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Cited by 74Child Nutrition and Feeding IssuesAutism Spectrum Disorder ResearchEating Disorders and Behaviors

Gastrointestinal Symptoms and Feeding Problems and Their Associations with Dietary Interventions, Food Supplement Use, and Behavioral Characteristics in a Sample of Children and Adolescents with Autism Spectrum Disorders

Open access
Babinska, Katarina, Celusakova, Hana, Belica, Ivan, Szapuova, Zofia, Waczulikova, Iveta, Nemcsicsova, Dagmar, Tomova, Aleksandra, Ostatnikova, Daniela·2020·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph17176372PMC PMC7503400
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Abstract

Autism spectrum disorders (ASD) are characterized by impairments in social interaction, communication, and restricted, stereotyped behavior. Gastrointestinal (GI), nutritional, and feeding problems are often reported in ASD. We investigated the prevalence of GI symptoms, food selectivity, and mealtime difficulties, and their associations with dietary interventions, food supplement use, and behavioral characteristics in a sample involving 247 participants with ASD and 267 controls aged 2–18 years. Data were collected by a questionnaire. GI symptoms were observed in 88.9% of children and adolescents with ASD, more often in girls than in boys. High rates of food selectivity (69.1%) and mealtime problems (64.3%) were found. Food supplements were used by 66.7% of individuals, mainly vitamins/minerals, probiotics, and omega-3 fatty acids. In the ASD sample, 21.2% of subjects followed a diet, mostly based on gluten and milk restriction, including individuals exhibiting food selectivity. Frequency of GI symptoms, food selectivity, and mealtime problems correlated weakly, but significantly with behavioral characteristics in the ASD group, but not with food supplement use. The study demonstrated that higher frequency of GI symptoms, food selectivity, and mealtime problems are a common problem in pre-schoolers, schoolchildren, and adolescents with ASD, and together with dietary modification, they are significantly associated with ASD.

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Written from the paper’s full text.

TL;DR

In a Slovak questionnaire study of 247 children and adolescents with ASD and 267 controls, GI symptoms, food selectivity, and mealtime problems were highly prevalent and more frequent in ASD. These problems correlated weakly with ASD behavioral characteristics, while dietary restrictions and supplement use were common but not consistently linked to GI/feeding symptoms.

Key findings

  • GI symptoms occurred in 88.7% of ASD participants vs. 79.0% of controls (χ² = 8.7, p = 0.003); 47.6% of ASD participants had symptoms several times per week or daily vs. 24.3% of controls. Constipation/hard stools (61.9% vs. 44.6%) and voluminous stools (51.0% vs. 22.1%) were more prevalent in ASD. Girls with ASD had GI symptoms more often than boys (97.1% vs. 87.6%, p = 0.009), with 70.6% of girls vs. 44.5% of boys reporting frequent symptoms.
  • Food selectivity was found in 69.1% of ASD participants vs. 37.1% of controls, and mealtime problems in 64.3% vs. 25.9% (p = 0.000). Food selectivity several times per week or daily occurred in 48.8% of ASD participants vs. 13.1% of controls; mealtime problems occurred at that frequency in 41.8% of the ASD group.
  • In the ASD sample, 21.2% followed a diet; the most common was gluten-free/casein-free (40.4% of those on a diet), followed by milk/lactose restriction (23.1%), gluten-only restriction (17.3%), GAPS diet (15.4%), and casein restriction (5.8%). Supplement use did not differ significantly between groups overall; in ASD, probiotics were used by 42.8%, omega-3 PUFAs by 28.3%, and carnosine and vitamin B by 12.7% each.
  • GI symptoms weakly correlated with food selectivity (ρ = 0.216, p = 0.001) and mealtime problems (ρ = 0.180, p = 0.005); mealtime problems correlated with food selectivity (ρ = 0.531, p = 0.000). GI symptoms, food selectivity, and mealtime problems showed weak but significant positive correlations with ADI-R core symptom severity, but not with supplement use; verbal skills negatively correlated with dietary intervention (ρ = −0.169, p = 0.009).

