Feeding Problems and Nutrient Intake in Children with Autism Spectrum Disorders: A Meta-analysis and Comprehensive Review of the Literature
Abstract
We conducted a comprehensive review and meta-analysis of research regarding feeding problems and nutrient status among children with autism spectrum disorders (ASD). The systematic search yielded 17 prospective studies involving a comparison group. Using rigorous meta-analysis techniques, we calculated the standardized mean difference (SMD) with standard error and corresponding odds ratio (OR) with 95 % confidence intervals (CI). Results indicated children with ASD experienced significantly more feeding problems versus peers, with an overall SMD of 0.89 (0.08) and a corresponding OR of 5.11, 95 % CI 3.74-6.97. Nutrient analyses indicated significantly lower intake of calcium (SMD: -0.65 [0.29]; OR: 0.31, 95 % CI 0.11-0.85) and protein (SMD: -0.58 [0.25]; OR: 0.35, 95 % CI: 0.14-0.56) in ASD. Future research must address critical questions regarding the cause, long-term impact, and remediation of atypical feeding in this population.
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Many people with ARFID experience somatic, interoceptive, or sensory sensations as aversive and act to suppress them.
“Early medical conditions and/or somatic symptoms such as abdominal pain may lead some with ARFID to experience somatic sensations as aversive.”
From Feeling and body investigators (FBI): ARFID division—An acceptance-based interoceptive exposure treatment for children with ARFID (2019) · cites this paper as Sharp et al., 2013
Unpleasant or painful bodily sensations are frequent among children with ARFID.
“painful or unpleasant somatic sensations are common in children with ARFID (Cooney, Lieberman, Guimond, & Katzman, 2018; Sharp et al., 2013).”
From Feeling and body investigators (FBI): ARFID division—An acceptance-based interoceptive exposure treatment for children with ARFID (2019) · cites this paper as Sharp et al., 2013
Many individuals with ASD or depression without co-occurring EDs exhibit atypical eating behaviours that do not necessarily stem from weight and shape concerns or difficulties processing hunger or satiety.
“many individuals with ASD or depression without co-occurring EDs still exhibit atypical eating behaviours that do not necessarily stem from weight and shape concerns or difficulties processing hunger or satiety”
From Atypical interoception as a common risk factor for psychopathology: A review (2021) · cites this paper as Sharp et al., 2013
Children with ASD are approximately five times more likely to experience feeding problems than children without ASD.
“Additionally, research indicates a significant disparity in feeding problems between children with and without ASD, with those in the former group being approximately five times more likely to experience such issues [6].”
From Unraveling the Connections: Eating Issues, Microbiome, and Gastrointestinal Symptoms in Autism Spectrum Disorder (2025) · cites this paper as [6]
In our sample, the intake of protein was higher than the recommendations and similar to the general population.
“while here the intake of protein was higher than the recommendations and similar to the general population [15,51].”
From Dietary Patterns, Eating Behavior, and Nutrient Intakes of Spanish Preschool Children with Autism Spectrum Disorders (2021) · cites this paper as [15]
Sharp et al. (2013) and Esteban-Figuerola et al. (2019) reported a lower intake of calcium and protein in autistic children compared with a control group.
“Sharp et al. (2013) [15] and Esteban-Figuerola et al. (2019) [51] have reported a lower intake of calcium and protein in autistic children compared with a control group”
From Dietary Patterns, Eating Behavior, and Nutrient Intakes of Spanish Preschool Children with Autism Spectrum Disorders (2021) · cites this paper as [15]
Selective eating patterns are not necessarily associated with higher risk for growth retardation, a marker of nutritional deficits and trigger for clinical attention.
“This is because selective eating patterns are not necessarily associated with higher risk for growth retardation that is a marker of nutritional deficits and triggers clinical attention of pediatricians [18].”
Feeding problems in ASD may remain unattended by healthcare providers.
“Feeding problems in ASD may remain unattended by the healthcare providers.”
A strong preference for starches, snacks, and processed foods, along with rejection of fruits, vegetables, or protein, is common in ASD.
“A strong preference for starches, snacks and processed foods, along with a rejection of fruits, vegetables or protein, is particularly common [56,57].”
From Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions (2019) · cites this paper as [56]
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- Authors
- Sharp, W. G., Berry, R. C., McCracken, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., Klin, A., Jones, W., & Jaquess, D. L.
- Affiliations
- Emory University (US)
- Corresponding author
- Sharp, William G.
- Venue
- Journal of Autism and Developmental Disorders
- Published
- 2013-02-01
- Volume
- 43
- Issue
- 9
- Pages
- 2159-2173
- ISSN
- 0162-3257 (ISSN-L)
- 1573-3432
- OpenAlex
- W1991509027
- Cited by
- 643
- References
- 13
- Citations by year
- 2026: 73 · 2025: 71 · 2024: 62 · 2023: 64 · 2022: 61 · 2021: 76 · 2020: 54 · 2019: 48 · 2018: 41 · 2017: 30 · 2016: 20 · 2015: 23 · 2014: 9 · 2013: 10
- FWCI
- 2.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Autism and Developmental Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- autism spectrum disorder, feeding difficulties, nutrient intake, calcium intake, protein intake, nutrient status, children
- MeSH terms
- Energy Intake, Child, Child Development Disorders, Pervasive, Eating, Humans, Feeding and Eating Disorders of Childhood
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