Are there anthropometric and body composition differences between children with autism spectrum disorder and children with typical development? Analysis by age and spectrum severity in a school population
Restricted accessResearch articleFirst published online July, 2021
Are there anthropometric and body composition differences between children with autism spectrum disorder and children with typical development? Analysis by age and spectrum severity in a school population
Overweight and obesity have been reported to be more prevalent in populations with autism spectrum disorder than in children with typical development. The aim of this study was to compare the anthropometric status of children with autism spectrum disorder (diagnosed and subclinical) and children with typical development and analyse which variables can affect the anthropometric and health status of children with autism spectrum disorder. We present a two-phase epidemiological study in a school population of two age groups which assesses autism spectrum disorder diagnosis, anthropometric data and bioelectrical impedance analysis. From an initial sample of 3,713 children, 79 with autism spectrum disorder, 42 with subclinical autism spectrum disorder and 350 with typical development participated in the study. Pre-schoolers with autism spectrum disorder were taller than pre-schoolers with typical development. School-age children with autism spectrum disorder showed a significantly higher body mass index and rate of overweight/obesity than children with typical development (63.4% vs 46.3%). No significant differences were found for bioelectrical impedance analysis, but school-age children with autism spectrum disorder showed a significantly higher waist circumference, waist/height ratio and cardiovascular risk than children with typical development. The quality of the diet was lower in children with autism spectrum disorder than in children with typical development. Multiple regression analyses showed that having autism spectrum disorder and internalizing psychological problems were associated with waist/height ratio and high cardiovascular risk in school-age children.
Lay abstract
This study makes a comparison between the growth status of pre-school and school-age children with autism spectrum disorder and typical development children. Pre-schoolers with autism spectrum disorder were taller than children with typical development. School-age children with autism spectrum disorder were more overweight/obese, had more body fat and a greater waist circumference and waist/height ratio than children with typical development. The presence of autism spectrum disorder and internalizing problems was associated with cardiovascular risk in school-age children.
AchenbachT. M. (1991). Manual for the youth self-report and 1991 profile. Department of Psychiatry, University of Vermont.
2.
AchenbachT. M.RescorlaL. A. (2000). Manual for the ASEBA preschool forms and profiles. Research Center for Children, Youth, & Families, University of Vermont.
3.
AchenbachT. M.RescorlaL. A. (2001). Manual for the ASEBA school-age forms and profiles. Research Center for Children, Youth, & Families, University of Vermont.
4.
AlmeidaS. M.FurtadoJ. M.MascarenhasP.FerrazM. E.SilvaL. R.FerreiraJ. C.. . . FerrazF. P. (2016). Anthropometric predictors of body fat in a large population of 9-year-old school-aged children. Obesity Science & Practice, 2(3), 272–281. https://doi.org/10.1002/osp4.51
5.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
6.
AmiriS.BehnezhadS. (2019). Obesity and anxiety symptoms: A systematic review and meta-analysis. Neuropsychiatrie, 33(2), 72–89. https://doi.org/10.1007/s40211-019-0302-9
7.
AparicioE.CanalsJ.VoltasN.Hernández-MartínezC.ArijaV. (2013). Emotional psychopathology and increased adiposity: Follow-up study in adolescents. Journal of Adolescence, 36(2), 319–330. https://doi.org/10.1016/j.adolescence.2012.12.003
8.
AparicioE.CanalsJ.VoltasN.ValenzanoA.ArijaV. (2017). Emotional symptoms and dietary patterns in early adolescence: A school-based follow-up study. Journal of Nutrition Education and Behaviour, 49(5), 405–414. https://doi.org/10.1016/j.jneb.2017.01.015
9.
AshwellM.GunnP.GibsonS. (2012). Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Systematic review and meta-analysis. Obesity Reviews: International Association for the Study of Obesity, 13(3), 275–286. https://doi.org/10.1111/j.1467-789X.2011.00952.x
10.
BarnhillK.GutierrezA.GhossainyM.MarediyaZ.MartiC. N.HewitsonL. (2017). Growth status of children with autism spectrum disorder: A case-control study. Journal of Human Nutrition and Dietetics, 30(1), 59–65. https://doi.org/10.1111/jhn.12396
11.
