible preventive and therapeutic interventions.

Methods: Autistic children (n?=?52) and healthy children [n?=?58 (31 siblings and 27 unrelated subjects)] were recruited and body fluids and clinical data collected. The diagnosis of autism was made according to DSM V criteria, then with GMDS 0-2, WPPSI, and ADOS. Ochratoxin A (OTA), gliotoxin, zearalenone, and sphingosine/sphinganine ratio were determined by LC analysis in sera and urines. Statistical analysis was performed by the Wilcoxon Rank Sum (Mann–Whitney) test and Spearman test.

Results: By comparing the results of autistic patients with those of unrelated controls, a significant association was found for OTA levels in urines (P?=?0.0002) and sera (P?=?0.0017), and also comparing patients with siblings and unrelated controls together (P?=?0.0081).

Discussion: Our results are the first describing a possible role of OTA in the pathobiology of autism. Recalling the male prevalence of ASD (male/female?=?4–5/1), it is noted that, in animal models, OTA exerts its neurotoxicity especially in males. Moreover, in vitro, OTA increases microRNA-132 that is dysregulated in autistic patients and involved in reciprocal regulation of the autism-related genes MeCP2 and PTEN. A personalized diet coupled with probiotic administration, especially OTA adsorbing Lactobacillus, could ameliorate autistic symptoms in OTA-positive patients.     

Vitamin D status in autism spectrum disorders and the efficacy of vitamin D supplementation in autistic children

Objectives: Autism spectrum disorder (ASD) is a developmental disorder characterized by pervasive deficits in social interaction, impairment in verbal and non-verbal communication, and stereotyped patterns of interests and activities. Vitamin-D deficiency was previously reported in autistic children. However, the data on the relationship between vitamin D deficiency and the severity of autism are limited.

Methods: We performed a case–controlled cross-sectional analysis conducted on 122 ASD children, to assess their vitamin D status compared to controls and the relationship between vitamin D deficiency and the severity of autism. We also conducted an open trial of vitamin D supplementation in ASD children.

Results: Fifty-seven percent of the patients in the present study had vitamin D deficiency, and 30% had vitamin D insufficiency. The mean 25-OHD levels in patients with severe autism were significantly lower than those in patients with mild/moderate autism. Serum 25-OHD levels had significant negative correlations with Childhood Autism Rating Scale (CARS) scores. Of the ASD group, 106 patients with low-serum 25-OHD levels (<30?ng/ml) participated in the open label trial. They received vitamin D3 (300?IU/kg/day not to exceed 5000 IU/day) for 3 months. Eighty-three subjects completed 3 months of daily vitamin D treatment. Collectively, 80.72% (67/83) of subjects who received vitamin D3 treatment had significantly improved outcome, which was mainly in the sections of the CARS and aberrant behavior checklist subscales that measure behavior, stereotypy, eye contact, and attention span.

Conclusion: Vitamin D is inexpensive, readily available and safe. It may have beneficial effects in ASD subjects, especially when the final serum level is more than 40?ng/ml.

Trial registration number: UMIN-CTR Study Design: trial Number: R000016846.     

Clinical improvement following vitamin D3 supplementation in Autism Spectrum Disorder

Objective: High prevalence of vitamin D deficiency was previously reported in children with Autism Spectrum Disorder (ASD), but little is known about the efficacy of vitamin D3 treatment in ASD, although data from pilot studies seem promising. We hypothesized that serum vitamin D levels are reduced in ASD and correlate with the severity of disease. Also, we hypothesized that vitamin D3 treatment may be beneficial for a considerable portion of children with ASD.

Methods: In total, 215 children with ASD and 285 healthy control children were recruited in our study. Thirty seven of 215 ASD children received vitamin D3 treatment. The Autism Behaviour Checklist (ABC) and the Childhood Autism Rating Scale (CARS) were used to assess autism symptoms. High-performance liquid chromatography was used to assess the serum 25-hydroxyvitamin D [25(OH) D] level. Evaluations of ABC, CARS, and serum 25(OH) D levels were performed before and after 3 months of treatment.

