Dietary Adequacy of Egyptian Children with Autism Spectrum Disorder Compared to Healthy Developing Children
Abstract
Although the etiology and pathology of autism spectrum disorder (ASD) is still poorly understood, a number of environmental, anthropological, neurobiological and genetic factors have been related to the pathophysiology of ASD, even the impact of oxidative stress response related to the environment and nutrition intake. Usual recommended dietary habits are based on the combination of behavioral and dietary or nutraceutical interventions together with pharmacotherapy. Investigations about a reliable relationship between diet and ASD are still lacking. The present study aimed at comparing dietary regimens and habits of normally developing apparently healthy children, without diagnosed ASD, with a pediatric population of individuals affected by autistic disorder. Assessments of nutritional and anthropometric data, in addition to biochemical evaluation for nutrient deficiencies, were performed. A total of 80 children with autistic disorder and 80 healthy, normally developing pediatric individuals were enrolled in the study. Parents were asked to complete the standardized questionnaire regarding the different types of food and the proportion of a serving for their children. Biochemical analysis of micro- and macronutrients were also done. Plotting on the Egyptian sex-specific anthropometric growth (auximetric) chart, absolute weights as well as weight-related for age classes, were significantly higher in cases than healthy controls. No differences between groups were observed in regard to total kilocalories (kcal), carbohydrates, and fat intake. A total of 23.8% of children with autistic disorder vs. 11.3% in the healthy control group had a nutrient intake with features below the Recommended Dietary Allowance (RDA) of protein. Children with autistic disorder showed low dietary intake of some micronutrients; calcium (Ca), magnesium (Mg), iron (Fe), selenium (Se) and sodium (Na), also they had significantly high intake of potassium (K) and vitamin C compared to healthy controls. Serum Mg, Fe, Ca, folate and vitamin B12 in children with autistic disorder were significantly low compared with healthy children. Significant positive correlations between serum Mg, Fe, Ca, vitamin B12 and folate and their levels in food were present. These results confirmed that different nutritional inadequacy was observed in Egyptian children with autistic disorder. The evidence reported in the present study should recommend screening of the nutritional status of ASD children for nutrient adequacy to reduce these deficiencies by dietary means or by administering appropriate vitamin and mineral supplements. Nutritional intervention plan should be tailored to address specific needs.
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Consistent findings across various studies indicate deficiencies in calcium, zinc, potassium, sodium, magnesium, iron, selenium, and copper in children with ASD.
“Consistent findings across various studies indicate additional deficiencies in micronutrients: calcium, zinc, potassium, sodium, magnesium, iron, selenium, and copper [58,59,60].”
From Unraveling the Connections: Eating Issues, Microbiome, and Gastrointestinal Symptoms in Autism Spectrum Disorder (2025) · cites this paper as [60]
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Variations in pattern of pubertal changes in girls
Marshall, W. A., & Tanner, J. M. (1969) · Archives of Disease in Childhood · doi:10.1136/adc.44.235.291 · Cited by 5,963 · see citing works
Variations in the pattern of pubertal changes in boys
Marshall, W. A., & Tanner, J. M. (1970) · Archives of Disease in Childhood · doi:10.1136/adc.45.239.13 · Cited by 5,147 · see citing works
Trumbo (2001) · doi:10.1016/s0002-8223(01)00078-5 · Cited by 4,852 · see citing works
Institute of Medicine (2001) · National Academies Press eBooks · doi:10.17226/10026 · Cited by 4,191 · see citing works
Institute of Medicine (1998) · National Academies Press eBooks · doi:10.17226/6015 · Cited by 2,464 · see citing works
Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids
Compounds, P. O. D. A. A. R., Nutrients, S. O. U. R. L. O., Intakes, S. O. I. A. U. O. D. R., Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, & Institute of Medicine (2000) · doi:10.17226/9810 · Cited by 2,034 · see citing works
Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride
Institute of Medicine (1997) · National Academies Press eBooks · doi:10.17226/5776 · Cited by 1,788 · see citing works
The who Multicentre Growth Reference Study: Planning, Study Design, and Methodology
