91 - Nutritional Blind Spot: Vitamin A Deficiency in Autism Spectrum Disorder

Publication Number: 1083.91

Rashida Jawadwala MD, Baylor College of Medicine, Houston, TX, United States; Holly Harris, Baylor College of Medicine, Houston, TX, United States; Madhuri Chilakapati, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, United States; Kamsiyochukwu Daniel, Texas Children's Hospital, Houston, TX, United States; Rosina A. Connelly, Baylor College of Medicine, Katy, TX, United States; Kathryn K. Ostermaier, Baylor College of Medicine, Houston, TX, United States

Background: Food aversion and selectivity are highly prevalent in children with Autism Spectrum Disorder (ASD), potentially leading to micronutrient deficiencies and preventable morbidity and mortality when left untreated. Deficiencies in ASD most often reported in the literature as causing severe illness requiring hospital evaluation or admission are vitamin C, Vitamin D, iron, and vitamin B12, all of which have multiple case reports or case series mostly in low resourced countries. Serious manifestations of other nutrient deficiencies are less commonly described, particularly in well-resourced countries.

Objective: To describe a case series of children and adolescents with autism spectrum disorder (ASD) and restrictive feeding behaviors who presented with vitamin A deficiency and associated micronutrient deficiencies at a single tertiary children’s hospital.

Design/Methods: This retrospective case series reviewed the medical records of nine children and adolescents with autism spectrum disorder (ASD) from June 2020- August 2025 who were evaluated for various eye concerns and found to have vitamin A deficiency along with other micronutrient deficits. The hospital’s electronic medical record (EMR) was used to extract relevant clinical and laboratory data.

Results: Of the 9 patients with ASD, 66% (6) were male, 66% (6) African American, 33% (3) Hispanic, and the average age at presentation was 7.9 years (range 6-15 yrs, SD 2.8). The average BMI was 55.9% +/- 32.6% (17.3 kg/m² ± 3.06), with only one case presenting with a BMI at the 0.66%, indicating caloric malnutrition. All presented with vitamin A deficiency of < 7 mcg/dl. Work up of co-occurring micronutrient deficiencies was inconsistent, but of those with additional micronutrient lab values, 33% (3/9) had low Calcium, 75% (6/8) Iow Vit D, 60% (3/5) low Vit B12, 67% (2/3) low Vit E, and 25% (1/4) low Vit C. Clinical presentations for low vitamin A included varying degrees of xerophthalmia with one case progressing to bilateral corneal melts, optic nerve pallor, hyperostosis of the optic canals, and blindness.

Conclusion(s): This case series represents the largest reported group of patients with coexisting Vitamin A deficiency and ASD, as well as other micronutrient deficiencies. Notably, all but one patient had a normal to high BMI, a potentially misleading indicator when screening for vitamin deficiency. These findings underscore the need for guidelines to identify and address micronutrient deficiencies in vulnerable populations, regardless of BMI, to prevent serious complications.