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Dietary Adequacy of Children with Autism Compared with Controls and the Impact of Restricted Diet

Graf-Myles, Jennifer MS, RD; Farmer, Cristan PhD; Thurm, Audrey PhD; Royster, Caitlin BS; Kahn, Phoebe BS; Soskey, Laura BS; Rothschild, Leah BA; Swedo, Susan MD

Journal of Developmental & Behavioral Pediatrics: September 2013 - Volume 34 - Issue 7 - p 449–459
doi: 10.1097/DBP.0b013e3182a00d17
Original Articles

Objective: Children with autism (AUT) may consume a restricted diet relative to typical peers, whether due to therapeutic measures or sensory sensitivities. The objective of this study was to compare children with AUT with both typically developing (TYP) and developmentally delayed children on nutrient and food group intake and overall diet quality and to evaluate the impact of diet restriction.

Methods: Three-day food records and interview information were analyzed from 69 children with AUT, 14 children with developmental delay, and 37 TYP children, drawn from a larger longitudinal study.

Results: Children with AUT did not differ significantly from children with other developmental delays on any dietary measures. Although there were differences in the average intake of some nutrients between AUT and typical controls, only calcium and dairy were also less likely to be consumed in adequate amounts by the AUT group. Intentional diet restriction accounted for most of the differences between AUT and typical controls. On average, all groups had inadequate fiber, vitamin D, and vegetable intake. Inadequate intake of folate, grains, and dairy was noted for the AUT subgroup with intentional diet restrictions. Children in the AUT group not following a restricted diet received significantly worse Healthy Eating Index-2005 scores than those following a restricted diet and typical controls. These differences were not nutritionally significant.

Conclusions: When evaluating nutritional adequacy of children with AUT, special consideration should be given to calcium, folate, dairy, and grains. Diets of all children with AUT should be evaluated for idiosyncratic deficiencies because of unique dietary patterns.

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*Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD;

Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD.

Address for reprints: Jennifer Myles, MS, RD, Nutrition Department, National Institutes of Health, Room B2-2426, Building 10, 10 Center Drive, Bethesda, MD 20892; e-mail:

Disclosure: The authors declare no conflict of interest.

This work was supported by the Intramural Program of the National Institute of Mental Health of the National Institutes of Health, NCT00298246, 06-M-0102.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions this article on the journal’s Web site (

Received March , 2013

Accepted June , 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.