Contagem de monócitos elevada em crianças e adolescentes com Transtorno do Espectro do Autismo: influência do excesso de peso e do comportamento alimentar.

Abstract

Immune dysfunction, inflammation, and the interaction between these factors have been related to both the etiology and severity of symptoms in Autism Spectrum Disorder (ASD). Overweight is known to be an independent factor associated with immune dysfunction, and is found in high prevalences in ASD, especially in those who tend to eat to cope with different emotional states. One of the avenues of investigation of the immune system is the analysis of white series blood cells, especially monocytes. The aim of this study was to investigate the number of monocytes and their association with overweight in children and adolescents with ASD. A cross-sectional study conducted from October 2018 to March 2020, at the Neurodevelopmental Center of the Faculty of Medicine, Federal University of Pelotas, Pelotas-RS. Sixty-eight patients diagnosed with ASD, between 3 and 18 years old, without diagnosis of genetic syndrome, neuropathy and congenital heart disease, allergy, neoplasia, or infection were included. The endpoint was the number of monocytes (/mm3). For this a 5mL blood sample was obtained fasting and the CBC was analyzed by electrical impedance. The primary exposure was overweight, considered as BMI>+1 z-score. Eating behavior, assessed with the Children's Eating Behaviour Questionnaire (CEBQ) scale, was used to describe the sample and as an adjustment factor. The distribution of the outcome variable was symmetrical and the comparison between two or more categories of exposure variables was performed with Student's t test or One Way ANOVA, respectively. Linear regression was used to assess the association between monocyte number and overweight (BMI <1 ez), adjusted for variables with p< 0.05. The adjustment factor retained in this analysis was the classification above or below the mean score on the subscale "emotional overeating". The level of statistical significance was p< 0.05. The project was approved by the Research Ethics Committee of the institution, under protocol number 2.835.793. The study participants were on average 8.6 ± 3.3 years old, most were male (79%), used antipsychotic drug (62%) and overweight (66%). The number of monocytes was higher in those who were overweight (522±211 /mm3) compared to those who were not overweight (394±142 / mm3) and in those who scored above average on the "emotional overeating" subscale (581±247 vs 452±126) compared to those below average. In regression analysis the increase in monocytes associated with overweight remained significant after adjusting for "emotional overeating". Children and adolescents with ASD showed elevated monocyte counts associated with overweight and greater "emotional overeating." A nutritional intervention to control weight and nutritional quality of the diet may mitigate the negative impact on inflammatory activity and immune dysfunction in these patients.