孤独症谱系障碍儿童饮食行为及营养素问题的研究进展

孤独症谱系障碍(autism spectrum disorder,ASD)的主要核心症状为社交互动障碍,狭隘的兴趣和重复刻板行为,后者常常也表现在饮食行为方面。ASD儿童存在严重的饮食行为问题,易引起摄入的食物种类减少,营养素水平降低,进一步加重ASD儿童的症状。因此,本文就ASD儿童的饮食行为、营养素问题及其干预进行总结和阐述。     

学龄前孤独症谱系障碍儿童情绪行为问题与饮食行为问题调查

目的 研究学龄前孤独症谱系障碍(ASD)儿童情绪行为问题与饮食行为问题,并对该群体中两者的关系进行初步探究。方法 2020年8月—2021年4月使用长处和困难问卷(SDQ,父母版)和学龄前儿童饮食行为问卷(PEBQ)对150例学龄前ASD儿童情绪行为问题及饮食行为问题展开评估,利用Logistic回归分析探究两者关系。结果 学龄前ASD儿童常见的情绪行为问题检出率分别为:同伴交往问题(86.0%)、社会行为问题(72.7%)、多动问题(51.3%)。常见的饮食行为问题检出率分别为:主动进食能力不足(83.3%)、挑食(57.3%)、情绪性进食(42.0%)。品行问题是学龄前ASD儿童食物响应问题(OR=3.48, 95%CI:1.04~11.63)和情绪性进食(OR=6.11, 95%CI:1.56~23.86)的危险因素。社会行为问题是学龄前ASD儿童挑食(OR=3.07,95%CI:1.40~6.74)和主动进食不足(OR=5.32,95%CI:1.25~22.70)的危险因素,多动问题是学龄前ASD儿童挑食(OR=3.40,95%CI:1.65~7.00)和不良饮食习惯(OR=4.29,95%CI:1.55~11.88)的危险因素。结论 学龄前ASD儿童情绪行为问题及饮食行为问题均较严重。学龄前ASD儿童情绪行为问题与挑食、主动进食能力不足、食物响应问题、不良饮食习惯及情绪性进食有关。     

孤独症谱系障碍儿童饮食行为调查

了解孤独症谱系障碍(ASD)儿童的饮食行为,探讨改善ASD儿童饮食行为问题的方法,为指导ASD儿童的科学喂养提供依据.方法 病例组为来自青岛某医院和某孤独症康复训练学校的2~6岁ASD儿童128例,对照组为青岛市数家幼儿园正常儿童133名,采用自编的儿童饮食行为问卷调查比较两组儿童的10种饮食行为与10类食物的选择情况.结果 病例组每位ASD儿童出现饮食行为问题的总数是(5.9±1.9)个,高于对照组每位儿童的(4.7±2.4)个(Z=-4.068,P<0.05);ASD儿童进餐时离开饭桌的发生率为93.0%,需喂食的发生率为88.3%,吐食物的发生率为71.1%,扔食物的发生率为47.7%,尖叫的发生率为36.7%,而对照组儿童分别为73.7%,71.4%,58.6%,23.3%和17.3%,差异均有统计学意义(P值均<0.05).食物选择方面,病例组ASD儿童拒绝食用杂粮、豆类和鱼虾贝类的报告率均超过了30%,明显高于对照组(均不足20%);病例组儿童食用水果的报告率为89.8%,而对照组儿童均食用水果,两组间差异均有统计学意义(P值均<0.05).结论 ASD儿童普遍存在多种饮食行为问题,建议采取有效的干预措施进行矫正.     

