Dietary Intake, Nutrient Status, and Growth Parameters in Children with Autism Spectrum Disorder and Severe Food Selectivity: An Electronic Medical Record Review
Abstract
Background Food selectivity is common in children with autism spectrum disorder (ASD). The clinical characteristics, however, of severe food selectivity in children with ASD is not well documented.Objective This study examined the demographic characteristics, anthropometric parameters, risk of nutritional inadequacy, dietary variety, and problematic mealtime behaviors in a sample of children with ASD with severe food selectivity.Design The study involved a cross-sectional electronic medical record review. Data extraction followed a systematic protocol for data extraction.Participants/setting Children (age 2 to 17 years) with ASD, severe food selectivity, and complete nutritional data who received a multidisciplinary evaluation at a specialty feeding clinic in the southeastern United States between January 2014 and January 2016. Criteria for severe food selectivity used in this clinical practice required complete omission of one or more food groups (eg, fruit, vegetable, protein, grain, dairy) or consuming a narrow range of items on a weekly basis (eg, five or fewer total food items).Main outcome measures Analyses examined demographic characteristics, dietary preferences, risk for nutritional inadequacies, anthropometric parameters, and problematic mealtime behaviors.Results Of the 279 patients evaluated during the 24-month period, 70 children with ASD and severe food selectivity met inclusion criteria. Caregivers reported 67% of the sample (n=47) omitted vegetables and 27% omitted fruits (n=19). Seventy-eight percent consumed a diet at risk for five or more inadequacies. Risk for specific inadequacies included vitamin D (97% of the sample), fiber (91%) vitamin E (83%), and calcium (71%). Children with five or more nutritional inadequacies (n=55) were more likely to make negative statements during meals (P<0.05). Severe food selectivity was not associated with compromised growth or obesity.Conclusion Children with ASD and severe food selectivity may be at increased risk for nutritional inadequacies. Future research should examine causes, consequences, and remediation of severe food selectivity in this population.
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Children with ASD who present mealtime problems are at higher risk of nutrient deficiencies than their nonselective peers.
“There is evidence that children with ASD who present mealtime problems are at higher risk of nutrient deficiencies than their nonselective peers [16,17].”
Just two of the papers reported specifically on individuals with a concurrent diagnosis of ARFID and ASD.
“Just two of the papers reported specifically on individuals with a concurrent diagnosis of ARFID and ASD.31,32”
From Avoidant/Restrictive Food Intake Disorder and Severe Food Selectivity in Children and Young People with Autism: A Scoping Review (2022) · cites this paper as [32]
Generally, the accepted foods for children with ASD are usually sweet, dry, and salty.
“Generally, the accepted foods are usually sweet, dry, and salty [9].”
From Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders (2022) · cites this paper as [9]
Molina-López et al. and Sharp et al. (2018) show associations between metabolic alterations, such as being overweight or underweight, and food selectivity in children with ASD.
“Unfortunately, both Molina-López et al. [61] and Sharp et al. (2018) [9] show associations between metabolic alterations, such as being overweight or underweight, with FS.”
From Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders (2022) · cites this paper as [9]
Food selectivity in ASD, depending on its severity, can lead to a significant nutritional imbalance and be a direct contributing factor in the appearance of GIS.
“FS in ASD, depending on its severity, can lead to a significant nutritional imbalance [9,57,64,65], and be a direct contributing factor in the appearance of GIS.”
From Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders (2022) · cites this paper as [9]
Children with ASD tend to prefer slices of bread made from refined wheat flour, sweetened boxed cereals, breaded chicken, sweetened yogurt, crackers, and chips, among other fried and baked foods.
“Regarding food preferences, children with ASD tend to prefer slices of bread made from refined wheat flour (70%), sweetened boxed cereals (50%), breaded chicken (chicken nuggets, 30–50%), sweetened yogurt (44%), crackers, and chips, among other fried and baked foods.”
From Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders (2022) · cites this paper as [9]
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- Authors
- Sharp, W. G., Postorino, V., McCracken, C. E., Berry, R. C., Criado, K. K., Burrell, T. L., & Scahill, L.
- Corresponding author
- Sharp, William G.
- ORCID
- Venue
- Journal of the Academy of Nutrition and Dietetics
- Publisher
- Elsevier BV
- Published
- 2018-10
- Volume
- 118
- Issue
- 10
- Pages
- 1943-1950
- ISSN
- 2212-2672 (ISSN-L)
- OpenAlex
- W2838558797
- Cited by
- 167
- References
- 34
- Citations by year
- 2026: 17 · 2025: 24 · 2024: 31 · 2023: 20 · 2022: 27 · 2021: 22 · 2020: 14 · 2019: 10 · 2018: 2
- FWCI
- 9.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the Academy of Nutrition and Dietetics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- autism spectrum disorder, nutritional deficiency, dietary intake, nutrient status, anthropometric parameters, dietary diversity, vitamin D deficiency, calcium deficiency, vitamin E deficiency, growth, obesity
- MeSH terms
- Autism Spectrum Disorder, Nutrients, Adolescent, Feeding and Eating Disorders, Child, Child Development, Child, Preschool, Cross-Sectional Studies, Diet, Female, Food Preferences, Humans, Male, Nutritional Status, Risk Factors, Child Nutrition Disorders, Electronic Health Records
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