Methods

  • Cross-sectional questionnaire study conducted by the Academic Research Centre for Autism at Comenius University, Bratislava, 2013–2019, including 247 children/adolescents with ASD (86.6% boys; 55.6% aged 2–5 years) and 267 neurotypical controls. ASD diagnosis used ADI-R and ADOS-2.
  • Parent/caregiver questionnaires assessed six GI symptoms in the last 3 months using an adaptation of the GI severity index; food selectivity and mealtime problems were rated on a 5-point Likert scale; dietary restriction and supplement use in the last 12 months were recorded. Vitamin D and short-term antibiotic-associated probiotics were excluded from supplement analyses.
  • Analyses included descriptive/inferential statistics, t-test or Mann–Whitney test, chi-square or Fisher’s exact test, Spearman correlations, and multivariable logistic regression adjusted for age and gender, with significance at 5%.

Limitations

  • Stated: the sample was not randomly selected and included volunteers meeting criteria, so results may be biased by sample selection; GI data came from parent questionnaires without medical verification; controls were not screened for ASD and absence of ASD was based only on parental report.
  • Evident from the text: the cross-sectional design cannot establish causality or temporality; the ASD sample was predominantly preschool-aged and had few girls, and the authors describe the gender-by-GI interaction as preliminary.
  • Evident from the text: diet and supplement data were self-reported, and some behaviors, such as aggression during mealtime, were assessed only in part of the ASD sample and not in controls.

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Integrity signals

Registry

Crossref · 10.3390/ijerph17176372

Cites

63 of 63 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 78 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the ASD group, 11.4% of subjects exhibited aggression during mealtime.

    “In addition, in the ASD group, 11.4% of subjects exhibited aggression during mealtime; but we have not assessed this behavior in the control group.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the control group, less frequent occurrence of GI symptoms (1-4 times/month) prevailed (54.7% of controls vs 41.1% of ASD).

    “In the group with ASD, 47.6% of individuals suffered from GI symptoms several times per week or daily in contrast to 24.3% of controls, whereas in the control group less frequent occurrence of GI symptoms (1–4 times/month) prevailed (41.1% of ASD, 54.7% of controls).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In both ASD and control groups, no correlations of food selectivity and mealtime problems with age or gender were found.

    “In both ASD and control group, no correlations of food selectivity and mealtime problems with age or gender were found.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the ASD sample, 21.2% of subjects followed a diet in the last 3 months.

    “In the sample with ASD, 21.2% of subjects followed a diet in last 3 months (Table 5).”
    • Also stated in: § Abstract · plain
      “In the ASD sample, 21.2% of subjects followed a diet, mostly based on gluten and milk restriction, including individuals exhibiting food selectivity.”
    Quote in the paperNot a substantial claim
  • Findingown data

    GAPS diet was followed by 15.4% of individuals with ASD.

    “Gut and Psychology Syndrome (GAPS) diet was followed by 15.4% of individuals with ASD.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 35
  • Classified as probably not a substantial claim. 28

  • May combine two claims.

    Findingown data

    All four assessed types of mealtime problems (anger, requesting food to be prepared in the same way, crying and shouting during meal, self-injurious behavior) were significantly more prevalent in ASD.

    “In the study, we assessed four types of mealtime problems: anger, requesting food to be prepared in the same way, crying and shouting during meal, self-injurious behavior. All of them were significantly more prevalent in ASD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the ASD sample, high prevalence of food selectivity (69.1%) and mealtime problems (64.3%) was found compared to controls (37.1% and 25.9%).

    “In the sample with ASD, high prevalence of food selectivity (69.1%) and mealtime problems (64.3%) was found in comparison to the controls (37.1% and 25.9%, respectively, p = 0.000, Table 4).”
    • Also stated in: § Abstract · plain
      “High rates of food selectivity (69.1%) and mealtime problems (64.3%) were found.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Within the 3-month period, some individuals switched from one type to another type of diet.

    “Within the time period of 3 months that was considered in our study, some individuals switched from one type to another type of diet.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among children with ASD, 70.6% of girls but only 44.5% of boys exhibited GI problems several times per week or daily.

    “GI symptoms occurred in girls with ASD more commonly than in boys (97.1% vs. 87.6%, χ2 = 13.57, p = 0.009), of that 70.6% of girls but only 44.5% of boys exhibited problems several times per week or daily.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Constipation/hard stool consistency was the most frequent GI symptom and occurred much more commonly in ASD than controls (61.9% vs 44.6%).

