Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Report
  • Published:

Critical vitamin deficiencies in autism spectrum disorder: Reversible and irreversible outcomes

European Journal of Clinical Nutrition volume 76, pages 1618–1621 (2022)Cite this article

Subjects

Abstract

Vitamin deficiencies are an emerging concern in the management of children with autism spectrum disorder (ASD). Particular attention is required for recognizing the variable signs caused by unbalanced food intakes. We herein report two patients with multiple vitamin deficiencies who needed critical care showing different prognoses. Patient 1 with ‘Shoshin’ beriberi presenting with cardiac arrest had thiamine deficiency developed severe neurological sequelae despite rapid vitamin supplementation. Patient 2, who had leg pain and a limping gait, showed a rapid recovery with intravenous infusion and tube feeding after being diagnosed with scurvy. A literature search revealed several children with ASD with critically ill thiamine deficiency, but few reports documented a life-threatening condition in the form of cardiac arrest at the onset. Considering the high observation rate of food selectivity in children with ASD, early intervention is required to prevent the exacerbation of vitamin deficiencies to severe neurological disabilities.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Imaging and histological findings of Patient 1 and Patient 2.

Similar content being viewed by others

Data availability

Data are available within the article or its supplementary materials.

References

  1. Sharp WG, Berry RC, McCracken C, Nuhu NN, Marvel E, Saulnier CA, et al. Feeding problems and nutrient intake in children with autism spectrum disorders: a meta-analysis and comprehensive review of the literature. J Autism Dev Disord. 2013;43:2159–73.

    Article  PubMed  Google Scholar 

  2. Yule S, Wanik J, Holm EM, Bruder MB, Shanley E, Sherman CQ, et al. Nutritional deficiency disease secondary to ARFID symptoms associated with autism and the broad autism phenotype: A qualitative systematic review of case reports and case series. J Acad Nutr Diet. 2021;121:467–92.

    Article  PubMed  Google Scholar 

  3. Adachi S, Torio M, Okuzono S, Motomura Y, Ichimiya Y, Sonoda Y, et al. Vitamin A deficiency-associated corneal perforation in a boy with autism spectrum disorder: a case report and literature review. Nutrition. 2021;90:111275.

    Article  CAS  PubMed  Google Scholar 

  4. Baird JS, Ravindranath TM. Vitamin B deficiencies in a critically ill autistic child with a restricted diet. Nutr Clin Pract. 2015;30:100–3.

    Article  PubMed  Google Scholar 

  5. Sechi G, Serra A. Wernicke’s encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007;6:442–55.

    Article  CAS  PubMed  Google Scholar 

  6. Watanabe S, Yamakura S, Hirano K, Okumura Y, Aiba H. Case of infantile autism with pediatric Wernicke’s encephalopathy due to severe eating disorder. No To Hattatsu. 2009;41:43–46.

    PubMed  Google Scholar 

  7. Ma NS, Thompson C, Weston S. Brief report: scurvy as a manifestation of food selectivity in children with autism. J Autism Dev Dis. 2016;46:1464–70.

    Article  Google Scholar 

  8. Duvall MG, Pikman Y, Kantor DB, Ariagno K, Summers L, Sectish TC, et al. Pulmonary hypertension associated with scurvy and vitamin deficiencies in an autistic child. Pediatrics. 2013;132:e1699–1703.

    Article  PubMed  Google Scholar 

  9. Doseděl M, Jirkovský E, Macáková K, Krčmová LK, Javorská L, Pourová J, et al. Vitamin C-sources, physiological role, kinetics, deficiency, use, toxicity, and determination. Nutrients. 2021;13.

  10. Golriz F, Donnelly LF, Devaraj S, Krishnamurthy R. Modern American scurvy - experience with vitamin C deficiency at a large children’s hospital. Pediatr Radiol. 2017;47:214–20.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the patients and their families for cooperating with our study as well as Yuichi Mushimoto, Kanako Ishii, Ryoji Taira, Kousuke Yonemoto and the co-medical staff in our hospital for their helpful discussion. This study was supported by JSPS KAKENHI grant numbers JP19K10613 (Chong), JP19K08281 (Sakai); AMED under the grant number JP20ek0109411, JP20wm0325002h; a research grant for prion diseases from the Ministry of Health, Labour and Welfare of Japan (JP20FC1054, Sakai); The Japan Epilepsy Research Foundation, and Kawano Masanori Memorial Public Interest Incorporated Foundation for Promotion of Pediatrics (Sakai). The funders had no role in the study design, writing of the report or decision to submit the article for publication.

Author information

Author notes

  1. These authors contributed equally: Pin Fee Chong, Michiko Torio.

Authors and Affiliations

  1. Department of Pediatrics, Kyushu University Hospital, Fukuoka, 812-8582, Japan

    Pin Fee Chong, Michiko Torio, Fumihiko Fujii, Yuichiro Hirata, Wakato Matsuoka, Yuri Sonoda, Yuko Ichimiya, Yutaro Yada, Noriyuki Kaku, Masataka Ishimura, Momoko Sasazuki, Yuhki Koga, Masafumi Sanefuji, Yasunari Sakai & Shouichi Ohga

  2. Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, 812-8582, Japan

    Wakato Matsuoka & Noriyuki Kaku

  3. Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan

    Yuri Sonoda & Masafumi Sanefuji

  4. Department of Health and Welfare, Seinan Jogakuin University, Kitakyushu, 803-0835, Japan

    Momoko Sasazuki

Authors
  1. Pin Fee Chong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michiko Torio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fumihiko Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuichiro Hirata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wakato Matsuoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuri Sonoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuko Ichimiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yutaro Yada
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Noriyuki Kaku
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Masataka Ishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Momoko Sasazuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yuhki Koga
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Masafumi Sanefuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yasunari Sakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Shouichi Ohga
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Chong, Torio, Sakai and Ohga conceptualized and designed the study, drafted the initial manuscript and reviewed and revised the manuscript; Fujii, Hirata, Matsuoka, Sonoda, Ichimiya, Yada, Kaku, Ishimura, Sasazuki, Koga and Sanefuji managed the patients, organized ethical discussions and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Yasunari Sakai.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was performed in stringent compliance with the protocol approved by the institutional review board at Kyushu University (#2021-306). Written informed consent was obtained from the parents for the content of this report. Multidisciplinary, repeated discussions were held before making a decision on tracheostomy for Patient 1. The members included physicians with different subspecialties, nurses, psychologists, medical social workers and the ethics board at Kyushu University Hospital.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chong, P.F., Torio, M., Fujii, F. et al. Critical vitamin deficiencies in autism spectrum disorder: Reversible and irreversible outcomes. Eur J Clin Nutr 76, 1618–1621 (2022). https://doi.org/10.1038/s41430-022-01170-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-022-01170-x

Search

Advanced search

Quick links