A balanced approach towards healthy eating in autism
Abstract
Background: This audit was undertaken to investigate the dietary intake and food‐related behaviour of children diagnosed within the autistic spectrum continuum. It was hoped to understand the difficulties faced by parents and carers and to offer a holistic service. Method: Parents of 17 autistic children aged 42–117 months were interviewed and data collected by 3‐day dietary recall and food frequency questionnaire. Weight and height measurements for each child were obtained. South Derbyshire Ethics Committee approval was given. Results: Nutrient intakes on analysis fell below reference nutrient intake (RNI) levels for 53% (nine) children in one or more of the following nutrients: vitamin C, iron, vitamin D, niacin, riboflavin, vitamin B 6, calcium and zinc. One child fell below the lower reference nutrient intake (LRNI) for iron and three children aged under 4 years did not meet the LRNI for vitamin D from dietary sources. Excessive milk consumption in 13 children raised calcium intake to levels above 200% of RNI levels.Conclusion: Eating habits were extremely prescriptive. Food preferences were specific for ‘dry’ or ‘wet’ forms, colour, shaped retail products and even brand packaging. Food refusal and introduction of new foods were cited as the most difficult problems faced by parents. Oral sensitivity, poor oral motor movements and difficult eating behaviours were identified and an integrated service involving dietitian, speech therapist and paediatric clinical psychologist was advocated.
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Evidence suggests that a large proportion of children with ASD do not meet vitamin D requirements.
“Evidence suggests that a large proportion of children with ASD do not meet vitamin D requirements [126,132,133,134,135,136].”
From Vitamin D and Autism Spectrum Disorder: A Literature Review (2016) · cites this paper as [134]
Although these studies illustrated a large proportion of children with ASD not meeting the recommendations for vitamin D intake, they did not find any evidence that dietary intake of vitamin D in children with ASD differed from that of typically developing controls.
“Although these studies illustrated a large proportion of children with ASD not meeting the recommendations for vitamin D intake, they did not find any evidence that dietary intake of vitamin D in children with ASD differed from that of typically developing controls.”
From Vitamin D and Autism Spectrum Disorder: A Literature Review (2016) · cites this paper as [134]
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“Email: michelle.a.suarez@wmich.edu 2010) and may show preference for foods that are “fatty” or sugary” (Cornish, 1998).”
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“…of the number of children with ASD presenting to feeding clinics (Schreck, Williams, & Smith, 2004), and growing concerns about the potential for feeding problems to have a negative impact on children with ASD and their families (Cornish, 1998) appear to have generated a recent surge in research.”
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Assessment of feeding problems in children with autism spectrum disorder
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“Feeding problems are relatively common in children, especially in children with developmental disorders such as Pervasive Developmental Disorders (PDD; Cornish, 1998; Kerwin, 1999; Whiteley, Rodgers, & Shattock, 2000).”
BackgroundResultInfluentialIron deficiency parameters in autism spectrum disorder: clinical correlates and associated factors
Güneş, S., Ekıncı, O., & Çelik, T. (2017) · The Italian Journal of Pediatrics/Italian journal of pediatrics · doi:10.1186/s13052-017-0407-3 · Cited by 71 · see citing works
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“Furthermore, intakes have been reported to be lower than DRIs for vitamin A (Sadowska and Cierebiej, 2011; Xia et al., 2010), vitamin C (Cornish, 1998; Xia et al., 2010), and vitamin K (Lindsay et al., 2006) in some individuals, although growth rates do not seem to be affected (Xia et al., 2010).”
BackgroundResultInfluentialDietary Patterns and Anthropometric Measures of Indian Children with Autism Spectrum Disorder
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“…in the literature, with researchers suggesting that children with ASD demonstrate strong preferences for carbohydrate-based diets (Schreck, Williams, & Smith, 2004; Williams, Gibbons, & Schreck, 2005) and against fruits and vegetables (Ahearn, Castine, Nault, & Green, 2001; Cornish, 1998; 2002).”
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“Previous studies on the prevalence of food selectivity in individuals with ASD have reported highly variable rates, ranging from 13 to 87% (Cornish, 1998; Klein and Nowak, 1999; Whiteley et al., 2000).”
BackgroundDietary status and nutrient intake of children with autism spectrum disorder: A case-control study
Barnhill, K. M., Gutierrez, A., Ghossainy, M. E., Marediya, Z., Devlin, M., Sachdev, P. K., Marti, C. N., & Hewitson, L. C. (2018) · Research in Autism · doi:10.1016/j.rasd.2018.03.002 · Cited by 43 · see citing works
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“[27] indicates the reluctance of children with ASD to eat fruits and vegetables.”
