Nutritional Status and ASD Severity of Autistic Spectrum Disorder Children in Addis Ababa, Ethiopia; Case Control Study

Study Overview
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Brief Summary
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The study conducts a case control analysis of the nutritional status and intake of autistic spectrum disorder diagnosed children as compared to typically developing children in Addis Ababa, Ethiopia. It included analysis of anthropometric measurements, three days food diary food intake, urinary iodine analysis, childhood autism rating scale diagnosis, food frequency and eating behavior questioner and proximate analysis of one day major meals of selected subjects.

Detailed Description
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Sample population was Addis Ababa city in which subjects were selected from one of the two autism centers in the country. Random sampling method was applied to select subject from the total enrolled children in the center using Ryan 2013 sample size calculation formula. Subjects already diagnose with autistic spectrum disorder that didn't have any other chronic disease that affect diet and nutrition were included in the study. Subjects were selected randomly from each grade level in the center. They were registered and taken for data collection. Sample and Data was collected with the help of each child's center caregiver and parent. Childhood autism rating scale diagnosis, eating behavior analysis were analyzed for the ASD and anthropometric indices Z scores, urine iodine concentration, three days food diary analysis, major meals proximate analysis, food frequency and dietary diversity was assessed and compared to typically developing children in Addis Ababa. Data entry and analysis was conducted using Emergency Nutrition Assessment software, Microsoft excel and Statistical Package for the Social Sciences software.

Official Title
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Assessment of Nutrient Profile, Nutritional Status, Development and Severity of Children With Autistic Spectrum Disorder in Comparison With Typically Developing Children in Addis Ababa, Ethiopia

Conditions
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Autistic Spectrum Disorder

Intervention / Treatment
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* Other: Nutritional status
* Behavioral: Eating behavior
* Other: Urine iodine concentration
* Other: Nutrient intake
* Other: Dietary assessment
* Other: Childhood autism rating scale


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children already diagnosed with ASD school aged children (4-18 years old) Exclusion Criteria: children with chronic illnesses ( such as cancer..) children taking heavy medications that may affect diet and nutrition

