Meal patterns in children and adolescents with autism spectrum disorder

Eating difficulties associated with autism spectrum disorder (ASD) influence food choices and mealtime routines, making it essential to investigate meal characteristics in this population. This study aimed to identify and examine factors associated with the meal patterns of children and adolescents with ASD.

A total of 361 patients diagnosed with ASD, aged 2 to under 19 years, were included. Dietary intake was assessed using three non-consecutive 24-hour recalls. Food items were grouped based on nutritional similarity. Principal component analyses were conducted for each meal (breakfast, lunch, afternoon snack, and dinner), with food group intake (g/d) as the input variable. Crude and adjusted regression models were used to evaluate the association of selected variables with meal patterns.

Two patterns were identified for breakfast, while three were identified for lunch, afternoon snack, and dinner. Traditional Brazilian foods, including coffee, bread, rice, beans, and meat; and ultra-processed foods, such as fat spreads, biscuits, sweets, chips, beverages, and processed meat, were observed across meals. Fruits were absent from all patterns, while vegetables were identified in lunch and dinner patterns. The afternoon snack had the highest energy intake (30.3% of daily energy) and energy density (1.6 kcal/g) compared to the other meals. Sociodemographic variables, anthropometric status, and antipsychotic use were associated with adherence to most patterns.

Meal patterns included traditional Brazilian foods and ultra-processed items. Given the influence of meal composition on health, these findings may support the development of nutritional interventions for this population.