衡阳市学龄前儿童孤独症谱系患病情况调查

目的 探讨衡阳市3～6岁学龄前儿童孤独症谱系患病情况,为降低孤独症的发病率及其三级预防工作提供现实参考依据.方法 采用随机整群抽样的方法,抽取衡阳市区18所幼儿园,使用克氏孤独症行为量表（CABRS）、自拟影响因素问卷方式筛查出可疑孤独症谱系障碍（autism spectrum disorders,ASDs）患儿,继而采用DSM-Ⅳ诊断标准同时利用儿童孤独症评定量表（CARS）对其进行诊断评估,统计分析得出ASDs患病情况.结果 （1）本样本ASDs患病率为62.7/万,男童26例,女童4例,男女比例为6.5∶1; （2）ASDs组儿童性别、父母亲生育年龄、母亲人工流产史及孕期情绪波动、新生儿窒息和黄疸、父亲有害职业史的分布差异,具有统计学意义（P＜0.05）.结论 衡阳市接受主流教育的3～6岁学龄前儿童ASDs患病率接近国外报道水平,分析出的相关因素可以为孕期保健工作提供建设性意见.     

Prevalence and Clinical Features of Celiac Disease in a Cohort of Italian Children with Autism Spectrum Disorders

Background: Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental conditions whose etiopathogenesis derives from a complex interaction between genetic liability and environmental factors. In this framework, mounting evidence suggests that immune system dysfunction could be a risk factor contributing to the development of ASD in at least a subpopulation of individuals. In particular, some studies suggest an association between celiac disease (CD)—a long-term autoimmune disorder that primarily affects the small intestine triggered by the ingestion of gluten—and ASD, while others hypothesized a random link. This investigation aimed to evaluate the prevalence of CD in a large sample of school-aged children with ASD and to characterize their clinical profile. Methods: Medical records of 405 children with ASD aged 5–11 years (mean age: 7.2 years; SD: 1.8 years) consecutively referred to a tertiary-care university hospital between January 2014 and December 2018 were reviewed; among them, 362 had carried out serological testing for CD. Results: Nine patients with positive CD serology were identified, eight of which satisfied the criteria for CD diagnosis. The estimated CD prevalence in ASD children was 2.18% (95% CI, 0.8–3.7), which was not statistically different (1.58%; p = 0.36) from that of an Italian population, matched for age range, considered as a control group (95% CI, 1.26–1.90). Three out of the eight ASD patients with CD did not have any symptoms suggestive of CD. Conclusions: Our findings did not show a higher prevalence of CD in ASD children than in the control population, but could suggest the utility of routine CD screening, given its frequent atypical clinical presentation in this population.     

Dietary Patterns and Weight Status in Italian Preschoolers with Autism Spectrum Disorder and Typically Developing Children

Atypical eating habits are more common in children with autism spectrum disorders (ASD) than typically developing (TD) peers. Feeding problems may lead to the double burden of specific nutrient deficiencies and excessive weight gain, with a consequent increase in obesity prevalence. The dietary intake of Italian preschoolers with ASD compared to their TD peers and the impact of their dietary choices on their weight status and relationship to food selectivity (FS) were investigated. Dietary patterns and their associations with body mass index (BMI) were evaluated in 65 children with ASD and 82 peers with TD aged 1.3–6.4 years. Eating habits were assessed with a modified version of a parent-rated semi-quantitative Food Frequency Questionnaire. Moreover, the prevalence of FS and possible links with dietary patterns and BMI were investigated in the ASD group. Children with ASD consumed significantly higher amounts of simple sugars, processed and ultra-processed carbohydrates, both low- and high-fat animal proteins, and lower amounts of vegetables and fruits compared to peers with TD. The obesity rate was 1.5% in children with TD and more than fourfold (6.2%) in children with ASD, although the difference between groups was not statistically significant. FS was significantly more frequent in children with ASD than in peers with TD. Children with ASD and FS showed significantly lower annual intakes of vegetable proteins and fiber (considered essential nutrients for a healthy diet) than children with ASD without FS. Our results showed that children with ASD showed different dietary habits than those with TD, with the higher consumption of energy-dense foods and lower amounts of food-sourced fibers, which could place them at increased risk to develop overweight, obesity, and micronutrient deficiencies later in life.     