BartonB. B.SeggerF.FischerK.ObermeierM.MusilR. (2020). Update on weight-gain caused by antipsychotics: A systematic review and meta-analysis. Expert Opinion on Drug Safety, 19(3), 295–314. https://doi.org/10.1080/14740338.2020.1713091
12.
BicerA. H.AlsaffarA. A. (2013). Body mass index, dietary intake and feeding problems of Turkish children with autism spectrum disorder (ASD). Research in Developmental Disabilities, 34(11), 3978–3987. https://doi.org/10.1016/j.ridd.2013.08.024
13.
BretlerT.WeisbergH.KorenO.NeumanH. (2019). The effects of antipsychotic medications on microbiome and weight gain in children and adolescents. BMC Medicine, 17(1), Article 112. https://doi.org/10.1186/s12916-019-1346-1
14.
Broder-FingertS.BrazauskasK.LindgrenK.IannuzziD.Van CleaveJ. (2014). Prevalence of overweight and obesity in a large clinical sample of children with autism. Academic Pediatrics, 14(4), 408–414. https://doi.org/10.1016/j.acap.2014.04.004
15.
Canals-SansJ.Blanco-GómezA.LuqueV.FerréN.Morales-HidalgoP.Closa-MonasteroloR.EscribanoJ. (2018). Association between psychological problems and overweight and obesity in school children. Revista de psicopatología y psicologia clínica, 23(1), 25–34. https://doi.org/10.5944/rppc.vol.23.num.1.2018.19758
16.
CarlssonL. H.NorrelgenF.KjellmerL.WesterlundJ.GillbergC.FernellE. (2013). Coexisting disorders and problems in preschool children with autism spectrum disorders. The Scientific World Journal, 2013, Article 213979. https://doi.org/10.1155/2013/213979
CastroK.FaccioliL. S.BaronioD.GottfriedC.PerryI. S.RiesgoR. (2017). Body composition of patients with autism spectrum disorder through bioelectrical impedance. Nutrición hospitalaria, 34(4), 875–879. https://doi.org/10.20960/nh.210
19.
CroenL. A.ZerboO.QianY.MassoloM. L.RichS.SidneyS.KripkeC. (2015). The health status on adults on the autism spectrum. Autism, 19(7), 814–823. https://doi.org/10.1177/1362361315577517
20.
de OnisM.OnyangoA. W.BorghiE.SiyamA.NishidaaC.SiekmannJ. (2007). Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization, 85, 660–667. https://www.scielosp.org/pdf/bwho/2007.v85n9/660-667/en
21.
El AnsariW.AdetunjiH.OskrochiR. (2014). Food and mental health: Relationship between food and perceived stress and depressive symptoms among university students in the United Kingdom. Central European Journal of Public Health, 22(2), 90–97. https://doi.org/10.21101/cejph.a3941
22.
EspositoM.SloanJ.NappoR.FaddaR.FotiaF.NapoliE.. . . VicariE. S. (2019). Sensory processing, gastrointestinal symptoms and parental feeding practices in the explanation of food selectivity: Clustering children with and without autism. International Journal of Autism & Related Disabilities, 2019, 1–12. https://doi.org/10.29011/IJARD-120
23.
FournierK. A.HassC. J.NaikS. K.LodhaN.CauraughJ. H. (2010). Motor coordination in autism spectrum disorders: A synthesis and meta-analysis. Journal of Autism and Developmental Disorders, 40(10), 1227–1240. https://doi.org/10.1007/s10803-010-0981-3
24.
García-PastorT.SalineroJ. J.TheirsC. I.Ruiz-VicenteD. (2019). Obesity status and physical activity level in children and adults with autism spectrum disorders: A pilot study. Journal of Autism and Developmental Disorders, 49(1), 165–172. https://doi.org/10.1007/s10803-018-3692-9
25.
Generalitat de Catalunya. (2007). General Health Physical Exercise Prescription Guide (PEFS)Direcció General de Salut Pública. http://hdl.handle.net/11351/3541
26.
