الفهرس 
INTRODUCTION .Only 14 pages are availabe for public view
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Abstract
Autism spectrum disorder is one of the pediatric neuro-developmental disorders of
great concern that needs to a lifelong management and treatment. It affects males more than
females and the mean age of diagnosis was found to be around 4-5 years. The global rise in
the prevalence of ASD was linked to the interaction between different factors such as
genetic, environmental, and nutritional factors. Those risk factors had been identified to play
a role in the development of autism. Other factors were also identified like immunological
factors, as well as the role of gut microbiota, and hypersensitivity from gluten and casein.
The early signs of ASD included lack of eye contact and social smile, impaired verbal
call, poor facial expression and poor quality of movements with joint attention. The first
decline of social interactions may occur between 2 and 6 months more generic alterations in
sleep, feeding and temperament may occur during the first year in children at risk for ASD.
ASD caused many children to have different disabilities of great importance for their
development such as lack of social development and language impairment. This usually been
evident during the first 3 years of life then recognized later in childhood. Accordingly, screening
of all children for autism at ages 18 and 24 months was recommended by the American Academy
of Pediatrics, along with regular developmental surveillance.
Commonly available therapeutic modalities for ASD included behavioral and
communication techniques, medications, dietary intervention or complementary approaches.
Regarding dietary management, many nutrition interventions were proved to be effective in
improving the ASD symptoms through different mechanisms such as gluten and/or casein free
diets, vitamin D, vitamin A, omega-3 supplementation, and breastfeeding.
Using virgin coconut oil supplementation provides the medium chain fatty acids
(MCTs) to the ASD children. MCTs found in the virgin coconut oil has lots of benefits such
as giving a quick and good source of energy to the brain thus helping to reduce the core
symptoms of autism. Moreover, MCTs can decrease the gut inflammation as well as
disrupting the wall of the pathogenic Candida Spp. in the intestine as the severity of the
gastrointestinal symptoms is strongly linked to the severity of the ASD symptoms.
Virgin coconut oil carries many health benefits which draw the attention to its
nutraceutical effect as it has anti-inflammatory, analgesic, antipyretic, anti-oxidant, antistress, antimicrobial properties, bone loss prevention as well as cardio protective effect. The
study aims to investigate the effect of dietary supplementation with virgin coconut oil on the
core symptoms of autism spectrum disorder, bowel function, and Candida Spp. overgrowth
in the gut.
In the present study, a total of 61 children with autism spectrum disorder (ASD)
attending the pediatric neuro-developmental and behavioral disorders outpatient clinic of
Alexandria University Children Hospital (Semoha), from both sexes, and of up to 18 years
old were recruited after signing a written consent by his/ her caregiver. The study excluded any
child having a serious health problem such as chronic diseases or under cytotoxic or
immunosuppressive drugs, or using anti-fungal drugs or laxative.
A predesigned interview questionnaire was used to collect information about personal and
family characteristics such as age of the child, sex, order of child, and consanguinity. Medical
history such as factors and conditions associated with pregnancy and delivery of the child, and
food allergy tests. Dietary habits about the number of daily meals, the frequency of consumption
of fruits or vegetables, following a special dietary regimen such as gluten-free and/or casein-free
diets, and using nutritional supplements, and pattern of feeding of the child after birth. Life style
practices including the total number of minutes of physical activity spent by the child per week
and number of hours spent watching television.
Each studied child was weighed and the height was recorded in order to calculate BMI.
Also a stool sample was taken for analysis in order to detect Candida Spp. CARS 2 and
ATEC were assessed for each child. Dietary intake was assessed through a 24-hour recall.
Before the intervention, nutritional education sessions were carried out by the researcher to
the caregivers of autistic children to educate them about the benefits of taking VCO to the
ASD children as well as other important topics for the parents of those children. Those who
agreed to participate in the study sign a written consent and received the VCO bottles for 3
months and followed for 12 weeks by both telephone and clinic visit.