    “Constipation/hard stool consistency was the most frequent GI symptom, that occurred much more commonly in the sample with ASD than in controls (61.9% vs. 44.6%, χ2 = 15.5, p = 0.000).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The GFCF diet was the most prevalent type of diet; it was followed by 40.4% of all children and adolescents on a diet.

    “The GFCF (gluten-free/casein-free) diet based on elimination of both gluten and casein was the most prevalent type of diet; it was followed by 40.4% of all children and adolescents on a diet.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No significant differences in frequency of GI symptoms were observed across age groups 2-5, 6-10, and 11-18 years, neither in ASD nor controls.

    “No significant differences in frequency of GI symptoms were observed across the age groups 2–5, 6–10, and 11–18 y old children and adolescents, neither in the sample with ASD nor in the controls.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Mealtime problems occurred several times per week or daily in 41.8% of individuals with ASD, while in controls they occurred with much lower frequency.

    “A large proportion of individuals with ASD displayed food selectivity several times per week or on a daily basis (48.8% vs. 13.1% of controls), similarly the mealtime problems (41.8%), while in the controls they occurred with much lower frequency.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    GI symptoms were observed in 88.7% of subjects with ASD and 79.0% of controls in the last 3 months.

    “We found that 88.7% of subjects with ASD and 79.0% of controls experienced gastrointestinal symptoms in last 3 months (χ2 = 8.7, p = 0.003).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The GFCF diet was introduced also due to elevated levels of opioid peptides detected in the children by previous urianalysis.

    “The GFCF diet was introduced also due to elevated levels of opioid peptides detected in the children by previous urianalysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In both ASD and control groups, the supplement users consumed on average two types of supplements in the last 12 months.

    “In both ASD and control group, the supplement users consumed on average two types of supplements in the last 12 months.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No correlation between GI symptoms and ASD severity based on ADOS-2 scores was found, with exception of a weak negative correlation with restricted, repetitive, and stereotyped patterns of behavior.

    “No correlation between GI symptoms and ASD severity based on ADOS-2 scores, with exception of a weak negative correlation with restricted, repetitive, and stereotyped patterns of behavior.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Some parents decided for the diet because they studied resources encouraging that this might be treatment for ASD, others because they observed improvements of behavior and/or GI symptoms.

    “Some of them decided for the diet because they studied resources encouraging that this might be treatment for ASD, others followed the diet because they observed improvements of behavior and/or GI symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the ASD group, use of carnosine and vitamin B was significantly more prevalent (both 12.7%).

    “In the ASD group, use of probiotics was significantly more prevalent (42.8% of subjects), as well as of omega-3 PUFAs (28.3%), carnosine and vitamin B (both 12.7%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of the 13 controls on a diet, in 10 cases parents reported it was recommended by a pediatrician due to medical conditions, and the remaining children did not provide the cause.

    “Of that, in 10 cases the parents reported that it was recommended by a pediatrician due to medical conditions, and the remaining children have not provided the cause for a diet.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In our sample with ASD, high rates of problem behavior related to food intake were demonstrated in boys and girls of all ages that correlated with severity of ASD symptoms in ADI-R domains.

    “In our sample with ASD, high rates of problem behavior related to food intake were demonstrated in boys and girls of all ages that correlated with severity of ASD symptoms in ADI-R domains.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    High rates of food supplement use were found in the ASD group and also in the control sample.

    “High rates of food supplement use were found in our study in the ASD group, but also in the control sample.”
    • Also stated in: § 5. Conclusions · plain
      “We found that dietary restrictions were introduced also to children exhibiting food selectivity, as well as extensive use of food supplements, although it often lacks sufficient scientific support.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Some parents reported giving supplements to enhance verbal skills in their children with delayed language development.

    “In fact, some parents reported that they give the supplements in order to enhance verbal skills in their children presenting delay in language development.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    GI symptoms, food selectivity, mealtime problems, and dietary modification are significantly associated with ASD.