孤独症谱系障碍儿童饮食行为问题的研究

目的探讨孤独症谱系障碍(autism spectrum disorder,ASD)儿童的饮食行为问题,为建立ASD的生活自理能力训练方法提供研究基础。方法实验组为2013年07月-2014年06月于本科就诊的ASD患儿53例,对照组为正常儿童50例,分别对两组儿童的主要照顾者进行饮食行为问题及一般信息调查。结果实验组在进食能力、进食行为、食物选择和喂养行为四个维度不良饮食行为的发生率均高于对照组。实验组咀嚼有困难占32例(60%);不会自己吃饭,需要喂饭的有30例(57%);拒绝一切食物的发生率为8例(15%);而对照组在这三个条目的发生率均为0例(0%)。此外,实验组不能在餐桌进餐、吃饭时间超过30min、需要特定的餐桌/餐具摆放,或需要特定的餐具、不愿尝试新食物等条目的发生率也明显高于对照组。结论饮食行为问题在ASD儿童中普遍存在,且种类多,程度重。因此,饮食行为问题是ASD儿童生活自理能力训练的重要项目之一。     

孤独症谱系障碍儿童血清多不饱和脂肪酸水平的研究

目的 研究孤独症谱系障碍(ASD)儿童血清多不饱和脂肪酸(PUFAs)的表达水平,为ASD的诊治提供理论依据。方法 2020年12月—2021年6月在上海市儿童医院儿童保健科选取45例ASD儿童及30例对照组儿童为研究对象,通过液相-串联质谱法对其外周血血清进行PUFAs含量测定;通过简易孤独症饮食行为量表(BAMBI)及自制膳食调查问卷了解ASD儿童与对照组饮食行为习惯及饮食结构上的差异,进一步分析ASD儿童血清PUFAs表达水平的影响因素。结果 ASD组儿童血清中二十碳五烯酸(EPA)、二十二碳六烯酸(DHA)、花生四烯酸(AA)、亚油酸(LA)、总n-3 PUFAs及总n-6 PUFAs下降(t=2.81、2.04、2.94、2.33、2.11、2.63,P＜0.05),其中EPA及AA下降明显(P＜0.01)。ASD组儿童在拒食行为、与ASD特征相关喂养问题、食物谱狭窄及总分方面均高于对照组儿童(t=2.93、13.42、2.22、8.40,P＜0.05),ASD组儿童对饮食的总体兴趣低于对照组(t=2.70,P＜0.05),尤其对鱼类的兴趣偏低(t=5.03,P＜0.05)。结论 ASD儿童血清多数PUFAs含量比正常儿童低,可能与饮食行为及饮食偏好有关,补充PUFAs可能成为ASD儿童的辅助治疗手段之一。     

孤独症儿童饮食行为问题及相关干预

目的 调查孤独症谱系障碍(ASD)患儿饮食行为问题,探索通过家长教育、以家庭为主体的综合饮食干预的疗效。方法 选取2017年12月-2018年12月在复旦大学附属儿科医院儿保科门诊就诊并确诊的18~72月龄ASD患儿为研究对象,采用问卷调查饮食行为,对存在饮食行为问题的家庭给予饮食指导,为期1个月。同时对儿童进行体格测量,检测血清营养学指标。结果 研究最终调查310名儿童,其中51.0%的ASD儿童有挑食行为,其他高发的行为问题有进餐容易分心(35.3%)、进餐要看电视或玩玩具(25.5%)、不愿在餐桌进餐(19.0%)。ASD儿童体重过重(11.6%)及肥胖(11.2%)的比例较高,个别儿童维生素A、维生素D、维生素B₁₂、锌降低。本研究最终干预问题条目有7条,每个问题条目干预过程中都有不同比例的儿童得到改善。同时个别条目干预中发现主要照顾者为父母及主要照顾者文化程度高的干预改善率更高(OR＞1,P＜0.05)。结论 ASD儿童饮食行为问题发生率高,应推动以家庭为单位的ASD儿童饮食行为临床干预。     