de Onís, M., Garza, C., Victora, C. G., Onyango, A. W., Frongillo, E. A., & Martines, J. (2004) · Food and Nutrition Bulletin · doi:10.1177/15648265040251s104 · Cited by 964 · see citing works
Fao, J. (2004) · Medical Entomology and Zoology · Cited by 947 · see citing works
Food selectivity and sensory sensitivity in children with autism spectrum disorders
Cermak, S. A., Curtin, C., & Bandini, L. G. (2010) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2009.10.032 · Cited by 750 · see citing works
Food Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children
Bandini, L. G., Anderson, S. E., Curtin, C., Cermak, S., Evans, E. W., Scampini, R., Maslin, M., & Must, A. (2010) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2010.02.013 · Cited by 664 · see citing works
Prevalence of Autism in a United States Population: The Brick Township, New Jersey, Investigation
Bertrand, J., Mars, A. E., Boyle, C. A., Bove, F., Yeargin‐Allsopp, M., & Decouflé, P. (2001) · PEDIATRICS · doi:10.1542/peds.108.5.1155 · Cited by 573 · see citing works
Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A., & Blumberg, S. J. (2015) · PubMed · Cited by 535 · see citing works
Feeding Symptoms, Dietary Patterns, and Growth in Young Children With Autism Spectrum Disorders
Emond, A., Emmett, P., Steer, C., & Golding, J. (2010) · Pediatrics · doi:10.1542/peds.2009-2391 · Cited by 338 · see citing works
Mandy, W., & Lai, M. (2016) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12501 · Cited by 283 · see citing works
Siu, A. L., and the US Preventive Services Task Force (USPSTF), Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W., Ebell, M., García, F. A. R., Gillman, M., Herzstein, J., et al. (2016) · JAMA · doi:10.1001/jama.2016.0018 · Cited by 261 · see citing works
Autism and gastrointestinal symptoms
Horvath, K., & Perman, J. A. (2002) · Current Gastroenterology Reports · doi:10.1007/s11894-002-0071-6 · Cited by 260 · see citing works
Nutrient Intake From Food in Children With Autism
Hyman, S. L., Stewart, P. A., Schmidt, B., Cain, U., Lemcke, N., Foley, J. T., Peck, R., Clemons, T., Reynolds, A., Johnson, C., et al. (2012) · Pediatrics · doi:10.1542/peds.2012-0900l · Cited by 255 · see citing works
Food variety as a predictor of nutritional status among children with autism
Zimmer, M. H., Hart, L. C., Manning-Courtney, P., Murray, D. S., Bing, N. M., & Summer, S. (2012) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-011-1268-z · Cited by 254 · see citing works
Molloy, C. A., & Manning-Courtney, P. (2003) · Autism · doi:10.1177/1362361303007002004 · Cited by 249 · see citing works
Herndon, A. C., DiGuiseppi, C., Johnson, S. L., Leiferman, J., & Reynolds, A. (2009) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-008-0606-2 · Cited by 227 · see citing works
Santocchi, E., Guiducci, L., Fulceri, F., Billeci, L., Buzzigoli, E., Apicella, F., Calderoni, S., Grossi, E., Morales, M. A., & Muratori, F. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0887-5 · Cited by 213 · see citing works
Palmieri, L., Papaleo, V., Porcelli, V., Scarcia, P., Gaita, L., Sacco, R., Hager, J., Rousseau, F., Curatolo, P., Manzi, B., et al. (2008) · Molecular Psychiatry · doi:10.1038/mp.2008.63 · Cited by 210 · see citing works
The plasma zinc/serum copper ratio as a biomarker in children with autism spectrum disorders
Faber, S., Zinn, G. M., Kern, J. C., & Kingston, H. M. (2009) · Biomarkers · doi:10.1080/13547500902783747 · Cited by 200 · see citing works
Children with autism: effect of iron supplementation on sleep and ferritin
Dosman, C. F., Brian, J. A., Drmic, I. E., Senthilselvan, A., Harford, M. M., Smith, R. W., Sharieff, W., Zlotkin, S. H., Moldofsky, H., & Roberts, S. W. (2007) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2006.11.004 · Cited by 189 · see citing works
The role of zinc and copper in autism spectrum disorders
Bjørklund, G. (2013) · Acta Neurobiologiae Experimentalis · doi:10.55782/ane-2013-1932 · Cited by 181 · see citing works
Self-citationAdams, J. B., & Holloway, C. (2004) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2004.10.1033 · Cited by 178 · see citing works
Reduced serum levels of 25-hydroxy and 1,25-dihydroxy vitamin D in egyptian children with autism
Meguid, N. A., Hashish, A. F., Anwar, M., & Sidhom, G. (2010) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2009.0349 · Cited by 154 · see citing works
Self-citationA balanced approach towards healthy eating in autism
Cornish, E. (1998) · Journal of Human Nutrition and Dietetics · doi:10.1046/j.1365-277x.1998.00132.x · Cited by 153 · cited 2× · see citing works
“Breakfast meal frequency was still higher in healthy controls than autistic subjects (93.2% of controls vs. 66.7% cases) but about 14.7% of autistic cases vs. 10.7% of healthy controls rarely had breakfast.”