Results: Serum levels of 25(OH) D were significantly lower in ASD children than typically developing children. Levels of serum 25(OH) D were negatively correlated with ABC total scores and language subscale scores. After vitamin D3 supplementation, symptom scores were significantly reduced on the CARS and ABC. In addition, the data also suggest that treatment effects were more pronounced in younger children with ASD.

Conclusion: Vitamin D deficiency might contribute to the aetiology of ASD. Supplementation of vitamin D3, which is a safe and cost-effective form of treatment, may significantly improve the outcome of some children with ASD, especially younger children (identifier ChiCTR-CCC-13004498).

Clinical Trial Registration: The trial ‘Association of Polymorphisms of Vitamin D Metabolism-Related Genes With Autism and the Treatment of Autism with Vitamin D’ has been registered at www.chictr.org/cn/proj/show.aspx? proj=6135 (identifier ChiCTR-CCC-13004498).     

The level of arabinitol in autistic children after probiotic therapy

ObjectiveThe level of D-arabinitol (DA) and the ratio of D-/L-arabinitol (DA/LA) in the urine of children with autism were investigated. The changes in DA/LA after probiotic treatment in urine samples of children with autism were studied.MethodsDA and LA and the DA/LA ratio were identified by capillary gas chromatography/mass spectrometry in urine before and after the probiotic therapy.ResultsThe level of DA is significantly higher (P < 0.05) in the urine of autistic children before (A) and after probiotic supplementation (A1) (160.04 ± 22.88 μmol/mmol creatinine and 89.53 ± 37.41 μmol/mmol creatinine, respectively). Nonetheless, the probiotic supplementation let to a significant decrease in DA and DA/LA and to a significant improvement in ability of concentration and carrying out orders.ConclusionThe use of probiotics seems to be helpful in reducing the level of DA and the ratio of DA/LA in the urine of children with autism.     

Cell-free extracts of Lactobacillus acidophilus and Lactobacillus delbrueckii display antiproliferative and antioxidant activities against HT-29 cell line

Abstract

Many beneficial effects of probiotic Lactobacilli on cancer prevention and therapy were previously presented. So finding probiotics with proapoptotic activities is a promising approach for cancer drug discovery. Here, the antiproliferative and antioxidant activities of cell-free extracts of Lactobacillus acidophilus and Lactobacillus delbrueckii on HT-29 cell line were evaluated employing MTT and DPPH assays. The induction of apoptosis was assessed by Hoechst staining and flow cytometry analysis which was further confirmed by expression analysis of BCL-2, BAX, caspase-3, caspase-8, and caspase-9 genes using real-time quantitative PCR. Caspase-3 activity was also analyzed. Results showed that cell viability was significantly reduced to 42.2?±?0.01% and 19.40?±?0.01% by 5 and 8?mg?ml^?1 of L. acidophilus and L. delbrueckii extracts, respectively. Apoptosis induction was shown with both bacterial extracts. Caspase-9 and caspase-3 overexpression as well as Bax/Bcl-2 ratio increase revealed the ability of both probiotics to induce intrinsic pathway-dependent apoptosis. The extrinsic pathway was also activated by L. acidophilus. At the concentration of 198?µg?ml^?1, L. acidophilus and L. delbrueckii had a DPPH scavenging activity of 59.37?±?3.97% and 71.19?±?3.64%, respectively. Taken together, these findings provide evidence for antiproliferative, proapoptotic, and antioxidant effects driven by these probiotic lactic acid bacteria (LAB) strains.     

Association between pica and gastrointestinal symptoms in preschoolers with and without autism spectrum disorder: Study to Explore Early Development

