Does food selectivity drive differences in dietary resemblance between children with intellectual disabilities and typical development?

Although children's dietary intake often resembles that of their parents', dietary resemblance has not been examined among children with intellectual disabilities (ID), where food selectivity is a common parental concern. We compared dietary resemblance in children with typical development (TD), ID, and ID and co-occurring autism (ID + A) in parent-child dyads, and examined whether child food selectivity mediated between-group differences. Dietary data from parents and their children (3-8 years, male = 61.8%, TD = 52.9%, ID = 18.6%, ID + A = 28.4%) were analyzed as mother-child (n = 100) and father-child (n = 70) dyads. Dietary resemblance was operationalized as the proportion of foods that were reported as eaten/not eaten by both parent and child in parent-completed Food Frequency Questionnaires. Food refusal rate was used to capture food selectivity (total foods children would not eat/total foods offered). Among mother-child dyads, dietary resemblance did not differ between children with ID compared to TD (P = 0.243). Among father-child dyads, dietary resemblance was 10% lower in children with ID than TD (66.4% vs. 74.1%, P = 0.032), and the difference was partially explained (mediated) by food refusal. Among mother-child dyads, dietary resemblance was 19% lower among children with ID + A than TD (61.5% vs. 75.6%, P = 0.001), and the difference was completely explained by food refusal. Among father-child dyads, dietary resemblance was 22% lower among children with ID + A than TD (57.9% vs. 74.1%, P < 0.001), and the difference was completely explained by food refusal. Subanalyses by food groups produced similar results. Compared to TD children, dietary resemblance was lower in children with ID + A, but not children with ID, and differences were explained by food selectivity. Our findings suggest parents of children with ID + A may have less influence over their child's dietary intake than parents of children with ID or TD.

Systematic Reviews on Eating Disorders and Autism Spectrum Disorder Emphasize a Call to Further Expand High-Quality Research.

Two recent systematic reviews provide important insights into the current state of the eating disorder literature regarding autistic traits, ASD prevalence, and experience with accessing treatment, with a specific focus on anorexia nervosa (AN). The extant literature provides converging evidence for elevated autistic traits in individuals with AN, while evidence for increased prevalence of ASD in AN is less robust. Presence of autistic traits or a formal ASD diagnosis both appear to elevate the potential for a more complicated experience during eating disorder treatment. Together, this work provides compelling justification to expand the breadth of inquiry regarding eating disorders and ASD, with a specific call for increased methodological rigor when designing and conducting future research. My commentary calls for specific steps to advance our understanding of ASD and eating disorders.

Altered sex differences related to food intake, hedonic preference, and FosB/deltaFosB expression within central neural circuit involved in homeostatic and hedonic food intake regulation in Shank3B mouse model of autism spectrum disorder.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder accompanied by narrow interests, difficulties in communication and social interaction, and repetitive behavior. In addition, ASD is frequently associated with eating and feeding problems. Although the symptoms of ASD are more likely to be observed in boys, the prevalence of eating disorders is more common in females. The ingestive behavior is regulated by the integrative system of the brain, which involves both homeostatic and hedonic neural circuits. Sex differences in the physiology of food intake depend on sex hormones regulating the expression of the ASD-associated Shank genes. Shank3 mutation leads to ASD-like traits and Shank3B -/- mice have been established as an animal model to study the neurobiology of ASD. Therefore, the long-lasting neuronal activity in the central neural circuit related to the homeostatic and hedonic regulation of food intake was evaluated in both sexes of Shank3B mice, followed by the evaluation of the food intake and preference. In the Shank3B +/+ genotype, well-preserved relationships in the tonic activity within the homeostatic neural network together with the relationships between ingestion and hedonic preference were observed in males but were reduced in females. These interrelations were partially or completely lost in the mice with the Shank3B -/- genotype. A decreased hedonic preference for the sweet taste but increased total food intake was found in the Shank3B -/- mice. In the Shank3B -/- group, there were altered sex differences related to the amount of tonic cell activity in the hedonic and homeostatic neural networks, together with altered sex differences in sweet and sweet-fat solution intake. Furthermore, the Shank3B -/- females exhibited an increased intake and preference for cheese compared to the Shank3B +/+ ones. The obtained data indicate altered functional crosstalk between the central homeostatic and hedonic neural circuits involved in the regulation of food intake in ASD.

