Children with autism spectrum disorder frequently demonstrate atypical eating behaviors, including food refusal, restricted food preferences, prolonged mealtimes, and strong sensory responses to food characteristics. These behaviors may reduce dietary variety and increase the risk of insufficient intake of essential micronutrients. Iron, vitamin D, vitamin B12, folate, zinc, calcium, and other nutrients are important for normal neurological development, neurotransmitter synthesis, energy metabolism, immune function, and cognitive performance. Nutritional deficiencies during childhood may potentially aggravate existing difficulties in attention, learning, emotional regulation, sleep, and behavior. At the same time, cognitive and behavioral manifestations in children with ASD are multifactorial and cannot be attributed to nutritional deficiencies alone. Therefore, identifying the relationship between selective eating patterns and nutritional status is important for comprehensive pediatric assessment and individualized intervention.
To assess the association between food selectivity and micronutrient deficiencies in children with autism spectrum disorder and to evaluate their potential relationship with cognitive, emotional, and behavioral manifestations.
The assessment may include children diagnosed with ASD according to established diagnostic criteria. Dietary selectivity can be evaluated using a structured nutritional history, food-frequency assessment, and documentation of accepted and rejected food groups, sensory food preferences, meal duration, and frequency of food refusal. Anthropometric measurements, including body weight, height, and body mass index, should be recorded. Laboratory assessment may include complete blood count, serum ferritin and iron parameters, 25-hydroxyvitamin D, vitamin B12, folate, zinc, and other clinically indicated micronutrient markers. Cognitive and behavioral characteristics can be evaluated using standardized developmental, behavioral, and neuropsychological instruments appropriate for the child's age and developmental level. Attention, sleep quality, irritability, repetitive behaviors, emotional regulation, adaptive functioning, and learning difficulties may be assessed. Potential confounding factors such as age, sex, medication use, gastrointestinal symptoms, socioeconomic status, physical activity, and overall dietary intake should also be considered.
Children with pronounced food selectivity may have a greater risk of inadequate intake of several essential micronutrients because of the exclusion of nutritionally important food groups. The most clinically relevant nutritional concerns may include inadequate iron, vitamin D, vitamin B12, folate, zinc, and calcium intake, although the specific deficiencies vary between individual children. Nutritional inadequacy may coexist with manifestations such as fatigue, reduced attention, irritability, sleep disturbances, decreased learning efficiency, and difficulties with emotional and behavioral regulation. However, these manifestations are not specific to micronutrient deficiency and may also reflect the underlying neurodevelopmental characteristics of ASD. The relationship between nutritional status and behavioral symptoms should therefore be interpreted within a comprehensive clinical context. Identification of highly restricted diets may serve as an important indicator for targeted nutritional screening.
Food selectivity is an important nutritional concern in children with autism spectrum disorder and may increase the risk of inadequate micronutrient intake. Deficiencies of iron, vitamin D, vitamin B12, folate, zinc, and calcium may potentially contribute to fatigue, attention difficulties, sleep problems, and impaired cognitive or behavioral regulation, although a direct causal relationship cannot be assumed in every child. Nutritional assessment should therefore form part of comprehensive clinical care for children with significant dietary restriction. Early identification of nutritional deficiencies, individualized dietary intervention, appropriate supplementation when laboratory-confirmed deficiency is present, and multidisciplinary cooperation between pediatricians, nutrition specialists, developmental clinicians, and families may help improve overall health and functioning.
1. Sharp WG, Berry RC, McCracken C, et al. Feeding problems and nutrient intake in children with autism spectrum disorders: a meta-analysis and comprehensive review of the literature. Journal of Autism and Developmental Disorders. 2013;43:2159–2173.
2. Bandini LG, Anderson SE, Curtin C, et al. Food selectivity in children with autism spectrum disorders and typically developing children. Journal of Pediatrics. 2010;157(2):259–264.
3. Marí-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-González A, Morales-Suárez-Varela M. Food selectivity in autism spectrum disorders: a systematic review. Journal of Child Neurology. 2014;29(11):1554–1561.
4. Hyman SL, Levy SE, Myers SM. Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics. 2020;145(1).
5. Esposito K, et al. Nutritional and feeding problems in children with autism spectrum disorder. Nutrients.
6. Zimmer MH, Hart LC, Manning-Courtney P, et al. Food variety as a predictor of nutritional status among children with autism. Journal of Autism and Developmental Disorders. 2012;42:549–556.
7. Adams JB, Audhya T, McDonough-Means S, et al. Nutritional and metabolic status of children with autism vs. neurotypical children. Journal of Applied Nutrition. 2011;13(1):1–45.
8. Fattal-Valevski A, et al. Nutritional deficiencies and their potential neurological consequences in children.
9. National Institutes of Health, Office of Dietary Supplements. Vitamin and mineral fact sheets for health professionals.
10. Med1.uz. Nutrition, micronutrient deficiencies and child health. Medical information resource. https://med1.uz/