BackgroundPica, the repeated ingestion of nonfood items, can result in gastrointestinal (GI) outcomes. Children with autism spectrum disorder (ASD) and other developmental disabilities (DDs) are disproportionately affected by both pica and GI symptoms. Study of the inter-relationship between pica, GI symptoms, and ASD/DD is limited.Objective/HypothesisWe assessed associations between pica and GI symptoms in preschool-aged children with and without ASD and other (non-ASD) DDs in the Study to Explore Early Development.MethodsOur sample included children with ASD (n = 1244), other DDs (n = 1593), and population (POP) controls (n = 1487). Data to define final case-control status, pica, and GI symptoms were from standardized developmental assessments/questionnaires. Prevalence ratios, adjusted for sociodemographic factors (aPRs), and 95% confidence intervals were derived from modified Poisson regression.ResultsWithin each group (ASD, DD, POP) and for the total sample, pica was associated with vomiting (aPR for total sample 2.6 [1.7, 4.0]), diarrhea (1.8 [1.4, 2.2]), and loose stools (1.8 [1.4, 2.2]). In the DD group, pica was associated with constipation (1.4 [1.03, 1.9]) and pain on stooling (1.8 [1.2, 2.6]). In analyses of the subgroup without pica, increases in GI symptoms were still evident in the ASD and DD groups compared to POP group.ConclusionThese findings highlight an important adverse effect of pica, GI symptoms, in children with and without ASD and DDs; nonetheless, pica does not fully explain the increased risk for GI symptoms among children with ASD and DDs. These findings inform the specialized healthcare needs of children with ASD and other DDs.     

The use of inulin-type fructans improves stool consistency in constipated children. A randomised clinical trial: pilot study

Background: Constipation is a common disorder in children.

Objective: The objective of this study is to assess the beneficial effects of a daily supplementation with Orafti^® inulin‐type fructans in 2–5 year old constipated children.

Methods: Double‐blind, randomised, placebo‐controlled parallel group trial where constipated children received two doses of 2?g Orafti^® inulin‐type fructans (OF:IN) or placebo (maltodextrin) for 6 weeks. Primary outcome was stool consistency. Secondary outcomes were stool frequency and gastrointestinal symptoms.

Results: Twenty-two children were included, 17 completed the study protocol (nine and eight for the control and the OF:IN group, respectively). Results showed that Orafti^® inulin‐type fructans supplemented children had softer stools (p?=?.003). The longitudinal analysis showed no significant changes in controls, whereas supplemented children increased their stool consistency from 2.2 to 2.6 on the modified Bristol scale for children (five items instead of seven) (p?=?.040).

Conclusions: Prebiotic inulin‐type fructans supplementation improves stool consistency in constipated 2–5-year old children.

Clinicaltrials.gov, with number NCT02863848.     

Persistence of Lactobacillus reuteri DSM17938 in the Human Intestinal Tract: Response to Consecutive and Alternate-Day Supplementation

Background: Probiotics may enhance gastrointestinal health and immune function. The efficacy of different probiotic dosing strategies on colonization and persistence of probiotics is undefined.

Objective: The authors assessed colonization and persistence of Lactobacillus reuteri (L. reuteri) DSM17938 (BioGaia AB, Stockholm, Sweden) after daily or alternate-day dosing.

Methods: Volunteers ate pudding with L. reuteri (10⁹ CFU) daily (n = 9) or on alternate days (n = 9) over 7 days. Fecal samples were collected on dosing days (D1–7) and after dosing ended (D13–15 and D20–22) and were analyzed for the presence of L. reuteri. Results are reported in 3-day increments (D2–4, D5–7, D13–15, and D20–22).

Results: L. reuteri count rose in response to daily supplementation ([mean ± SD] D2–4: 4 × 10⁴ ± 2 × 10⁴ CFU, p < 0.01; D5–7: 10 × 10⁴ ± 9 × 10⁴ CFU, p < 0.01) and alternate-day supplementation (D2–4: 21 × 10⁴ ± 20 × 10⁴ CFU, p < 0.01; D5–7: 11 × 10⁴ ± 15 × 10⁴ CFU, p = 0.06) and fell in both groups 1 week after dosing ended (p < 0.01). Total volunteers with detectable L. reuteri 1 and 2 weeks after dosing ended was similar in response to daily feeding (4/9 and 2/9, respectively) and alternate-day feeding (3/9 and 2/9, respectively). L. reuteri count was higher D2–4 in response to alternate-day vs daily feeding (p < 0.05) but similar thereafter.

Conclusions: Alternate-day probiotic intake achieves equivalent colonization to daily intake, but colonization declines rapidly once dosing stops. It is possible that, initially, responsiveness to probiotics may differ between individuals, but those differences do not persist with longer consumption.     