Nutrient intake and food selectivity in children with Tourette syndrome.

Objectives: Children with Tourette syndrome (TS) have been shown to exhibit high levels of food selectivity; however, its association with nutritional status has yet to be explored. The current study explored macro and micronutrient intake and food selectivity among children with and without TS, using 24-hour dietary recall and the Child Eating Behaviour Questionnaire.Method: Parents of 43 children diagnosed with TS and 38 age-matched children without a clinical diagnosis completed an online 24-hour food diary.Results: Fifty-eight per cent of children with TS were identified as falling outside of the healthy BMI range (underweight = 24.2%; overweight = 27.3%; obese = 6.1%). Children with TS also consumed fewer portions of fruit and vegetables along with meeting the daily reference nutrient intake guidelines significantly less often for vitamins B3, B6 and C, selenium and phosphorus compared to children without TS.Conclusions: Understanding the nutritional risk of children with TS relative to other children is important to clinicians and health care professionals who oversee nutritional inspection in primary care, and caregivers who are worried about the impact of limited or restricted diets.

Negative Aspects of Dietary Habits in Children and Adolescents with Autism Spectrum Disorders.

BACKGROUND/OBJECTIVES: Diet therapy is a key component of a holistic approach to the physiological and psychological health of children with autism spectrum disorders. A personalized diet, tailored to clinical symptoms, yields positive therapeutic effects. The aim of this study was to assess the intake of specific food groups and the dietary methods used among children and adolescents with autism. METHODS: This study included 141 patients from neuropediatric centers diagnosed with autism spectrum disorders. Inclusion criteria were parental consent for the study, age of the child, and autism diagnosis. The research tool was a custom questionnaire covering patients' demographic data, type of disorder, and a qualitative analysis of the dietary habits of selected products. RESULTS: The predominant dietary models were the basic diet (n = 26; 72.22%) and the elimination diet (n = 9; 25%), with a higher application rate among children with autism spectrum disorders. Aversion to specific foods/products was more prevalent in children with autism (n = 79; 75.24%) compared to those with other neurodevelopmental disorders (n = 10; 27.78%). Snacking between meals was significantly more common among the overall neuropediatric patient group (n = 140; 99.29%), with fruit purees (n = 33; 23.57%) and fruits (n = 28; 20%) being the most frequently consumed snacks. CONCLUSIONS: The qualitative analysis of dietary habits revealed selective food aversions and eating disorders due to a narrow range of frequently consumed products within dietary groups.

Exploring Dietary Interventions in Autism Spectrum Disorder.

Autism spectrum disorder (ASD) involves social communication difficulties and repetitive behaviors, and it has a growing prevalence worldwide. Symptoms include cognitive impairments, gastrointestinal (GI) issues, feeding difficulties, and psychological problems. A significant concern in ASD is food selectivity, leading to nutrient deficiencies. Common GI issues in ASD, such as constipation and irritable bowel syndrome, stem from abnormal gut flora and immune system dysregulation. Sensory sensitivities and behavioral challenges exacerbate these problems, correlating with neurological symptom severity. Children with ASD also exhibit higher oxidative stress due to low antioxidant levels like glutathione. Therapeutic diets, including ketogenic, high-antioxidant, gluten-free and casein-free, and probiotic-rich diets, show potential in managing ASD symptoms like behavior, communication, GI issues, and oxidative stress, though the evidence is limited. Various studies have focused on different populations, but there is increasing concern about the impact among children. This review aims to highlight the food preferences of the ASD population, analyze the effect of the physicochemical and nutritional properties of foods on the selectivity in its consumption, GI problems, and antioxidant deficiencies in individuals with ASD, and evaluate the effectiveness of therapeutic diets, including diets rich in antioxidants, gluten-free and casein-free, ketogenic and essential fatty acids, and probiotic-rich diets in managing these challenges.

Preference of position in the proximity of various sugars revealed by location analysis of Drosophila melanogaster.

