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Cited by 78Child Nutrition and Feeding IssuesGut microbiota and healthAutism Spectrum Disorder Research

Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders

Open access
Valenzuela-Zamora, Angel F., Ramírez-Valenzuela, David G., Ramos-Jiménez, Arnulfo·2022·Nutrients
DOI 10.3390/nu14132660PMC PMC9268444
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Abstract

Food selectivity (FS) in children with autism spectrum disorders (ASD) is common, and its impact on a nutritional level is known. However, the etiology of gastrointestinal disorders (GID) related to alterations in the intestinal microbiota in children with ASD remains unclear. This article provides a narrative review of the literature on FS from the last 15 years, and its relationship with GID in children with ASD. Sensory aversion in ASD leads to food elimination, based on consistencies, preferences, and other sensory issues. The restriction of food groups that modulate the gut microbiota, such as fruits and vegetables, as well as the fibers of some cereals, triggers an intestinal dysbiosis with increased abundance in Enterobacteriaceae, Salmonella Escherichia/Shigella, and Clostridium XIVa, which, together with an aberrant immune response and a leaky gut, may trigger GID. It is observed that FS can be the product of previous GID. GID could provide information to generate a hypothesis of the bidirectional relationship between FS and GID. Emphasis is placed on the need for more studies with methodological rigor in selecting children with ASD, the need for homogeneous criteria in the evaluation of GID, and the adequate classification of FS in children with ASD.

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Written from the paper’s full text.

TL;DR

This narrative review examines food selectivity (FS) in children with autism spectrum disorders (ASD) and its possible relationship with gastrointestinal disorders (GID). It proposes that unbalanced FS alters gut microbiota and may trigger GI symptoms, but concludes the evidence is inconclusive and more rigorous studies are needed.

Key findings

  • Feeding problems are more common in ASD than in neurotypical (NT) children: about 80% vs. 25–35%, with 58–68% of parents/caregivers reporting eating problems; children with ASD are reported to have a 4–5 times higher risk of eating disorders than NT children.
  • Sensory aversion, especially oral sensory over-responsiveness, is described as a leading cause of food neophobia and FS; reported aversions include texture (69%), appearance/color (58%), taste (45%), smell (36%), and temperature (22%).
  • Severe FS is linked to nutritional deficiencies: one study of 279 patients with ASD and severe FS reported at least 67% omitted vegetables and 27% omitted fruits; vitamin D, E, calcium, and fiber deficiencies were reported in >50%, and at least 20 case reports involving 24 children with severe FS (accepting only 5–10 foods) had scurvy.
  • GI symptoms are frequent but prevalence estimates vary widely (9–91%); mean prevalence of any GID in children with ASD is reported as 46.8%, with constipation (22%) and diarrhea (13%) most reported. One study found FS associated with higher GI score (6.63 vs. 3.6, p < 0.05) and greater abundance of Enterobacteriaceae, Salmonella Escherichia/Shigella, and Clostridium XIVa.

Methods

  • Narrative literature review of publications from the last 15 years, searched in PubMed, Google Scholar, and Elsevier, using keywords such as “food selectivity,” “food neophobia,” “autism spectrum disorder,” “gastrointestinal symptoms,” “constipation,” “diarrhea,” and “oral over-responsiveness.”
  • Included clinical trials, case studies, randomized controlled trials, and case series; the review synthesizes studies on eating behavior, sensory sensitivity, FS, GID, and gut microbiota in children with ASD.

Limitations

  • The paper states that more studies are needed with methodological rigor in selecting children with ASD, homogeneous criteria for evaluating GID, and adequate classification of FS in children with ASD; it also states that evidence linking gut microbiota to GID/GIS is not conclusive due to limited studies and heterogeneous methods and participant criteria.
  • The paper repeatedly notes limitations in the reviewed studies, including reliance on subjective parent/caregiver questionnaires, unvalidated FS instruments, small samples, non-random samples, and lack of direct medical or food-intake assessment.
  • Evident from the text: as a narrative review, it does not report a systematic search strategy, formal quality appraisal, or quantitative synthesis, so its conclusions are hypothesis-generating rather than definitive.

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Integrity signals

Registry

Crossref · 10.3390/nu14132660

Cites

91 of 91 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 80 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    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].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] 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.

  • Findingreasoning

    Children with ASD who present some pattern of food selectivity tend to present higher levels of constipation than NT children.

