Unlocking the Link: Exploring the Association Between Food Selectivity and Health Outcome in Autism Spectrum Disorder-A Systematic Review.

Context: Individuals with autism spectrum disorder (ASD) often face behavioral challenges during meals, such as food refusal and restricted food consumption, which encompass the concept of food selectivity (FS). The exclusion of food groups such as fruits and vegetables and preferences toward ultraprocessed foods, therefore, can expose this population to an increased risk of developing different types of malnutrition, such as overweight, obesity, and micronutrient deficiencies.

Objective: The aim of this systematic review was to assess if FS is a risk factor for poor health outcomes in individuals with ASD, based on findings in the literature published between 2012 and 2023.

Data sources: Four databases (PubMed, Embase, Scopus, and Cochrane) were searched for relevant articles. The search was conducted in May 2023.

Data extraction: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A checklist was used for data extraction, including descriptive information, study design, study aim, participant information, data collection characteristics, and significant findings. A total of 15 articles were included.

Data synthesis: Individuals with ASD and with FS appear to have inadequate weight (particularly conditions of overweight and obesity), increased waist circumference, elevated waist-to-height ratio index, and insufficient nutritional intake, all of which increase their susceptibility to malnutrition.

Conclusions: Food selectivity, common in this population, increases the risk of micronutrient deficiencies, gastrointestinal issues, eating disorders, hypertriglyceridemia, overweight, and obesity. However, outcomes vary due to differences in assessment tools and definitions of FS across studies. The lack of standardized methods for evaluating FS complicates the ability to draw consistent conclusions, emphasizing the need for ASD-specific validated tools. Future research should focus on standardizing assessments and exploring long-term health effects and interventions.

Systematic review registration: PROSPERO registration No. CRD42023435018.