Advertisement

Dietary Intake, Nutrient Status, and Growth Parameters in Children with Autism Spectrum Disorder and Severe Food Selectivity: An Electronic Medical Record Review

      Abstract

      Background

      Food selectivity is common in children with autism spectrum disorder (ASD). The clinical characteristics, however, of severe food selectivity in children with ASD is not well documented.

      Objective

      This study examined the demographic characteristics, anthropometric parameters, risk of nutritional inadequacy, dietary variety, and problematic mealtime behaviors in a sample of children with ASD with severe food selectivity.

      Design

      The study involved a cross-sectional electronic medical record review. Data extraction followed a systematic protocol for data extraction.

      Participants/setting

      Children (age 2 to 17 years) with ASD, severe food selectivity, and complete nutritional data who received a multidisciplinary evaluation at a specialty feeding clinic in the southeastern United States between January 2014 and January 2016. Criteria for severe food selectivity used in this clinical practice required complete omission of one or more food groups (eg, fruit, vegetable, protein, grain, dairy) or consuming a narrow range of items on a weekly basis (eg, five or fewer total food items).

      Main outcome measures

      Analyses examined demographic characteristics, dietary preferences, risk for nutritional inadequacies, anthropometric parameters, and problematic mealtime behaviors.

      Results

      Of the 279 patients evaluated during the 24-month period, 70 children with ASD and severe food selectivity met inclusion criteria. Caregivers reported 67% of the sample (n=47) omitted vegetables and 27% omitted fruits (n=19). Seventy-eight percent consumed a diet at risk for five or more inadequacies. Risk for specific inadequacies included vitamin D (97% of the sample), fiber (91%) vitamin E (83%), and calcium (71%). Children with five or more nutritional inadequacies (n=55) were more likely to make negative statements during meals (P<0.05). Severe food selectivity was not associated with compromised growth or obesity.

      Conclusion

      Children with ASD and severe food selectivity may be at increased risk for nutritional inadequacies. Future research should examine causes, consequences, and remediation of severe food selectivity in this population.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Curtin C.
        • Hubbard K.
        • Anderson S.E.
        • Mick E.
        • Must A.
        • Bandini L.G.
        Food selectivity, mealtime behavior problems, spousal stress, and family food choices in children with and without autism spectrum disorder.
        J Autism Dev Disord. 2015; 45: 3308-3315
        • Suarez M.A.
        • Atchison B.J.
        • Lagerwey M.
        Phenomenological examination of the mealtime experience for mothers of children with autism and food selectivity.
        Am J Occup Ther. 2014; 68: 102-107
        • Sharp W.G.
        • Berry R.C.
        • McCracken C.
        • et al.
        Feeding problems and nutrient intake in children with autism spectrum disorders: A meta-analysis and comprehensive review of the literature.
        J Autism Dev Disord. 2013; 43: 2159-2173
        • Bandini L.G.
        • Anderson S.E.
        • Curtin C.
        • et al.
        Food selectivity in children with autism spectrum disorders and typically developing children.
        J Pediatr. 2010; 157: 259-264
        • Berry R.C.
        • Novak P.
        • Withrow N.
        • et al.
        Nutrition management of gastrointestinal symptoms in children with autism spectrum disorder: guideline from an expert panel.
        J Acad Nutr Diet. 2015; 115: 1919-1927
        • Schmitt L.
        • Heiss C.J.
        • Campdell E.
        A comparison of nutrient intake and eating behaviors of boys with and without autism.
        Top Clin Nutr. 2008; 23: 23-31
        • Martins Y.
        • Young R.L.
        • Robson D.C.
        Feeding and eating behaviors in children with autism and typically developing children.
        J Autism Dev Disord. 2008; 38: 1878-1887
        • Emond A.
        • Emmett P.
        • Steer C.
        • Golding J.
        Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders.
        Pediatrics. 2010; 126: 337-342
        • Hubbard K.L.
        • Anderson S.E.
        • Curtin C.
        • Must A.
        • Bandini L.G.
        A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children.
        J Acad Nutr Diet. 2014; 114: 1981-1987
        • Marquenie K.
        • Rodger S.
        • Mangohig K.
        • Cronin A.
        Dinnertime and bedtime routines and rituals in families with a young child with an autism spectrum disorder.
        Aust Occup Ther J. 2011; 58: 145-154
        • Melhi P.
        • Venkatesh L.
        • Bharti B.
        • Singhi P.
        Feeding problems and nutrient intake in children with and without autism: A comparative study.
        Indian J Pediatr. 2017; 84: 283-288
        • Meguld N.A.
        • Anwar M.
        • Bjorklund G.
        • et al.
        Dietary adequacy of Egyptian children with autism spectrum disorder compared to healthy developing children.
        Melab Brian Dis. 2017; 32: 607-615
        • Mari-Bauset S.
        • Llopis-Gonzalez A.
        • Zazpe I.
        • Mari-Sanchis A.
        • Morale Suarez-Valera M.
        Comparison of nutritional status between children with autism spectrum disorder and typically developing children in the Mediterranean Region (Valencia, Spain).
        Autism. 2017; 21: 310-322
        • Ma N.S.
        • Thompson C.
        • Weston S.
        Brief report: Scurvy as a manifestation of food selectivity in children with autism.
        J Autism Dev Disord. 2016; 46: 1464-1470
        • Stewart C.
        • Latif A.
        Symptomatic nutritional rickets in a teenager with autistic spectrum disorder.
        Child Care Health Dev. 2008; 34: 276-278
        • McAlbee G.N.
        • Prieto D.M.
        • Kirby J.
        • Santilli A.M.
        • Setty R.
        Permanent visual loss dye to dietary vitamin A deficiency in an autistic adolescent.
        J Child Neurol. 2009; 24: 1288-1289
        • Latif A.
        • Heinz P.
        • Cook R.
        Iron deficiency in autism and Asperger syndrome.
        Autism. 2002; 6: 103-114
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        5th ed. American Psychiatric Publishing, Washington, DC2013
        • Hediger M.
        • England L.G.
        • Molloy C.A.
        • Yu K.F.
        • Manning-Courtney P.
        • Mills J.
        Reduced bone cortical thickness in boys with autism or autism spectrum disorder.
        J Autism Dev Disord. 2008; 38: 848-856
        • Neumeyer A.M.
        • O’Rourke J.A.
        • Massa A.
        • Lee H.
        • Lawson E.A.
        • McDougle C.J.
        • Misra M.
        Brief report: bone fractures in children and adults with autism spectrum disorders.
        J Autism Dev Disord. 2015; 45: 881-887
        • Ekhlaspour L.
        • Baskaran C.
        • Campoverde K.J.
        • Sokoloff N.C.
        • Neumeyer A.M.
        • Misra M.
        Bone density in adolescents and young adults with autism spectrum disorders.
        J Autism Dev Disord. 2016; 46: 3387-3391
        • Zimmer M.H.
        • Hart L.C.
        • Manning-Courtney P.
        • Murray D.S.
        • Bing N.M.
        • Summer S.
        Food variety as a predictor of nutritional status among children with autism.
        J Autism Dev Disord. 2012; 42: 549-556
        • Sharp W.G.
        • Postorino V.
        Food selectivity in autism spectrum disorder.
        in: Anderson L.K. Murray S.B. Kaye W.H. Clinical Handbook of Atypical and Complex Eating Disorders. Oxford University Press, New York, NY2017
      1. ICD-9-CM Diagnosis Codes—International Classification of Diseases—Medical Diagnosis Codes. www.findacode.com.