    “It is observed that children with ASD who present some pattern of FS tend to present higher levels of constipation than NT children; this may be explained by the fact that children with ASD who are picky eaters often avoid fruits and vegetables, and eat foods low in dietary fiber; these eating patterns promote constipation, even in NT subjects.”
    Quote in the paperSubstantial claim
  • Findingreasoning

    The prevalence of GID is not established among ASD and NT people, due to its wide observed range between studies (9-91%).

    “The prevalence of GID is not established among ASD and NT people, due to its wide observed range between studies (9–91%) (Table 3).”
    Quote in the paperNot a substantial claim
  • Findingcitation

    Children with ASD who present some GIS also present more behavioral alterations.

    “It is observed that children with ASD who present some GIS also present more behavioral alterations [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Prosperi, 2017, Behavioral Phenotype of ASD Preschoolers with Gastrointestinal Symptoms or Food Selectivity, J. Autism Dev. Disord. source

      Not checked in the free run.

  • Findingcitation

    It is common for subjects with ASD, or their parents and caregivers, to attribute food selectivity to sensory aversions to smell, taste, texture, temperature, color, and appearance, and to the distribution of food.

    “It is common for subjects with ASD, or their parents and caregivers, to attribute FS to sensory aversions to smell (36%), taste (45%), texture (69%), temperature (22%), color, and appearance (58%), and even to the distribution of food.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] Hartman, 2021, Nutritional Rickets Due to Severe Food Selectivity in Autism Spectrum Disorder, J. Dev. Behav. Pediatr. source

      Not checked in the free run.

  • May combine two claims. 36
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Findingcitation

    GID are one of the most frequent problems in children with ASD, with a three-fold increased risk of presenting any GIS, compared to NT children.

    “GID are one of the most frequent problems in children with ASD, with a three-fold increased risk of presenting any GIS, compared to NT children [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Lefter, R., Ciobica, A., Timofte, D., Stanciu, C., and Trifan, A. (2019). A Descriptive Review on the Prevalence of Gastrointestinal Disturbances and Their Multiple Associations in Autism Spectrum Disorder. Medicina, 56. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    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.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] 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.

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

    Findingnone given

    The pathophysiological mechanisms associated with GID in ASD are not fully understood.

    “The pathophysiological mechanisms associated with GID in ASD are not fully understood.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Although it is proposed that FS may be a consequence of GIS, there is no substantial evidence to support this theory.

    “Although it is proposed that FS may be a consequence of GIS, there is no substantial evidence to support this theory.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    IQ differences might impact sensory responses; high-functioning children with ASD show less atypical sensory responses than low-functioning children.

    “In addition, it is observed that IQ differences might impact sensory responses. High-functioning children with ASD show less atypical sensory responses than low-functioning children.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Leekam et al. (2007)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Children with ASD exhibit abnormal or atypical visual, tactile/oral, olfactory, and auditory sensory responses; the entire somatosensory system presents alterations in the generation and processing of information.

    “Children with ASD exhibit abnormal or atypical visual, tactile/oral, olfactory, and auditory sensory responses; the entire somatosensory system that provides information from the environment, and allows its interaction with it, presents alterations in the generation and processing of information [34].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Grabrucker, A.M. (2022, May 25). Atypical Sensory Characteristics in Autism Spectrum Disorders, Autism Spectrum Disorders, Available online: https://www.ncbi.nlm.nih.gov/books/NBK573615/doi:10.36255/exonpublications.autismspectrumdisorders.2021.atypicalsensorycharacteristics. source

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

    Premisecitation

    A meta-analysis by Ben-Sasson et al. (2009) reports a lower prevalence of impaired sensory response in individuals with ASD (45-46%).

    “A meta-analysis by Ben-Sasson et al. (2009) reports a lower prevalence of impaired sensory response in individuals with ASD (45–46%) [33].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ben-Sasson et al. (2009)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The clinical study by Dudova et al. (2011) identifies that children with ASD have a lower olfactory capacity than NT children, indicating a lower sensitivity and food identification in children with ASD.

    “The clinical study by Dudova et al. (2011) identifies that children with ASD have a lower olfactory capacity than NT children, indicating a lower sensitivity and food identification in children with ASD [49].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dudova et al. (2011) source

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  • May combine two claims.

    Premisecitation

    The preferred texture is uniform or crunchy, with neutral colors, hot temperatures, and sweet flavors.

