People With Autism May Be More Likely to Develop Diabetes, Heart Issues

People with autism faced a higher risk of developing diabetes and cardiovascular disease (CVD), while children with autism had higher associated risks of developing diabetes and high blood pressure, researchers reported.

In the systematic review and meta-analysis that included >200,000 people with autism and >7 million without, autism was linked with higher risks of:

• Diabetes overall: relative risk (RR), 1.57 (95% CI, 1.23-2.01).
• T1D: RR, 1.64 (95% CI, 1.06-2.54).
• T2D: RR, 2.47 (95% CI, 1.30-4.70).
• Dyslipidemia: RR, 1.69 (95% CI, 1.20-2.40).
• Heart disease: RR, 1.46 (95% CI, 1.42-1.50).

And, while there was no significantly increased risk of hypertension and stroke in individuals with autism (RR, 1.22; 95% CI, 0.98-1.52; RR, 1.19; 95% CI, 0.63-2.24, respectively), a meta-regression analyses showed that children with autism were at a greater associated risk of developing diabetes and hypertension versus adults, the authors wrote in JAMA Pediatrics.

For kids with autism, the risk for diabetes was 184.2% higher, while for hypertension it was 153.7% higher, they explained.

They noted that the "[o]bserved autism-associated high risk of [T1D] is likely due to increased risk of autoimmune disease in autism," while their result of an increased risk of diabetes and hypertension, especially in children with autism, could be because "as age progresses, the prevalence of these diseases increases in the entire population, decreasing the group differences between those with and without autism. Similarly, individuals with autism tend to have a shorter life span thus, the studies comprising older patients may underrepresent individuals with autism."

The findings add "to a growing body of literature suggesting that autistic people have a much broader range of physical health problems than previously thought," beyond epilepsy/seizure disorders, sleep problems, and gastrointestinal conditions, noted Elizabeth M. Weir, PhD, of the University of Cambridge in England, in an editorial accompanying the study.

For instance, a 2021 Cell Systems study reported an overlap between 101 genes in the networks that are tied to autism spectrum disorder (ASD) and congenital heart disease. A 2020 Clinical Practice Epidemiology in Mental Health meta-analysis suggested chromosomal disorders and altered autoimmune cytokine secretion with a related "apoptotic destruction of pancreatic beta-cells," may also tie together ASD and diabetes.

A 2022 Research in ASDs analysis stated that "[a]typical antipsychotic medications are…a useful short-term indication to treat irritability for those with ASD," but [b]ecause people with ASD are frequently prescribed atypical antipsychotics, this may be one mechanism underlying metabolic dysfunction in those with ASD."

While the current data were generated under less-than-perfect circumstances—"its quality is inherently limited by the quality of the studies that it meta-analyzed" and "cannot provide information about the contributing factors to these increased risks," Weir noted—they still should encourage providers to "radically rethink the health care provision that is currently provided to autistic people."

She acknowledged that there is currently no evidence-based guidance on improving healthcare access for autistic people, but research has indicated that those with autism feel that they would benefit from extra time during appointments, guidance on how to prepare for healthcare visits and how to navigate the health system, continuity of care, and giving them alternative ways to communicate, such as written or chat-based.

Boosting physical activity has been explored as a potential avenue for better overall health in people with autism. A 2021 Autism meta-analysis found that "physical activity interventions were effective for improving communication and social functioning in autistic children and adolescents," while a 2022 Journal of Prevention and Intervention in the Community systematic review suggested that those with ASD who were more physical activity seemed to see better BMI and fitness with aerobic and anaerobic activities done in school and community-based settings.

In a 2020 Frontiers in Behavioral Neuroscience mini review, Jessica Atef Nassef Sefen, MB, BCh, of the Royal College of Surgeons in Ireland-Bahrain in Al Muharraq, and co-authors noted that a 2016 study "considered the two best forms of physical intervention for [ASD] to be martial arts and horseback riding, whilst there was a limited benefit in yoga, dance, and swimming," and a 2020 study touted dance as having positive physical and mental health effects on children with ASD.

For the current analysis, Kahathuduwa’s group looked at 34 studies with 276,173 participants with autism and 7.7 million without autism. Mean age of participants was 31.2 years and the pooled proportion of females was 47%.

In terms of the findings in children with autism, the authors reported a 2.84 RR (95% CI, 1.81 to 4.47) for the development of diabetes and a 2.54 RR (95% CI, 1.56 to 4.12) for the development of hypertension.

For high cholesterol, they noted that triglyceride level was significantly increased in those with autism while HDL level was significantly decreased versus those without autism. In 2022, an American Heart Association (AHA) Professional Heart Daily article stated that "[c]hildren with CHD are at greater risk for developmental disabilities (DD) due to biologic factors such as abnormal cardiac physiology and the surgical and medical therapies used to treat their heart disease or underlying genetic disorders."

Patricia O’Brien, RN, MSN, of Children’s Hospital in Boston, also pointed out in the AHA article that ASDs "are more prevalent among high-risk children with CHD than in the general population, and specific screening is recommended at 18 and 24 months…Many infants with complex heart disease are referred to early intervention programs at the time of discharge from the hospital. While low-risk children with CHD can be well-served by the screening and surveillance for DD and autism spectrum disorders recommended by the AAP [American Academy of Pediatrics], children at high risk for DD should undergo formal developmental evaluation."

Current study limitations included the lack of distinction between T1D and T2D in some research, inconsistent definitions of CVD, and the inability "to examine the association with several critical potential moderators (e.g., intellectual disability, body mass index, psychotropic medication use), Kahathuduwa and co-authors said.

They advised that "[b]ecause developing cardiometabolic disease at an early age raises morbidity and health concerns, the need for health care, and mortality, clinicians should vigilantly monitor individuals with autism for early signs of cardiometabolic disease and their complications."

Kahathuduwa and co-authors reported no relationships relevant to the contents of this paper to disclose.

Weir reported support from, and/or relationships with, the Autism Centre of Excellence at Cambridge, Queen Anne’s Gate Foundation, Queens’ College/University of Cambridge/Bye Fellowship, Rosetrees Trust, Cambridgeshire and Peterborough NHS Foundation Trust, John Byron Corbin Charitable Fund, and the Charles Slater Fund, Department of Psychiatry/University of Cambridge/National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre, and the NIHR East of England Applied Research Centre.

Dhanasekara CS, et al "Association between autism spectrum disorders and cardiometabolic diseases: A systematic review and meta-analysis" JAMA Pediatr 2023; DOI: 10.1001/jamapediatrics.2022.5629.

Weir EM "Autism, physical health conditions, and a need for reform" JAMA Pediatr 2023; DOI: 10.1001/jamapediatrics.2022.5639.