Screening for Autistic Manifestations in Cases with Dietetic Rickets

Eman Sayed Mohamed Al-Shony


Abstract


Nutritional rickets is gaining the attention of public health professionals and individual clinicians worldwide as the disease remains an endemic problem in many developing countries and has re-emerged in a number of developed countries, where it was thought that the disease had been almost eradicated. In the middle East vitamin D deficiency and rickets continues to be a public health problem despite abundant all year sunshine in many of the regions. Limited sunlight exposure is not the only factor predisposing to vitamin D deficiency in children as there are also exclusive or prolonged breastfeeding without vitamin D supplementation, gestational vitamin D deficiency, and low socio-economic status, all of which have a key role in the pathogenesis of the disease. The current case control cross sectional study was designed to investigate the frequency of autistic manifestations in an Egyptian sample of rachitic infants and children compared to age and sex matched healthy controls and to correlate the level of 25 hydroxy cholecalceferol and the severity of autistic symptomatology using Childhood Autism Rating Scale (CARS). To fulfill the aim of the current study, 35patients with vitamin D deficiency Rickets were recruited randomly from the Out Patients Clinic, Faculty of Medicine, Ain Shams University. Their ages ranged from 1-3 years with a mean age of 2.13±0.67years. They were 17 males and 18 females. Also, 35 clinically healthy age and sex matched children were enrolled as controls. The study was carried out from January 2012 to October 2012 and was approved by the Ethics Committee at Faculty of Medicine, Ain Shams University. All patients were subjected to careful medical history taking laying stress on dietetic history, developmental history, and history of vitamin supplementation, thorough clinical examination with special emphasis on anthropometric measurements including weight, height, head circumference, and body mass index and neurological examination. Psychometric assessment using CARS for all enrolled children and social IQ in selected cases. DSM IV TR criteria were used to confirm the diagnosis of autism. Laboratory investigations including total serum 25 hydroxy cholechalceferol, serum Ca, Phosphorus, and serum alkaline phosphatase, plain X-ray of extremities were also done. The results of the current study showed that the studied cases and controls were well matched as regards sex distribution (p>0.05). Also, there were statistically non significant differences between cases and controls as regards age at onset of weaning and age at time of study (p>0.05 of both). There were statistically non significant differences between cases and controls as regards type of feeding (breast, bottle, and mixed); and paternal and maternal occupation (p>0.05 for all). On the other hand, the habit of completely covering babies was significantly more encountered among rachitic cases (54.29%) compared to controls (14.28%) (2 = 10.716 , p=0.001*). On the other hand, there was statistically insignificant difference between cases and controls as regards adequacy of maternal intake of vitamin D (p>0.05); There were statistically insignificant differences between cases and controls as regards weight, height, head circumference, and birth weight (p>0.05 for all). On the other hand, body mass index was significantly lower in rachitic cases compared to controls (t= 10.00, p=0.00*). There were statistically insignificant differences between cases and controls as regards weight, height, head circumference, and birth weight (p>0.05 for all). On the other hand, mean value of body mass index was significantly lower in rachitic cases (13.82±0.26) compared to controls (14.38±0.20); t= 10.00, p=0.00*. There were statistically insignificant differences between cases and controls as regards frequency distribution of different weight and height percentiles (p>0.05 for both). Marfan's sign was the most frequently recorded manifestation (71.43%), followed by leg bowing (48.6%), delayed dentition (40%), and delayed motor milestones (22.9%). Recurrent respiratory tract infections was the commonest complication reported in enrolled cases (37.1%) followed by recurrent diarrhea (22.9%). Mild to moderate autism according to CARS scores were encountered in 25.70% of studied cases compared to none of controls; p<0.01. Below average social IQ was encountered in 29.41% of tested cases (17 out of 35 studied cases) while 70.58% had average social IQ. There was statistically insignificant reduction of mean values of serum phosphorus between studied cases and controls (p>0.05) while mean value of serum calcium was significantly lower in cases (7.91±0.76 mg/dl) compared to controls (9.55±0.66 mg/dl); and mean values of serum alkaline phosphatase was significantly higher in cases (708.17±187.54 IU) than in controls (73.23±15.81 IU); p<0.01 in both. Studied rachitic cases had significantly lower mean value of 25 (OH) cholecalceferol (32.60±11.18 nmol/L) compared to controls (75.20±18.54 nmol/L); (p<0.01). Sufficient 25(OH) cholicalceferol was found in only 8.60% of cases compared to 85.70% of controls. On the other hand, it was found to be insufficient in 45.70% of cases compared to 14.30% of controls and deficient in 45.70% compared to none of controls; p<0.01 for all. Deficient and insufficient 25(OH) cholicalceferol level were recorded in 44.44% & 33.33% of autistic rachitic cases respectively compared to 46.20% & 50% of non autistic ones respectively but because of the little numbers in some subgroups, the statistical comparison was not statistically convenient. There was a significant positive correlation between 25 (OH) cholicalceferol and current length or height meaning that the lower the 25 (OH) cholicalceferol, the shorter the child (r = +0.38, p<0.05). On the other hand, 25 (OH) cholicalceferol was significantly negatively correlated with the age, the current weight, the serum alkaline phosphatase, and CARS score meaning that the lower the 25 (OH) cholicalceferol , the older the child, the more the weight, the higher the alkaline phosphatase, and the higher the CARS score (p<0.05 for all). There was statistically insignificant association between serum 25(OH) cholicalceferol and adequate maternal intake of vitamin D in studied cases; p>0.05. Also, there were statistically insignificant associations between CARS scores and both adequate maternal intake of vitamin D and the type of feeding in studied cases; p>0.05 for both. In Conclusion, the current study showed that mild to moderate autism according to CARS scores and DSM IV TR criteria were encountered in 25.70% of studied rachitic cases compared to none of controls (p = 0.004). Deficient and insufficient 25(OH) cholicalceferol level were recorded in 44.44% & 33.33% of autistic rachitic cases respectively compared to 46.20% & 50% of non autistic ones respectively. On the other hand, there was a significant positive correlation between 25 (OH) cholicalceferol and current length or height meaning that the lower the 25 (OH) cholicalceferol, the shorter the child. 25 (OH) cholicalceferol was proved also to be significantly negatively correlated with the age, the current weight, the serum alkaline phosphatase, and CARS score meaning that the lower the 25 (OH) cholicalceferol, the older the child, the more the weight, the higher the alkaline phosphatase, and the higher the CARS score.


Other data

Other Titles دراسة لوجود أعراض التوحد فى حالات الكساح عند الأطفال
Issue Date 2014
URI http://research.asu.edu.eg/handle/12345678/40788


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