BackgroundInfluentialLockner, D. W., Crowe, T. K., & Skipper, B. J. (2008) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2008.05.003 · Cited by 152 · see citing works
A preliminary study on nutritional status and intake in Chinese children with autism
Xia, W., Zhou, Y., Sun, C., Wang, J., & Wu, L. (2010) · European Journal of Pediatrics · doi:10.1007/s00431-010-1203-x · Cited by 124 · see citing works
Al-Farsi, Y. M., Waly, M. I., Al‐Sharbati, M. M., Al‐Shafaee, M., Al-Farsi, O. A., Al‐Khaduri, M., Gupta, I., Ouhtit, A., Al‐Adawi, S., Al-Said, M. F., et al. (2012) · Biological Trace Element Research · doi:10.1007/s12011-012-9553-z · Cited by 124 · see citing works
Serum copper and zinc levels in individuals with autism spectrum disorders
Li, S.-O., Wang, J.-L., Bjørklund, G., Zhao, W.-N., & Yin, C.-H. (2014) · NeuroReport · doi:10.1097/wnr.0000000000000251 · Cited by 121 · see citing works
Self-citationMinerals in the hair and nutrient intake of autistic children
Shearer, T. R., Larson, K. R., Neuschwander, J., & Gedney, B. (1982) · Journal of Autism and Developmental Disorders · doi:10.1007/bf01531671 · Cited by 115 · see citing works
Eating habits and dietary status in young children with autism
Johnson, C. R., Handen, B. L., Mayer-Costa, M., & Sacco, K. (2008) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-008-9111-y · Cited by 114 · see citing works
Cornish, J., Callon, K. E., King, A. R., Cooper, G. J. S., & Reid, I. R. (1998) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1998.275.4.e694 · Cited by 102 · see citing works
Hyperhomocysteinemia among Omani autistic children: a case-control study.
Ali, A., Waly, M. I., Al-Farsi, Y. M., Essa, M. M., Al‐Sharbati, M. M., & Deth, R. C. (2011) · Acta Biochimica Polonica · doi:10.18388/abp.2011_2223 · Cited by 89 · see citing works
Dietary adequacy of children with autism compared with controls and the impact of restricted diet
Graf-Myles, J., Farmer, C., Thurm, A., Royster, C., Kahn, P., Soskey, L., Rothschild, L., & Swedo, S. (2013) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e3182a00d17 · Cited by 84 · see citing works
Macedoni-Lukšič, M., Gosar, D., Bjørklund, G., Oražem, J., Kodrič, J., Musek, P. L., Zupančič, M., Štiglic, A. F., Sešek‐Briški, A., Neubauer, D., et al. (2014) · Biological Trace Element Research · doi:10.1007/s12011-014-0121-6 · Cited by 78 · see citing works
Self-citationThe Brain-Gut-Microbiome Axis: What Role Does it Play in Autism Spectrum Disorder?