Are ‘leaky gut’ and behavior associated with gluten and dairy containing diet in children with autism spectrum disorders?

Abstract

Objectives

Studies have suggested a link between diet and behavior in children with autism spectrum disorders (ASDs). Parental reports of behavioral changes upon exposure to gluten and/or casein are common in clinical practice. An association between diet type, intestinal permeability (IP) (‘leaky gut’), and behavior has been long proposed but not substantiated. We explored this possible association in this trial.

Methods

This randomized double-blind, placebo-controlled study explored the effects of gluten and milk on IP and behavior in children with ASDs over a period of 4 weeks. IP assessed by lactulose:mannitol (L/M) sugar permeability test and behavior assessed by the Aberrant Behavior Checklist and Conners Parent Rating were measured. Gastrointestinal symptoms in both groups were also monitored.

Results

Neither the L/M ratio nor behavioral scores were different between groups exposed to gluten/dairy or placebo. The changes observed were noted to be small and not clinically significant.

Discussion

Our study although underpowered to show small differences does not support an association between dietary gluten/milk, IP, and behavioral changes in subjects with ASD.     

Which Probiotic Is the Most Effective for Treating Acute Diarrhea in Children? A Bayesian Network Meta-Analysis of Randomized Controlled Trials

Acute diarrhea is a major cause of morbidity and mortality in children under five. Probiotics are beneficial for treating acute diarrhea in children, but unclear which specific probiotic is the most effective. We performed a Bayesian network meta-analysis to examine the comparative effectiveness of probiotics. By searching EMBASE, PubMed, and the Cochrane Library up to 31 March 2021, randomized clinical trials (RCTs) on probiotics for treating acute diarrhea in children were included. Primary outcomes included the duration of diarrhea and diarrhea lasting ≥2 days, and secondary outcomes included the mean stool frequency on day 2 and duration of hospitalization, fever, and vomiting. We assessed the certainty of the evidence of outcomes according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline. Eighty-four studies with twenty-one different interventions in 13,443 children were included. For the primary outcomes, moderate evidence indicated that, Lactobacillus reuteri [mean difference (MD) = −0.84 day; 95% confidence interval (CI), −1.39, −0.29], Bifidobacterium lactis (MD = −0.98 day; 95%CI, −1.82, −0.14), Saccharomyces boulardii (MD = −1.25 day; 95%CI, −1.59, −0.91), Lactobacillus species (spp.) plus Bifidobacterium spp. plus Saccharomyces spp. (MD = −1.19 day; 95%CI, −1.81, −0.58), and Bacillus spp. plus Enterococcus spp. plus Clostridium spp. (MD = −1.1 day; 95%CI, −1.84, −0.35) significantly reduced the duration of diarrhea when compared with placebo. Saccharomyces boulardii [Odds ratio (OR) = 0.22; 95%CI, 0.11, 0.41] and Lactobacillus reuteri (OR = 0.23; 95%CI, 0.090, 0.60) significantly reduced the risk of diarrhea lasting ≥2 days when compared with placebo or no treatment, with moderate evidence. Among all probiotics, Saccharomyces boulardii may be the most effective in reducing both duration of diarrhea (compared with placebo) and risk of diarrhea lasting ≥2 days (compared with placebo or no treatment), with moderate evidence. To be conclusive, Saccharomyces boulardii may be the most effective probiotic for treating acute diarrhea in children, followed by several other single-strain and multi-strain probiotics.     

Plasma cobalamin and folate and their metabolic markers methylmalonic acid and total homocysteine among Egyptian children before and after nutritional supplementation with the probiotic bacteria Lactobacillus acidophilus in yoghurt matrix

Objective To evaluate the biopotency of the viable probiotic Lactobacillus acidophilus (La1) in yoghurt matrix consumed by Egyptian children on their plasma vitamin B₁₂ and folate levels, and their metabolic markers methylmalonic acid (MMA) and total homocysteine (t-Hcy).

Methods A randomized nutritional supplementation trial (42 days duration) was performed in free-living children of both sexes (11 years old). The La1 in yoghurt matrix was administered to provide 10¹² colony-forming units/subject/day. Blood sampling for the analysis of plasma vitamin B₁₂, folate and t-Hcy was performed by standardized methods. Five-hour urine collection was used for the analysis of MMA and t-Hcy.

