Dietary intake and plasma levels of choline and betaine in children with autism spectrum disorders

Joanna C Hamlin, Margaret Pauly, Stepan Melnyk, Oleksandra Pavliv, William Starrett, Tina A Crook, S Jill James, Joanna C Hamlin, Margaret Pauly, Stepan Melnyk, Oleksandra Pavliv, William Starrett, Tina A Crook, S Jill James

Abstract

Abnormalities in folate-dependent one-carbon metabolism have been reported in many children with autism. Because inadequate choline and betaine can negatively affect folate metabolism and in turn downstream methylation and antioxidant capacity, we sought to determine whether dietary intake of choline and betaine in children with autism was adequate to meet nutritional needs based on national recommendations. Three-day food records were analyzed for 288 children with autism (ASDs) who participated in the national Autism Intervention Research Network for Physical Health (AIR-P) Study on Diet and Nutrition in children with autism. Plasma concentrations of choline and betaine were measured in a subgroup of 35 children with ASDs and 32 age-matched control children. The results indicated that 60-93% of children with ASDs were consuming less than the recommended Adequate Intake (AI) for choline. Strong positive correlations were found between dietary intake and plasma concentrations of choline and betaine in autistic children as well as lower plasma concentrations compared to the control group. We conclude that choline and betaine intake is inadequate in a significant subgroup of children with ASDs and is reflected in lower plasma levels. Inadequate intake of choline and betaine may contribute to the metabolic abnormalities observed in many children with autism and warrants attention in nutritional counseling.

Figures

Figure 1
Figure 1
Interrelated and interdependent pathways of (1) folate- and betaine-dependent methionine resynthesis from homocysteine utilizing folate-dependent methionine synthase (MS) and betaine-dependent betaine : homocysteine methyltransferase (BHMT); (2) choline-dependent betaine synthesis; (3) phosphtidylethanoloamine methyltransferasse (PEMT) conversion of phosphatidylethanolamine (PE) to phosphatidylcholine (PC); and (4) choline-dependent synthesis of PC and acetylcholine.
Figure 2
Figure 2
Correlation between dietary intake and plasma choline concentrations in children with ASD (n = 35). r = 0.86 and P ≤ 0.001 using Pearson's product-moment correlation coefficient. ASD: autism spectrum disorder.
Figure 3
Figure 3
Correlation between dietary intake and plasma betaine concentrations in children with ASD (n = 35). r = 0.67 and P ≤ 0.001 using Pearson's product-moment correlation coefficient. ASD: autism spectrum disorder.
Figure 4
Figure 4
Plasma levels of choline, betaine, and the betaine/choline ratio in children with autism compared to age-matched controls.

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