Background: Iron
has an important role in cognitive, behavioral, and motor development. A
high prevalence of iron deficiency (ID) has been reported in people
with autism. Children with autism are at risk for ID and this condition
may increase the severity of psychomotor and behavioral problems, some
of which already inherently exist in these children.
Aim: The aim of this study is to investigate the association between
autism and iron deficiency in autistic children in the northern West
Bank and to identify food selectivity and compare indices of food
selectivity among children with autism, children with mental disorders
and typically developing children (normal children).
Participant and Methods: 90 children with an age range of 3 to 13 years
participated in a case control study distributed into study group and
two control groups. Thirty children diagnosed with autism according to
DSM-IV and ICD-10criteria served as a study group, 30 children with
mental disorders other than autism served as a control group, and 30
typically developing children taken from the public functioned as a
second control group. The three groups were matched for age, gender and
geographical area. Serum ferritin, hemoglobin, hematocrit, mean
corpuscular volume, and red cell distribution width values were measured
and analyzed with food habit survey and demographic data.
Results: ID was detected in 20% (N = 6/30) of autistic children based on
Serum ferritin level (SF< 10µ/l), compared with 0% for the two
control groups (p= 0.0001). Anemia was defined as hemoglobin <110g/l
for children under the age of 6 years and hemoglobin <120g/l for
children between 6 and 13 years of age .When analysis done for HGB to
these six children (children who have low serum ferritin); it was found
that 66.6% (4/6) of the children two were pre-school male children (HGB
is less than 110g/1), and the other two were one male and one female of
school children (HGB is less than 120g/l) have iron deficiency anemia,
and the iron deficiency anemia was 13.3% (4\30) for all autistic group.
The results indicated that these differences were for males. It was
found also that the frequency of low iron intake in these children was
associated with feeding difficulties and food selectivity; there was a
significant difference between children in the autistic group who chose
foods with a red color as a favorite 23% (7/30) compared to the other
two control groups: 0%, respectively (p= 0.0001). The results
demonstrated also a significant difference in the frequency of snacks
per day (≥ 4) in autistic children 40% (12/30) compared to both mental
disorder 16.7 % (n = 5/30) (p = 0.006) and typically developing children
6.7% (n = 2/30) groups (p = 0.001).
Conclusion: Results of this study indicated that there is an association
between autism, iron deficiency and anemia. Low levels of serum
ferritin in autistic children might be a sign of iron deficiency and an
early precursor of iron deficiency anemia. These findings suggest that
food selectivity is more common in children with autism than in
typically developing children. These findings suggest that ferritin
levels should be measured in children with autism as a part of routine
investigation.
Keywords: Child, Autism, Mental disorder, typically developing children,
Iron deficiency, Iron deficiency anemia, Ferritin.