Feeding behaviors are determined by two main factors. One is the internal state, such as hunger or previous experiences; the other is external factors, such as sensory stimulation. During starvation, animals must balance food-seeking behavior with energy conservation. The fruit fly, Drosophila melanogaster, serves as a useful model for studying food selectivity and various behaviors related to food intake. However, few studies have directly connected food selectivity with other behaviors, such as locomotor activity and sleep. In this study, we report that flies exhibited a preference for specific positions and spent more time in the proximity of sweet sugars, such as sucrose and sucralose, but not non-sweet and nutritious sugars like xylitol and sorbitol. On the other hand, prolonged exposure to sorbitol increased the staying time of flies in the proximity of sorbitol. Additionally, after starvation, flies immediately exhibited a position preference in the proximity of sorbitol. These findings suggest that flies prefer the proximity of sweet food, and starvation alters their preference for nutritious food, which may be beneficial for their survival.

Food density drives diet shift of the invasive mysid shrimp, Limnomysis benedeni.

Understanding the diet preferences and food selection of invasive species is crucial to better predict their impact on community structure and ecosystem functioning. Limnomysis benedeni, a Ponto-Caspian invasive mysid shrimp, is one of the most successful invaders in numerous European river and lake ecosystems. While existing studies suggest potentially strong trophic impact due to high predation pressure on native plankton communities, little is known of its food selectivity between phyto- and zooplankton, under different food concentrations. Here, we therefore investigated the feeding selectivity of L. benedeni on two commonly occurring prey organisms in freshwaters, the small rotifer zooplankton Brachionus calyciflorus together with the microphytoplankton Cryptomonas sp. present in increasing densities. Our results demonstrated a clear shift in food selection, with L. benedeni switching from B. calyciflorus to Cryptomonas sp. already when the two prey species were provided in equal biomasses. Different functional responses were observed for the two food types, indicating somewhat different foraging mechanisms for each food type. These findings provide experimental evidence on the feeding flexibility of invasive mysid shrimps and potential implications for trophic interactions in invaded ecosystems.

Food, nutrition, and autism: from soil to fork.

Food and nutrition-related factors have the potential to impact development of autism spectrum disorder (ASD) and quality of life for people with ASD, but gaps in evidence exist. On 10 November 2022, Tufts University's Friedman School of Nutrition Science and Policy and Food and Nutrition Innovation Institute hosted a 1-d meeting to explore the evidence and evidence gaps regarding the relationships of food and nutrition with ASD. This meeting report summarizes the presentations and deliberations from the meeting. Topics addressed included prenatal and child dietary intake, the microbiome, obesity, food-related environmental exposures, mechanisms and biological processes linking these factors and ASD, food-related social factors, and data sources for future research. Presentations highlighted evidence for protective associations with prenatal folic acid supplementation and ASD development, increases in risk of ASD with maternal gestational obesity, and the potential for exposure to environmental contaminants in foods and food packaging to influence ASD development. The importance of the maternal and child microbiome in ASD development or ASD-related behaviors in the child was reviewed, as was the role of discrimination in leading to disparities in environmental exposures and psychosocial factors that may influence ASD. The role of child diet and high prevalence of food selectivity in children with ASD and its association with adverse outcomes were also discussed. Priority evidence gaps identified by participants include further clarifying ASD development, including biomarkers and key mechanisms; interactions among psychosocial, social, and biological determinants; interventions addressing diet, supplementation, and the microbiome to prevent and improve quality of life for people with ASD; and mechanisms of action of diet-related factors associated with ASD. Participants developed research proposals to address the priority evidence gaps. The workshop findings serve as a foundation for future prioritization of scientific research to address evidence gaps related to food, nutrition, and ASD.

Clinical Correlates and Prevalence of Food Selectivity in Children with Autism Spectrum Disorder.

