Food Selectivity and Nutritional Deficits in Children with Autism Spectrum Disorder: Electronic Medical Record Review

Background: Children with Autism Spectrum Disorder (ASD) may exhibit a range of behavioral problems, including aggression, disruptive behavior, abnormal sleep patterns, toileting issues, and feeding problems. Food selectivity by type (i.e., eating only a narrow variety of foods) is a well-documented feeding concern in ASD, often involving strong preferences for starches and snack foods coinciding with a bias against fruits and vegetables. Children with food selectivity by type are at increased risk of nutritional deficiencies. Food selectivity by type falls under the diagnosis of Avoidant/Restrictive Food Intake Disorder (ARFID; APA, 2013), which requires failure to meet nutrition and/or energy needs. To date, however, research on food selectivity by type and associated health consequences is limited.

Objectives: This study describes food selectivity by type and nutritional deficiency in sample of patients with ASD referred for an interdisciplinary evaluation to the Pediatric Feeding Disorders Program at the Marcus Autism Center.

Methods: Electronic medical records of all patients referred for an interdisciplinary evaluation between January 2015 and January 2016 were reviewed. The electronic medical record review included: sex, age, diagnosis, chief complaint, anthropometric parameters, disruptive behaviors during meal time, and dietary status.

Results:  A total of 163 children (age range 2.78 to 17.55 years) were referred for evaluation. Of these, 54 (33.1%) patients had a diagnosis of ASD and food selectivity by type and, thus, met inclusion criteria. All children exhibited disruptive behaviors during mealtime. 9.3% of children were underweight; 24.1% were overweight or obese. Detailed data on dietary intake were available for 33 patients; 24 of these children were deficient in 5 or more nutrients. Poor dietary intake of the following micronutrients was observed: vitamin A, vitamin B12, vitamin C, vitamin D, vitamin E, folic acid, calcium, iron, and zinc (Table 1).

Conclusions: These results suggest that in children with ASD and food selectivity by type are not consuming a diet adequate in vitamins and minerals. Children with ASD and food selectivity by type may require nutritional monitoring to prevent nutritional deficiencies. Further examination of the nutritional deficiencies in ASD associated with food selectivity by type, and associated health consequences, could contribute to the development of nutritional guidelines for clinicians and parents facing the challenges of food selectivity by type in children with ASD.