GothamK.PicklesA.LordC. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705. https://doi.org/10.1007/s10803-008-0674-3
27.
HealyS.AignerC. J.HaegeleJ. A. (2019). Prevalence of overweight and obesity among US youth with autism spectrum disorder. Autism, 23(4), 1046–1050. https://doi.org/10.1177/1362361318791817
28.
HirvikoskiT.Mittendorfer-RutzE.BomanM.LarssonH.LichtensteinP.BölteS. (2016). Premature mortality in autism spectrum disorder. The British Journal of Psychiatry: The Journal of Mental Science, 208(3), 232–238. https://doi.org/10.1192/bjp.bp.114.160192
29.
HollingsheadA. B. (2011). Four factor index of social status. Yale Journal of Sociology, 8, 21–52.
30.
HymanS. L.StewartP. A.SchmidtB.CainU.LemckeN.FoleyJ. T.. . . NgP. K. (2012). Nutrient intake from food in children with autism. Pediatrics, 130, 145–153. https://doi.org/10.1542/peds.2012-0900L
31.
Kamal NorN.GhozaliA. H.IsmailJ. (2019). Prevalence of overweight and obesity among children and adolescents with autism spectrum disorder and associated risk factors. Frontiers in Pediatrics, 7, Article 38. https://doi.org/10.3389/fped.2019.00038
32.
KaufmanJ.BirmaherB.BrentD.RaoU.FlynnC.MoreciP.. . . RyanN. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 980–988. https://doi.org/10.1097/00004583-199707000-00021
33.
KonstM. J.MatsonJ. L. (2014). Comorbid psychopathology symptom rates in infants and toddlers with autism spectrum disorders. Research in Autism Spectrum Disorders, 8(2), 147–155. https://doi.org/10.1016/j.rasd.2013.10.011
34.
LaneR.RadeskyJ. (2019). Digital media and autism spectrum disorders: Review of evidence, theoretical concerns, and opportunities for intervention. Journal of Developmental and Behavioural Pediatrics, 40(5), 364–368. https://doi.org/10.1097/DBP.0000000000000664
35.
LevyS. E.Pinto-MartinJ. A.BradleyC. B.ChittamsJ.JohnsonS. L.PandeyJ.. . . KralT. V. E. (2019). Relationship of weight outcomes, co-occurring conditions, and severity of autism spectrum disorder in the study to explore early development. The Journal of Pediatrics, 205, 202–209. https://doi.org/10.1016/j.jpeds.2018.09.003
36.
LipS. Z. L.ChillingworthA.WrightC. M. (2018). Prevalence of under and over weight in children with neurodisability, using body composition measures. European Journal of Clinical Nutrition, 72, 1451–1454. https://doi.org/10.1038/s41430-018-0168-0
37.
LiuT.KellyJ.DavisL.ZamoraK. (2019). Nutrition, BMI and motor competence in children with autism spectrum disorder. Medicina, 55(5), 135. https://doi.org/10.3390/medicina55050135
38.
LordC.RutterM.DiLavoreP.RisiS.GothamK.BishopS. (2012). Autism Diagnostic Observation Schedule-(ADOS-2). Western Psychological Corporation.
39.
LudwigD. S.AstrupA.BazzanoL. A.EbbelingC. B.HeymsfieldS. B.KingJ. C.WillettW. C. (2019). Ultra-processed food and obesity: The pitfalls of extrapolation from short studies. Cell Metabolism, 30(1), 3–4. https://doi.org/10.1016/j.cmet.2019.06.004
40.
MaennerM. J.ShawK. A.BaioJ.WashingtonA.PatrickM.DiRienzoM.. . . DietzP. M. (2020). Prevalence of autism spectrum disorder among children aged 8 years – Autism and developmental disabilities monitoring network, 11 sites, United States, 2016. Morbidity and Mortality Weekly Report: Surveillance Summaries, 69(16), 1–12. https://doi.org/10.15585/mmwr.ss6904a1
41.
