DIETARY AND ANTHROPOMETRIC EVALUATION OF A SAMPLE OF AUTISTIC SUBJECTS IN JORDAN By Amani Abd Al-Rahman Al- Hadid Supervisor Dr. Mousa Numan Ahmad This Thesis was Submitted in Partial Fulfillment of the Requirements for the Master's Degree of Science in Nutrition and Food Technology Faculty of Graduate Studies University of Jordan August, 2006 xiii DIETARY AND ANTHROPOMETRIC EVALUATION OF A SAMPLE OF AUTISTIC SUBJECTS IN JORDAN By Amani Abd Al-Rahman Al- Hadid Supervisor Dr. Mousa Numan Ahmad ABSTRACT This study was carried out in order to assess the nutritional and anthropometric status of a sample of autistic subjects in Jordan, and to study the different dietary patterns and practices of this sample, as well as to know how the nutritional status correlates with the severity of the disorder. The study sample consisted of 59 subjects (49 males, 10 females), aged between 4-23 yr, and diagnosed according to either one of the two diagnostic scales; CARS, n= 31 or GARS, n= 28. A special questionnaire was used to collect data about dietary practices and patterns related to meals and snacks, dieting, use of supplements, eating problems and gastrointestinal disturbances. A three- day dietary record was also used to collect dietary intake data. Body weight, height, midarm circumference, skinfold thickness and head circumference were measured, and their indices were calculated for evaluating the anthropometric status. Autism Treatment Evaluation Checklist (ATEC) was used to determine the current severity of the disorder, and the Healthy Eating Index (HEI) was used to determine the current overall diet adequacy. The sample was divided into four age groups according to the Food and Nutrition Board age classification. The groups were as follows: group 1: 4-8 yr (n= 31, 26 males, 5 females), group 2: 9-13 yr (n= 17, 12 males, 5 females), group 3: 14-16 yr (n= 5 males), and group 4: 21-23 yr (n= 6 males). The results indicated that 64% of the subjects had normal body weight, whereas 12%, 14%, 10% were underweight, at risk of overweight or overweight respectively. The % median of the main anthropometric measurements of the sample groups ranged from 83%-104% in body weight, 94%-99% in height, 96%-111% in BMI and 79%-115 % in AMA. Energy intake was adequate (>90% of the recommended intake) in 48 (81%) subjects, and the intake of protein and carbohydrate was >100% of DRI in 58 (98%) subjects. Fat intake as a percent of energy was compatible with the Acceptable Macronutrient Distribution Range (AMDR) in 41 (69%) subjects. The intake of all of the studied micronutrients was adequate (>80% of DRI) for > 80% of the subjects except for Ca, I and vitamin D. Thirty six subjects (61%) were applying one or more type of diet, twenty subjects (34%) were using supplements, 25 subjects (42%) had one or more type of gastrointestinal disturbances, and all subjects had one or more type of eating problems. Soft drinks, sweets and foods containing food additives were the most problematic food groups with a reported negative effect in 58%, 53% and 44% of the subjects respectively. The mean ATEC score of the whole sample was 71.2 (S.D= 30.5), which corresponds to moderate-to- severe degree of autism severity, and the mean HEI score of the whole sample was 75.1 (S.D= 6.2), which corresponds to "needs improvement" grade of diet adequacy. The significant differences detected between the xiv different age and sex groups with respect to the median values of the anthropometric and dietary variables were subtle. Dieters had significantly (<0.05) lower intake, as compared to non- dieters, of the following nutrients: carbohydrate as %DRI (232 ±15% vs. 292±23%), vitamins D (2.6±0.3 µg/d vs. 3.8±0.5 µg/d), thiamin (1.6±0.1 mg/d vs. 2.0±0.1 mg/d), riboflavin (1.6±0.1 mg/d vs. 2.0±0.1 mg/d), niacin (31±3 mg/d vs. 43±5 mg/d), B12 (2.2±0.2 µg /d vs. 3.2±0.3 µg /d), folate (379±31µg /d vs. 510±42 µg /d), calcium (627±40 mg/d vs. 864±65 mg/d), selenium (66±6 mg/d vs. 99±8 mg/d), magnesium (249±22 mg/d vs. 339±36 mg/d) and iodine (27±4 µg /d vs. 53±9 µg /d). However, No significant differences (>0.05) were found in any of the major anthropometric measurements, nor in the scores of ATEC or HEI. The ATEC score was significantly correlated with the following variables: percent contribution to total energy intake of plant protein (r= 0.32, =0.01), fat (r= -0.28, = 0.03), MUFA (r= -0.33, =0.01), PUFA (r =-0.27, = 0.04); as well as the intake of linoleic acid and its percentage from the recommended intake (r= -0.29, =0.03 and r= 0.31,= 0.02 respectively), presence and number of GIT disturbances (r= 0.28, =0.03, r= 0.33, = 0.01 respectively). The HEI score was not significantly correlated with the ATEC score (r= 0.12, =0.36), nor any of the anthropometric variables was. Only two factors were found to significantly predict the value of the ATEC score; intake of PUFA (r2= 0.10, = 0.01), and number of GIT disturbances (r2= 0.11, = 0.01). It could be concluded that autistic subjects in Jordan do not form a distinct group with respect to their anthropometric measures, which showed little or no association with the severity of autism. The dietary intake of the autistic subjects was generally adequate, but needed improvement as suggested by the HEI score. It seems that some dietary factors can either positively or negatively affect severity of the autistic symptoms, which indicate possible nutritional intervention as a therapeutic approach for autism. Age and sex seem to minimally affect the autistic status. Incorrect dietary practices and various eating problems were evident in many autistic subjects in this study. Ultimately, the findings of this study do support the importance of appropriate nutritional intervention in autism, to ensure diet adequacy and help autistics attain their maximum potential. 180                                         23 4      10 49 59   CARS, GARS                                                                    ATEC             HEI               17   8 4          5  12 17    13 9      5  12 6   23 21    5    18 16           64             10 14 12               111 96 99 94 104 83     115 79     90      100       81 48         98 58     96 41  AMDR      80          61 36        80     3420                  42 25  181                                  44 53 58      6.2  71.2    (ATEC      HEI                   6.2   75.1                     <0.05                    2.6±0.3 µg/d  (292±23% 232 ±15%     1.6±0.1)   (2.0±0.1 mg/d 1.6±0.1 mg/d 3.8±0.5 µg/d  B12  43±5 mg/d 31±3 mg/d  2.0±0.1 mg/d mg/d 510±42 µg 379±31µg /d   3.2±0.3 µg /d 2.2±0.2 µg /d 66±6 mg/d   864±65 mg/d 627±40 mg/d  /d 27±4 µg   339±36 mg/d 249±22 mg/d  99±8 mg/d      (>0.05)     53±9 µg /d /d HEI  ATEC        ATEC   <0.05)    r= -0.28, =  r= 0.32, =0.01          (r=-0.33, =0.01)     0.03)          (r =-0.27, = 0.04    r= -0.31,= 0.02 r= -0.29, =0.03       r=0.28, = 0.03, r= 0.33, = 0.01            (>0.05            (r= 0.12, =0.36)             2     (r = 0.10, = 0.01     2 (r = 0.11, = 0.01)                                                                                                           