Luna, R. A., Savidge, T., & Williams, K. C. (2016) · Current Developmental Disorders Reports · doi:10.1007/s40474-016-0077-7 · Cited by 73 · see citing works
Evaluation of whole blood zinc and copper levels in children with autism spectrum disorder
Crăciun, E. C., Bjørklund, G., Tinkov, A. A., Urbina, M. A., Skalny, A. V., Rad, F., & Dronca, E. (2016) · Metabolic Brain Disease · doi:10.1007/s11011-016-9823-0 · Cited by 70 · see citing works
Self-citationDosman, C. F., Drmic, I., Brian, J. A., Senthilselvan, A., Harford, M., Smith, R. W., & Roberts, S. W. (2006) · Developmental Medicine & Child Neurology · doi:10.1017/s0012162206232225 · Cited by 66 · see citing works
Iron deficiency in children with global developmental delay and autism spectrum disorder
Sidrak, S., Yoong, T., & Woolfenden, S. R. (2013) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.12483 · Cited by 64 · see citing works
Strambi, M., Longini, M., Hayek, J., Berni, S., Macucci, F., Scalacci, E., & Vezzosi, P. (2006) · Biological Trace Element Research · doi:10.1385/bter:109:2:097 · Cited by 60 · see citing works
Sun, C., Xia, W. T., Zhao, Y., Li, N., Zhao, D., & Wu, L. (2013) · Journal of Nutritional Science · doi:10.1017/jns.2013.9 · Cited by 57 · see citing works
Lindsay, R. L., Eugene Arnold, L., Aman, M. G., Vitiello, B., Posey, D. J., McDougle, C. J., Scahill, L., Pachler, M., McCracken, J. T., Tierney, E., et al. (2006) · Journal of Intellectual & Developmental Disability · doi:10.1080/13668250601006924 · Cited by 52 · see citing works
Impact of nutrition on serum levels of docosahexaenoic acid among Omani children with autism
Al-Farsi, Y. M., Waly, M. I., Deth, R. C., Al‐Sharbati, M. M., Al‐Shafaee, M., Al-Farsi, O. A., Al‐Khaduri, M., Al‐Adawi, S., Hodgson, N., Gupta, I., et al. (2013) · Nutrition · doi:10.1016/j.nut.2013.03.009 · Cited by 46 · see citing works
Han, Y., Xi, Q., Dai, W., Yang, S., Gao, L., Su, Y., & Zhang, X. (2015) · International Journal of Developmental Neuroscience · doi:10.1016/j.ijdevneu.2015.06.006 · Cited by 41 · see citing works
Iron deficiency in preschool children with autistic spectrum disorders
Bi̇lgi̇ç, A., Gürkan, K., Türkoğlu, S., Akça, Ö. F., Kılıç, B. G., & Uslu, R. I. (2010) · Research in Autism · doi:10.1016/j.rasd.2009.12.008 · Cited by 41 · see citing works
Limitations of Data on Fluid Intake
Fulgoni, V. L. (2007) · Journal of the American College of Nutrition · doi:10.1080/07315724.2007.10719663 · Cited by 40 · see citing works
Dietary Patterns of Children with Autism Spectrum Disorder: A Study Based in Egypt
Meguid, N., Anwar, M., Zaki, S., Kandeel, W., Ahmed, N., & Tewfik, I. (2015) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2015.051 · Cited by 35 · see citing works
Self-citationNutrition, Physical Activity, and Bone Mineral Density in Youth With Autistic Spectrum Disorders
Soden, S. E., Garrison, C. B., Egan, A. M., & Beckwith, A. M. (2012) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e318260943c · Cited by 32 · see citing works
Whiteley, P. (2003) · Child Care Health and Development · doi:10.1111/j.1365-2214.2004.00380.x · Cited by 30 · see citing works
Endreffy, I., Bjørklund, G., Dicso, F., Urbina, M. A., & Endreffy, E. (2015) · Metabolic Brain Disease · doi:10.1007/s11011-015-9745-2 · Cited by 29 · see citing works
Self-citationSymptomatic nutritional rickets in a teenager with autistic spectrum disorder
Stewart, C., & Latif, A. (2008) · Child Care Health and Development · doi:10.1111/j.1365-2214.2007.00806.x · Cited by 29 · see citing works
[The new dietary reference intakes from the Institute of Medicine for calcium and vitamin D].