母亲喂养行为对学前儿童饮食行为的影响

目的了解母亲喂养行为对学前儿童饮食行为的影响,进而从家庭喂养的角度为培养儿童良好的饮食行为习惯提供依据及建议。方法采用《儿童喂养量表》和《儿童饮食行为量表》对128例母亲的喂养态度、行为及其孩子的饮食行为状况进行评估,并采用多元逐步回归分析考察母亲喂养行为对儿童饮食行为的影响。结果限制饮食是大多数母亲在生活中经常表现出的喂养行为;过饱响应、进食缓慢以及挑食是当前儿童存在的不良饮食行为;限制饮食对食物响应、食物喜好具有显著的正向预测作用;逼迫进食对儿童过饱响应、进食缓慢、挑食、渴望饮料、情绪性饮食减少及情绪性过度饮食具有显著的正向预测作用,对儿童的食物喜好具有显著的负向预测作用。监督对儿童的挑食具有显著的负向预测作用。结论母亲喂养行为与儿童饮食行为存在密切关系。     

孤独症谱系障碍儿童食物不耐受与肠道菌群的关系

目的通过检测孤独症谱系障碍(ASD)儿童血清不耐受食物和肠道菌群,分析食物不耐受(FI)与ASD儿童胃肠道症状的相关性,并探讨FI对ASD儿童行为影响的可能机制。方法选取2020年1—12月就诊于泉州市妇幼保健院·儿童医院康复科2~6岁ASD儿童95例,采用酶联免疫法(ELISA)检测14种血清食物特异性IgG,并依据血清食物特异性IgG抗体检测水平评估FI程度。依据FI检测结果将入组ASD儿童分为FI组(52例)及无FI组(43例)。两组儿童均采用自行设计的ASD儿童胃肠道症状评估调查表进行评估,并采用16S高通量基因测序法检测粪便中肠道菌群的分布状况。结果(1)FI组腹胀、便秘、呕吐及按压腹部同时哭闹发生率显著高于无FI组,差异均有统计学意义(χ^(2)=6.924、5.573、4.198、4.533,P<0.05)。(2)FI水平与腹胀、便秘、恶心及按压腹部同时哭闹存在正相关(r=0.341、0.428、0.340、0.227,均P<0.05)。(3)FI组chao1数值、拟杆菌数量、大肠埃希菌数量及乳酸杆菌相对数量显著高于无FI组,差异均有统计学意义(t=8.207、10.469、11.090、2.229,P<0.05);FI组双歧杆菌数量显著低于无FI组,差异有统计学意义(t=-2.862,P<0.05)。结论伴有FI的ASD存在较多的胃肠道症状,FI与部分胃肠道症状密切相关,对存在胃肠道问题的ASD儿童应注意有无FI。FI儿童存在更为明显的肠道菌群紊乱。     

南宁市301例儿童饮食行为调查分析

【目的】 了解南宁市社区1~3岁儿童饮食行为问题及家庭喂养状况,为进一步开展早期干预提供科学依据。 【方法】 随机抽取南宁市两个社区1岁至不满4岁健康儿童301名作为调查对象,采用自填问卷的调查方法,内容包括儿童一般资料,儿童饮食行为问题,抚养人的喂养行为问题。 【结果】 65.1%的儿童存在有饮食行为问题, 饮食行为问题发生率由高到低顺位依次为进餐时间过长46.5%、进餐分心37.9%、吃得少35.9%、进餐地点不固定34.2%,对食物不感兴趣23.6%、强烈偏爱某种食物20.6%、拒绝某种食物 19.3%、不愿尝试新食物11.0%。 【结论】 南宁市社区1~3岁儿童饮食行为问题发生率较多见,加强营养与喂养知识的健康教育,针对个性化指导和行为干预,使儿童形成良好的饮食行为习惯。     

