Nutritional Neuroscience An International Journal on Nutrition, Diet and Nervous System
ISSN: 1028-415X (Print) 1476-8305 (Online) Journal homepage: http://www.tandfonline.com/loi/ynns20
Vitamin D status in autism spectrum disorders and the efficacy of vitamin D supplementation in autistic children Khaled Saad, Ahmed A. Abdel-rahman, Yasser M. Elserogy, Abdulrahman A. Al-Atram, John J. Cannell, Geir Bjørklund, Mohamed K. Abdel-Reheim, Hisham A. K. Othman, Amira A. El-Houfey, Nafisa H. R. Abd El-Aziz, Khaled A. Abd El-Baseer, Ahmed E. Ahmed & Ahmed M. Ali To cite this article: Khaled Saad, Ahmed A. Abdel-rahman, Yasser M. Elserogy, Abdulrahman A. Al-Atram, John J. Cannell, Geir Bjørklund, Mohamed K. Abdel-Reheim, Hisham A. K. Othman, Amira A. El-Houfey, Nafisa H. R. Abd El-Aziz, Khaled A. Abd El-Baseer, Ahmed E. Ahmed & Ahmed M. Ali (2015): Vitamin D status in autism spectrum disorders and the efficacy of vitamin D supplementation in autistic children, Nutritional Neuroscience To link to this article: http://dx.doi.org/10.1179/1476830515Y.0000000019
Published online: 15 Apr 2015.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ynns20 Download by: [Gazi University]
Date: 03 February 2016, At: 01:46
Vitamin D status in autism spectrum disorders and the efficacy of vitamin D supplementation in autistic children Khaled Saad 1, Ahmed A. Abdel-rahman 2, Yasser M. Elserogy2, Abdulrahman A. Al-Atram 3, John J. Cannell 4, Geir Bjørklund 5, Mohamed K. Abdel-Reheim6, Hisham A. K. Othman7, Amira A. El-Houfey8, Nafisa H. R. Abd El-Aziz 1, Khaled A. Abd El-Baseer 9, Ahmed E. Ahmed 9, Ahmed M. Ali 1
Downloaded by [Gazi University] at 01:46 03 February 2016
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Egypt, 2Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Egypt, 3Department of Psychiatry, College of Medicine, Almajmaah University, KSA, 4Vitamin D Council, 1411 Marsh Street, Suite 203, San Luis Obispo, CA 93401, USA, 5Council for Nutritional and Environmental Medicine, Mo i Rana, Norway, 6Dorset County Hospital, Dorchester, UK, 7 Department of Clinical Pathology, Aswan University, Egypt, 8Department of Community Health Nursing, Faculty of Nursing, Assiut University, Egypt, 9Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Egypt Objectives: Autism spectrum disorder (ASD) is a developmental disorder characterized by pervasive deficits in social interaction, impairment in verbal and non-verbal communication, and stereotyped patterns of interests and activities. Vitamin-D deficiency was previously reported in autistic children. However, the data on the relationship between vitamin D deficiency and the severity of autism are limited. Methods: We performed a case–controlled cross-sectional analysis conducted on 122 ASD children, to assess their vitamin D status compared to controls and the relationship between vitamin D deficiency and the severity of autism. We also conducted an open trial of vitamin D supplementation in ASD children. Results: Fifty-seven percent of the patients in the present study had vitamin D deficiency, and 30% had vitamin D insufficiency. The mean 25-OHD levels in patients with severe autism were significantly lower than those in patients with mild/moderate autism. Serum 25-OHD levels had significant negative correlations with Childhood Autism Rating Scale (CARS) scores. Of the ASD group, 106 patients with lowserum 25-OHD levels (40 ng/ml; all had decreased CARS scores between 3.5 and 6.5 points. The second group consisted of 49 patients with final serum 25-OHD levels between 30 and 39 ng/ml. Most of them (31/49 patients) had decreased CARS scores by 1.5–4.5 points, while the rest of this group (18 patients) had no improvements. Collectively, 80.72% (67/83) of subjects who received vitamin D3 treatment (5000 IU/day) had significantly improved (P ≤ 0.05) outcome. Table 3 and Fig. 2 showed the details of CARS scores before and after vitamin D therapy. Regarding ABC subscales before and after vitamin D therapy, there were statistically significant improvement in irritability (P = 0.021), lethargy/social withdrawal (P = 0.028), hyperactivity (P = 0.01), and stereotypic behavior (P = 0.04), with no significant difference in inappropriate speech (Table 4).
Table 3
CARS scores in ASD patients before and after vitamin D therapy
Outcome measure Relating to people Emotional response Imitation Body use Object use Adaptation to change Listening response Taste, smell, touch Visual response Fear Verbal communication Activity level Non-verbal communication Level and consistency of intellectual response General impression Total CARS score *Significant values.
