Dietary Supplementation in Children with Autism Spectrum Disorders: Common, Insufficient, and Excessive
Abstract
Background Little is known about the effect on dietary adequacy of supplements given to children with autism spectrum disorder (ASD).Objective This cross-sectional study examines dietary supplement use and micronutrient intake in children with ASD.Design Three-day diet/supplement records and use of a gluten/casein-free diet (GFCF) were documented. Estimates of usual intake of micronutrients from food and supplements were compared with the Dietary Reference Intakes.Participants Children aged 2 to 11 years (N=288) with ASD from five Autism Treatment Network sites from 2009-2011.Main outcome measures Percentage of children meeting or exceeding upper limits of micronutrient intake with or without supplements and relative to GFCF diet status.Statistical analysis Micronutrient intake from food and supplements was compared by Spearman rank correlation. Usual intake was estimated by the National Cancer Institute method adjusted for age, sex, supplement use, and GFCF diet. Adequacy of intake was compared between supplement use status and between food and total intake in supplement users relative to Dietary Reference Intakes limits.Results Dietary supplements, especially multivitamin/minerals, were used by 56% of children with ASD. The most common micronutrient deficits were not corrected (vitamin D, calcium, potassium, pantothenic acid, and choline) by supplements. Almost one-third of children remained deficient for vitamin D and up to 54% for calcium. Children receiving GFCF diets had similar micronutrient intake but were more likely to use supplements (78% vs 56%; P=0.01). Supplementation led to excess vitamin A, folate, and zinc intake across the sample, vitamin C, and copper among children aged 2 to 3 years, and manganese and copper for children aged 4 to 8 years.Conclusions Few children with ASD need most of the micronutrients they are commonly given as supplements, which often leads to excess intake. Even when supplements are used, careful attention should be given to adequacy of vitamin D and calcium intake.
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Evidence suggests that a large proportion of children with ASD do not meet vitamin D requirements.
“Evidence suggests that a large proportion of children with ASD do not meet vitamin D requirements [126,132,133,134,135,136].”
From Vitamin D and Autism Spectrum Disorder: A Literature Review (2016) · cites this paper as [126]
Although these studies illustrated a large proportion of children with ASD not meeting the recommendations for vitamin D intake, they did not find any evidence that dietary intake of vitamin D in children with ASD differed from that of typically developing controls.
“Although these studies illustrated a large proportion of children with ASD not meeting the recommendations for vitamin D intake, they did not find any evidence that dietary intake of vitamin D in children with ASD differed from that of typically developing controls.”
From Vitamin D and Autism Spectrum Disorder: A Literature Review (2016) · cites this paper as [126]
Stewart et al. (2015) reported a probable risk of inadequate intake of six micronutrients in >40% of children with ASD, one of which was vitamin D.
“Using three-day food records, Stewart et al. (2015) reported a probable risk of inadequate intake of six micronutrients in >40% of children with ASD, one of which was vitamin D [126].”
From Vitamin D and Autism Spectrum Disorder: A Literature Review (2016) · cites this paper as [126]
Children with ASD may receive less sunlight due to lower outdoor activity and have inadequate intake of vitamin D, i.e., reverse causality.
“Furthermore, children with ASD may receive less sunlight due to lower outdoor activity and have inadequate intake of vitamin D [114,118,126,127,128,129,130,131,132,133,134,135,136], i.e., reverse causality.”
From Vitamin D and Autism Spectrum Disorder: A Literature Review (2016) · cites this paper as [126]
Even though vitamin D intake was improved in response to vitamin D supplementation, it did not reach the adequate intake in 30%-40% of children.
“Even though vitamin D intake was improved in response to vitamin D supplementation, it did not reach the adequate intake in 30%–40% of children.”
From Vitamin D and Autism Spectrum Disorder: A Literature Review (2016) · cites this paper as [126]
The scenario would be worse if more children of African American, mixed-race/ethnicity and less educated parents were enrolled because the socio-demographic characteristics of the study population was biased toward highly educated parents and those of white ethnicity.
“The scenario would be worse if more children of African American, mixed-race/ethnicity and less educated parents were enrolled because the socio-demographic characteristics of the study population was biased toward highly educated parents and those of white ethnicity who might have been more concerned about nutrition.”
From Vitamin D and Autism Spectrum Disorder: A Literature Review (2016) · cites this paper as [126]
Children with ASD have lower protein intake.
“Children with ASD were shown to have a lower protein intake, and their diets may be low in micronutrients [47,48].”
Diets of children with ASD may be low in micronutrients.
“Children with ASD were shown to have a lower protein intake, and their diets may be low in micronutrients [47,48].”
Supplement usage led to excess intake of vitamin A, folate, and zinc.
“Additionally, the usage of supplement lead to excess intake of vitamin A, folate, and zinc.”
The most frequently used forms of supplements are vitamins and minerals in a variety of combinations, also in the ASD population.
“Evidence shows that the most frequently used forms of supplements are vitamins and minerals in a variety of combinations; also in the ASD population [47,51,57].”
Despite supplementation, the most common micronutrient deficits in ASD (vitamin D, calcium, potassium, pantothenic acid) were found not to have been corrected.
“According to a study of Stewart et al. [47], despite supplementation, the most common micronutrient deficits in ASD (vitamin D, calcium, potassium, panthothenic acid) were found to have not been corrected.”
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- Authors
- Stewart, P. A., Hyman, S. L., Schmidt, B. L., Macklin, E. A., Reynolds, A., Johnson, C. R., James, S. J., & Manning-Courtney, P.
- Corresponding author
- Stewart, Patricia A.
- Venue
- Journal of the Academy of Nutrition and Dietetics
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 115
- Issue
- 8
- Pages
- 1237-1248
- ISSN
- 2212-2672 (ISSN-L)
- OpenAlex
- W1502979464
- Cited by
- 87
- References
- 25
- Citations by year
- 2026: 7 · 2025: 2 · 2024: 8 · 2023: 10 · 2022: 9 · 2021: 10 · 2020: 7 · 2019: 8 · 2018: 11 · 2017: 6 · 2016: 7 · 2015: 2
- FWCI
- 7.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the Academy of Nutrition and Dietetics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Autism Speaks
- Health Resources and Services Administration
- National Institutes of Health
- Department of Health and Human Services
- University of Rochester
- National Center for Advancing Translational Sciences
- Harvard NeuroDiscovery Center
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- autism spectrum disorder, dietary supplements, micronutrient intake, multivitamin and mineral supplements, gluten-free casein-free diet, vitamin D deficiency, calcium deficiency, micronutrient excess, children, Dietary Reference Intakes, usual intake estimation
- MeSH terms
- Child, Child Development Disorders, Pervasive, Child, Preschool, Cross-Sectional Studies, Diet, Female, Humans, Male, Nutritional Requirements, Nutritional Status, Diet Records, Treatment Outcome, Micronutrients, Dietary Supplements
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