Child Autistic Traits, Food Selectivity and Diet Quality: A Population-Based Study

Children with Autism Spectrum Disorders (ASD) tend to have sensory disturbances and behavioral rigidity which may predispose them to be selective in their food intake, potentially compromising their nutritional status. While ASD captures severe levels of impairment, autistic traits vary on a continuum throughout the general population. Yet, little is known about how subclinical autistic traits relate to dietary intake. Therefore, this study study examines how autistic traits throughout early childhood are associated with diet quality (DQ) in mid-childhood and explores the mediating role of food selectivity. Participants were children (n = 4061) from the population-based birth cohort, Generation R (the Netherlands). Parents completed assessments on their child’s autistic traits at 1.5, 3 and 6 years, food selectivity at 4 years and food intake at 8 years (via a Food Frequency Questionnaire), from which a DQ score (comprising of 10 food groups, scale 0 to 10) was derived based on adherence to age-specific dietary guidelines. Multiple linear regression models examined the association between autistic trait SD score at each assessment wave and DQ. A mediation analysis was performed using structural equation modeling to examine the indirect effect of autistic traits at 3 years and DQ at 8 years through food selectivity at 4 years. Models adjusted for child sex, age, energy intake, ethnicity, birth weight, BMIz score, and maternal age and education. Autistic trait SD score at each wave was associated with decreased DQ score (e.g., 3 years: β = –0.06; 95% CI: –0.10, –0.03). Post-hoc analyses showed that associations between autistic traits and DQ were consistently driven by lower consumption of fruit, vegetable and whole grain food groups at each wave. The indirect effect of food selectivity (β = –0.03, 95% CI: –0.03, –0.02) explained 60% of the total association between autistic traits and DQ. Expression of autistic traits across childhood is associated with poorer DQ in mid-childhood, and food selectivity may be one key behavioral mechanism explaining this association. Dietary interventions intended to optimize nutrition in children with elevated autistic traits may integrate behavioral strategies to support parents’ appropriately responding to and managing food selectivity. European Union’s Horizon 2020 programme.