      2. Medicode. ICD-9-CM: International Classification of Diseases, 9th Revision, Clinical Modification. Medicode, Salt Lake City, UT1996
        • Sharp W.G.
        • Volkert V.M.
        • Scahill L.
        • McCracken C.E.
        • McElhanon B.
        A systematic review and meta-analysis of intensive multidisciplinary intervention for pediatric feeding disorders: How standard is the standard of care?.
        J Pediatr. 2017; 181: 116-124.e4
      3. Centers for Disease Control and Prevention (CDC). CDC clinical growth charts: United States. http://www.cdc.gov/growthcharts/. Accessed July 24, 2017.

      4. ESHA Research. Food Processor SQL nutrition and fitness software. Version 10.14x. 2014. http://www.esha.com. Accessed July 15, 2017.

        • Institute of Medicine
        DRI, Dietary Reference Intakes: The Essential Guide to Nutrient Requirements.
        National Academies Press, Washington, DC2006
      5. SAS. Version 9.4. Cary, NC: SAS Institute; 2012.

      6. Centers for Disease Control and Prevention (CDC). Defining childhood obesity. http://www.cdc.gov/obesity/childhood/defining.html. Accessed July 24, 2009.

        • Ledford R.J.
        • Gast D.L.
        Feeding problems in children with autism spectrum disorders: A review.
        Focus Autism Other Dev Disabl. 2006; 21: 153-166
        • Bandini L.G.
        • Curtin C.
        • Phillips S.
        • Anderson S.E.
        • Maslin M.
        • Must A.
        Changes in food selectivity in children with autism spectrum disorder.
        J Autism Dev Disord. 2017; 47: 439-446
        • de Vinck-Baroody O.
        • Shui A.
        • Macklin E.A.
        • Hyman S.L.
        • Leventhal J.M.
        • Weitzman C.
        Overweight and obesity in a sample of children with autism spectrum disorder.
        Acad Pediatr. 2015; 15: 396-404
        • Criado K.K.
        • Sharp W.G.
        • McCracken C.E.
        • et al.
        Overweight and obese status in children with autism spectrum disorder and disruptive behavior.
        Autism. 2017; 1 (1362361316683888)
        • Johnson C.R.
        • Handon B.L.
        • Mayer-Costa M.
        • Sacco K.
        Eating habits and dietary status on young children with autism.
        J Autism Dev Disord. 2008; 20: 437-448
        • Schoeller D.A.
        Limitations in the assessment of dietary energy intake by self-report.
        Metabolism. 1995; 44: 18-22
        • Stumbo P.
        Considerations for selecting a dietary assessment system.
        J Food Compost Anal. 2008; 21: S13-S19
        • Hyman S.L.
        • Stewart P.A.
        • Schmidt B.
        • et al.
        Nutrient intake from food in children with autism.
        Pediatrics. 2012; 130: S145-S153

      Biography

      W. G. Sharp is director, Pediatric Feeding Disorders Program, Marcus Autism Center, Atlanta, GA, and associate professor, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.

      Biography

      V. Postorino is postdoctoral fellow, Emory University School of Medicine, Atlanta, GA, and Marcus Autism Center, Atlanta, GA.

      Biography

      C. E. McCracken is director, Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.

      Biography

      R. C. Berry is lead nutritionist, Pediatric Feeding Disorders Program, Marcus Autism Center, Atlanta, GA.

      Biography

      K. K. Criado is a psychologist, Pediatric Feeding Disorders Program, Marcus Autism Center, Atlanta, GA, and assistant professor, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.

      Biography

      T. L. Burrell is a psychologist, Pediatric Feeding Disorders Program, Marcus Autism Center, Atlanta, GA, and assistant professor, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.

      Biography

      L. Scahill is director, Clinical Trials, Marcus Autism Center and professor, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.