OBJECTIVE: To examine clinical correlates and prevalence of food selectivity (FS) - ie, self-restricted diet, reluctance to try new foods - in children with autism spectrum disorder (ASD) ascertained from a general outpatient autism clinic. STUDY DESIGN: A multidisciplinary team (pediatric nurse practitioner, psychologist and dietitian) assessed medical and psychosocial histories and dietary habits in 103 children with ASD (mean age = 5.8 ± 2.2 years; range 2-10). Parents rated child mealtime behavior on the Brief Autism Mealtime Behavior Inventory (BAMBI) and disruptive behavior on the Aberrant Behavior Checklist (ABC). Height and weight measurements were collected. Children were classified as FS or no FS based on parent reported intake and mealtime behavior. A 24-hour dietary recall was used to record intake percentages < 80%. Logistic regression and multivariable modeling were used to evaluate clinical correlates with FS. RESULTS: Of 103 children, 45.6% (n = 47) were classified as FS; 54.4% (n = 56) no FS. After adjusting for potential confounders, the odds of FS increased by 1.91 (95% CI: 1.38, 2.64, P < .001) for every half-SD increase in BAMBI total score and by 1.35 (95% CI: 1.05, 1.74, P = .020) for every half-SD increase in ABC Hyperactivity/Noncompliance. No group differences in anthropometrics or nutritional intake were identified. CONCLUSIONS: Food selectivity (FS) in children with ASD was strongly associated with greater severity of disruptive mealtime and hyperactivity/noncompliance behaviors. FS was not associated with anthropometrics or nutritional intake.

Evaluating a Treatment Package for Avoidant/Restrictive Food Intake Disorder to Increase Food Variety.

There is a dearth of published research evaluating behavior-analytic assessment and treatment of avoidant/restrictive food intake disorder (ARFID) given the recent revisions in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In this study, therapists conducted periodic food preference assessments to help guide treatment for a typically developing child with ARFID and food selectivity. Further, therapists evaluated a treatment package including demand fading, escape prevention, and self-monitoring to increase food variety. Consumption increased during treatment with target foods; however, preference shifts were minor when compared to the pretreatment food preference assessment. Variety continued to increase overtime using the same treatment package and treatment effects were generalized to family meals and other locations. Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-023-00821-0.

Risco de distúrbio alimentar Pediátrico em pré-escolares nascidos prematuros / Risk of pediatric eating disorders in preschoolers born prematurely

RESUMO Objetivo verificar o risco de distúrbio alimentar pediátrico em pré-escolares que nasceram prematuros e relacionar com os aspectos neonatais, de aleitamento materno e de hábitos orais. Métodos estudo descritivo e longitudinal. A amostra foi composta por pré-escolares que nasceram prematuros e que foram acompanhados até os 24 meses de idade corrigida. A coleta de dados consistiu em análise de prontuários, entrevista e aplicação da Escala Brasileira de Alimentação Infantil. Resultados participaram 19 pré-escolares, com média de idade de 5 anos e 1 mês, nascidos prematuros (idade gestacional de 32 semanas), saudáveis e com função motora oral normal aos 2 anos de idade corrigida. A aplicação da escala permitiu identificar risco de distúrbio alimentar pediátrico em 31,57% da amostra. Não houve diferença entre os grupos com e sem risco do distúrbio quanto às variáveis neonatais, de aleitamento materno e de hábitos orais. Apenas a variável tempo de transição alimentar no período de internação neonatal apresentou diferença entre os grupos, sendo maior em crianças que não apresentaram risco para o distúrbio. Conclusão O risco de distúrbio alimentar pediátrico ocorreu em quase um terço dos prematuros em idade pré-escolar. O tempo de transição alimentar no período de internação neonatal foi a única variável que apresentou diferença entre os grupos com e sem risco para o distúrbio. Assim, pode-se refletir que o momento de introdução da alimentação oral e a forma de progressão da dieta até a via oral plena na internação neonatal podem ter relação com o comportamento alimentar em outras fases do desenvolvimento infantil.