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“On the other hand, Cornish 1998 reported low intake of vitamin B6 in approximately half of participated children in his study, this could be due to ethnic dietary habit variations [28].”
BackgroundOromotor skills in autism spectrum disorder: A scoping review
Maffei, M. F., Chenausky, K. V., Gill, S. V., Tager-Flusberg, H. B., & Green, J. R. (2023) · Autism Research · doi:10.1002/aur.2923 · Cited by 40 · see citing works
“There is much research interest in the feeding behaviors of children diagnosed with ASD since they are five times more likely to experience feeding problems compared to their peers (Sharp et al., 2013), leading to a high rate of nutritional deficiencies (Cornish, 1998).”
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“Food selectivity was categorized into three levels based on the objective evidence in a study by Cornish (1998) that addressed the degree of nutritional deficit resulting from food selectivity.”
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“…com TEA (Nadon et al., 2011; Leekam et al., 2007; Williams et al., 2000; Ahearn et al., 2001), bem como da restrição no número de alimentos (Cornish, 1998), que muitas vezes resulta da defensividade sensorial, em especial a tátil (Bandini et al., 2010) M. apresentou dificuldade na…”
BackgroundMarshall, J., Hill, R. J., & Dodrill, P. (2013) · International Journal of Speech-Language Pathology · doi:10.3109/17549507.2013.777972 · Cited by 32 · see citing works
“during mealtimes, including only eating foods with specifi c brands or packaging (Cornish, 1998; Provost et al., 2010), insistence on using the same utensils or plates repeatedly (Schreck et al., 2004; Williams, Gibbons, & Schreck, 2005), and refusing to eat unless food is prepared the same way for…”
BackgroundStough, C. C. O., Gillette, M. L. D., Roberts, M. C., Jorgensen, T. D., & Patton, S. R. (2015) · Appetite · doi:10.1016/j.appet.2015.07.019 · Cited by 31 · see citing works
“Children with ASD may display specific eating habits such as requiring foods to be particular textures, colors, shapes, or commercial brands (Cornish, 1998).”
Miyajima, A., Tateyama, K., Fuji, S., Nakaoka, K., Hirao, K., & Higaki, K. (2017) · Hong Kong Journal of Occupational Therapy · doi:10.1016/j.hkjot.2017.10.001 · Cited by 30 · see citing works
“Food selectivity can become a significant problem because it can be associated with inadequate nutrition owing to the limited nutritional intake of a restricted diet (Cornish, 1998; Dovey, Staples, Gibson, & Halford, 2008; Herndon, DiGuiseppi, Johnson, Leiferman, & Reynolds, 2009; Lockner, Crowe, & Skipper, 2008; Rait…”
BackgroundSymptomatic nutritional rickets in a teenager with autistic spectrum disorder
Stewart, C., & Latif, A. (2008) · Child Care Health and Development · doi:10.1111/j.1365-2214.2007.00806.x · Cited by 29 · see citing works
Shmaya, Y., Eilat-Adar, S., Leitner, Y., Reif, S. S., & Gabis, L. V. (2017) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2017.05.004 · Cited by 29 · see citing works
Knox, M., Rue, H. C., Wildenger, L. K., Lamb, K., & Luiselli, J. K. (2012) · Education and Treatment of Children · doi:10.1353/etc.2012.0016 · Cited by 29 · see citing works
“Children who demonstrate selective eating have restricted diets that can cause malnutrition, dehydration, and similar health concerns (Cornish, 1998; Emond, Emmett, Steer, & Golding, 2010).”
BackgroundMeral, B. F., & Fidan, A. (2014) · Research in Autism · doi:10.1016/j.rasd.2014.11.009 · Cited by 28 · see citing works
Feeding Issues Associated with the Autism Spectrum Disorders
Nadon, G., Feldman, D. E., & Gisel, E. G. (2013) · InTech eBooks · doi:10.5772/53644 · Cited by 28 · see citing works
“A systematic literature review of feeding problems reported by parents, shows that many symptoms are similar to those associated with sensory feeding problems [4, 5, 10, 11, 14, 17, 20, 26, 53-55].”
