A review of dietary and nutritional interventions available for management of autism spectrum disorder symptoms in children and adolescents - Kenya

Research on the challenges of raising a child with autism is mostly reported from Europe, North America and Australia. There is limited autism spectrum disorder (ASD) research in Kenya and families lack support as the etiology is linked to witchcraft and sorcery. Research indicates an increase in ASD prevalence globally and in Africa. Malnutrition and neuro-disability are major public health problems in Africa. Approximately one billion people, 15% of the world’s population, have a disability of some kind and 80% live in Low- and Middle-Income countries (LMICs). Of these, 53 million are children aged below 5 years living in sub-Saharan Africa. In Kenya, 2.2% (0.9 million people) live with some form of disability. Children diagnosed with autism spectrum disorder (ASD) suffer from neuro disabilities eliciting: altered sensory processing, restricted interests, and behavioral rigidity. Autism spectrum disorders have no cure, management is by use of interventional targeting autistic symptoms such as linguistic development, non-verbal cognitive development, and motor development. The objectives of this review were: to identify dietary and nutritional interventions available for the management of ASD symptoms in children and adolescents - Kenya, and to analyze the results of existing research in this area in order to understand and describe the characteristics and results of these studies to enable their use in the management of ASD symptoms. Cochrane Library, PubMed, PMC, Google scholar, and Free Full databases were searched to identify studies published between September 2011 and September 2021. Included were studies on nutrition or dietary interventions given to ASD children and adolescents that assessed autistic behavior and/or gastrointestinal symptoms. Excluded were those articles that evaluated surrogate outcomes as the primary outcome such as urinary peptide excretion and other neuro-disabilities other than ASD. Eighteen articles were included: 12 randomized case-control trials, 3 open-label trials, one 2×2 factorial study, and 2 cross-over trials. The following dietary and nutritional interventions were evaluated: gluten and casein-free diet, ketogenic diets; probiotic supplements, specific carbohydrate diets, polyunsaturated fatty acids, vitamin and mineral supplantation (A, B6, B12, D, magnesium, folic acid), and alternative diets. Authors report improvements in the symptoms associated with ASD individuals receiving nutritional interventions such as vitamin and mineral supplementation however, their safety and efficacy needs to be evaluated. The study findings will help policymakers and implementers to understand the consistency and precision and impact of these interventions. These findings will contribute to improving the safety and efficacy of these interventions, positively impacting the health and nutrition outcomes of children and adolescents with ASD. These study findings indicate that more research targeting ASD dietary and Nutritional Interventions for management of ASD symptoms is required in Kenya and other resource constrained settings. Key words: autism spectrum disorder, nutritional intervention, diet therapy, child, adolescent, Kenya