    “The preferred texture is uniform or crunchy, with neutral colors, hot temperatures, and sweet flavors.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Page, 2021, Correlates of Feeding Difficulties Among Children with Autism Spectrum Disorder: A Systematic Review, J. Autism Dev. Disord. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Atypical sensory processing results in an over-response to food stimuli, perhaps leading to increased food rejection and food neophobia.

    “Atypical sensory processing results in an over-response to food stimuli, perhaps leading to increased food rejection and food neophobia.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Their feeding struggles may be due to rituals at mealtime, chewing problems, vomiting, saturating themselves with food in the mouth, keeping food in the mouth for long periods without swallowing, food sensitivity, or neophobia.

    “Their feeding struggles may be due to rituals at mealtime, chewing problems, vomiting, saturating themselves with food in the mouth, keeping food in the mouth for long periods without swallowing, food sensitivity, or neophobia [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Margari, 2020, Eating and Mealtime Behaviors in Patients with Autism Spectrum Disorder: Current Perspectives, Neuropsychiatr. Dis. Treat. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There are various characteristic patterns of ASD, but sensory sensitivity is significantly affected, leading to hyper or hypo-reactivity in these patients.

    “There are various characteristic patterns of ASD, but sensory sensitivity is significantly affected, leading to hyper or hypo-reactivity in these patients [43].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Miller, 2007, Concept Evolution in Sensory Integration: A Proposed Nosology for Diagnosis, Am. J. Occup. Ther. source

      Not checked in the free run.

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

    Premisecitation

    The process of eating is complex and includes integration of various sensory aspects that influence individual acceptance and preference for food or its groups.

    “The process of eating is quite complex, and includes the integration of various sensory aspects that influence individual acceptance and preference for food or its groups [41,42].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [41] Malhi, 2021, Sensory Processing Dysfunction and Mealtime Behavior Problems in Children with Autism, Indian Pediatr. source

      Not checked in the free run.

    • cites [42] Andrianopoulos, 2015, Sensory Differences and Mealtime Behavior in Children with Autism, Am. J. Occup. Ther.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both processes make feeding difficult, and can lead to propitiating alterations in the feeding of children with ASD.

    “Both processes make feeding difficult, and can lead to propitiating alterations in the feeding of children with ASD [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Dudova, 2011, Odor detection threshold, but not odor identification, is impaired in children with autism, Eur. Child Adolesc. Psychiatry source

      Not checked in the free run.

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

    Premisecitation

    FS was included within the phenotypic characteristics of ASD since the primary description by Kanner (1968).

    “FS was included within the phenotypic characteristics of ASD since the primary description by Kanner (1968).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kanner (1968)

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

    Premisecitation

    Currently, no diagnosis for FS exists, but is instead included within ARFID.

    “Currently, no diagnosis for FS exists, but is instead included within avoidant/restrictive food intake disorder (ARFID).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Pan American Medical Editorial. [5th ed.]. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Oral defensiveness turns out to be a great trigger for neophobia and FS; oral over-response causes rejection of food textures.

    “Oral defensiveness turns out to be a great trigger for neophobia and FS; oral over-response causes rejection of food textures.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The high frequency of single food intake is limited to consuming a single food more than 4-5 times a day.

    “However, the high frequency of single food intake is limited to consuming a single food more than 4–5 times a day.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Martins, 2008, Feeding and Eating Behaviors in Children with Autism and Typically Developing Children, J. Autism Dev. Disord. source

      Not checked in the free run.

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

    Premisenone given

    There is no standardized definition for FS.

    “Although FS, eating problems, and rigid eating in children with ASD are highly reported, there is no standardized definition for FS.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The tools to assess oral sensory sensitivity are based on reports from parents and caregivers of children with ASD, and these reports generate a necessary subjectivity that does not allow truthful conclusions to be made.

    “One of the main limitations is that the tools to assess this atypical sensory response are based on reports from parents and caregivers of children with ASD. These reports generate a necessary subjectivity that does not allow truthful conclusions to be made.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Bandini et al. (2010) propose a definition of FS based on the eating patterns of children with ASD, classifying FS into three types: (1) food refusal, (2) limited food repertoire, and (3) high frequency of single food intake.

    “Bandini et al. (2010) propose a definition of FS based on the eating patterns of children with ASD [57]. This definition includes the classification of FS into three types: (1) food refusal, (2) limited food repertoire, and (3) high frequency of single food intake (Table 2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bandini et al. (2010) source

      Not checked in the free run.