Altered Gut Microbiota in Korean Children with Autism Spectrum Disorders

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social and behavioral impairments. Recent studies have suggested that gut microbiota play a critical role in ASD pathogenesis. Herein, we investigated the fecal microflora of Korean ASD children to determine gut microbiota profiles associated with ASD. Specifically, fecal samples were obtained from 54 children with ASD and 38 age-matched children exhibiting typical development. Systematic bioinformatic analysis revealed that the composition of gut microbiota differed between ASD and typically developing children (TDC). Moreover, the total amounts of short-chain fatty acids, metabolites produced by bacteria, were increased in ASD children. At the phylum level, we found a significant decrease in the relative Bacteroidetes abundance of the ASD group, whereas Actinobacteria abundance was significantly increased. Furthermore, we found significantly lower Bacteroides levels and higher Bifidobacterium levels in the ASD group than in the TDC group at the genus level. Functional analysis of the microbiota in ASD children predicted that several pathways, including genetic information processing and amino acid metabolism, can be associated with ASD pathogenesis. Although more research is needed to determine whether the differences between ASD and TDC are actually related to ASD pathogenesis, these results provide further evidence of altered gut microbiota in children with ASD, possibly providing new perspectives on the diagnosis and therapeutic approaches for ASD patients.     

Association of Breastfeeding for the First Six Months of Life and Autism Spectrum Disorders: A National Multi-Center Study in China

Previous studies have shown that exclusive breastfeeding is associated with lower odds of having autism spectrum disorders (ASD) in children, but data are lacking in Asian countries, especially China. This cross-sectional study of seven cities in China collected data from August 2016 to March 2017 from 6049 toddlers aged 16–30 months and their parents who responded to questionnaires. The breastfeeding status was collected via questionnaires based on recommendations from the World Health Organization. The standard procedure for screening and diagnosis was applied to identify toddlers with ASD. Among the 6049 toddlers (3364 boys [55.6%]; mean [SD] age, 22.7 [4.1] months), 71 toddlers (1.2%) were identified as ASD. The prevalence of exclusive breastfeeding, partial breastfeeding, and not breastfeeding was 48.8%, 42.2%, and 9.1%, respectively. Compared to toddlers with exclusive breastfeeding, toddlers with partial breastfeeding or without breastfeeding had higher odds of having ASD (odd ratios [OR]: 1.55, 95% confidence interval [CI]: 0.90–2.74; OR: 2.34, 95% CI: 1.10–4.82). We did not find significant modification of demographic characteristics on the associations. The results remained robust in multiple sensitivity analyses. Toddlers without breastfeeding for the first six months of life had higher odds of having ASD, and our findings shed light on the necessity of strengthening public health efforts to increase exclusive breastfeeding in China.     

Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders

Food selectivity (FS) in children with autism spectrum disorders (ASD) is common, and its impact on a nutritional level is known. However, the etiology of gastrointestinal disorders (GID) related to alterations in the intestinal microbiota in children with ASD remains unclear. This article provides a narrative review of the literature on FS from the last 15 years, and its relationship with GID in children with ASD. Sensory aversion in ASD leads to food elimination, based on consistencies, preferences, and other sensory issues. The restriction of food groups that modulate the gut microbiota, such as fruits and vegetables, as well as the fibers of some cereals, triggers an intestinal dysbiosis with increased abundance in Enterobacteriaceae, Salmonella Escherichia/Shigella, and Clostridium XIVa, which, together with an aberrant immune response and a leaky gut, may trigger GID. It is observed that FS can be the product of previous GID. GID could provide information to generate a hypothesis of the bidirectional relationship between FS and GID. Emphasis is placed on the need for more studies with methodological rigor in selecting children with ASD, the need for homogeneous criteria in the evaluation of GID, and the adequate classification of FS in children with ASD.     

A Narrative Review about Autism Spectrum Disorders and Exclusion of Gluten and Casein from the Diet

Objective: Autism spectrum disorders (ASDs) appear in the early stages of neurodevelopment, and they remain constant throughout life. Currently, due to limitations in ASDs treatment, alternative approaches, such as nutritional interventions, have frequently been implemented. The aim of this narrative review is to gather the most relevant and updated studies about dietary interventions related to ASDs etiopathogenesis. Results: Our literature search focused on the gluten- and casein-free (GFCF) diet. The literature found shows the inexistence of enough scientific evidence to support a general recommendation of dietary intervention in children with ASD. Protocols and procedures for assessing risk and safety are also needed. Future lines: Prospective and controlled research studies with larger sample sizes and longer follow-up times are scarce and needed. In addition, studies considering an assessment of intestinal permeability, bacterial population, enzymatic, and inflammatory gastrointestinal activity are interesting to identify possible responders. Besides brain imaging techniques, genetic tests can also contribute as markers to evaluate the comorbidity of gastrointestinal symptoms.     

