Nutritional issues in children with autism spectrum disorder

Nutritional issues in children with autism spectrum disorder

M.E. Lobanov, Yu.V. Chernenkov, O.I. Gumenyuk, A.Kh. Afashagov, I.M. Shmukler, E.K. Pogosyan, A.G. Lutsenko, E.A. Nefedova

V.I. Razumovsky Saratov State Medical University, Saratov, Russian Federation

Background: between 50% and 80% of children with autism spectrum disorder (ASD) exhibit eating behavior disturbances. The majority of research has focused on children with marked food selectivity. Children with ASD without clinically significant eating disturbances remain understudied, although their diet may harbor latent deviations. Ultra-processed foods (UPFs), industrially manufactured products with low nutrient density, warrant particular attention. Their share in children's diets is growing, and their association with metabolic risks has been well documented; however, data on UPF consumption in children with ASD without overt food selectivity are lacking.

Aim: to evaluate dietary patterns and factors associated with diet quality in children with ASD in the absence of marked eating behavior disturbances.

Materials and Methods: the study enrolled 84 children aged 3 to 17 years with a verified diagnosis of ASD without clinically significant eating disturbances, attending a specialized educational institution. Dietary patterns were assessed using three summary nutritional indices calculated from a food frequency questionnaire: the Dietary Diversity Index, the Healthy Eating Index, and the Ultra-Processed Food Index according to the NOVA classification. Data on infant feeding during the first year of life were collected retrospectively through parental questionnaires. Associations between feeding practices, timing of complementary food introduction, and current dietary patterns were analyzed. Spearman's rank correlation analysis, Fisher's exact test, and binary logistic regression were applied.

Results: daily vegetable consumption was documented in only one-third (33.3%) of the children, while fish remained an occasional food item for half of the subjects. Confectionery and processed meat products were regularly present in the diet. High UPF consumption was identified in 19% of the children. A paradoxical positive association was established between dietary diversity and UPF consumption (p=0.009): children with a broader food repertoire were significantly more likely to fall into the high UPF consumption group (odds ratio [OR] 5.82; 95% confidence interval [CI] 1.54–21.99). The principal independent factor for high UPF consumption was the type of beverages consumed (OR 0.08; 95% CI 0.02–0.30; p<0.001): among children who predominantly consumed sweetened and industrially produced beverages, a high level of UPF consumption was observed in the vast majority, whereas among children who predominantly drank water and unsweetened beverages, this was noted in fewer than half. Importantly, the expansion of the food repertoire was not accompanied by an improvement in diet quality: newly accepted foods were frequently ultra-processed. The associations between breastfeeding duration and the presence of allergic reactions with UPF consumption did not reach statistical significance.

Conclusion: the diet of children with ASD without clinically significant eating behavior disturbances is characterized by a systematic deficiency of nutritionally valuable foods (fish, vegetables) coupled with the regular presence of UPFs. Expansion of the food repertoire does not guarantee improvement in diet quality and may occur at the expense of UPFs. The type of beverages consumed serves as an informative marker of overall diet quality and may be utilized for rapid dietary assessment. Thus, the incorporation of targeted nutritional screening into clinical management protocols for children with ASD is warranted, regardless of the absence of complaints regarding eating behavior.

Keywords: autism spectrum disorder, child nutrition, diet quality, ultra-processed foods, dietary diversity, eating behavior, nutritional status, sugar-sweetened beverages, nutritional screening, pediatrics.

For citation: Lobanov M.E., Chernenkov Yu.V., Gumenyuk O.I., Afashagov A.Kh., Shmukler I.M., Pogosyan E.K., Lutsenko A.G., Nefedova E.A. Nutritional issues in children with autism spectrum disorder. Russian Journal of Woman and Child Health. 2026;9(2):182–189 (in Russ.). DOI: 10.32364/2618-8430-2026-9-2-13