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

    Interpretationreasoning

    The severity of FS increases when there is a limited repertoire of foods because there are only single foods consumed for periods of 3 to 5 days.

    “The severity of FS increases when there is a limited repertoire of foods because there are only single foods consumed for periods of 3 to 5 days.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Although visual and olfactory sensory sensitivities are reported to impact eating behaviors in children with ASD, they do not affect them as severely as tactile hypersensitivities, especially atypical oral responses.

    “Although visual and olfactory sensory sensitivities are reported to impact eating behaviors in children with ASD, they do not affect them as severely as tactile hypersensitivities, especially atypical oral responses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The study conducted by Chistol et al. (2018) reports a direct association between oral sensory hypersensitivity with FS, being more common in children with ASD than in NT children.

    “The study conducted by Chistol et al. (2018) reports a direct association between oral sensory hypersensitivity with FS, being more common in children with ASD than in NT children [47].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Chistol et al. (2018) source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Children with ASD are more likely to reject food because of its texture and consistency, due to the atypical oral sensitivity they present, without forgetting smell and taste.

    “Children with ASD are more likely to reject food because of its texture and consistency, due to the atypical oral sensitivity they present, without forgetting smell and taste.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Psychological studies by Bennetto et al. (2007) report a lower detection of sugars, and a greater preference for drinks such as juices.

    “Psychological studies by Bennetto et al. (2007) report a lower detection of sugars, and a greater preference for drinks such as juices [51].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bennetto et al. (2007) source

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

    Premisecitation

    ARFID is not limited to age and duration.

    “This modification was because ARFID is not limited to age and duration [54].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Dovey, 2019, Eating behaviour, behavioural problems and sensory profiles of children with avoidant/restrictive food intake disorder (ARFID), autistic spectrum disorders or picky eating: Same or different?, Eur. Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The refusal of food usually does not represent a risk to the child's health with ASD because there are a certain number of foods that the child will consume.

    “The refusal of food usually does not represent a risk to the child’s health with ASD because there are a certain number of foods that the child will consume.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Inadequate intake in children with ASD with severe food selectivity impacts nutritional status and directly affects GI physiology and intestinal microbiota balance, leading to GI alterations.

    “This inadequate intake impacts the nutritional status of children with ASD, and directly affects GI physiology and intestinal microbiota balance, leading to GI alterations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Children with ASD who are picky eaters often avoid fruits and vegetables and eat foods low in dietary fiber, and these eating patterns promote constipation even in NT subjects.

    “this may be explained by the fact that children with ASD who are picky eaters often avoid fruits and vegetables, and eat foods low in dietary fiber; these eating patterns promote constipation, even in NT subjects.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The evaluation and management of symptoms and GID are relevant in the treatment of ASD, because a close relationship is observed between the progressive worsening of behavior and cognition with the severity of GI symptoms.

    “The evaluation and management of symptoms and GID are relevant in the treatment of ASD, because a close relationship is observed between the progressive worsening of behavior and cognition with the severity of GI symptoms [66].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [66] Harris, 2021, The role of food selectivity in the association between child autistic traits and constipation, Int. J. Eat. Disord. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    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.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [9] 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 [57] Martins, 2008, Feeding and Eating Behaviors in Children with Autism and Typically Developing Children, J. Autism Dev. Disord. source

      Not checked in the free run.

    • cites [64] Leader, 2021, Relationships among gastrointestinal symptoms, sleep problems, challenging behaviour, comorbid psychopathology and autism spectrum disorder symptoms in children and adolescents with 15q duplication syndrome, J. Intellect. Disabil. Res. source

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    • cites [65] Holingue, 2018, Gastrointestinal symptoms in autism spectrum disorder: A review of the literature on ascertainment and prevalence, Autism Res. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    GI symptoms in ASD are not presented in a typical way, and are usually identified by unusual behavioral changes, triggered spontaneously without any environmental stressor.

    “These GI symptoms in ASD are not presented in a typical way, and are usually identified by unusual behavioral changes, triggered spontaneously without any environmental stressor.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    It is difficult to calculate the statistical significance of GID between ASD and NT children, but genetic heterogeneity, phenotypic manifestation, and clinical definition of GIS are just a few reasons.