Dietary Intakes and Eating Behavior between Metabolically Healthy and Unhealthy Obesity Phenotypes in Asian Children and Adolescents

Diet plays a critical role in the development of obesity and obesity-related morbidities. Our study aimed to evaluate the dietary food groups, nutrient intakes and eating behaviors of metabolically healthy and unhealthy obesity phenotypes in an Asian cohort of children and adolescents. Participants (n = 52) were asked to record their diet using a 3-day food diary and intakes were analyzed using a nutrient software. Eating behavior was assessed using a validated questionnaire. Metabolically healthy obesity (MHO) or metabolically unhealthy obesity (MUO) were defined based on criteria of metabolic syndrome. Children/adolescents with MUO consumed fewer whole grains (median: 0.00 (interquartile range: 0.00–0.00 g) vs. 18.5 g (0.00–69.8 g)) and less polyunsaturated fat (6.26% kcal (5.17–7.45% kcal) vs. 6.92% kcal (5.85–9.02% kcal)), and had lower cognitive dietary restraint (15.0 (13.0–17.0) vs. 16.0 (14.0–19.0)) compared to children/adolescents with MHO. Deep fried food, fast food and processed convenience food were positively associated with both systolic (β: 2.84, 95%CI: 0.95–6.62) and diastolic blood pressure (β: 4.83, 95%CI: 0.61–9.04). Higher polyunsaturated fat intake (OR: 0.529, 95%CI: 0.284–0.986) and cognitive dietary restraint (OR: 0.681, 95%CI: 0.472–0.984) were associated with a lower risk of the MUO phenotype. A healthier diet composition and positive eating behavior may contribute to favorable metabolic outcomes in children and adolescents with obesity.     

Dietary Fat Effect on the Gut Microbiome,and Its Role in the Modulation of Gastrointestinal Disorders in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) report a higher frequency and severity of gastrointestinal disorders (GID) than typically developing (TD) children. GID-associated discomfort increases feelings of anxiety and frustration, contributing to the severity of ASD. Emerging evidence supports the biological intersection of neurodevelopment and microbiome, indicating the integral contribution of GM in the development and function of the nervous system, and mental health, and disease balance. Dysbiotic GM could be a contributing factor in the pathogenesis of GID in children with ASD. High-fat diets may modulate GM through accelerated growth of bile-tolerant bacteria, altered bacterial ratios, and reduced bacterial diversity, which may increase the risk of GID. Notably, saturated fatty acids are considered to have a pronounced effect on the increase of bile-tolerant bacteria and reduction in microbial diversity. Additionally, omega-3 exerts a favorable impact on GM and gut health due to its anti-inflammatory properties. Despite inconsistencies in the data elaborated in the review, the dietary fat composition, as part of an overall dietary intervention, plays a role in modulating GID, specifically in ASD, due to the altered microbiome profile. This review emphasizes the need to conduct future experimental studies investigating the effect of diets with varying fatty acid compositions on GID-specific microbiome profiles in children with ASD.     

孤独症谱系障碍儿童血液34种重金属水平及影响因素分析

目的:了解孤独症谱系障碍(Autism spectrum disorder,ASD)儿童重金属水平及相关影响因素.方法:检测ASD组儿童(n=28)及对照组正常儿童(n=26)体内血液34种重金属含量,同时采用调查问卷方法评估两组人口学信息、社会经济信息以及潜在重金属源的风险因素.结果:ASD组儿童血锰高于对照组儿童,...     

学龄前儿童孤独症行为危险因素的研究

目的 探讨城市学龄前儿童孤独症行为的危险因素。方法 采用整群随机抽样方法，对铜陵市区21所幼儿园3559名3-5岁儿童进行研究，用克氏孤独症行为量表和儿童及其父母有关情况调查问卷进行调查。用EPI-5软件进行数据录入，用SPSS10.0for windows对资料进行单因素和多因素非条件Logistic回归分析。结果 儿童孤独症行为的检出率为11.8%，男性高于女性。儿童出生月份为12月和1月，过期出生，早生，新生儿期住院。父亲年龄35岁以上，母亲孕期盆身，孕晚期下肢浮肿及父母亲化程度低等，为儿童孤独症行为的危险因素。结论 儿童孤独症行为与父母化程度，儿童出生季节，是否足月出生，新生儿期是否住院等自身因素及有关环境因素有关。     

青春期儿童饮食行为及饮食心理调查

目的研究影响城乡青春期儿童生长发育的心理及行为因素。方法采用分层、整群随机抽样方法,分别抽取南充市城乡共5所小学五、六年级1 820名学生进行问卷调查。结果城乡学生BMI差异有统计学意义（P〈0.01）,其中影响城市儿童生长发育的主要因素包括不吃早餐（4.7%）、为减肥不吃主食（1.4%）、边吃饭边看电视（37.2%）及认为自己该减肥（32.2%）、体型不标准（偏胖：29.9%、偏瘦：21.6%）等;而影响农村儿童生长发育的主要因素包括会为减肥不吃主食（3.2%）、零食代替主食的习惯（3.5%）、认为自己该减肥（18.8%）、体型不标准（偏胖：15.9%、偏瘦：24.8%）。结论行为及心理因素均会影响儿童的生长发育,家长及老师应对学生进行正确的引导,为青少年儿童的健康成长提供良好的环境。     

Dietary Patterns and Dietary Adequacy of Street Children in Dhaka,Bangladesh

The negative impact of poverty on the biological well-being of children is well established. The purpose of the present study was to evaluate the impact of the stress of full-time street life on the dietary patterns and dietary adequacy of street children living in Dhaka, Bangladesh. This was accomplished by comparing the nutritional patterns of full-time street children with those of other poor children in Dhaka who also spend their days on the streets but who return to their families at night. There were few differences between groups, possibly due to street children being a select group. However, there were significant sex differences in both groups of children, with boys tending to have more diverse and more adequate diets than girls. The cause of this latter pattern could not be determined with the available data but may involve cultural values favoring males over females.     