Atkinson, S. A. (2011) · PubMed · Cited by 29 · see citing works
The serum copper/zinc ratio in childhood and educational attainment: a population-based study
Böckerman, P., Bryson, A., Viinikainen, J., et al. (2015) · Journal of Public Health · doi:10.1093/pubmed/fdv187 · Cited by 19 · see citing works
Mercury as a possible link between maternal obesity and autism spectrum disorder
Skalny, A. V., Геннадиевна, С. М., Bjørklund, G., Nikonorov, A. А., & Tinkov, A. A. (2016) · Medical Hypotheses · doi:10.1016/j.mehy.2016.04.021 · Cited by 16 · see citing works
Self-citationNutritional and Environmental Influences on Autism Spectrum Disorder
Bjørklund, G., & Chartrand, M. S. (2016) · Journal of Nutritional Disorders & Therapy · doi:10.4172/2161-0509.1000e123 · Cited by 15 · see citing works
Self-citationApproches substitutive et diététique du trouble autistique de l’enfant : intérêts ou limites ?
Hjiej, H., Doyen, C., Couprie, C., Kaye, K., & Contejean, Y. (2008) · L Encéphale · doi:10.1016/j.encep.2007.10.011 · Cited by 14 · see citing works
[Children with Asperger syndrome].
Bjørklund, G. (1998) · PubMed · Cited by 7 · see citing works
Self-citation
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Adams, J., Audhya, T., Geis, E., Gehn, E., Fimbres, V., Pollard, E., Mitchell, J., Ingram, J., Hellmers, R., Laake, D., et al. (2018) · Nutrients · doi:10.3390/nu10030369 · Cited by 267 · see citing works
Esteban-Figuerola, P., Canals, J., Fernández-Cao, J. C., & Arija Val, V. (2019) · Autism · doi:10.1177/1362361318794179 · Cited by 181 · see citing works
Sharp, W. G., Postorino, V., McCracken, C. E., Berry, R. C., Criado, K. K., Burrell, T. L., & Scahill, L. (2018) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2018.05.005 · Cited by 167 · see citing works
Zulkifli, M. N., Kadar, M., Fenech, M., & Hamzaid, N. H. (2022) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2022.101928 · Cited by 46 · see citing works
Tomaszek, N., Urbaniak, A. D., Bałdyga, D., Chwesiuk, K., Modzelewski, S., & Waszkiewicz, N. (2025) · Nutrients · doi:10.3390/nu17030486 · Cited by 30 · see citing works
- Authors
- Meguid, N. A., Anwar, M., Bjørklund, G., Hashish, A., Chirumbolo, S., Hemimi, M., & Sultan, E.
- Affiliations
- National Research Centre (EG)
- Council for Nutritional and Environmental Medicine (NO)
- University of Verona (IT)
- Corresponding author
- Bjørklund, Geir
- ORCID
- Venue
- Metabolic Brain Disease
- Published
- 2017-01-10
- Volume
- 32
- Issue
- 2
- Pages
- 607-615
- ISSN
- 0885-7490 (ISSN-L)
- 1573-7365
- OpenAlex
- W2571364220
- Cited by
- 79
- References
- 63
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 12 · 2023: 10 · 2022: 12 · 2021: 10 · 2020: 9 · 2019: 7 · 2018: 9 · 2017: 4
- FWCI
- 6.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Metabolic Brain Disease (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Science and Technology Development Fund (5541)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- autism spectrum disorder, nutritional adequacy, nutritional status, micronutrient deficiency, protein intake, serum magnesium, serum iron, serum calcium, folic acid, vitamin B12, vitamin C, potassium intake, anthropometric growth, children, Egyptian children
- MeSH terms
- Autism Spectrum Disorder, Anthropometry, Child, Child Development, Child, Preschool, Diet Surveys, Eating, Egypt, Feeding Behavior, Female, Health Status, Humans, Male, Minerals, Nutritional Status, Psychiatric Status Rating Scales, Sex Factors, Vitamins, Recommended Dietary Allowances
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