ABSTRACT Purpose To verify the risk of pediatric eating disorders in preschoolers who were born prematurely and relate it to neonatal aspects, breastfeeding and oral habits. Methods Descriptive and longitudinal study. The sample was made up of preschoolers who were born prematurely and who were followed up until 24 months of corrected age. Data collection consisted of analysis of medical records, interviews and application of the Brazilian Infant Feeding Scale (EBAI). Results 19 preschoolers participated, with a mean age of 5.11±0.51, born prematurely (gestational age of 32.05 ± 3.26 weeks), healthy and with normal oral motor function at 2 years of corrected age. The application of the EBAI made it possible to identify the risk of pediatric eating disorders in 31.57% of the sample. There was no difference between the groups with and without risk of pediatric eating disorders regarding neonatal variables, breastfeeding and oral habits. Only the variable feeding time during the neonatal hospitalization period showed a difference between the groups, being higher in children who were not at risk for pediatric eating disorders. Conclusion The risk of pediatric eating disorders occurred in almost a third of pre-school-age premature infants. The dietary transition time during the neonatal hospitalization period was the only variable that showed a difference between the groups with and without risk of pediatric eating disorders. Thus, one may consider that, the moment of introduction of oral feeding and the way in which the diet progresses until the full oral route, during neonatal hospitalization, may be related to eating behavior in other phases of child development.

Dificuldades alimentares em pré-escolares de uma escola de educação infantil / Feeding difficulties in preschool children at an early childhood education school

Dificuldade alimentar é todo problema que afeta negativamente o processo dos pais ou cuidadores de suprirem alimento ou nutrientes à criança. O objetivo deste trabalho foi investigar as dificuldades alimentares em pré-escolares de uma escola municipal de educação infantil de Uruguaiana/RS. O estudo foi aprovado pelo Comitê de Ética em Pesquisa e realizado entre outubro e novembro de 2022. Foram convidadas a participar da pesquisa todos os pais ou responsáveis das crianças (n=70) que frequentavam a escola, na faixa etária de 4-5 anos. Todos receberam o Termo de Consentimento Livre e Esclarecido, bem como o questionário de pesquisa. O instrumento utilizado foi a Escala Brasileira de Alimentação Infantil (EBAI), que possui 14 perguntas referentes à alimentação das crianças. Foi realizada estatística descritiva, em termos de frequência e realizada análise de variância (ANOVA) para comparações entre os sexos (p<0,05). Foram obtidas 31 respostas dos pais relativas à alimentação das crianças. Os dados revelaram que 9,68% (n=3) possuíam algum grau de dificuldade alimentar, sendo 3,33% (n=1) com grau severo e 6,45% (n=2) com grau moderado. As demais crianças (n=28) também apresentaram comportamentos relacionados às dificuldades alimentares, porém, sem pontuação suficiente para serem classificadas com dificuldade alimentar. Os comportamentos mais frequentemente descritos foram: o responsável usar distrações ou ir atrás da criança para que ela coma, tempo de a alimentação em torno de 31-60min ou mais, criança que nauseia, cospe ou vomita com algum tipo de alimento e a influência negativa da alimentação nas relações familiares. Desta forma, observou-se um baixo percentual de dificuldades alimentares na população estudada, de acordo com a literatura estudada.

Feeding difficulties are any problem that negatively affects the process of parents or caregivers providing food or nutrients to the child. The objective of this work was to investigate eating difficulties in preschool children at a municipal early childhood education school in Uruguaiana/RS. The study was approved by the Research Ethics Committee and carried out between October and November 2022. All parents or guardians of children (n=70) who attended school, aged 4-5 years, were invited to participate in the research. Everyone received the Free and Informed Consent Form, as well as the research questionnaire. The instrument used was the Brazilian Infant Feeding Scale (EBAI), which has 14 questions regarding children's nutrition. Descriptive statistics were performed in terms of frequency and analysis of variance (ANOVA) was performed for comparisons between sexes (p<0.05). 31 responses were obtained from parents regarding children's nutrition. The data revealed that 9.68% (n=3) had some degree of feeding difficulty, 3.33% (n=1) with a severe degree and 6.45% (n=2) with a moderate degree. The remaining children (n=28) also presented behaviors related to feeding difficulties, however, without enough scores to be classified as having feeding difficulties. The most frequently described behaviors were: the caregiver using distractions or going after the child to make them eat, feeding time around 31-60 minutes or more, child who nauseates, spits or vomits with some type of food and the negative influence of food in family relationships. Thus, a low percentage of feeding difficulties was observed in the studied population, in accordance with the literature studied.