Ages Eligible for Study
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Minimum Age: 4 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ASD ( autistic spectrum disorder)<br>Children already diagnosed with autistic spectrum disorder | Other: Nutritional status<br>* Nutritional status of children as analyzed by anthropometric indices was under study<br>Behavioral: Eating behavior<br>* The eating behavior of ASD children as analyzed by frequency of refusal of new food, sensitivity to food, food allergy and gastrointestinal systems was under study<br>Other: Urine iodine concentration<br>* the 24 urine iodine concentration of all subjects was under study<br>Other: Nutrient intake<br>* The nutrient intake as analyzed by three days food diary and major meal proximate analysis of subjects was under study<br>Other: Dietary assessment<br>* The food frequency and dietary diversity of all subjects as analyzed by food frequency questioner, dietary diversity score and food variety score was under study<br>Other: Childhood autism rating scale<br>* The autistic severity of ASD diagnosed children was under study as analyzed by childhood autism rating scale diagnosis<br>|
| TDC (typically developing children)<br>Children within the typically development | Other: Nutritional status<br>* Nutritional status of children as analyzed by anthropometric indices was under study<br>Other: Urine iodine concentration<br>* the 24 urine iodine concentration of all subjects was under study<br>Other: Nutrient intake<br>* The nutrient intake as analyzed by three days food diary and major meal proximate analysis of subjects was under study<br>Other: Dietary assessment<br>* The food frequency and dietary diversity of all subjects as analyzed by food frequency questioner, dietary diversity score and food variety score was under study<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body Mass Index for age z-scores | Body Mass Index and age will be combined to report Body mass index for age z-score in Kg/m2 for age in months | 1 day | 
| Height for age z-scores | Height and age will be combined to report height for age z-scores in centimeter for age in months | 1 day | 
| Weight for age z-scores | weight and age will be combined to report weight for age z-scores in kg for age in months | 1 day | 
| Zinc intake using three days food diary questioner | Three days food diary questioner will be used to report intake of zinc in mg/day | 5 days | 
| Energy intake using three days food diary questioner | Three days food diary questioner will be used to report intake of energy in kcal/day | 5 days | 
| Protein intake using three days food diary questioner | Three days food diary questioner will be used to report intake of protein in gm/day | 5 days | 
| Lipid intake using three days food diary questioner | Three days food diary questioner will be used to report intake of lipid in gm/day | 5 days | 
| Carbohydrate intake using three days food diary questioner | Three days food diary questioner will be used to report intake of carbohydrate in gm/day | 5 days | 
| Calcium intake using three days food diary questioner | Three days food diary questioner will be used to report intake of calcium in mg/day | 5 days | 
| Iron intake using three days food diary questioner | Three days food diary questioner will be used to report intake of Iron in mg/day | 5 days | 
| Thiamine intake using three days food diary questioner | Three days food diary questioner will be used to report intake of Thiamine in mg/day | 5 days | 
| Vitamin C intake using three days food diary questioner | Three days food diary questioner will be used to report intake of vitamin C in mg/day | 5 days | 
| Vitamin B2 intake using three days food diary questioner | Three days food diary questioner will be used to report intake of vitamin B2 in mg/day | 5 days | 
| Niacin intake using three days food diary questioner | Three days food diary questioner will be used to report intake of niacin in mg/day | 5 days | 
| Vitamin A intake using three days food diary questioner | Three days food diary questioner will be used to report intake of vitamin A in mg/day | 5 days | 
| Urine iodine concentration of children | Urine iodine concentration of children in µg /L | 2 month | 
| Autism symptom severity of children using Childhood Autism rating Scale diagnosis | Childhood autism rating scale assessed by total raw scores by age. for age 0-12, scores of 15-29.5 indicate limited behavior related to autism, score of 30-36.5 indicate mild to moderate level of behavior related to autism, score 37-60 indicate sever level behavior related to autism. for age 13 years and older, 15-27.5 indicate limited behavior related to autism, score of 28-34.5 indicate mild to moderate level of behavior related to autism, score 35-60 indicate sever level behavior related to autism. | 2 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| energy intake using proximate analysis of one day major meals | proximate analysis of one day major meals will be used to report intake of energy in k cal /100gm | 2 months | 
| Ash intake using proximate analysis of one day major meals | proximate analysis of one day major meals will be used to report intake of Ash in gm/100gm | 2 months | 
| Lipid intake using proximate analysis of one day major meals | proximate analysis of one day major meals will be used to report intake of lipid in gm/100gm | 2 months | 
| protein intake using proximate analysis of one day major meals | proximate analysis of one day major meals will be used to report intake of protein in gm/100gm | 2 months | 
| Carbohydrate intake using proximate analysis of one day major meals | proximate analysis of one day major meals will be used to report intake of carbohydrate in gm/100gm | 1 week | 
| frequency of food group consumption using food frequency questioner | percentage of children consuming from each food groups using a food frequency questioner | 5 days | 
| dietary diversity score of children using three days food diary | consumption of 1-3 food groups is scored as low dietary diversity score, consumption of 4-5 food groups is scored as medium dietary diversity score, consumption of >5 food groups is scored as high dietary diversity score. | 5 days | 
| frequency of food refusal in children using a questioner | frequency is scored as never to seldom, mild and sever | 5 days | 
| frequency of sensitivity to food | frequency is scored as never to seldom, mild and sever | 5 days | 
| frequency of gastrointestinal symptoms | frequency is scored as never to seldom, mild and sever | 5 days | 
| frequency of food allergic reactions | frequency is scored as never to seldom, mild and sever | 5 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Autistic spectrum disorder (ASD), Typically developing children (TDC), Nutritional status, Nutrient intake, Urine Iodine, Autistic severity