4
Many studies have investigated the plasma levels of vitamin D directly in individuals with ASD. In agreement of the present study, Mostafa and Al-Ayadhi29 reported that autistic children had significantly lower serum levels of 25-OHD than healthy children and 25-OHD was inversely associated with severity on autism rating scales (R = 0.84). In addition, children with ASD had significantly higher serum levels of anti-MAG autoantibodies (R = 0.86). Gong et al. 30 reported that mean serum 25-OHD levels were significantly lower in autistic children as compared with normal cases. There was a significant negative relationship between circulating serum 25-OHD levels and the severity of ASD. Meguid et al. 4 reported a cohort of autistic children having significantly lower levels of calcifediol and calcitriol values compared to healthy controls. The season of birth in relation to vitamin D and ASD was also taken into account, but no significant difference was found for the month or season of birth in either group. Molloy et al. 23 compared the plasma calcifediol levels in a cohort of autistic boys (4–8 years old) and a group of boys having intravenous catheters placed for outpatient tonsillectomies. There were no differences observed in the levels of vitamin D between ASD and controls. The drawbacks of this study were that the patient group included only males, and the control groups were all suffering from acute inflammation, which could affect the levels of plasma vitamin D.18 Humble et al. 22 tested vitamin D levels in adult patients with psychiatric disorders and found that those with a diagnosis of ASD had significantly lower levels of vitamin D than any of the other groups. However, the study did not have a control group and examined only adults with a range of disorders, not only ASD.18 Another study examined
Nutritional Neuroscience
2015
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Mean ± SD scores before therapy
Mean ± SD scores after therapy
t
P-value
3.05 ± 1.7 2.30 ± 1.6 3.01 ± 1.0 1.9 ± 1.1 1.42 ± 1.1 2.18 ± 1.3 1.92 ± 1.0 2.00 ± 1.3 2.89 ± 1.0 2.61 ± 0.8 2.66 ± 1.2 2.00 ± 0.8 2.04 ± 2.2 2.77 ± 1.3 3.31 ± 1.2 37.7 ± 2.4
2.09 ± 1.8 1.02 ± 0.7 1.76 ± 0.3 1.47 ± 1.7 1.03 ± 0.8 1.89 ± 1.0 1.57 ± 1.7 2.02 ± 1.1 2.29 ± 1.2 2.46 ± 0.7 2.35 ± 1.1 1.93 ± 0.9 2.19 ± 1.8 2.67 ± 1.2 2.41 ± 0.8 30.7 ± 2.8
5.58 4.89 5.02 2.77 2.82 3.21 2.71 1.93 3.34 1.71 1.04 1.01 1.04 1.6 6.65 5.77
ISSN: 1028-415X (Print) 1476-8305 (Online) Journal homepage: http://www.tandfonline.com/loi/ynns20
Vitamin D status in autism spectrum disorders and the efficacy of vitamin D supplementation in autistic children Khaled Saad, Ahmed A. Abdel-rahman, Yasser M. Elserogy, Abdulrahman A. Al-Atram, John J. Cannell, Geir Bjørklund, Mohamed K. Abdel-Reheim, Hisham A. K. Othman, Amira A. El-Houfey, Nafisa H. R. Abd El-Aziz, Khaled A. Abd El-Baseer, Ahmed E. Ahmed & Ahmed M. Ali To cite this article: Khaled Saad, Ahmed A. Abdel-rahman, Yasser M. Elserogy, Abdulrahman A. Al-Atram, John J. Cannell, Geir Bjørklund, Mohamed K. Abdel-Reheim, Hisham A. K. Othman, Amira A. El-Houfey, Nafisa H. R. Abd El-Aziz, Khaled A. Abd El-Baseer, Ahmed E. Ahmed & Ahmed M. Ali (2015): Vitamin D status in autism spectrum disorders and the efficacy of vitamin D supplementation in autistic children, Nutritional Neuroscience To link to this article: http://dx.doi.org/10.1179/1476830515Y.0000000019
Published online: 15 Apr 2015.