Fussy Eating among Children and Their Parents: Associations in Parent-Child Dyads,in a Sample of Children with and without Neurodevelopmental Disorders

Parents are important agents in shaping children’s eating habits. However, the associations between children’s and parents’ eating behaviors are complex and may be convoluted for various reasons, such as parenting feeding styles, stressful mealtimes, and children’s neurodevelopmental disorders (ND), such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). The purpose of this study was to analyze associations between parents and their children’s fussy eating, in a cross-sectional sample of children, with and without ND. Ninety-seven parents answered screening questionnaires prior to an intervention study. Associations were investigated using two-way ANOVAs and chi-square analyses. Overall, children with ND accepted fewer food items and consumed unhealthier foods more frequently than children without ND. Fussy eating parents had children who accepted fewer food items and consumed unhealthier foods more frequently than children whose parents were not fussy eaters. Interaction effects were not significant. A higher proportion of fussy eating parents, than non-fussy eating parents, had children who had difficulties with combined foods and hidden ingredients. The findings highlight the need for further investigation into the relationships between parents’ influence on their children’s eating behavior and food consumption, as well as possible reciprocal impacts.     

Nutritional Impact and Eating Pattern Changes in Schizophrenic Spectrum Disorders after Health Education Program on Symbiotic Dietary Modulation Offered by Specialised Psychiatric Nursing–Two-Arm Randomised Clinical Trial

Background: The traditional therapeutic approach has perceived the role of nutrition as a minor intervention in psychiatry. The microbiota–gut–brain axis theory evidences the influence of dietary and nutritional patterns on mental health. Aims: To evidence the impact of dietary advice on increasing symbiotic intake on nutritional status and dietary habits in individuals with schizophrenia spectrum disorders. Methods: Randomised clinical trial (two-arm, double-blind, balanced-block, six-month intervention) in 50 individuals diagnosed with schizophrenia spectrum disorders. The control group received conventional dietary advice on an individual basis. A personal nutritional education programme was established in the intervention group (IG) to increase prebiotic and probiotic intake through dietary advice (dairy and fermented foods, green leafy vegetables, high-fibre fruit, whole grains, etc.). Data on nutritional status and dietary habits were collected (baseline and six months). The degree of dietary adherence to the recommended patterns was recorded weekly. Anthropometric parameters were also analysed monthly. Results: Finally, 44 subjects completed the follow-up. All participants exceeded the dietary reference intakes. The overall and intra-group analysis showed a statistically significant (p < 0.05) reduction in macro and micronutrient intakes with a closer approximation to the recommended dietary intakes, except for polyunsaturated fatty acids, oligosaccharides, polysaccharides and dietary fibre. After six months of intervention, statistical differences (p < 0.001) were found in all variables of the anthropometric profile in the IG, as well as an increase in the consumption of foods with a high symbiotic content (at baseline and six months). Likewise, a reduction in eggs, meat, fish, sugars and ultra-processed foods was evident, leading to significant intra-group differences (p < 0.05). Conclusions: Implementing conventional nutritional education strategies and specific nutritional advice with a symbiotic effect improves the dietary-nutritional profile in patients with schizophrenia spectrum disorders. Furthermore, it highlights the nutritional impact on mental health, stating itself as adjuvant therapy for physical health and lifestyle improvement.     

Family-Centered Occupational Therapy and Telerehabilitation for Children with Autism Spectrum Disorders

ABSTRACT

The purpose of this pilot project was to explore the use of telerehabilitation for collaborative occupational therapy sessions with parents of children with autism spectrum disorders (ASD). The aim was to improve carryover of therapeutic strategies by parents to address children's sensory modulation in their natural environments. Four families participated in clinic-based sessions with the therapist followed by online sessions for six weeks. Data consisted of family schedules, sensory diets, archived webcam sessions, and Sensory Processing Measure Home Form scores before and after initiation of the telerehabilitation sessions. Results demonstrated the potential for using telerehabilitation as a tool to provide collaborative occupational therapy in order to improve carryover of home programs for children with ASD by providing opportunities for parents to ask questions, review sensory techniques, and understand the therapist's clinical reasoning