孤独症谱系障碍儿童喂养问题现况调查及其相关因素分析

目的 分析孤独症谱系障碍(ASD)儿童中喂养问题的现状及ASD儿童喂养问题的相关因素,为临床指导ASD儿童喂养问题的行为矫正提供理论依据。方法 于2015年8月—2016年1月通过收集119例ASD儿童和185名正常儿童的进食行为量表(BAMBI)得分来比较两组在喂养问题上的差异,采用Spearman秩相关分析喂养问题的相关因素。结果 ASD男童的拒绝进食行为、食物谱狭窄和BAMBI总分均高于正常男童(9.64±3.18 vs. 8.15±2.85,P=0.003;21.21±5.53 vs. 18.76±4.93,P=0.004;41.44±9.41 vs. 37.05±7.41,P=0.001),ASD女童的孤独症特征相关的喂养问题得分明显高于ASD男童(12.17±2.25 vs. 10.58±2.60,P=0.029)。低功能ASD男童拒绝进食行为得分、孤独症特征相关的喂养问题得分和BAMBI总分均高于正常男童(9.83±3.21 vs. 7.61±2.56,P=0.004;11.72±3.03 vs. 10.07±2.31,P=0.029;42.62±10.54 vs. 36.89±7.41,P=0.028)。ASD儿童中,拒绝进食行为得分与刻板行为、自伤行为、强迫行为、仪式单调行为、受限行为得分呈正相关(P＜0.05);孤独症特征相关的喂养问题得分与年龄、刻板行为、仪式单调行为、受限行为得分呈正相关(P＜0.05);食物谱狭窄得分与刻板行为、强迫行为、仪式单调行为、受限行为得分呈正相关(P＜0.05)。结论 ASD男童较正常男童存在更多的喂养问题,低功能ASD男童的喂养问题可能受重复刻板行为影响,临床工作者需给予更多的关注,并进行个体化的行为矫正。     

Meals in Our Household: reliability and initial validation of a questionnaire to assess child mealtime behaviors and family mealtime environments

Mealtimes in families with young children are increasingly of interest to nutrition and public health researchers, yet assessment tools are limited. Meals in Our Household is a new parent-report questionnaire that measures six domains: 1) structure of family meals, 2) problematic child mealtime behaviors, 3) use of food as reward, 4) parental concern about child diet, 5) spousal stress related to child's mealtime behavior, and 6) influence of child's food preferences on what other family members eat. Reliability and initial face, construct, and discriminant validity of the questionnaire were evaluated between January 2007 and December 2009 in two cross-sectional studies comprising a total of 305 parents of 3- to 11-year-old children (including 53 children with autism spectrum disorders). Internal consistencies (Cronbach's α) for the six domains averaged .77 across both studies. Test-retest reliability, assessed among a subsample of 44 parents who repeated the questionnaire after between 10 and 30 days, was excellent (Spearman correlations for the domain scores between two administrations ranged from 0.80 to 0.95). Initial construct validity of the instrument was supported by observation of hypothesized inter-relationships between domain scores that were of the same direction and similar magnitude in both studies. Consistent with discriminant validity, children with autism spectrum disorders had statistically significantly (P<0.05) higher domain scores for problematic child mealtime behaviors, use of food as reward, parental concern about child diet, and spousal stress, as compared to typically developing children. Meals in Our Household may be a useful tool for researchers studying family mealtime environments and children's mealtime behaviors.     

Eating Behaviors of Children with Autism—Pilot Study,Part II

Autism spectrum disorder is characterized by social communication deficit and non-normative behavior. The people with autism often experience troubles with feeding. The purpose of this study was to conduct evaluation of the feeding and eating behaviors among children with autism. Patients and Methods: The study group included 41 high-functioning autistic children. The control group consisted of 34 children without the ASD. The questionnaire was used to assess the nutritional status. Results: The children with ASD fuss during mealtimes more frequently, they require entertaining and diverting their attention, they are fed by parents, and they consume their meals away from the table. The significant difference found in the use of utensils and food selectivity works to the disadvantage of the Study Group. Conclusions: The food selectivity occurs significantly more frequently among children with ASD. The feeding and eating problems should be considered on a wider scale. The cooperation of the multidisciplinary and the parents teams should be proposed in the ASD patients care.     

