Review finds association between autism, cardiometabolic diseases
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People with autism are at an increased risk for cardiometabolic diseases, and the risks are even higher among children with autism, according to findings from a systematic review and meta-analysis published in JAMA Pediatrics.
Co-authors Chathurika S. Dhanasekara, MD, PhD, MS, and Chanaka N. Kahathuduwa, MD, PhD, MPhil, both of the Texas Tech University Health Sciences Center, told Healio in joint written responses that the study was prompted by a previous meta-analysis in which they observed “a significant association between autism and obesity.”
“This made us wonder whether autism is associated with other cardiometabolic risks associated with obesity,” they said.
Dhanasekara, Kahathuduwa and colleagues examined 34 studies that included 276,173 participants with autism and 7,733,306 participants without autism. They determined that autism was associated with greater risks for developing diabetes overall (RR = 1.57; 95% CI, 1.23-2.01; 20 studies), type 1 diabetes (RR = 1.64; 95% CI, 1.06-2.54; six studies), and type 2 diabetes (RR = 2.47; 95% CI, 1.30-4.70; three studies), increased risks for dyslipidemia (RR = 1.69; 95% CI, 1.20-2.40; seven studies) and heart disease (RR = 1.46; 95% CI, 1.42-1.50; three studies).
They did not find associated risks of hypertension and stroke. Children with autism were at a higher associated risk for developing diabetes and hypertension compared with adults.
Dhanasekara and Kahathuduwa said the results were mostly expected.
“It was a little surprising to see hypertension not being significantly associated with autism when all studies were pooled together. However, when we separated kids and adults, this difference emerged in kids but not in adults,” they said. “One possible explanation may be that adults with autism and other cardiometabolic risks may not be living long enough vs. people without autism. Also, people without autism also tend to develop essential hypertension with age, and we believe the between-group differences may be decreasing.”
They added that “without reasonable doubt, there is an association between autism and obesity as well as autism and cardiometabolic disease, including diabetes and dyslipidemia.”
“We don’t have data to come to a conclusion that autism is causing these metabolic derangements,” they said. “But since we know that a child with autism is more likely to develop these metabolic complications and derangements down the road, we should evaluate them more vigilantly and maybe start screening them earlier than the usual. Also, we should be very cautious in prescribing medications that have metabolic adverse effects, such as olanzapine, to kids with autism.”
The study was accompanied by a commentary from Elizabeth M. Weir, PhD, from the Autism Research Centre at the University of Cambridge.
“The results from this systematic review and meta-analysis require clinicians and researchers alike to radically rethink the health care provision that is currently provided to autistic people,” Weir wrote. “More support for both mental and physical health care across the life span should be offered, and new research on how to improve outcomes is critical. Providing appropriate screening for conditions and support for healthy lifestyle habits during childhood is integral; early intervention in these areas is essential for ensuring that autistic people are able to live healthy, long, and fulfilling lives.”
Kahathuduwa said he would like to see “more representative large-sample multicenter studies being conducted to identify the subgroups among children and adults with autism who are more susceptible to develop obesity and cardiometabolic complications.”
“I would also like to see studies exploring the role of obesity and body composition in autistic people in increasing the risk of cardiovascular and metabolic disease,” he added.
References:
Dhanasekara CS, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2022.5629.
Kahathuduwa CN, et al. Obes Rev. 2019; doi:10.1111/obr.12933.
Weir EM. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2022.5639.