Results Initially 33.3% of the children presented with biochemical vitamin B₁₂ deficiency (<208 pg/ml), while one-fifth (21%) were biochemically deficient in folate (<3 ng/ml folate/ml plasma or 0.68 nmol/l). Fifty percent of the children presented with high plasma t-Hcy (>15.0 µmol/l). The daily consumption of the probiotic La1 yoghurt for 42 days significantly improved the mean levels of plasma vitamin B₁₂ (P<0.05) and folate (P<0.01) among the studied children compared with the respective baseline data. On the other hand, the average levels of plasma t-Hcy and urinary MMA decreased significantly (P<0.05) at the termination of the 42-day nutritional supplementation, compared with the respective initial mean levels. The consumption of the probiotic yoghurt was also associated with a significant (χ²=8.0; P<0.01) reduction in the percentage prevalence of anemia (hemoglobin <120 g/l).

Conclusion The long-term ingestion of viable probiotic La1 potentially promoted the overall nutritional status of the studied children.     

Role of Probiotics in Short Bowel Syndrome in Infants and Children—A Systematic Review

Short bowel syndrome (SBS) is a cause of significant morbidity and mortality in children. Probiotics, due to their beneficial effects on the gastrointestinal tract (e.g., improving gut barrier function, motility, facilitation of intestinal adaptation and decreasing pathogen load and inflammation) may have a therapeutic role in the management of SBS. To conduct a systematic review of the current evidence for the effects of probiotic supplementation in children with SBS, the standard Cochrane methodology for systematic reviews was used. The databases, Pubmed, Embase, ACTR, CENTRAL, and the international trial registry, and reference lists of articles were searched for randomised (RCT) or quasi-randomised controlled trials reporting on the use of probiotics in SBS. Our search revealed no RCTs on the use of probiotics in children with SBS. We found one small cross-over RCT (placebo controlled crossover clinical trial), one case control study and nine case reports on the use of probiotics in children with SBS. In the crossover RCT, there was no consistent effect on intestinal permeability (primary outcome) after supplementation with Lactobacillus rhamnosus (LGG) in nine children with SBS. The case control study (four cases: four controls) reported a trend for increase in height and weight velocity and improvement in non-clinical outcomes, such as gut flora, lymphocyte count and serum prealbumin. Five of the nine case reports showed that children (n = 12) with SBS were benefited (e.g., cessation of diarrhoea, improved faecal flora, weight gain and weaning from parenteral nutrition) by probiotic supplementation. The remaining four reported on the adverse effects, such as Lactobacillus sepsis (n = 3) and D-lactic acidosis (n = 2). There is insufficient evidence on the effects of probiotics in children with SBS. The safety and efficacy of probiotic supplementation in this high-risk cohort needs to be evaluated in large definitive trials.     

母亲孕期被动吸烟和补充叶酸与其子女孤独症行为的交互作用

目的 探讨母亲孕期被动吸烟和补充叶酸与儿童孤独症行为的交互作用。方法 以2014年深圳市龙华新区新入园的小班（3岁）儿童为研究对象,由家长填写问卷,询问儿童年龄、性别、早产、低出生体重、父母学历、父母生育年龄、家庭收入等,用孤独症行为量表评估儿童孤独症行为,按筛检界值31分和诊断界值62分将儿童分为正常组（<31分）、亚临床组（31～61分）和疑似临床组（≥62分）。控制混杂因素后,采用多分类logistic回归模型,分析孕期母亲被动吸烟和补充叶酸对儿童孤独症行为的主效应和交互作用。结果 孕期母亲被动吸烟与儿童孤独症行为呈正相关（亚临床组：OR=1.48,P<0.05;疑似临床组：OR=2.85,P<0.05）,孕期母亲补充叶酸与儿童孤独症行为的关联无统计学意义（亚临床组：OR=1.04,P>0.05;疑似临床组：OR=0.75,P>0.05）。分层分析显示,孕期母亲未被动吸烟的儿童中,孕期母亲补充叶酸与儿童孤独症行为呈负关联（疑似临床组：OR=0.30,P<0.05）;孕期母亲补充叶酸的儿童中,孕期母亲被动吸烟与儿童孤独症行为显著正关联（亚临床组：OR=1.52,P<0.05;疑似临床组：OR=4.45,P<0.05）。进一步交互作用分析显示,孕期母亲被动吸烟和补充叶酸对儿童孤独症行为疑似临床组的交互作用明显（OR=5.30,P<0.05）。结论 孕期母亲被动吸烟和补充叶酸与儿童孤独症行为关联,且存在交互作用。     