BackgroundMorris, N. K., Knight, R. M., Bruni, T. P., Sayers, L., & Drayton, A. K. (2017) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2017.02.011 · Cited by 27 · see citing works
Patton, S. R., Stough, C. C. O., Pan, T. Y., Holcomb, L., & Gillette, M. L. D. (2020) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2020.103676 · Cited by 25 · see citing works
“Feeding problems may occur in young children with ASD due to the occurrence of gastrointestinal problems, sensory impairments, and oral and fine motor skills deficits (Cornish, 1998; Dailey, 2009; Cumine, Leach, & Stevenson, 2000; Rutter, 2006).”
BackgroundMarí-Bauset, S., Zazpe, I., Marí-Sanchis, A., González, A. L., & Morales‐Suárez‐Varela, M. (2014) · Research in Autism · doi:10.1016/j.rasd.2014.08.012 · Cited by 27 · see citing works
Food Choices of Children With Autism Spectrum Disorders
Suarez, M. A., & Crinion, K. M. (2015) · International Journal of School Health · doi:10.17795/intjsh-27502 · Cited by 31 · see citing works
“(18) demonstrated nutritional risks for children who ate 20 or less foods and Suarez et al.”
BackgroundThe role of nutraceuticals in the management of autism
Alanazi, A. (2012) · Saudi Pharmaceutical Journal · doi:10.1016/j.jsps.2012.10.001 · Cited by 26 · see citing works
“Cornish (1998) noticed that 13 of 17 autistic children were consuming excessive amount of milk while intake of many nutrients was lower than normal, when he interviewed the parents of autistic children.”
Pediatric Scurvy: How an Old Disease Is Becoming a New Problem
Fortenberry, M., D’Amico, H., & Gaines, K. (2020) · The Journal of Pediatric Pharmacology and Therapeutics · doi:10.5863/1551-6776-25.8.735 · Cited by 24 · see citing works
A Systematic Review of Dietary Assessment Tools for Children Age 11 Years and Younger
Olukotun, O., & Seal, N. (2015) · ICAN Infant Child & Adolescent Nutrition · doi:10.1177/1941406415584819 · Cited by 24 · see citing works
Kim, S. Y., Chung, K., & Jung, S. (2018) · Research in Autism · doi:10.1016/j.rasd.2018.01.003 · Cited by 24 · see citing works
Mealtime Behaviors and Food Preferences of Students with Autism Spectrum Disorder
Park, H. J., Choi, S. J., Kim, Y., Cho, M. S., Kim, Y., & Oh, J. (2020) · Foods · doi:10.3390/foods10010049 · Cited by 24 · see citing works
“Picky eating is a cause of weakness, anemia, or chronic disease as a result of limited eating, and is an important problem that can be associated with malnutrition [15,20,21].”
BackgroundMirizzi, P., Esposito, M., Ricciardi, O., Bove, D., Fadda, R., Caffò, A. O., Mazza, M., & Valenti, M. (2025) · Nutrients · doi:10.3390/nu17172798 · Cited by 19 · see citing works
Meral, B. F., & Fidan, A. (2014) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2014.01.008 · Cited by 19 · see citing works
“Feeding problems are historically linked with ASD (Ahearn et al., 2001; Cornish, 1998; Kanner, 1943; Ritvo & Freeman, 1978).”
BackgroundSeiverling, L. J., Williams, K. E., Ward‐Horner, J. C., & Sturmey, P. (2011) · Springer eBooks · doi:10.1007/978-1-4419-8065-6_31 · Cited by 18 · see citing works
“Ledford and Gast (2006) found seven descriptive studies examining the prevalence of feeding problems in children with ASD (Ahearn, Castine, Nault, & Green, 2001 ;B owers, 2002; Collins et al., 2003; Cornish, 1998, 2002; Field, Garland, & Williams, 2003; Shreck, Williams, & Smith, 2004).”
BackgroundEsposito, M. (2019) · International Journal of Autism & Related Disabilities · doi:10.29011/2642-3227.000020 · Cited by 17 · see citing works
Eggs, sugar, grated bones: colour-based food preferences in autism, eating disorders, and beyond
Strand, M. (2020) · Medical Humanities · doi:10.1136/medhum-2019-011811 · Cited by 17 · see citing works
“In general, children with autism tend to prefer crispy or crunchy food 31 as well as salty and savoury dishes, 32 but they may also be more likely to only accept foods of low texture, such as puréed foods.”
