Assessment of Dietary Intake of Zinc and its Association with the Immune Status and Gut Health in Children Diagnosed with Autism Spectrum Disorder (ASD) Aged 6-14 Years

Abstract

Autism Spectrum Disorder (ASD) is often accompanied by immune dysfunction, gastrointestinal disturbances, and selective eating behaviors, which can lead to micronutrient deficiencies, particularly zinc. Zinc is a vital trace element required for immune function, intestinal integrity, and neurodevelopment. Children with ASD are at a heightened risk for zinc deficiency due to restricted diets and poor dietary diversity. Methods: A cross-sectional observational study was conducted among 30 children aged 6–14 years diagnosed with ASD at a special education institute in Mumbai, India. Data collection involved structured dietary and health assessment tools, including a 24-hour dietary recall, semi-quantitative Food Frequency Questionnaire (FFQ), Immune Status Questionnaire (ISQ), and Gastrointestinal Health Assessment Questionnaire. Dietary intake was analyzed against the ICMR-NIN (2020, updated 2024) Recommended Dietary Allowances (RDA). Statistical analysis was performed using SPSS (version 21). Results: Zinc intake was found to be inadequate in 73.3% of participants and was significantly associated with lower intake of energy (p = 0.001), protein (p = 0.001), fats (p = 0.004), and carbohydrates (p = 0.044). Children with lower zinc intake exhibited a higher prevalence of immune-related symptoms (e.g., recurrent upper respiratory tract infections and diarrhea) and gastrointestinal complaints, although these differences were not statistically significant. Among dietary components, only the consumption of dals (lentils) showed a statistically significant association with better zinc intake (p = 0.05). No significant differences in anthropometric parameters were observed between the poor and adequate zinc intake groups. Conclusion: This study highlights a high prevalence of suboptimal zinc intake among children with ASD, likely driven by dietary selectivity and limited nutritional variety. Although statistical significance was not established for immune and gastrointestinal health outcomes, observed trends reinforce zinc\'s critical role in these functions. Early dietary interventions and targeted nutritional planning are essential to address zinc deficiency and support overall health in children with ASD.

Introduction

Background

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by social communication difficulties and repetitive behaviors. It affects multiple systems—neurological, gastrointestinal (GI), and immune—which depend on adequate zinc levels. Zinc is vital for cognitive function, immune health, and gut integrity. Children with ASD often experience zinc deficiency, largely due to selective eating habits, leading to compounded health issues.

Study Objective

To evaluate the relationship between dietary zinc intake, immune status, and gut health in 30 children (aged 6–14) with ASD in Mumbai, India.

Methodology

• Design: Cross-sectional observational study

• Sample: 30 children diagnosed with ASD

• Tools Used: Dietary recall, Food Frequency Questionnaire (FFQ), Immune Status Questionnaire (ISQ), Gastrointestinal Health Questionnaire, anthropometric assessments

• Analysis: SPSS (version 21), t-test, ANOVA, chi-square test

• Standards: ICMR-NIN RDA 2020 (updated 2024)

Key Findings

1. Demographics & Anthropometrics

   • 73.3% were aged 6–9 years; 90% were male.

   • No significant anthropometric differences between children with poor vs. good zinc intake.

   • Underweight and stunting were more common in the poor zinc group but without statistical significance.

2. Dietary Intake

   • Zinc intake: Significantly higher in the good intake group (5.38 mg) vs. poor intake (2.55 mg), p < 0.001.

   • Energy, protein, fat, and carbohydrate intake were also significantly higher in the good zinc group.

   • Children aged 13–14 had the highest nutrient and zinc intakes.

3. Food Frequency

   • Most zinc-rich animal foods (meat, eggs, fish) were consumed infrequently by both groups.

   • Only dals showed a statistically significant association with better zinc intake (p = 0.05).

   • Dairy and legumes were consumed more frequently by those with better zinc intake, but not significantly so.

4. Immune Status

   • 70% had moderate immunity; only 16.7% had excellent immunity.

   • No statistically significant differences in symptoms (fever, diarrhea, allergies, URTIs) between groups.

   • However, excellent immunity was more prevalent in the good zinc intake group.

5. Gastrointestinal Health

   • Common symptoms included constipation and indigestion.

   • GI symptoms were more frequently reported in the poor zinc group but were not statistically significant.

Conclusion

This study highlights a significant association between dietary zinc intake and the immune status and gastrointestinal health of children with Autism Spectrum Disorder (ASD). The majority of participants exhibited poor zinc intake, which correlated with increased immune-related symptoms and gastrointestinal disturbances. Despite normal anthropometric measures in most children, subclinical micronutrient deficiencies were evident, driven by food selectivity and unbalanced dietary patterns common in ASD. These findings emphasize the critical role of adequate zinc consumption in supporting immune function and gut integrity, emphasizing the need for early dietary assessment and targeted nutritional interventions to improve the overall health and quality of life in children with ASD.

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Copyright

Copyright © 2025 Ms. Bushra Gandhi, Dr. Nisha Bellare. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.