Community participation and environment of children with and without autism spectrum disorder: parent perspectives

Aim: This study explored parent perspectives of participation patterns and environmental supports and barriers for high-functioning children with autism spectrum disorder (ASD) within their communities compared with a group of children without ASD.

Method: The Participation and Environment Measure for Children and Youth was used to gather online data from parents of 99 children with ASD and 241 children without ASD. Mann–Whitney U test and chi-square tests were used to explore differences between groups and Cohen's d was calculated to examine effect sizes.

Results: Significant differences between children with and without ASD were observed for all participation and environment summary scores. Children with ASD participated less frequently, were less involved, and their parents were less satisfied with their child’s participation in community-based activities. Parents of children with ASD also identified fewer supports for their child’s participation and more environmental barriers than other parents.

Conclusion: Children with ASD participated less in community-related activities than children without ASD as perceived by their parents. Barriers limiting community participation included features of the social and physical environment and limited resources.

Significance: Occupational therapists should focus on decreasing environmental challenges in their efforts to facilitate participation of children with ASD in the community.     

Probiotics and health: a review of the evidence

Probiotics are live microorganisms – mainly bacteria – which when administered in adequate amounts confer a health benefit on the host. There is rising interest in this area, but reports in the media are often conflicting. The aim of this review is to consider the current evidence on the effects of probiotics on health, focusing on gut‐related health issues and the immune system, with the objective to provide a clearer picture of whether and how probiotics can be beneficial for health. The outcomes of this review are based on more than 100 original studies, meta‐analyses and systematic reviews. A variety of different strains have been used in studies on probiotics, and it is important to remember that the effectiveness of probiotics is strain‐specific, which means that each single probiotic strain has to be tested to assess its potential health benefits. Overall, despite the diversity of strains used in the studies included in this review, there is evidence that probiotics have the potential to be beneficial for our health. Studies in patients with inflammatory bowel disease show probiotic strains to be able to decrease the recurrence of ulcerative colitis and occurrence and recurrence of pouchitis, however, current evidence suggests that probiotics are ineffective in treating patients with Crohn's disease. Patients with irritable bowel syndrome show a reduction in symptoms when treated with selected probiotic strains, but high placebo effects have been reported as well. The evidence of the efficacy of probiotics in patients suffering from constipation is limited, but the evidence seems promising for some strains to bring relief to patients suffering from constipation. There is good evidence that a number of probiotic strains are effective in preventing antibiotic‐associated diarrhoea. The most commonly studied strains are Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii, but other strains and mixtures of strains seem to be effective as well. There is also promising evidence of a preventive effect of probiotics in Clostridium difficile‐associated diarrhoea, although some studies have been too small to obtain statistically significant findings. The effect of probiotics in acute diarrhoea, particularly in children, is well studied. Selected probiotic strains seem to be effective in reducing the duration of acute diarrhoea. LGG and S. boulardii are again the most commonly used strains and a number of studies have shown them to be effective, although one meta‐analysis showed that the effect of LGG was only significant in children in Western countries, not in children in developing countries, which may be due to different causes of diarrhoea in these regions. Studies investigating the preventive effect of probiotics in the context of common cold and flu infections show that the studied strains failed to lower the incidence of episodes but that they have the potential to decrease the duration of episodes, which suggests that the immune system may be more efficient in fighting off common cold and flu infections after consuming these strains. The evidence so far does not suggest that probiotics are effective in preventing or treating allergies or in treating eczema. However, some probiotic strains seem to lower the risk of developing eczema if taken by pregnant women and their infants in early life.