MakaremN.BanderaE. V.NicholsonJ. M.ParekhN. (2018). Consumption of sugars, sugary foods, and sugary beverages in relation to cancer risk: A systematic review of longitudinal studies. Annual Review of Nutrition, 38(1), 17–39.
42.
MalhiP.VenkateshL.BhartiB.SinghiP. (2017). Feeding problems and nutrient intake in children with and without autism: A comparative study. The Indian Journal of Pediatrics, 84(4), 283–288. https://doi.org/10.1007/s12098-016-2285-x
43.
Marí-BausetS.Llopis-GonzálezA.ZazpeI.Mari-SanchisA.Morales-Suárez-VarelaM. (2015). Anthropometric measures of Spanish children with autism spectrum disorder. Research in Autism Spectrum Disorders, 9, 26–33. https://doi.org/10.1016/j.rasd.2014.09.013
44.
MathesonB. E.DouglasJ. M. (2017). Overweight and obesity in children with autism spectrum disorder (ASD): A critical review investigating the development, and maintenance of this relationship. Review Journal of Autism and Developmental Disorders, 4, 4142–4156. https://doi.org/10.1007/s40489-017-0103-7
45.
McCoyS. M.MorganK. (2019). Obesity, physical activity, and sedentary behaviors in adolescents with autism spectrum disorder compared with typically developing peers. Autism, 24(2), 387–399. https://doi.org/10.1177/1362361319861579
46.
MeguidN. A.KandeelW. A.WakeelK. E.El-NofelyA. A. (2014). Anthropometric assessment of a Middle Eastern group of autistic children. World Journal of Pediatrics, 10(4), 318–323. https://doi.org/10.1007/s12519-014-0510-0
47.
Morales-HidalgoP.Hernández-MartínezC.VoltasN.CanalsJ. (2017). EDUTEA: A DSM-5 teacher screening questionnaire for autism spectrum disorder and social pragmatic communication disorder. International Journal of Clinical and Health Psychology, 17(3), 269–281. https://doi.org/10.1016/j.ijchp.2017.05.002
48.
NorteA. I. N.OrtizR. M. (2011). Spanish diet quality according to the healthy eating index. Nutrición hospitalaria, 26(2), 330–336.
49.
PisulaE.PudłoM.SłowińskaM.KawaR.StrząskaM.BanasiakA.WolańczykT. (2017). Behavioral and emotional problems in high-functioning girls and boys with autism spectrum disorders: Parents’ reports and adolescents’ self-reports. Autism, 21(6), 738–748. https://doi.org/10.1177/1362361316675119
50.
RithikaP. H.SushmaB. V. (2019). Correlates of dietary profile, nutritional, and health status among children with reference to autism spectrum disorder. International Journal of Biological & Medical Research, 10(3), 6828–6832.
SalazarF.BairdG.ChandlerS.TsengE.O’sullivanT.HowlinP.. . . SimonoffE. (2015). Co-occurring psychiatric disorders in preschool and elementary school-aged children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2283–2294. https://doi.org/10.1007/s10803-015-2361-5
53.
SalehiH.AghanooriM. R.ShahmohammadluS.HosseiniB.MitchellS. E.MahmudiM.DjafarianK. (2015). Body composition in Iranian boys with autism spectrum disorders. Paediatria Croatica, 59(3), 159–165. https://doi.org/10.13112/PC.2015.24
54.
SamirM.PatilR. (2018). Nutritional status of autistic and totally developing children in Mumbai. International Journal of Current Research, 10(6), 70402–70406. https://doi.org/10.24941/ijcr.31111.06.2018
55.
SchmittL.HeissC. J.CampbellE. E. (2008). A comparison of nutrient intake and eating behaviors of boys with and without autism. Topics in Clinical Nutrition, 23(1), 23–31. https://doi.org/10.1097/01.TIN.0000312077.45953.6c
56.
ScottF. J.Baron-CohenS.BoltonP.BrayneC. (2002). The CAST (Childhood Asperger Syndrome Test) preliminary development of a UK screen for mainstream primary-school-age children. Autism, 6(1), 9–31. https://doi.org/10.1177/1362361302006001003
57.