    “The present study demonstrated that higher frequency of GI symptoms, food selectivity, and mealtime problems are a common problem in pre-schoolers, schoolchildren, and adolescents with ASD, and together with dietary modification they are significantly associated with ASD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Non-verbal children were more likely to be on a diet or to use food supplements, and less likely to display food selectivity and mealtime problems.

    “Verbal skills were negatively correlated with dietary intervention (ρ = −0.169, p = 0.009), and there was a trend towards negative correlation with food supplement use (ρ = −0,120, p = 0.062), i.e., non-verbal children were more likely to be on a diet or to use food supplements, on the other hand, they were less likely to display food selectivity and mealtime problems.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Feeding problems in ASD are of multifactorial origin and appear to be associated with core behavioral characteristics of ASD.

    “There is evidence that feeding problems in ASD are of multifactorial origin, and they appear to be associated with the core behavioral characteristics of ASD.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [17] Vissoker, 2015, Eating and feeding problems and gastrointestinal dysfunction in Autism Spectrum Disorders, Res. Autism Spectr. Disord. source

      Not checked in the free run.

    • cites [43] Ashley, 2020, Onset, Trajectory, and Pattern of Feeding Difficulties in Toddlers Later Diagnosed with Autism, J. Dev. Behav. Pediatr. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Absence of ASD symptoms or diagnosis of a neurodevelopmental disorder in controls was based on parents' reports.

    “Absence of ASD symptoms or diagnosis of a neurodevelopmental disorder was based on parents’ reports.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The Ethics Committee of the Comenius University Faculty of Medicine and University Hospital in Bratislava approved the study protocol.

    “The Ethics Committee of the Comenius University Faculty of Medicine and University Hospital in Bratislava approved the study protocol.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Due to limited number of girls in the sample, the finding of gender differences in GI symptoms needs to be interpreted with caution.

    “Still, due to limited number of girls in our sample, this finding needs to be interpreted with caution.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    GI symptoms seem to have a multifactorial basis.

    “GI symptoms seem to have multifactorial basis [37].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Geir, 2020, Gastrointestinal Alterations in Autism Spectrum Disorder: What Do We Know?, Neurosci. Biobehav. Rev. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Having a higher GI score may be associated with increased odds of being classified as ASD in girls, but with lower odds in boys.

    “Thus, having a higher GI score may be associated with increased odds of being classified as ASD in girls (coded as 0), but with lower odds in boys (coded as 1).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    About 70% of children with ASD are reported to have some feeding problems.

    “About 70% of children with ASD are reported to have some feeding problems [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Vissoker, 2015, Eating and feeding problems and gastrointestinal dysfunction in Autism Spectrum Disorders, Res. Autism Spectr. Disord. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study conformed to the code of ethics stated in the Declaration of Helsinki.

    “The study conformed to the code of ethics stated in the Declaration of Helsinki.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Written informed consent was obtained from all subjects or their caregivers.

    “Written informed consent was obtained from all subjects or their caregivers.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All children enrolled in the study had to meet criteria for ASD on both ASD diagnostic tools.

    “ASD diagnosis was made based on clinical evaluation; all children enrolled in the study had to meet criteria for ASD on both ASD diagnostic tools.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Feeding problems in ASD reflect repetitiveness and preference for sameness, ritualism, unusual interest in sensory properties of food, diminished responsiveness to social reward, and increased reactivity in response to frustration.

    “They reflect repetitiveness and preference for sameness, ritualism, unusual interest in sensory properties of food, but also diminished responsiveness to social reward, and increased reactivity in response to frustration [17,43].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [17] Vissoker, 2015, Eating and feeding problems and gastrointestinal dysfunction in Autism Spectrum Disorders, Res. Autism Spectr. Disord. source

      Not checked in the free run.

    • cites [43] Ashley, 2020, Onset, Trajectory, and Pattern of Feeding Difficulties in Toddlers Later Diagnosed with Autism, J. Dev. Behav. Pediatr. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    For assessment of GI symptoms, an adaptation of the GI severity index questionnaire was used.

    “For assessment of GI symptoms, adaptation of GI severity index questionnaire was used [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Schneider, 2006, Oral Human Immunoglobulin for Children with Autism and Gastrointestinal Dysfunction: A Prospective, Open-Label Study, J. Autism Dev. Disord. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    Study participants were diagnosed with ASD by trained examiners using ADI-R and ADOS-2, both considered an international gold standard in the ASD diagnostic process.