Submit your article to this journal
Article views: 1
View related articles
Citing articles: 3 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ynns20 Download by: [Gazi University]
Date: 03 February 2016, At: 01:46
Vitamin D status in autism spectrum disorders and the efficacy of vitamin D supplementation in autistic children Khaled Saad 1, Ahmed A. Abdel-rahman 2, Yasser M. Elserogy2, Abdulrahman A. Al-Atram 3, John J. Cannell 4, Geir Bjørklund 5, Mohamed K. Abdel-Reheim6, Hisham A. K. Othman7, Amira A. El-Houfey8, Nafisa H. R. Abd El-Aziz 1, Khaled A. Abd El-Baseer 9, Ahmed E. Ahmed 9, Ahmed M. Ali 1
Downloaded by [Gazi University] at 01:46 03 February 2016
1
Department of Pediatrics, Faculty of Medicine, Assiut University, Egypt, 2Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Egypt, 3Department of Psychiatry, College of Medicine, Almajmaah University, KSA, 4Vitamin D Council, 1411 Marsh Street, Suite 203, San Luis Obispo, CA 93401, USA, 5Council for Nutritional and Environmental Medicine, Mo i Rana, Norway, 6Dorset County Hospital, Dorchester, UK, 7 Department of Clinical Pathology, Aswan University, Egypt, 8Department of Community Health Nursing, Faculty of Nursing, Assiut University, Egypt, 9Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Egypt Objectives: Autism spectrum disorder (ASD) is a developmental disorder characterized by pervasive deficits in social interaction, impairment in verbal and non-verbal communication, and stereotyped patterns of interests and activities. Vitamin-D deficiency was previously reported in autistic children. However, the data on the relationship between vitamin D deficiency and the severity of autism are limited. Methods: We performed a case–controlled cross-sectional analysis conducted on 122 ASD children, to assess their vitamin D status compared to controls and the relationship between vitamin D deficiency and the severity of autism. We also conducted an open trial of vitamin D supplementation in ASD children. Results: Fifty-seven percent of the patients in the present study had vitamin D deficiency, and 30% had vitamin D insufficiency. The mean 25-OHD levels in patients with severe autism were significantly lower than those in patients with mild/moderate autism. Serum 25-OHD levels had significant negative correlations with Childhood Autism Rating Scale (CARS) scores. Of the ASD group, 106 patients with lowserum 25-OHD levels (40 ng/ml; all had decreased CARS scores between 3.5 and 6.5 points. The second group consisted of 49 patients with final serum 25-OHD levels between 30 and 39 ng/ml. Most of them (31/49 patients) had decreased CARS scores by 1.5–4.5 points, while the rest of this group (18 patients) had no improvements. Collectively, 80.72% (67/83) of subjects who received vitamin D3 treatment (5000 IU/day) had significantly improved (P ≤ 0.05) outcome. Table 3 and Fig. 2 showed the details of CARS scores before and after vitamin D therapy. Regarding ABC subscales before and after vitamin D therapy, there were statistically significant improvement in irritability (P = 0.021), lethargy/social withdrawal (P = 0.028), hyperactivity (P = 0.01), and stereotypic behavior (P = 0.04), with no significant difference in inappropriate speech (Table 4).
Table 3
CARS scores in ASD patients before and after vitamin D therapy
Outcome measure Relating to people Emotional response Imitation Body use Object use Adaptation to change Listening response Taste, smell, touch Visual response Fear Verbal communication Activity level Non-verbal communication Level and consistency of intellectual response General impression Total CARS score *Significant values.
4
Many studies have investigated the plasma levels of vitamin D directly in individuals with ASD. In agreement of the present study, Mostafa and Al-Ayadhi29 reported that autistic children had significantly lower serum levels of 25-OHD than healthy children and 25-OHD was inversely associated with severity on autism rating scales (R = 0.84). In addition, children with ASD had significantly higher serum levels of anti-MAG autoantibodies (R = 0.86). Gong et al. 30 reported that mean serum 25-OHD levels were significantly lower in autistic children as compared with normal cases. There was a significant negative relationship between circulating serum 25-OHD levels and the severity of ASD. Meguid et al. 4 reported a cohort of autistic children having significantly lower levels of calcifediol and calcitriol values compared to healthy controls. The season of birth in relation to vitamin D and ASD was also taken into account, but no significant difference was found for the month or season of birth in either group. Molloy et al. 23 compared the plasma calcifediol levels in a cohort of autistic boys (4–8 years old) and a group of boys having intravenous catheters placed for outpatient tonsillectomies. There were no differences observed in the levels of vitamin D between ASD and controls. The drawbacks of this study were that the patient group included only males, and the control groups were all suffering from acute inflammation, which could affect the levels of plasma vitamin D.18 Humble et al. 22 tested vitamin D levels in adult patients with psychiatric disorders and found that those with a diagnosis of ASD had significantly lower levels of vitamin D than any of the other groups. However, the study did not have a control group and examined only adults with a range of disorders, not only ASD.18 Another study examined
Nutritional Neuroscience
2015
VOL.
0
NO.
0
Mean ± SD scores before therapy
Mean ± SD scores after therapy
t
P-value
3.05 ± 1.7 2.30 ± 1.6 3.01 ± 1.0 1.9 ± 1.1 1.42 ± 1.1 2.18 ± 1.3 1.92 ± 1.0 2.00 ± 1.3 2.89 ± 1.0 2.61 ± 0.8 2.66 ± 1.2 2.00 ± 0.8 2.04 ± 2.2 2.77 ± 1.3 3.31 ± 1.2 37.7 ± 2.4
2.09 ± 1.8 1.02 ± 0.7 1.76 ± 0.3 1.47 ± 1.7 1.03 ± 0.8 1.89 ± 1.0 1.57 ± 1.7 2.02 ± 1.1 2.29 ± 1.2 2.46 ± 0.7 2.35 ± 1.1 1.93 ± 0.9 2.19 ± 1.8 2.67 ± 1.2 2.41 ± 0.8 30.7 ± 2.8
5.58 4.89 5.02 2.77 2.82 3.21 2.71 1.93 3.34 1.71 1.04 1.01 1.04 1.6 6.65 5.77