    “It is difficult to calculate the statistical significance of GID between ASD and NT children, but genetic heterogeneity, phenotypic manifestation, and clinical definition of GIS are just a few reasons [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Lefter, R., Ciobica, A., Timofte, D., Stanciu, C., and Trifan, A. (2019). A Descriptive Review on the Prevalence of Gastrointestinal Disturbances and Their Multiple Associations in Autism Spectrum Disorder. Medicina, 56. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Alterations in the gut microbiota may harm gut health in ASD subjects.

    “As mentioned above, alterations in the gut microbiota may harm gut health in ASD subjects.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Food and eating patterns are central modulators of the intestinal microbiota.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Only a few studies search for physiological or molecular mechanisms associated with FS.

    “Only a few studies search for physiological or molecular mechanisms associated with FS.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Intestinal dysbiosis, permeability defects, inflammatory processes, aberrant immune reactions, and other alterations in the microbiota-gut-brain axis are the main factors currently involved in the pathophysiology of ASD.

    “Intestinal dysbiosis, permeability defects, various inflammatory processes, aberrant immune reactions [5,70], and other alterations in the microbiota–gut–brain axis are the main factors currently involved in the pathophysiology of ASD [71].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [5] Ferguson, 2019, The Relationship Among Gastrointestinal Symptoms, Problem Behaviors, and Internalizing Symptoms in Children and Adolescents with Autism Spectrum Disorder, Front. Psychiatry source

      Not checked in the free run.

    • cites [70] Picardi, 2013, Antibodies against Food Antigens in Patients with Autistic Spectrum Disorders, BioMed Res. Int.

      Not checked in the free run.

    • cites [71] Barbaro, M.R., Cremon, C., Wrona, D., Fuschi, D., Marasco, G., Stanghellini, V., and Barbara, G. (2020). Non-Celiac Gluten Sensitivity in the Context of Functional Gastrointestinal Disorders. Nutrients, 12. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent study identified a significant association between FS and the composition of the fecal microbiota, and between FS and GIS in children with ASD, unlike NT children (6.63 vs. 3.6 points in GI score analysis, p < 0.05).

    “A recent study identifies a significant association between FS and the composition of the fecal microbiota, as well as an association between FS and GIS in children with ASD, unlike NT children (6.63 vs. 3.6 points in GI score analysis, respectively, p < 0.05) [75].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Tomova, 2015, Gastrointestinal microbiota in children with autism in Slovakia, Physiol. Behav. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Children with FS ("picky eaters") present more significant heterogeneity in the intestinal microbiota composition at the phyla level, with greater abundance of Enterobacteriaceae, Salmonella Escherichia/Shigella, and Clostridium XIVa than in children with ASD without FS.

    “They find that children with FS (“picky eaters”) present more significant heterogeneity in the intestinal microbiota composition at the phyla level, where the genera Enterobacteriaceae, Salmonella Escherichia/Shigella, and Clostridium XIVa, are more abundant than in children with ASD without FS.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Tomova, 2015, Gastrointestinal microbiota in children with autism in Slovakia, Physiol. Behav. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    NCWS causes the exacerbation of intestinal and extraintestinal symptoms, which disappear once wheat is eliminated from the diet.

    “NCWS causes the exacerbation of intestinal and extraintestinal symptoms, which disappear once wheat, or the food that contains it, is eliminated from the diet.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] 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.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The relationship between FS and GIS has not yet been fully studied.

    “The relationship between FS and GIS has not yet been fully studied.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    It is common in studies that evaluate the impact of FS on the appearance and severity of GIS in children with ASD to base themselves on subjective questionnaires for the classification of FS and GIS, and therefore their accuracy in the classification of FS, and the correlation with GIS, can be misleading.

    “It is common in studies that evaluate the impact of FS on the appearance and severity of GIS in children with ASD to base themselves on subjective questionnaires for the classification of FS and GIS. Therefore, their accuracy in the classification of FS, and the correlation with GIS, can be misleading.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    This fiber intake in children with ASD is not typical, and is mainly due to an attempt to improve GIS with a high fiber intake, being counterproductive in most cases.

    “This fiber intake in children with ASD is not typical, and is mainly due to an attempt to improve GIS with a high fiber intake, being counterproductive in most cases [5].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Ferguson, 2019, The Relationship Among Gastrointestinal Symptoms, Problem Behaviors, and Internalizing Symptoms in Children and Adolescents with Autism Spectrum Disorder, Front. Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A retrospective case-cohort study partially confirms the proposal that FS in ASD patients may occur because of food rejection, gastroesophageal reflux, chronic constipation, delayed gastro emptying, and functional dyspepsia.