    “Study participants were diagnosed with ASD by trained examiners. The diagnostic tools involved the Autism Diagnostic Interview-Revised (ADI-R), and the Autism Diagnostic Observation Schedule—Second Edition (ADOS-2), both considered as an international gold standard in the ASD diagnostic process.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] Lord, 1994, Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders, J. Autism Dev. Disord. source

      Not checked in the free run.

    • cites [27] Lord, C., Rutter, M., DiLavore, P.C., Risi, S., Gotham, K., and Bishop, S. (2012). Autism Diagnostic Observation Schedule, Springer. [2nd ed.].

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In ASD, picky eating appears at an early age and escalates more quickly than in typically developing children.

    “A study revealed that in ASD, the “picky eating” appears at early age and escalates more quickly than in typically developing children [43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Ashley, 2020, Onset, Trajectory, and Pattern of Feeding Difficulties in Toddlers Later Diagnosed with Autism, J. Dev. Behav. Pediatr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Food selectivity and feeding disorders are present to some extent in neurotypical children but are more severe in children with ASD.

    “To some extent, food selectivity and feeding disorders are present in neurotypical children, but they are more severe in ASD [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Zazpe, 2014, Food Selectivity in Autism Spectrum Disorders: A Systematic Review, J. Child Neurol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The most frequently omitted food group is vegetables, followed by fruits.

    “The most frequently omitted food group is vegetables, followed by fruits [16,42].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [16] Sharp, 2018, Dietary Intake, Nutrient Status, and Growth Parameters in Children with Autism Spectrum Disorder and Severe Food Selectivity: An Electronic Medical Record Review, J. Acad. Nutr. Diet. source

      Not checked in the free run.

    • cites [42] Tomova, A., Soltys, K., Kemenyova, P., Karhanek, M., and Babinska, K. (2020). The Influence of Food Intake Specificity in Children with Autism on Gut Microbiota. Int. J. Mol. Sci., 21. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    GI and nutrition-related problems often receive less attention than behavioral or other clinical concerns.

    “GI and nutrition-related problems are often getting less attention in comparison to behavioral or other clinical concerns [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Hyman, 2020, Council On Children with Disabilities, Section On Developmental And Behavioral Pediatrics Identification, Evaluation, and Management of Children With Autism Spectrum Disorder, Pediatrics source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In a study of children with ASD, top reasons parents gave supplements were to enhance the child's diet and to promote immune system function.

    “A study that involved children with ASD reported that the top reasons of parents for giving supplements were also to enhance the child’s diet, and to promote immune system function [51].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] Trudeau, M.S., Madden, R.F., Parnell, J.A., Gibbard, W.B., and Shearer, J. (2019). Dietary and Supplement-Based Complementary and Alternative Medicine Use in Pediatric Autism Spectrum Disorder. Nutrients, 11. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Neuroprotective action of carnosine has been reported and beneficial effects on behavior in ASD observed in some studies but not confirmed by others; there is insufficient support for efficacy of carnosine in ASD.

    “Neuroprotective action of carnosine has been reported, and beneficial effects on behavior of subjects with ASD have been observed in some studies, however, they were not confirmed by other studies. At present, there is insufficient support for efficacy of carnosine in ASD [60].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] Brondino, 2015, Complementary and Alternative Therapies for Autism Spectrum Disorder, Evid. Based Complement. Altern. Med. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There are reports that supplements were given to prevent or treat conditions for which there is only limited evidence of efficacy.

    “Interestingly, there are reports that supplements were given to prevent or treat conditions for which there is only limited evidence of their efficacy [58].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Dwyer, 2013, Prevalence and predictors of children’s dietary supplement use: The 2007 National Health Interview Survey, Am. J. Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Food supplement use by children and adolescents can improve micronutrient status but can also increase risk of excessive intake of certain vitamins and minerals.

    “The use of food supplements by children and adolescents can improve micronutrient status, but it can also increase the risk of excessive intake of certain vitamins and minerals [57].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Kang, 2016, The nutrition contribution of dietary supplements on total nutrient intake in children and adolescents, Eur. J. Clin. Nutr. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Supplementation with vitamins and omega-3 PUFAs had positive effects on some behavioral presentations of subjects with ASD with small effect size.

