Feeding problems are frequently associated with autism spectrum disorders (ASD), yet there has been no systematic integration of empirical studies focusing on eating behaviors and related nutritional concerns in ASD.
Our goal was to compare the level of feeding problems and nutrient intake in children with ASD to peers.
We conducted a systematic review and meta-analysis in accordance with guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched MedLine, PsychINFO, and PubMed databases (January 1980 and June 2011), reviewed reference lists, and conducted ancestral and online first searches in English language journals for eligible studies. The search yielded 17 empirical studies involving a comparison group. Two researchers independently coded all extracted information using a standardized protocol and agreement between coders was high. We calculated effect sizes and associated 95% confidence intervals using a random-effects model and conducted heterogeneity tests, assessment of bias, and sensitivity analyses.
Children with ASD experienced significantly more feeding problems, characterized by food selectivity, food refusal, and behavioral rigidity during meals, when compared with typically developing peers, siblings, or children with other developmental concerns. The effect size for feeding problems between children with ASD and the combined comparison group was .89 (.087), 95% CI: .72 - 1.06. Nutrient analysis also indicated significantly lower intake of calcium (0.65 [.28]; 95% CI: -1.21 to -0.09) and protein (-.58 [.25]; 95% CI: -1.07 to -0.09) in children with ASD. The groups had similar levels of Vitamins A, C, D, & E, Zinc, Iron, Fiber, Energy, Total fat, and Carbohydrates.
This meta-analysis supports the historical association between ASD and feeding problems, while also highlighting lower intake of calcium and protein compared with peers. Future research can expand on these findings through more detailed ASD diagnostic screening, increased uniformity in the assessment of feeding problems, and exploration of potential moderators, including ASD severity and parent imposed dietary restrictions.
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