Associations of picky eating levels with dietary diversity, nutrient intake, and eating behaviors in preschool children with autism spectrum disorder: a cross-sectional study

Background: Picky eating is common among children with autism spectrum disorder (ASD). However, the specific effects of different levels of picky eating on nutritional status, dietary diversity, and eating behaviors in preschool-aged children with ASD remain unclear. This study aimed to compare these aspects between children with low versus high levels of picky eating.

Methods: A cross-sectional study design was employed, enrolling 130 children with ASD aged 3 to 6 years who met the DSM-5 diagnostic criteria [Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-V)]. Trained personnel measured each child's height and weight using standardized instruments. Validated dietary diversity scores and preschool eating behavior scales were used to assess dietary diversity and nutrient intake and eating behaviors. energy and macronutrient intake were quantified through three non-consecutive 24-hour dietary recalls. Children were divided into a low picky eating group and a high picky eating group based on the degree of picky eating for comparative analysis.

Results: There were no statistically significant differences in height and weight indicators between the two groups, with most children falling within the normal range of growth and development. However, distinct differences were observed in nutrient intake and eating behaviors: children in the low picky eating group showed significantly higher total dietary diversity scores (P<0.05). Regarding nutrient intake, children in the low picky eating group exhibited higher intake levels of total energy, polyunsaturated fatty acids, and dietary fiber compared to those in the high picky eating group; in specific food categories, intake of starchy tubers, fruits, nuts, and legumes was also significantly higher. Regarding eating behaviors, children in the low picky eating group showed lower scores for picky eating and problematic eating behaviors, whereas exhibited heightened satiety responsiveness, with all differences reaching statistical significance (P<0.05).

Conclusions: The degree of picky eating is a key factor influencing dietary quality and eating behaviors in preschool-age children with ASD. Low levels of picky eating are associated with more comprehensive nutrient intake, richer dietary diversity, and more favorable eating behavior patterns. Early identification and intervention targeting picky eating behavior are of significant importance for improving the nutritional status of children with ASD.