Investigating the topic of food restricting and avoiding in people with autism Original paper

Avoidant/restrictive food intake disorder (ARFID) is defined as a lack of interest in eating related to sensory processing difficulties and sensitivities as well as avoidance of negative consequences, such as gastrointestinal distress. Self-imposed food restriction due to narrow dietary preferences is common in people with autism spectrum disorder (ASD). What are the demographics, health and dietary statuses, and nutrient deficiency diseases observed in the most severe cases of ARFID disorder associated with ASD?

This systematic review of 63 articles included 76 people (ages 2.5–17) and focused on the following objectives:

• Determining the demographics of people with ASD and ARFID
• Evaluating the development of diseases related to nutritional deficiency
• Identifying the most frequently reported dietary preferences

Out of 76 cases, 67 involved boys. Interestingly,the study noted that the first nutritional deficiency disease was reported in a male in 1993, but the first nutritional deficiency disease in a female wasn’t reported until 20 years later, in 2013.

Nearly 23% of the children were underweight, and over 14% were overweight or obese. Most of the children included in this review reported eating 10 foods or fewer. Many of the studies did not report multivitamin/multimineral use, but in those that did, the children either refused or discontinued supplementation.

Scurvy, a vitamin C deficiency, was reported in more than two-thirds of the cases (53 of 76). Eye disorders resulting from lack of vitamin A were the second most common deficiency disease (13 of 76). Vitamin B₁₂ deficiency resulted in 4 cases of vision loss, and 4 cases of vitamin D deficiency led to rickets. Thiamin deficiency was observed in 2 cases (pulmonary hypertension and Wernicke’s encephalopathy).

Children who ate potatoes had a lower risk of developing scurvy, and those who refused dairy were more prone to vitamin D deficiencies. Grains and grain products were popular food items in many of the children’s diets, which may have protected them from many of the B-vitamin deficiencies.

Because children are commonly diagnosed with ASD after they turn 4, early identification of ASD and ARFID in toddlers is critical to avoid nutritional deficiency diseases. An early-intervention, multidisciplinary team of speech/occupational therapists, dietitians, and psychologists may be necessary to increase food diversity in this population.

This review is based on an uncontrolled study design and case reports, which carry an increased risk of bias.