The results of the study showed that most of the studied sample was boys (80.3%),
delivered by cesarean section (56.7%), and that obesity was found 45.9% of ASD children
in the present study. The mean age of studied children was 7.4 years old, mainly from the
urban areas (93.4%) and the consanguinity was found only in 16.4% of them. Most of the
studied sample were breastfed (82.5%) in the first 6 months with a birth weight from 2.5 to
4 kg and half of them had a digestive problem (55.7%) in the form of constipation, bloating,
abdominal pain, and diarrhea. More than half of the sample were watching television or any
other means of modern screens such as mobile (60.7%) with average number of 5 hours were
spent watching television.
Supplementation with VCO showed a significant improvement in the core symptoms
assessed by ATEC, bowel function assessed by Bristol stool scale and GI-severity score
among the studied sample. The most significant improvement in the ATEC was in
Health/Physical/Behavior followed by sociability, then Sensory/ Cognitive Awareness then
Speech/Language Communication. Virgin coconut oil consumption was highly effective for
treating almost all constipated ASD children in the study and improved their offensive smell
of their stool. A significant decline in the Candida growth and count was also noted. The
degree of improvement in the ATEC, GI-severity score was significantly and inversely
correlated to the compliance of the studied ASD children. The highest improvement in the
core symptoms and GI symptoms of autism was among those who completed the 90 days of
intervention.
The weight and height significantly increased during the intervention but the BMI
remained unchanged. VCO caused diarrhea in some cases which resulted in 3 withdrawal
cases from the study and one case had a hyperactivity symptom in the form of continuous
laughing for half an hour after the intake of the VCO. The duration of breastfeeding affected
the degree of improvement in the core symptoms of the studied sample of ASD children.
The most predictive factor was watching television or any other means of modern
screens during the intervention was the most significant predictor for the percent of change
in the ATEC score. It affected negatively the degree of improvement in the core symptoms
of autism assessed by ATEC test. Consuming starches as their favorite food group did affect
negatively the percent of change in the GI-severity index during the intervention in both
univariate and multivariate regression analysis.
from data of the current study, the following conclusions have been reached:
The daily consumption of virgin coconut oil improved the main core symptoms of
children with autism spectrum disorder assessed by the ATEC score. ASD children who
completed the full duration of the intervention (90 days) showed the highest improvement
in the core symptoms of ASD.
The longer the duration of breastfeeding especially exclusive for the first 4 months,
the more decline in the core symptoms of ASD and hence, decreases the ATEC score of the
ASD children.
Watching television or any other means of modern screens during the intervention
affected negatively the degree of improvement in the core symptoms of autism assessed by
the ATEC scale .The increase in the severity of the disease using the CARS 2 score is
associated with a decrease in the percent of change in the core symptoms of autism assessed
by ATEC when taking the VCO.
The daily intake of virgin coconut oil affected positively the bowel function of children
with autism spectrum disorder assessed by the GI-severity score and Bristol stool scale.
Children taking medications for the treatment of autism showed a significant
improvement in the percent of change in the GI-severity index during the intervention.
Children who consume starches as their favorite food group did affect negatively the degree
of improvement in the GI-severity index during the intervention.
The virgin coconut oil showed an antimicrobial effect on Candida Spp as it significantly
decreased the count of the Candida in a cultured stool sample from the studied ASD children.
Bristol score was not highly indicative of the bowel function of ASD children while the GIseverity index provided a very good tool for assessing the bowel habits of ASD children that
goes in line with the microbiological analysis of stool samples.
from results of the present study, the following recommendations are
proposed:
Nutrition education to the mothers of ASD children as regards:
Taking virgin coconut oil daily along with medications prescribed by the neuropsychiatric
pediatrician for ASD children is recommended for a better improvement and control of the
severity of their core symptoms.
Supplementation with virgin coconut oil for treating almost all constipated ASD children
is also recommended.
Virgin coconut oil can be used as a safe and natural antifungal treatment for Candida
infection in the gut of ASD children.
Encourage breastfeeding for infants for the longest duration recommended by the WHO.
Discourage watching Television or any other means of modern screens with replacing it
with physical activity and sports.
Decrease the high level of intake of simple carbohydrates and starches by the ASD
children.
Educating mothers who had an autistic child about how to prepare virgin coconut oil at
home from the coconut fruit.
Further studies are recommended for longer periods with a control group in order to assess
the long term effect of VCO dietary supplementation on the core symptoms,
gastrointestinal symptoms, and Candida infection of ASD children.