Parent training for feeding problems in children with autism spectrum disorder: A review of the literature

A scoping review of the literature was conducted to identify published studies in which parents of children with Autism spectrum disorder (ASD) were trained to implement interventions designed to improve their child’s feeding and mealtime behaviors. Twenty-six studies were included in the review. Of these, 23 used single subject designs, and 3 used group designs. All reported improvements in target behaviors (usually acceptance of novel foods or reduction in disruptive mealtime behavior). However, only 3 described a procedure for incorporating parent input into the intervention plan; 7 directly measured parents’ fidelity in implementing intervention procedures; and 7 assessed social validity or parent satisfaction. Thus, there is a need for more systematic involvement of parents in treatment for feeding in children with ASD and more comprehensive outcome assessment.     

Assessing Children's Mealtime Problems With the Mealtime Behavior Questionnaire

A caregiver questionnaire that assesses mealtime problems in children aged 2 to 6 years old was developed. Community caregivers (n = 712) completed the Mealtime Behavior Questionnaire (MBQ) and measures of child behavior and family mealtime behaviors and environment. Exploratory and confirmatory factor analyses revealed and validated the MBQ's 4 subscales (food refusal/avoidance; food manipulation; mealtime aggression/distress; and choking/, gagging/vomiting). Mealtime problems occurred from “sometimes” to “always” for 1% to 61% of the sample. The MBQ demonstrated excellent to fair internal consistencies, and preliminary evidence for validity was found.     

Dietary Intake,Nutrient Status,and Growth Parameters in Children with Autism Spectrum Disorder and Severe Food Selectivity: An Electronic Medical Record Review

Background

Food selectivity is common in children with autism spectrum disorder (ASD). The clinical characteristics, however, of severe food selectivity in children with ASD is not well documented.

Examining mealtime behaviors in families of young children with type 1 diabetes on intensive insulin therapy

This study examined mealtime behaviors in families of young children with type 1 diabetes (T1DM) on intensive insulin therapy. Behaviors were compared to published data for children on conventional therapy and examined for correlations with glycemic control. Thirty-nine families participated and had at least three home meals videotaped while children wore a continuous glucose monitor. Videotaped meals were coded for parent, child, and child eating behaviors using a valid coding system. A group difference was found for child request for food only. There were also associations found between children's glycemic control and child play and away. However, no associations were found between parent and child behaviors within meals and children's corresponding post-prandial glycemic control. Results reinforce existing research indicating that mealtime behavior problems exist for families of young children even in the context of intensive therapy and that some child behaviors may relate to glycemic control.     

孤独症谱系障碍儿童胃肠问题及相关临床特征关联分析

探讨孤独症谱系障碍(ASD)儿童胃肠问题的发生情况及其与临床表型特征的关系,为ASD儿童的综合干预提供参考.方法 选取在哈尔滨医科大学儿童发育行为研究中心就诊及进行康复训练的ASD儿童110名及与其年龄、性别匹配的正常儿童110名,收集儿童胃肠道症状、情绪、睡眠等临床特征资料,比较儿童胃肠问题发生情况;采用孤独症诊断访谈量表修订版(ADI-R)对ASD儿童进行评估,分析有无胃肠问题的ASD儿童的ADI-R得分以及其他临床特征的组间差异.结果 ASD儿童胃肠问题总检出率(44.5%)高于正常儿童(24.5%)(x2=9.730,P<0.01);各类胃肠问题腹泻、腹胀、腹痛和便秘ASD组均高于对照组,在腹泻、腹胀方面差异均有统计学意义(X2值分别为6.62,6.74,P值均<0.05).与无胃肠问题的发生率ASD儿童相比较(3.83±2.29),伴有胃肠问题的ASD儿童ADI-R的重复刻板行为评分(5.30±2.55)明显增高(t=3.17,P<0.01);有无胃肠问题组ASD儿童在情绪和睡眠问题上检出率差异均有统计学意义(X2值分别为7.01,4.27,P值均<0.05).结论 ASD儿童的胃肠问题检出率较高,有胃肠问题的ASD儿童重复刻板行为症状较重,并影响儿童情绪和睡眠.在ASD儿童的干预过程中要关注儿童伴有的临床相关问题,进行综合治疗和管理.