Abnormalities in folate-dependent one-carbon metabolism have been reported in many children with autism. Because inadequate choline and betaine can negatively affect folate metabolism and in turn downstream methylation and antioxidant capacity, we sought to determine whether dietary intake of choline and betaine in children with autism was adequate to meet nutritional needs based on national recommendations. Three-day food records were analyzed for 288 children with autism (ASDs) who participated in the national Autism Intervention Research Network for Physical Health (AIR-P) Study on Diet and Nutrition in children with autism. Plasma concentrations of choline and betaine were measured in a subgroup of 35 children with ASDs and 32 age-matched control children. The results indicated that 60–93% of children with ASDs were consuming less than the recommended Adequate Intake (AI) for choline. Strong positive correlations were found between dietary intake and plasma concentrations of choline and betaine in autistic children as well as lower plasma concentrations compared to the control group. We conclude that choline and betaine intake is inadequate in a significant subgroup of children with ASDs and is reflected in lower plasma levels. Inadequate intake of choline and betaine may contribute to the metabolic abnormalities observed in many children with autism and warrants attention in nutritional counseling. 1. Introduction Autism is a complex, behaviorally-defined neurodevelopmental disorder characterized by significant impairments in social interaction, verbal and nonverbal communication, and by restrictive, repetitive, and stereotypic patterns of behavior. The Centers for Disease Control estimates that the current prevalence of autism spectrum disorders (ASD) in the United States is 1 in 110 children [1]. Nutritional screening and assessment of children with ASDs is an important clinical consideration for several reasons. First, these children often exhibit nutrition-related medical issues including gastrointestinal discomfort, bowel inflammation, diarrhea, constipation, and acid reflux [1]. Abnormal sensory processing can affect taste and texture perception leading to food avoidance and restricted food intake in many children with ASD. “Insistence on sameness” and compulsive repetitive behaviors reinforce rigid dietary preferences and lead to a limited food repertoire [2]. Finally, accumulating research indicates that nutrient metabolism and requirements may be altered in some children with ASDs compared to typically developing children [3–5]. Thus,
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