    “Recently, a meta-analysis revealed that supplementation with vitamins and omega-3 PUFAs had positive effects on some behavioral presentations of subjects with ASD with small effects size [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Fraguas, 2019, Dietary Interventions for Autism Spectrum Disorder: A Meta-analysis, Pediatrics source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Two meta-analyses on omega-3 PUFA supplementation in ASD gained discordant results, so more studies are needed to elucidate efficacy.

    “Two meta-analyses gained discordant results, thus more studies are needed to elucidate their efficacy [59].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Bozzatello, P., Rocca, P., Mantelli, E., and Bellino, S. (2019). Polyunsaturated Fatty Acids: What is Their Role in Treatment of Psychiatric Disorders?. Int. J. Mol. Sci., 20. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Frequent vitamin D use was reported in individuals with ASD.

    “Frequent vitamin D was reported in individuals with ASD [51].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] Trudeau, M.S., Madden, R.F., Parnell, J.A., Gibbard, W.B., and Shearer, J. (2019). Dietary and Supplement-Based Complementary and Alternative Medicine Use in Pediatric Autism Spectrum Disorder. Nutrients, 11. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individuals with ASD are more frequently affected by food allergies and intolerances, requiring diet as a treatment method for their medical condition.

    “There is evidence that individuals with ASD are more frequently affected by food allergies and intolerances, requiring diet as a treatment method of their medical condition [22].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Xu, 2018, Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children, JAMA Netw. Open source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Omega-3 PUFAs play a role in neurodevelopment, and supplementation with omega-3 PUFAs exhibited positive effects on some core symptoms of ASD.

    “There is evidence that omega-3 PUFAs play role in neurodevelopment, and supplementation with omega-3 PUFAs exhibited positive effects on some core symptoms of ASD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Bozzatello, P., Rocca, P., Mantelli, E., and Bellino, S. (2019). Polyunsaturated Fatty Acids: What is Their Role in Treatment of Psychiatric Disorders?. Int. J. Mol. Sci., 20. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    One explanation for the correlation between supplement use and being on a diet may be that parents attempted to substitute potential nutritional deficits resulting from lower variety of diet.

    “One explanation may be that the parents attempted to substitute potential nutritional deficits resulting from lower variety of diet.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The most frequently used forms of supplements are vitamins and minerals in a variety of combinations, also in the ASD population.

    “Evidence shows that the most frequently used forms of supplements are vitamins and minerals in a variety of combinations; also in the ASD population [47,51,57].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [47] Stewart, 2015, Dietary Supplementation in Children with Autism Spectrum Disorders: Common, Insufficient, and Excessive, J. Acad. Nutr. Diet. source

      Not checked in the free run.

    • cites [51] Trudeau, M.S., Madden, R.F., Parnell, J.A., Gibbard, W.B., and Shearer, J. (2019). Dietary and Supplement-Based Complementary and Alternative Medicine Use in Pediatric Autism Spectrum Disorder. Nutrients, 11. source

      Not checked in the free run.

    • cites [57] Kang, 2016, The nutrition contribution of dietary supplements on total nutrient intake in children and adolescents, Eur. J. Clin. Nutr. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    GFCF diet is the most used dietary intervention in ASD.

    “Implementation of a GFCF (gluten-free/casein-free) diet is the most used dietary intervention in ASD [23,52].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [23] Monteiro, 2020, Autism spectrum disorder: A systematic review about nutritional interventions, Rev. Paul. Pediatr. source

      Not checked in the free run.

    • cites [52] Zazpe, 2016, Nutritional Impact of a Gluten-Free Casein-Free Diet in Children with Autism Spectrum Disorder, J. Autism Dev. Disord. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Evidence for ketogenic diet in ASD is promising but data are still limited and insufficient to encourage KD as a treatment for ASD.

    “Although the evidence is promising, data are still limited, and insufficient to encourage KD as a treatment for ASD [54].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Castro, 2015, Effect of a ketogenic diet on autism spectrum disorder: A systematic review, Res. Autism Spectr. Disord. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Probiotic administration is a promising intervention for behavioral symptoms and GI dysfunction, but clinical studies are still limited and inconclusive.

