1. A UTISM R ATES A SSOCIATED WITH N UTRITION AND THE WIC P ROGRAM Emma Frandsen Nutrition 190

2. B ACKGROUND I NFORMATION Autism or autism spectrum disorder (ASD) is the term for a group of complex disorders of brain development ASD includes autism, Asperger disorder, and pervasive developmental disorder Characterized by: difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors

3. B ACKGROUND I NFORMATION No confirmed cause of autism Undiagnosed until age 3 Increasing at a rate of 14- 20% per year in the US and Canada The same diagnostic techniques have been used for 20 years; increase due to environmental factors

4. S TUDY P URPOSE AND H YPOTHESIS Purpose: compare the rates of autism for the 50 States of America with the published measures of infant nutrition (duration of exclusive breastfeeding, WIC program participation, etc.) to link the possible cause of autism to nutrition Hypothesis: Better nutrition practices (WHO recommendations) during infant feeding and development associated with lower rates of autism

5. M ETHOD : E COLOGICAL S TUDY D ESIGN Ecological study: study that averages the impact of risk-modifying factors on health outcomes for populations defined either geographically or temporally Population: 50 states Risk-modifying factors: possible environmental/nutritional causes of autism (thiamine, vitamin D, MMR shot)

6. M ETHODS AND D ATA : A UTISM R ATES For comparison among states, rates needed to be established 2000 US census; number of autism cases divided by the number of individuals age 3-21 living in a particular state at the time of the 2000

7. A UTISM RATES COMPARED WITH … Per capita income WIC program participation percentage Percentage of breastfeeding Solar irradiation (vitamin D exposure) Average of children receiving their measles, mumps, and rubella (MMR) shots from 2001- 2004

8. D ATA : WIC PROGRAM AND B REASTFEEDING WIC program participation listed by state by the US Department of Agriculture Program helps women make nutritious choices; breastfeeding women can stay in program longer than non-breastfeeding mothers CDC lists breastfeeding by state; categorized into 1)ever breastfeeding 2) 6 mo exclusive 3) 12 mo exclusive

9. R ESULTS Per-capita income correlated to autism (r=-0.54 p<0.001) Greater income = ability to afford more nutritious food and health care WIC children considerably less likely to have autism than non-WIC children

10. C ASES OF A UTISM VS.WIC P ARTICIPATION The autism rate from 2000–2003 and the percentage of WIC participation in 50 states in 2004. The correlation is −0.37 with a probability of <0.02.

11. E XCLUSIVE B REASTFEEDING AND A UTISM Positive correlation found between 6 months exclusive breastfeeding and the autism rates for 2000-2003 Infants exclusively breastfed for 1 year also had higher correlation No significant correlation for 3 months exclusive breastfeeding

12. T HE TOTAL AUTISM CASES AND THE AVERAGE PERCENTAGE OF EXCLUSIVE 6- MONTH BREAST - FEEDING IN THE U NITED S TATES FROM 2000– 2004

13. B REAST M ILK VS. C OWS ’ M ILK Ecological link of breastfeeding to autism observed Compared levels of thiamine, riboflavin, and vitamin D in breast milk with cows’ milk (derived from National Dairy Council) Breast milk had markedly lower amounts of the 3 vitamins Different study (Lonsdale and Shamberger) found an improvement in older autistic children treated with a thiamine derivative

14. D ISCUSSION Results show ecological statistical links between autism and infant nutrition WIC provides low-income mothers with important vitamin source for infants Breast milk in combination with nutritious food lowers autism risk

15. D ISCUSSION Correlation between solar energy exposure and autism not significant; study concluded vitamin D not a factor in autism No correlation between MMR shots and autism rates

16. D ISCUSSION Longer the duration of exclusive breastfeeding, the greater the correlation with autism A lack of thiamine or riboflavin could result in autism Mothers who breastfeed should take prenatal vitamins and eat a diet high in B-vitamin-rich food

17. S TUDY L IMITATIONS Little control in an ecological study design Does not account for many other possible variables Future observational or interventional study to confirm link between thiamine or riboflavin deficiency and autism