SetyowatiD.PrasetyoB.HusadaD. (2019). Differences in growth of children with autism and normal in Surabaya, Indonesia. Indian Journal of Public Health Research & Development, 10(7), 899–903. https://doi.org/10.5958/0976-5506.2019.01692.9
58.
SharpW. G.BerryR. C.McCrackenC.NuhuN. N.MarvelE.SaulnierC. A.. . . JaquessD. L. (2013). Feeding problems and nutrient intake in children with autism spectrum disorders: A meta-analysis and comprehensive review of the literature. Journal of Autism and Developmental Disorders, 43(9), 2159–2173. https://doi.org/10.1007/s10803-013-1771-5
59.
SharpW. G.PostorinoV.McCrackenC. E.BerryR. C.CriadoK. K.BurrellT. L.ScahillL. (2018). Dietary intake, nutrient status, and growth parameters in children with autism spectrum disorder and severe food selectivity: An electronic medical record review. Journal of the Academy of Nutrition and Dietetics, 118(10), 1943–1950. https://doi.org/10.10167j.jand.2018.05.005
60.
SiddiqiS.UroojA.D’SouzaM. J. (2019). Dietary patterns and anthropometric measures of Indian children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 19, 1586–1598. https://doi.org/10.1007/s10803-018-3850-0
61.
SrinivasanS. M.PescatelloL. S.BhatA. N. (2014). Current perspectives on physical activity and exercise recommendations for children and adolescents with autism spectrum disorders. Physical Therapy, 94(6), 875–889. https://doi.org/10.2522/ptj.20130157
62.
TrinidadI. R.FernándezJ. B.CucóG. P.BiarnésE. J.ArijaV. V. (2008). Validation of a short questionnaire on frequency of dietary intake: Reproducibility and validity.Nutrición hospitalaria, 23(3), 242–252.
63.
TuranS.AkayA. P. (2019). The effects of stimulants on eating patterns in children and adolescents with attention deficit hyperactivity disorder. Journal of Mind and Medical Sciences, 6(2), 253–260. https://doi.org/10.22543/7674.62.P253260
64.
VaillancourtT.HaltiganJ. D.SmithI.ZwaigenbaumL.SzatmariP.FombonneE.. . . BrysonS. (2017). Joint trajectories of internalizing and externalizing problems in preschool children with autism spectrum disorder. Development and Psychopathology, 29(1), 203–214. https://doi.org/10.1017/S0954579416000043
65.
WechslerD. (2012). Wechsler Preschool and Primary Scale of Intelligence – Fourth edition technical manual and interpretive manual. Pearson Clinical & Talent Assessment.
66.
WechslerD. (2003). Wechsler Intelligence Scale for Children – Fourth edition technical and interpretive manual. TEA Ediciones.
67.
WeiH.ChengQ.MeiQ.ZhangX.ChenL.LiuX.. . . LiT. (2018). Head circumference, body growth and development quotient in autism spectrum disorders are related in Chongqing, China. Research in Autism Spectrum Disorders, 54, 83–89. https://doi.org/10.1016/j.rasd.2018.07.003
XuM.XuX.LiJ.LiF. (2019). Association between gut microbiota and autism spectrum disorder: A systematic review and meta-analysis. Frontiers in Psychiatry, 10, Article 473. https://doi.org/10.3389/fpsyt.2019.00473
72.
YooE. (2016). Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk. Korean Journal of Pediatrics, 59(11), 425–431. https://doi.org/10.3345/kjp.2016.59.11.425
73.
ZhengZ.ZhangL.LiS.ZhaoF.WangY.Huang . . .MuD. (2017). Association among obesity, overweight and autism spectrum disorder: A systematic review and meta-analysis. Scientific Reports, 7(1), Article 11697. https://doi.org/10.1038/s41598-017-12003-4
74.
ZimmerM. H.HartL. C.Manning-CourtneyP. (2012). Food variety as a predictor of nutritional status among children with autism. Journal of Autism and Developmental Disorders, 42(4), 549–556. http://doi.org/10.1007/s10803-011-1268-z
