Summary:
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterised by difficulties in social communication, along with restricted and repetitive patterns of behaviour. Reported prevalence has increased in recent decades, with estimates suggesting approximately 1 in 36 children in some populations. Feeding difficulties are highly prevalent in children with ASD and occur at substantially higher rates than in neurotypical children. This systematic review reports that food-related challenges commonly include strong food preferences, refusal of certain foods, and rigid eating patterns. These behaviours are associated with an increased likelihood of inadequate nutrient intake and may contribute to additional health concerns such as impaired growth, gastrointestinal disturbances, immune dysfunction, and micronutrient deficiencies. Evidence also suggests a bidirectional relationship where restrictive eating patterns may worsen gastrointestinal health, which in turn may exacerbate behavioural symptoms. The mechanisms underlying eating behaviours in ASD are complex and involve interactions between neurological function, sensory processing, metabolic factors, and the gut microbiome. This study highlights the role of the gut-brain axis as a key pathway linking diet, gastrointestinal health, and neurodevelopmental outcomes. A range of interventions have been explored to address these issues, including dietary modification, nutritional supplementation, behavioural therapies, and microbiome-targeted treatments. This study reports that while some emerging evidence suggests potential benefits for specific interventions, overall results remain inconsistent. The paper concludes that improving dietary management in children with ASD requires a clearer understanding of underlying biological mechanisms and the development of individualized approaches. Further research is needed to strengthen the evidence base and support more effective clinical strategies.
Abstract:
This review systematically evaluated the research progress on the dietary behavior characteristics and intervention strategies for children with Autism Spectrum Disorder (ASD). A substantial body of evidence indicated that children with ASD frequently exhibit significant dietary behavior challenges, including food selectivity, picky eating, and food refusal, which may increase the risk of nutritional imbalances and related comorbidities. Recent studies have elucidated the complex interactions between these atypical eating behaviors and neurodevelopmental abnormalities, gut microbiota dysbiosis, immune dysfunction, and metabolic disturbances. The microbiota-gut-brain axis (MGBA) was considered a central mediating mechanism in this context. Current intervention strategies primarily encompassed specialized dietary therapies, targeted nutritional supplementation, behavioral interventions, and microbiota-directed therapies. Promising recent randomized controlled trials have begun to address this gap, showing for example the specific benefits of Limosilactobacillus reuteri adjunctive therapy for social functioning and the potential of mitochondrial-targeted agents to produce clinically meaningful improvements in core symptoms in selected subgroups. However, evidence regarding the efficacy and generalizability of these interventions remained inconsistent. This article synthesized the latest evidence-based findings to assess the applications and limitations of existing intervention strategies, and highlights future research directions. Further studies should focus on elucidating the precise mechanisms of the MGBA, developing individualized nutrition intervention plans, and conducting long-term rigorous evaluations of their efficacy, thereby providing a more reliable theoretical foundation and practical guidance for the clinical nutritional management and comprehensive care of children with ASD.
Article Publication Date: 17/03/2026
DOI: 10.1016/j.reia.2026.202903
