Beyond the plate: nutritional gaps and health risks in selective eaters with ASD - a narrative review

Food selectivity (FS) is among the most frequent and challenging feeding difficulties in children with autism spectrum disorder (ASD). It is often driven by sensory processing differences and behavioral rigidity, leading to restricted diets, nutritional deficiencies, and psychosocial strain. This review synthesizes current evidence on the prevalence, mechanisms, and health consequences of FS in children with ASD. A comprehensive search was conducted in PubMed, Scopus, Web of Science, and Google Scholar. Eligible studies included children aged ≤ 18 years with ASD and assessed FS or related eating difficulties. After screening 503 abstracts, 24 studies were included. Data were extracted on prevalence, mechanisms, nutritional and health outcomes, and family impact. FS prevalence ranged from 21% to 77%, most often related to texture, taste, and color sensitivities. Sensory over-responsivity and behavioral rigidity were consistent predictors, while parental feeding practices and gastrointestinal symptoms were contributing factors. Reported consequences included deficiencies in vitamin D, calcium, and fiber, unbalanced macronutrient intake, and both undernutrition and overweight/obesity. Families reported increased stress, mealtime conflict, and limited coping strategies. Only one behavioral intervention demonstrated short-term improvement without long-term dietary diversification. Food selectivity in ASD is highly prevalent, primarily sensory-driven, and maintained by behavioral contingencies. It contributes to nutritional inadequacies, growth alterations, and family distress. Future research should focus on standardized assessments, longitudinal follow-up, and multidisciplinary interventions addressing both child and family contexts.