    “The administration of probiotics, especially in the context of the “gut–brain-axis”, is a promising intervention for behavioral symptoms, at the same time for GI dysfunction, but clinical studies are still limited and inconclusive [38].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Fattorusso, A., Di Genova, L., Dell’Isola, G., Mencaroni, E., and Esposito, S. (2019). Autism Spectrum Disorders and the Gut Microbiota. Nutrients, 11. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    GI dysfunction, feeding problems, or imbalanced diet may result in inadequate nutrient intakes in children with ASD and subsequent nutrition-related health consequences.

    “There is evidence that GI dysfunction, feeding problems, or imbalanced diet may result in inadequate nutrient intakes in children with ASD, and subsequent nutrition related health consequences [15,44].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Leader, 2020, Feeding Problems, Gastrointestinal Symptoms, Challenging Behavior and Sensory Issues in Children and Adolescents with Autism Spectrum Disorder, J. Autism Dev. Disord. source

      Not checked in the free run.

    • cites [44] Zazpe, 2014, Food Selectivity in Autism Spectrum Disorders: A Systematic Review, J. Child Neurol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An increasing trend in food supplement use among children and adolescents has been observed.

    “Generally, an increasing trend in food supplement use among children and adolescents has been observed [57], that are given mainly to prevent or treat illnesses [58].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Kang, 2016, The nutrition contribution of dietary supplements on total nutrient intake in children and adolescents, Eur. J. Clin. Nutr. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Food supplements are given mainly to prevent or treat illnesses.

    “Generally, an increasing trend in food supplement use among children and adolescents has been observed [57], that are given mainly to prevent or treat illnesses [58].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Dwyer, 2013, Prevalence and predictors of children’s dietary supplement use: The 2007 National Health Interview Survey, Am. J. Clin. Nutr. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    Control subjects were not screened for ASD symptoms, and absence of the disorder was based only on parental report.

    “Additionally, the subjects in the control sample were not screened for symptoms of ASD, and absence of the disorder was based only on a parental report.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is scientific evidence about the efficiency of behavioral interventions such as ABA.

    “At present time, no causal therapy for ASD core symptoms is known, however, there is scientific evidence about efficiency of behavioral interventions, such as ABA [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Hyman, 2020, Council On Children with Disabilities, Section On Developmental And Behavioral Pediatrics Identification, Evaluation, and Management of Children With Autism Spectrum Disorder, Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    The sample was not randomly selected and included all volunteers who met criteria.

    “The sample was not randomly selected, and it included all volunteers who met the criteria, thus, the results may be biased by the sample selection.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    No causal therapy for ASD core symptoms is known at present.

    “At present time, no causal therapy for ASD core symptoms is known, however, there is scientific evidence about efficiency of behavioral interventions, such as ABA [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Hyman, 2020, Council On Children with Disabilities, Section On Developmental And Behavioral Pediatrics Identification, Evaluation, and Management of Children With Autism Spectrum Disorder, Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    The study had a well-defined sample of children carefully diagnosed for ASD with gold standard methods, a large number of participants, and inclusion of multiple markers in the analysis.

    “The strength of the study is the well-defined sample of children carefully diagnosed for the presence of ASD with golden standard methods, the number of participants, and inclusion of multiple markers into the analysis.”
    Quote in the paperSubstantial claim
59 of 59

  • The paper relies on this without support.

    There is limited information about associations of GI and feeding problems with dietary interventions and supplement use.

    “There is limited information about associations of GI and feeding problems with dietary interventions and supplement use.”

  • The paper relies on this without support.

    The self-reported questionnaires designed for the study accurately measure GI problems, mealtime behavior, and dietary interventions.

    “Data concerning GI problems, mealtime behavior, and dietary interventions were collected by self-reported questionnaires, designed for the purpose of the study.”

  • The paper relies on this without support.

    Parental reports accurately identify absence of ASD symptoms or diagnosis of a neurodevelopmental disorder in the control group.

    “Absence of ASD symptoms or diagnosis of a neurodevelopmental disorder was based on parents’ reports.”

