A quarterly publication of the Autism Research Institute
Fall, 2024 | Number 4, Volume 38
Children with autism spectrum disorders (ASD) who have extremely limited food preferences may be at risk for eye damage due to low levels of vitamin A, according to studies from New Zealand and Argentina.
In the first study, Jane Shi and colleagues reported on four young boys, three with ASD, who presented to a clinic with loss of vision and multiple vitamin deficiencies including severe deficiencies of vitamin A. They report, “All patients had severely restricted diet comprising of predominantly carbohydrates.” All of the children eventually developed marked optic atrophy, and all showed radiological evidence of cranial
hyperostosis (a thickening of the base of the skull). Cranial hyperostosis, a sign of severe vitamin A deficiency, can lead to optic nerve compression, resulting in vision loss. While the children received vitamin A suplementation, only one of the four experienced an improvement in vision.
The researchers say this may be due to the advanced state of their disease. The researchers conclude, “Hypovitaminosis A is a crucial form of nutritional deprivation that results in significant visual loss with potential hyperostosis and optic nerve compression exacerbating nutritional optic neuropathy. Additional micronutrient deficiencies usually co-exist and may contribute. Extra vigilance in vitamin replacement is required of clinicians with patients with autism who have restricted diets.”
In the second study, Natalia Moreno and colleagues identified 13 children with severe ophthalmological disease due to low levels of vitamin A. All of the children exhibited food selectivity, and eight had ASD. The researchers performed neuroimaging studies on 11 of the children and found that eight exhibited cranial hyperostosis. Lumbar punctures showed endocranial hypertension (increased pressure inside the skull due to a buildup of cerebrospinal fluid in the brain) in seven.
The researchers comment, “Food history allows early detection of nutrient deficiencies in children with restrictive feeding, especially in neuro-atypical patients. This is essential to implement preventive measures and treatment with vitamin A in order to avoid irreversible consequences.”
Editor’s note: These studies add to the medical literature showing that extreme food selectivity, which is very common in ASD, can lead to severe nutritional deficiencies and should be on the radar of clinicians treating autistic patients. Previous studies have linked food selectivity in ASD to serious conditions including iron-deficiency anemia, B12-deficiency anemia, scurvy due to a deficiency in vitamin C, and rickets due to a deficiency in vitamin D.
“Optic neuropathy from hypovitaminosis A in a series of children with severe dietary restrictions,” Jane Shi, James Caldwell, Leo Sheck, Bobby Tsang, Rebecca Alekzander, Julia Escardo-Paton, Andrea L. Vincent, Claire Spooner, Peter Heppner, Helen Danesh-Meyer, and Sarah Hull, Journal of Paediatrics and Child Health, July 25, 2024 (free online). Address: Jane Shi, Ophthalmology Department, Auckland University, Auckland, New Zealand, [email protected].
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“Decreased vision due to hypovitaminosis A in children with food selectivity,” Natalia Moreno, Florencia C. Lynch, María A. Zalazar, Carla F. Miranda, Sofía H. Vidal, and Marisa L. Armeno, Medicina Buenos Aires (Spanish language), 2024. Address: Natalia Moreno, Servicio de Nutrición y Diabetes, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina, [email protected].
