Implementation of An Elemental Diet in Five Children Diagnosed With Autism Spectrum Disorder Presenting With Gastrointestinal Disease: A Brief Report - Implementation of An Elemental Diet in Five Children Diagnosed With Autism Spectrum Disorder Presenting With Gastrointestinal Disease: A Brief Report - Open Access Pub

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by impaired communication and social interaction. Children with ASD are frequently diagnosed with gastrointestinal (GI) issues, including inflammatory bowel disease (IBD), gastroesophageal reflux, abdominal pain, diarrhea, and constipation, although the association between ASD and GI conditions is unclear. Underlying nutritional deficiencies are more common in children with ASD, and increase the risk of them developing medical conditions secondary to the behavioral diagnosis. This objective of this study was to examine the use of an elemental diet (ED) in the treatment of gastrointestinal disease in 5 children with ASD ages 2-21 years of age. In the study participants, the ED was well-tolerated with improvements in anthropometric measures, nutritional markers, and/or GI functioning reported after 12 weeks of intervention. Further research to advance the development of specific evidence-based guidelines in the management and treatment of gastrointestinal concerns in the ASD population is warranted. DOI10.14302/issn.2379-7835.ijn-20-3181 ASD is a complex pervasive developmental disorder characterized by impairments in social interaction, with deficits in verbal and non-verbal communication and/or restricted, repetitive and stereotyped patterns of behavior and interests 1. There is increasing evidence of an involvement of gastrointestinal (GI) issues in children with ASD 2, 3, 4, with a potential secondary impact on behavior 5, 6. Documented GI symptoms in ASD include eosinophilic esophagitis 7, gastroesophageal reflux (GERD), and abdominal pain, constipation and/or diarrhea 8, 9, 10, 11, 12. Furthermore, a subset of ASD children with GI symptoms have an inflammatory mucosal pathology 2, 11, 13, 14. Associated functional GI abnormalities in children with ASD include low activities of disaccharidase enzymes 15, defective sulfation of ingested phenolic amines 16, bacterial overgrowth with greater diversity and number of clostridial species 17, and increased intestinal permeability 18. Dietary restrictions and problem feeding behavior, nutrient malabsorption, and increased intestinal losses in children with ASD can compromise dietary intake and cause nutritional depletion. For example, in a study of 36 children with ASD, essential amino acid deficiencies indicative of poor protein intake occurred more frequently than in controls regardless of whether the diet was restricted or unrestricted 19. A compromised nutritional status negatively impacts growth velocity and increases the risk of