Comparing Simultaneous and Sequential Food Presentation to Increase Consumption of Novel Target Foods.

Two methods of food presentation (simultaneous and sequential) were compared in an adapted alternating treatment design to determine effects on consumption of target foods for three children with autism in a school setting. Preferred and nonpreferred target foods were nominated by parents, and consumption of reported preferred and nonpreferred foods was directly tested. Preferred and nonpreferred foods were then paired together and assigned to one of two conditions. In the simultaneous condition, bites of preferred and nonpreferred food were presented at the same time, with the nonpreferred food placed behind or inside the preferred food. In the sequential condition, a bite of preferred food was delivered contingent on consumption of a bite of nonpreferred food. Consumption increased in the sequential condition for two out of three participants. Implications for treatment of food selectivity in a school setting are discussed.This study describes two simple interventions to increase consumption of nonpreferred foods that can be implemented in a classroom settingThese data contribute to previous studies comparing sequential versus simultaneous presentation of foods by conducting the procedures in participants' natural settingResults indicate the efficacy of sequential presentation of preferred and nonpreferred foods without the use of escape extinctionResults also suggest further research comparing sequential versus simultaneous food presentation is warranted, given the few direct comparisons that currently exist and their overall mixed results regarding relative efficacy.

Patterns of Food Selectivity among Children with Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is a heterogeneous group of neurodevelopmental disorders characterized by food selectivity in a significant portion of the population. The nature of this selectivity remains unclear, with hypotheses suggesting associations with sensory disorders or stereotypical and repetitive patterns of activity and interests. This study aimed to determine the prevalence and nature of food selectivity traits in individuals with ASD compared with the neurotypical population. This study involved 219 participants, with 115 diagnosed with autism and 92 without. Twelve children undergoing diagnosis were excluded from the analyses. The findings revealed that food selectivity traits are more common in individuals with ASD, with differences in preferences mainly involving structure, color, taste, and serving method. Children with ASD had more food selectivity traits than those without, and the intake of certain food characteristics could be altered as they grow. Selectivity occurred for both sensory and stereotypical reasons, but stereotypical features significantly differentiated neurotypical individuals from those with ASD.

Metabolomics: Perspectives on Clinical Employment in Autism Spectrum Disorder.

Precision medicine is imminent, and metabolomics is one of the main actors on stage. We summarize and discuss the current literature on the clinical application of metabolomic techniques as a possible tool to improve early diagnosis of autism spectrum disorder (ASD), to define clinical phenotypes and to identify co-occurring medical conditions. A review of the current literature was carried out after PubMed, Medline and Google Scholar were consulted. A total of 37 articles published in the period 2010-2022 was included. Selected studies involve as a whole 2079 individuals diagnosed with ASD (1625 males, 394 females; mean age of 10, 9 years), 51 with other psychiatric comorbidities (developmental delays), 182 at-risk individuals (siblings, those with genetic conditions) and 1530 healthy controls (TD). Metabolomics, reflecting the interplay between genetics and environment, represents an innovative and promising technique to approach ASD. The metabotype may mirror the clinical heterogeneity of an autistic condition; several metabolites can be expressions of dysregulated metabolic pathways thus liable of leading to clinical profiles. However, the employment of metabolomic analyses in clinical practice is far from being introduced, which means there is a need for further studies for the full transition of metabolomics from clinical research to clinical diagnostic routine.

Food Selectivity in Children with Autism Spectrum Disorder: A Statistical Analysis in Southern Italy.

This paper focuses on autism spectrum disorder (ASD) and food selectivity, both of which are prevalent in the pediatric population. In this context, the authors paid attention to food selectivity and its possible correlation with the atypicality of sensory processes, outlining the useful rehabilitation treatments to draw on. This research included the parents or caregivers of pediatric patients diagnosed with autism spectrum disorder and placed within a therapeutic clinic. The sample is composed of 111 children, males and females, aged between 2 and 10 years, and includes 60 children diagnosed with autism and 51 children with normotypical development, similar in characteristics but without the disorder. The standardized questionnaire, "Brief Autism Mealtime Behavior Inventory", was developed to examine behavior during meals, especially in children with ASD. The "Brief Sensory Profile", and the "Child Oral and Motor Proficiency Scale", were also administered. The results obtained from the analysis lead to evidence of eating and food selectivity difficulty. Additionally, our study demonstrates that food selectivity can be caused by extreme sensory modulation and sensory problems related to the smell, texture, color, and temperature of food. In fact, the results obtained emphasize the correlation between food selectivity and the sensory domains of taste and smell. Furthermore, this research highlights a correlation between motor skills and eating skills, particularly regarding food selectivity, which is closely associated with atypical and disruptive behaviors during meals.