  • The authors state this as an assumption.

    The interaction between gender and GI problems was not specified a priori, and interaction terms adversely affect parsimony of the model and may lead to problems associated with sample size.

    “Assuming that the interaction was not specified a priori, and that interaction terms adversely affect parsimony of the model and may lead to problems associated with sample size, we consider this finding as preliminary.”

  • The paper relies on this without support.

    Food supplements are commonly given without previous assessment of nutritional status.

    “Still, food supplements are commonly given without previous assessment of nutritional status.”

  • The paper relies on this without support.

    This is the first study that evaluated GI symptoms and feeding problems in Slovak children and adolescents.

    “This is the first study that evaluated GI symptoms, feeding problems in Slovak children and adolescents.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Food selectivity and mealtime problems are common issues in preschoolers, school-age children, and adolescents with ASD, and they are associated with a higher frequency of gastrointestinal symptoms.

    “A recent study demonstrates that food selectivity and mealtime problems are common issues in preschoolers, school-age children, and adolescents with ASD, and they are associated with a higher frequency of gastrointestinal (GI) symptoms [49,50].”

    From Dietary Patterns, Eating Behavior, and Nutrient Intakes of Spanish Preschool Children with Autism Spectrum Disorders (2021) · cites this paper as [49]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Two different prevalences of GI symptoms in the ASD group

    Minor

    The abstract reports 88.9%, whereas the Results section reports 88.7% for GI symptoms in the ASD group.

  • One in 54 is not 1.7%

    Minor

    One in 54 corresponds to approximately 1.85%, which rounds to 1.9% at the reported precision, not 1.7%.

    Reported 1.7 · recomputed 1.851852

  • Reported prevalence in girls is incompatible with the sample composition

    Minor

    With 247 participants and 86.6% boys, the sample has 214 boys and 33 girls. Among at most 33 girls, a non-100% prevalence cannot round to 97.1%: 32 of 33 is 97.0%, while 33 of 34 would require more girls than the sample contains.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Babinska, 2016, Association of conduct problems and gastrointestinal symptoms in individuals with autism spectrum disorders, Act. Nerv. Super. Rediviva, 58, 69
  2. Lord, C., Rutter, M., DiLavore, P.C., Risi, S., Gotham, K., and Bishop, S. (2012). Autism Diagnostic Observation Schedule, Springer. [2nd ed.].
  3. Sturmey, P. (2020). Chapter 7—Pediatric feeding disorders. Functional Analysis in Clinical Treatment, Academic Press. [2nd ed.]. Practical Resources for the Mental Health Professional.

Cited by

Sorted by citations

Related

Authors
Babinska, K., Celusakova, H., Belica, I., Szapuova, Z., Waczulikova, I., Nemcsicsova, D., Tomova, A., & Ostatnikova, D.
Affiliations
  • Academic Research Centre for Autism, Institute of Physiology, Faculty of Medicine in Bratislava, Comenius University, 813 72 Bratislava, Slovakia
  • Comenius University Bratislava (SK)
  • Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics and Informatics, Comenius University, 842 48 Bratislava, Slovakia
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2020-09-01
Volume
17
Issue
17
Pages
6372
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph17176372
PMC
PMC7503400
OpenAlex
W3082387459
Semantic Scholar
e0d0914d63818ae464ed5f59a806ce6471f34f6e
Cited by
74
References
63
Citations by year
2026: 11 · 2025: 16 · 2024: 9 · 2023: 9 · 2022: 18 · 2021: 11
FWCI
6.92
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • Agentúra na Podporu Výskumu a Vývoja (APVV 15-0085, APVV 15-0045)
  • Vedecká Grantová Agentúra MŠVVaŠ SR a SAV (VEGA 1/0286/18)
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, gastrointestinal symptoms, picky eating, feeding difficulties, dietary intervention, dietary supplements, gluten-free diet, dairy-free diet, probiotics, omega-3 fatty acids, behavioral characteristics, children and adolescents
MeSH terms
Autism Spectrum Disorder, Adolescent, Feeding and Eating Disorders, Child, Child, Preschool, Diet, Female, Food Preferences, Gastrointestinal Diseases, Humans, Male, Dietary Supplements

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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