    “A retrospective case–cohort study partially confirms this proposal.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [79] Buie, 2010, Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals with ASDs: A Consensus Report, Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    This study's findings suggest a relationship between food selectivity and GI symptoms in children diagnosed with ASD, but more studies are needed to prove it.

    “This study’s findings suggest a relationship between food selectivity and GI symptoms in children diagnosed with ASD, but more studies are needed to prove it.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    GIS/GID are usually multifactorial, and their etiology is not determined solely by alterations in a group of bacteria in the intestinal microbiota.

    “In addition, GIS/GID are usually multifactorial, and their etiology is not determined solely by alterations in a group of bacteria in the intestinal microbiota.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The evidence continues to be inconsistent.

    “Unfortunately, the evidence continues to be inconsistent.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    This disturbance promotes intestinal dysbiosis that, together with aberrant immune responses, alters gut permeability and favorable phenotypes in the gut microbiota of children with ASD, thereby triggering the appearance of GIS.

    “This disturbance promotes intestinal dysbiosis that, together with aberrant immune responses, alters gut permeability and favorable phenotypes in the gut microbiota of children with ASD, thereby triggering the appearance of GIS.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Food and eating patterns are central modulators of the intestinal microbiota.
    • Rests on an assumption: Subjects with ASD, being selective eaters, affect the homeostasis of their intestinal microbiota.

  • Classified as probably not a substantial claim.

    Premisecitation

    It is proposed that FS in ASD patients may occur because some of them present food rejection, gastroesophageal reflux, chronic constipation, delayed gastro emptying, and functional dyspepsia.

    “On the other hand, it is proposed that FS in ASD patients may occur because some of them present food rejection, gastroesophageal reflux, chronic constipation, delayed gastro emptying, and functional dyspepsia [78].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [78] Ferguson, 2016, Associations between cytokines, endocrine stress response, and gastrointestinal symptoms in autism spectrum disorder, Brain, Behav. Immun. source

      Not checked in the free run.

49 of 49

  • The paper relies on this without support.

    Food and eating patterns are central modulators of the intestinal microbiota.

    “It is known that food and eating patterns are some of the central modulators of the intestinal microbiota”

  • The paper relies on this without support.

    Subjects with ASD, being selective eaters, affect the homeostasis of their intestinal microbiota.

    “and subjects with ASD, being selective eaters, affect the homeostasis of their intestinal microbiota.”

  • The paper relies on this without support.

    Diet has a predominant role in changes in the gut microbiota.

    “due to diet’s predominant role in changes in the gut microbiota.”
3 of 3

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?

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.

  • Babinska table entry cites a different paper

    Minor

    Table 3 attributes its Babinska et al. entry to reference [14], but reference [14] is by Inoue et al.; the Babinska et al. paper appears as reference [15].

  • Table 3 both affirms and denies FS evaluation

    Minor

    The Ferguson et al. 2019 row states that food selectivity was evaluated, but its limitations cell says it was not evaluated.

2 of 2

Cites

Flagged first, then by citations

1 of the 92 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Valenzuela-Zamora, A. F., Ramírez-Valenzuela, D. G., & Ramos-Jiménez, A.
Affiliations
  • Department of Chemical Biological Sciences, Institute of Biomedical Sciences, Autonomous University of Ciudad Juárez, Ciudad Juárez, Chihuahua 32310, Mexico
  • Universidad Autónoma de Ciudad Juárez (MX)
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2022-06-27
Volume
14
Issue
13
Pages
2660
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu14132660
PMC
PMC9268444
OpenAlex
W4283652499
Semantic Scholar
cf5e70105198f36bd6c01ab016bafbfcfb51c1ea
Cited by
78
References
92
Citations by year
2026: 20 · 2025: 26 · 2024: 15 · 2023: 17
FWCI
2.49
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Keywords
picky eating, autism spectrum disorder, gastrointestinal diseases, gut microbiota, dysbiosis, food elimination, dietary restriction, Enterobacteriaceae, Clostridium XIVa, leaky gut, bidirectional relationship, children
MeSH terms
Autism Spectrum Disorder, Gastrointestinal Microbiome, Child, Food Preferences, Gastrointestinal Diseases, Humans, Dysbiosis

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 2026-10-10.

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

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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