A study conducted by the Centers for Disease Control and Prevention (CDC) from 2009 to 2017 found that approximately 1 in 44 children ages 3-17 are diagnosed with some form of autism spectrum disorder (ASD). Research has also shown that children with ASD have an increased risk of obesity, and obesity has been associated with an increased risk of cardiometabolic disorders such as diabetes and dyslipidemia (high cholesterol or fat levels in the blood). However, the question of whether or not there is a link between autism, cardiometabolic disorders and obesity remains largely unanswered.
Collaboration team members included Kahathuduwa, Chathurika S. Dhanasekara, MD, Ph.D., Dominic Ancona, M-PAS, Leticia Cortes, M-PAS, Amy Hu, M-PAS, and Christina Robohm-Leavitt, M-PAS, DMSc , from the TTUHSC School of Health Professions; Afrina H. Rimu, MD, MS, Drew Payne, DO, and Sarah M. Wakefield, MD, of the TTUHSC School of Medicine; and Ann M. Mastergeorge, Ph.D., of the TTU College of Human Sciences.
For Kahathuduwa, the seeds for the study were planted shortly after receiving his Ph.D. in nutritional sciences with a focus on the neuroscience of obesity. He worked as a research assistant professor with Mastergeorge, a nationally known ASD expert, and was invited by Naima Moustaid-Moussa, Ph.D., director of TTU’s Obesity Research Cluster (now the Obesity Research Institute), to conduct a seminar present on the neuroscience of obesity and autism.
“As I searched the literature to prepare my presentation, I realized that the evidence for the link between obesity and autism was quite ambiguous,” recalled Kahathuduwa. “It took a solid meta-analysis to close this gap.”
That first meta-analysis led Kahathuduwa to investigate further. He investigated how neuroimaging can provide insight into relationships between ASD and obesity, the association between ASD and underweight patients, and the recently published study on autism and cardiometabolic risks. The studies gained momentum after Dhanasekara, who focused on obesity and metabolic health for her Ph.D. in food sciences, joined the collaboration.
In their latest meta-analysis, Kahathuduwa, Dhanasekara and collaborators reviewed 34 studies with 276,173 participants who had been diagnosed with ASD and 7,733,306 who had not. The results indicated that ASD was associated with greater risks of developing diabetes in general, including both type 1 and type 2 diabetes.
The meta-analysis also found that autism is associated with increased risks of dyslipidemia and heart disease, although there was no significantly increased risk of hypertension and stroke associated with autism. However, meta-regression analyzes found that children with autism were at greater risk of developing diabetes and hypertension compared to adults.
Kahathuduwa said the overall results demonstrate the associated increased risk of cardiometabolic disease in ASD patients, which should prompt clinicians to monitor these patients more closely for possible contributions, including signs of cardiometabolic disease and their complications.
“We established the associations between autism and obesity, as well as autism and cardiometabolic diseases, including diabetes and dyslipidemia,” Kahathuduwa said. “We don’t have data to support a conclusion that autism causes these metabolic disorders, but since we know that a child with autism is more likely to develop these metabolic complications and disorders later on, I think physicians should evaluate children with autism. .” more vigilant and perhaps start screening earlier than usual.”
Kahathuduwa also believes the study shows doctors should think twice before prescribing drugs like olanzapine that are known to have metabolic side effects in children with autism.
“Our findings should also be an eye-opener for patients with autism and parents of children with autism to simply consider the higher risk of developing obesity and metabolic complications,” Kahathuduwa added. “Then they can talk to their doctors about strategies to prevent obesity and metabolic disease.”
Kahathuduwa said the next logical step for the collaborating team would be to generate evidence that either supports or rejects causality regarding the observed associations.
“We’ve done some work with the ABIDE (Autism Brain Imaging Data Exchange) dataset on how neuroimaging shows the correlation between autism and obesity, but there’s more work to be done,” Kahathuduwa said. “None of these studies would have been possible without the help of the wonderful mentors, staff and students at both TTUHSC and TTU who have contributed in numerous ways and will continue their important efforts to advance these studies.”