BackgroundDosman, C. F., Adams, D., Wudel, B., Vogels, L., Turner, J. M., & Vohra, S. (2013) · Pediatrics in Review · doi:10.1542/pir.34-10-e36 · Cited by 16 · see citing works
Omar, M. K. A. E.-F. A. (2014) · International Interdisciplinary Journal of Education · doi:10.12816/0003002 · Cited by 16 · see citing works
“brand packaging [32,8].”
Shah, T., Tse, A., Gill, H., Wong, I. C. K., Sutcliffe, A. G., Gringras, P., APPLETON, R. E., & Tuleu, C. (2008) · Developmental Medicine & Child Neurology · doi:10.1111/j.1469-8749.2008.03092.x · Cited by 16 · see citing works
“Children with autism are reported to present with unusual eating habits, feeding difficulties, and restrictive diets.(10) Physical characteristics of food, colour, brand name, or packaging can be important, with any attempt to introduce foods not corresponding to the child’s preference being met with refusal.”
BackgroundFat intake in children with autism spectrum disorder in the Mediterranean region (Valencia, Spain)
Marí-Bauset, S., González, A. L., Zazpe, I., Marí-Sanchis, A., & Morales‐Suárez‐Varela, M. (2015) · Nutritional Neuroscience · doi:10.1179/1476830515y.0000000029 · Cited by 16 · see citing works
Food Difficulties in Infancy and ASD: A Literature Review
Vasilakis, M., Polychronis, K., Panagouli, E. D., Tzila, E., Papageorgiou, A., Thomaidou, L., Ψαλτοπούλου, Θ., Tsolia, M. N., Sergentanis, T. Ν., & Τσίτσικα, Ά. (2022) · Children · doi:10.3390/children10010084 · Cited by 14 · see citing works
“According to Cornish [18], all parents of ASD cases (n = 17) reported that their babies were eating everything but suddenly at 12 months a nutritional regression to eating nothing was noted, accompanied by loss of skills and delay in their development [18].”
BackgroundInfluentialNadon, G., Feldman, D. E., & Gisel, E. G. (2008) · Archives de Pédiatrie · doi:10.1016/j.arcped.2008.04.022 · Cited by 14 · see citing works
Assessing factors that influence young children's food preferences and choices
Zonneveld, K. L. M., Neidert, P. L., Dozier, C. L., Gureghian, D. L., & Bayles, M. W. (2018) · Journal of Applied Behavior Analysis · doi:10.1002/jaba.521 · Cited by 14 · see citing works
Sensory Sensitivity and Food Selectivity in Children with Autism Spectrum Disorders
Cermak, S. A., Curtin, C., & Bandini, L. G. (2013) · Springer eBooks · doi:10.1007/978-1-4614-4788-7_126 · Cited by 12 · see citing works
Islam, N., Hathaway, K. L., Anderson, B. S., Sharp, W. G., & Loechner, K. J. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-05976-x · Cited by 12 · see citing works
“Maladaptive dietary patterns in children with ASD often include a strong preference for processed foods, snacks, and starches, coinciding with frequent rejection of fruits, vegetables, and dairy (Cornish, 1998).”
Nutritional Intake and Sensory Processing in School-Aged Children with Autism Spectrum Disorder
Olson, A., Krall, J. R., Baranova, A. V., & Slavin, M. (2025) · Nutrients · doi:10.3390/nu17040604 · Cited by 11 · see citing works
“This runs counter to the much earlier literature on nutrition in autism, which once claimed that about half of autistic children may have nutrient deficiencies [54].”
Al-Ali, S. F., Russo, S. E., & Alkaissi, A. (2015) · Journal of Health, Medicine and Nursing · Cited by 11 · see citing works
- Authors
- Cornish, E.
- Corresponding author
- Cornish, E.
- Venue
- Journal of Human Nutrition and Dietetics
- Publisher
- Wiley
- Published
- 1998-12
- Volume
- 11
- Issue
- 6
- Pages
- 501-509
- ISSN
- 0952-3871 (ISSN-L)
- 1365-277X
- OpenAlex
- W2171274581
- Cited by
- 153
- References
- 5
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 7 · 2022: 6 · 2021: 5 · 2020: 13 · 2019: 7 · 2018: 7 · 2017: 8 · 2016: 7 · 2015: 10 · 2014: 16 · 2013: 14 · 2012: 9
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Human Nutrition and Dietetics (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, children with autism, dietary intake, nutrient intake, micronutrient deficiency, vitamin D, iron, calcium, milk consumption, food preferences, food refusal, eating behaviour, oral sensitivity, multidisciplinary services, dietitians, speech therapy
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