Dietary behaviors, energy intake, and assessment of school lunch consumption in Thai children with autism

Autism spectrum disorder (ASD) is associated with distinctive eating behaviors that can affect nutritional status and development. In Thailand, where ASD prevalence is rising, limited research exists on related nutritional challenges. This cross-sectional study assessed the nutritional status, dietary intake behaviors, and school lunch consumption among 47 children with ASD (ages 6 to 13) attending a special education school in Bangkok. Anthropometric assessments were performed using Z scores, dietary intake was evaluated through three-day food records and caregiver questionnaires, and school lunch consumption was measured using the direct weighing method. The results showed a high prevalence of overweight (15.56%) and obesity (40.00%), despite overall inadequate energy and nutrient intake. Most children consumed home-cooked meals independently but exhibited selective eating behaviors. A majority consumed insufficient vegetables (75%) and fruits (61.36%), with frequent preferences for energy-dense, nutrient-poor foods, and low intake of iron-rich and dairy products. At school, children consumed only 28% of the energy served at lunch, with similarly low intake of calcium, vitamin A, and fiber. These findings underscore the need for tailored, multidisciplinary interventions targeting both mealtime behaviors and nutritional adequacy. Collaboration among caregivers, educators, and health professionals is essential to improve dietary variety and support the health and development of children with ASD.