Dietary recommendations to customize canteen menus according to the nutritional and sensory needs of individuals with autism spectrum disorder.

Individuals with autism spectrum disorders (ASD) are often characterized by food-selectivity, food-neophobia and a marked preference for mild flavor, semi-liquid foods with pale colors. Therefore, they adopt a monotonous dietary pattern, and they prefer ultra-processed food, leading to a high risk of developing malnutrition. In Italy, where 75,072 individuals are diagnosed with ASD, center-based services play a crucial role in their daily management. Despite the centrality of nutrition in maintaining a good state of health, even more for vulnerable subjects, no validated protocol at collective catering level has been developed yet. The manuscript presents customized dietary recommendations aimed at managing the meals for individuals with ASD at collective catering service, derived from a non-systematic literature review exploring food behaviors and nutritional needs in individuals with ASD. Simple practical tips for mealtimes, such as eating together, proper seating, lighting, smell control, presenting food in a simple manner and using the same type of tableware at each meal, to meet the needs of individuals with ASD, were described. The proposal could represent a starting point in developing official guidelines aimed at ASD individuals, in collective catering service.Level of Evidence: Level V.

Brief Autism Mealtime Behavior Inventory (BAMBI): Italian Translation and Validation.

Food selectivity is among the most common problems for children with Autism Spectrum Disorder (ASD). The present study aims to validate the Brief Autism Mealtime Behavior Inventory (BAMBI) in an Italian population of children with ASD. BAMBI was translated and cross-culturally adapted following international guidelines, then we investigated internal consistency as measured by Cronbach's alpha and test-retest reliability, as measured by the Intraclass Correlation Coefficient (ICC) in a sample of both children with ASD and with typical development (TD). A total of 131 children were recruited in a clinical and community sample. Internal consistency revealed significant data for both TD and ASD children, with a Cronbach's Alpha of 0.86 and 0.71, respectively. Test-retest reliability showed excellent values for each item of the BAMBI (range 0.83-1.00). Furthermore, we investigated differences in gender and body max index; however, no significant differences were found among groups. In conclusion, the Italian version of the BAMBI showed good internal consistency and test-retest reliability and it can be used for clinical and research purposes.

Interrelated development of autism spectrum disorder symptoms and eating problems in childhood: a population-based cohort.

Eating problems, such as food selectivity or picky eating, are thought to be an epiphenomenon of autism spectrum disorders (ASD). Yet eating problems are also common in the general pediatric population and overlap with ASD symptoms. However, the temporal association between ASD symptoms and eating problems is poorly understood. This study examines the bidirectional association between ASD symptoms and eating problems across child development, and investigates whether these associations differ by child sex. Participants (N = 4,930) were from the population-based Generation R Study. Parents reported their child's ASD symptoms and eating problems using the Child Behavior Checklist at 5 assessments from toddlerhood to adolescence (1.5 to 14 years, 50% girls). A Random Intercept Cross-Lagged Panel Model was used to examine the lagged associations between ASD symptoms and eating problems at the within-person level, controlling for stable, trait-like differences at the between-person level. At the between-person level, there was a strong correlation between ASD symptoms and eating problems (ß = .48, 95% CI: 0.38 to 0.57). Controlling for these between-person effects, there was limited evidence for consistent, predictive effects of ASD symptoms and eating problems at the within-person level. Associations did not differ by child sex. Findings suggest that ASD symptoms and eating problems may represent a cluster of traits that are highly stable from early childhood to adolescence, which have a minimal reciprocal effect at the individual-level. Future research could focus on these trait-like qualities to inform the development of supportive, family-focused interventions.