Chen LB, Xu XQ, Chen YH. Serum folate and brain-derived neurotrophic factor in pediatric autism spectrum disorder and their predictive role in illness severity. World J Psychiatry 2026; 16(3): 112418 [DOI: 10.5498/wjp.v16.i3.112418]
Corresponding Author of This Article
Yan-Hui Chen, Professor, Department of Pediatrics, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou 350001, Fujian Province, China. deag0225@126.com
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Psychology
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Case Control Study
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Mar 19, 2026 (publication date) through Feb 27, 2026
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World Journal of Psychiatry
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Chen LB, Xu XQ, Chen YH. Serum folate and brain-derived neurotrophic factor in pediatric autism spectrum disorder and their predictive role in illness severity. World J Psychiatry 2026; 16(3): 112418 [DOI: 10.5498/wjp.v16.i3.112418]
World J Psychiatry. Mar 19, 2026; 16(3): 112418 Published online Mar 19, 2026. doi: 10.5498/wjp.v16.i3.112418
Serum folate and brain-derived neurotrophic factor in pediatric autism spectrum disorder and their predictive role in illness severity
Li-Bin Chen, Xiao-Qin Xu, Yan-Hui Chen
Li-Bin Chen, Fujian Medical University Union Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial Hospital, Fuzhou 350001, Fujian Province, China
Xiao-Qin Xu, The School of Pharmacy, Fujian Medical University, Fuzhou 350001, Fujian Province, China
Yan-Hui Chen, Department of Pediatrics, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Chen LB designed the research and wrote the first manuscript; Chen LB, Xu XQ and Chen YH contributed to conceiving the research and analyzing data; Chen LB conducted the analysis and provided guidance for the research.
Supported by Fujian Provincial Health Technology Project, No. 2020QNA012.
Institutional review board statement: This study was approved by the Ethic Committee of Fuzhou University Affiliated Provincial Hospital.
Informed consent statement: Patient/guardian were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient/guardian agreed to treatment by written consent.
Conflict-of-interest statement: There is no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Yan-Hui Chen, Professor, Department of Pediatrics, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Gulou District, Fuzhou 350001, Fujian Province, China. deag0225@126.com
Received: September 16, 2025 Revised: November 13, 2025 Accepted: December 10, 2025 Published online: March 19, 2026 Processing time: 163 Days and 23.4 Hours
Abstract
BACKGROUND
Autism spectrum disorder (ASD) involves social and neurological impairment, and affected individuals have an elevated risk of bullying.
AIM
To clarify serum folate (SF) and brain-derived neurotrophic factor (BDNF) expression in ASD-affected children and evaluate their prediction value for illness severity.
METHODS
From February 2023 to February 2025, 53 ASD-affected children and 50 healthy controls visiting Fuzhou University Affiliated Provincial Hospital were enrolled as the research and control groups, respectively. SF and BDNF levels were measured in all children. The Childhood Autism Rating Scale (CARS) was used to assess ASD symptom severity. In ASD cases, SF and BDNF expression differences were compared across illness-severity subgroups and before versus after treatment. Pearson r was used to assess correlations between SF/BDNF and CARS in the research group. Receiver operating characteristic (ROC) curves were used to assess their predictive value for ASD severity. Univariate and multivariate binary Logistic models were used to identify ASD progression determinants.
RESULTS
ASD children showed significantly lower SF and higher BDNF higher than controls. Severe cases had lower SF and higher BDNF than mild-to-moderate cases. SF correlated inversely with the CARS score, whereas BDNF correlated positively. For predicting ASD severity, the area under the ROC curve (AUC) of SF and BDNF was 0.700-0.750, and their combined use increased the AUC to 0.823. Both markers were confirmed to be independent determinants of ASD aggravation.
CONCLUSION
SF is down-regulated and BDNF is up-regulated in ASD-affected children, SF correlates negatively with ASD severity and BDNF correlates positively. Low SF and high BDNF are risk factors for ASD deterioration in children.
Core Tip: We selected 53 autism spectrum disorder (ASD)-affected children and 50 healthy controls. Serum folate (SF) was down-regulated and brain-derived neurotrophic factor (BDNF) was up-regulated in ASD children. Both indices related closely to illness severity and could reflect therapeutic effectiveness. Moreover, low SF and high BDNF levels held predictive value for ASD aggravation in children.
