Journal of Autism and Developmental Disorders

, Volume 49, Issue 4, pp 1586–1598 | Cite as

Dietary Patterns and Anthropometric Measures of Indian Children with Autism Spectrum Disorder

  • Seema Siddiqi
  • Asna UroojEmail author
  • Melwin James D’Souza
Original Paper


Research literature on dietary patterns & eating habits of children with Autism Spectrum Disorder (ASD) in India is limited. To explore this, a pilot study (n = 53) which included 45 boys and 8 girls (age group of 2–13 years) was conducted. Three day food records, Food Frequency Questionnaire and Children Eating Behavior Inventory were used to assess the dietary intakes and mealtime behavior problems respectively. Findings revealed lower intake of fruits and vegetables which reflected on their micronutrient status which was significantly (p ≤ 0.05) in lower amounts predominantly B-Complex, Calcium and Iron. The study has suggested a strong need for future implementation of nutritional intervention programs at the earliest to expand food variety among children with ASD of this region.


Autism spectrum disorders Somatic status Feeding problems Food selectivity Micronutrient deficits 



The authors acknowledge UGC, New Delhi, India, for the financial assistance (UGC DRS-II, No. F.25-1/2014-15 (BSR). Authors also express their deep gratitude to the team of Autism Spectrum Disorder unit at All India Institute of Speech & Hearing (AIISH), Mysore for their co-operation and support; as well as the children and their parents who participated in the study.

Author Contributions

SS and AU conceptualized and designed the study; MJD collected the data. SS drafted and consolidated the manuscript. AU gave the final approval of the manuscript.

Compliance with Ethical Standards

Conflict of interest

We declare that there is no conflict of interest to disclose.


  1. Ahearn, W. H., Casinte, T., Nault, K., & Green, G. (2001). An assessment of food acceptance with autism or pervasive developmental disorder- not otherwise specified. Journal of Autism and Developmental Disorders, 31, 505–511.Google Scholar
  2. Alpert, M. (2007). The autism diet. Scientific American, 296, 19–20.Google Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Arlington: American Psychiatric Association.Google Scholar
  4. Archer, L. A., Rosenbaum, P. L., & Streiner, D. L. (1991). The children’s eating behavior inventory: Reliability and validity results. Journal of Pediatric Psychology, 16(5), 629–642.Google Scholar
  5. Balasubramanian, B., Bhatt, C., & Goyel, N. (2009). Genetic studies in children with intellectual disability and autistic spectrum of disorders. Indian Journal of Human Genetics, 15, 103–107.Google Scholar
  6. Bandini, L. G., Anderson, S. E., Curtin, C., Cermak, S., Evans, E. W., Scampini, R., et al. (2010). Food selectivity in children with autism spectrum disorders and typically developing children. Journal of Pediatrics, 157, 259–264.Google Scholar
  7. Barrett-Connor, E. (1991). Nutrition epidemiology: How do we know what they ate? American Journal of Clinical Nutrition, 54, 182S–187S.Google Scholar
  8. Bicer, A. H., & Alsaffar, A. A. (2013). Body mass index, dietary intake and feeding problems of Turkish children with autism spectrum disorder (ASD). Research in Developmental Disabilities, 34(11), 3978.Google Scholar
  9. Birnbaum, A., & Cohen, H. J. (1993). On the importance of helping families: Policy implications from a national study. Mental Retardation, 31, 67–74.Google Scholar
  10. Black, R. E., et al. (2008). Maternal and child under nutrition: Global and regional exposures and health consequences. The Lancet, 371, 243–260.Google Scholar
  11. Bolte, S., Ozkara, N., & Poutska, F. (2002). Autism spectrum disorders and low body weight: Is there a really systematic association? International Journal of Autism Disorders, 31, 349–351.Google Scholar
  12. Caihong, S. (2013). Nutritional status survey of children with autism and typically developing children aged 4–6 years in Heilongjiang Province, China. Journal of Nutritional Science, 2, e16.Google Scholar
  13. Centers for Disease Control and Prevention (CDC). (2012). Prevalence of autism spectrum disorders. Surveillance Summaries MMWR.
  14. Cornish, E. (1998). A balanced approach toward healthy eating in autism. Journal of Human Nutrition & Dietetics, 11, 501–509.Google Scholar
  15. Cornish, E. (2002). Gluten and casein free diets in autism: A study of the effects on food choice and nutrition. Journal of Human Nutrition and Dietetics, 15(4), 261–269.Google Scholar
  16. Datta, A. K., Mandal, S., & Bhattacharya, S. (2009). Autism and mental retardation with convulsion in tuberous sclerosis: A case report. Cases Journal, 31, 2:7061.Google Scholar
  17. Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The early start Denver model. Pediatrics, 125(January 1), e17–e23.Google Scholar
  18. Desousa, A. (2010). An open-label trial of risperidone and fluoxetine in childrenwith autistic disorder. Indian Journal of Psychological Medicine, 32(1), 17–21.Google Scholar
  19. Elder, J. H. (2008). The gluten-free, casein-free diet in autism: An overview with clinical implications. Nutrition in Clinical Practice, 23(6), 583–588.Google Scholar
  20. Emond, A., Emmett, P., Steer, C., & Golding, J. (2010).Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics, 126, e337–e342.Google Scholar
  21. Feingold, S. M., Molitoris, D., Song, Y., Liu, C., Vaisanen, M. L., Bolte, E., & Collins, M. D. (2002). Gastrointestinal microflora studies in late-onset autism. Clinical Infectious Diseases, 35(Supplement 1), 6–16.Google Scholar
  22. Field, D., Garland, M., & Williams, K. (2003). Correlates of specific childhood feeding problems. Journal of Paediatrics and Child Health, 39, 299–304.Google Scholar
  23. Gillberg, C., & Coleman, M. (2000). The biology of the autistic syndromes. Cambridge: Cambridge University Press.Google Scholar
  24. Gottschall, E. (2004). Digestion-gut-autism connection: The specific carbohydrate diet. Medical Veritas, 1, 261–271.Google Scholar
  25. Gupta, S. K., & Ratnam, B. V. (2009). Cerebral perfusion abnormalities in children with autism and mental retardation: A segmental quantitative SPECT study. Indian Pediatrics, 46(2), 161–164.Google Scholar
  26. Gurdeep, K. (2015). A tool for dietary assessment and planning. New Delhi: Profound Tech Solutions.Google Scholar
  27. Herndon, A. C., DiGuiseppi, C., Johnson, S., Leiferman, J., & Reynolds, A. (2009). Does nutritional intake differ between children with autism spectrum disorders and children with typical development? Journal of Autism and Developmental Disorders, 39, 212–222.Google Scholar
  28. Ho, H. H., Eaves, L. C., & Peabody, D. (1997). Nutrient intake and obesity in children with autism. Focus on Autism and Other Developmental Disabilities, 12, 187–193.Google Scholar
  29. Hyman, S. L., Steward, P. A., Schmidt, B., Cain, U., Lemcke, N., Foley, J. T., et al. (2012). Nutrient intake from food in children with Autism. Pediatrics, 103, S145–S153.Google Scholar
  30. Institute of Medicine (IOM). (2001). Dietary reference intakes: Applications in dietary assessment. Washington, DC: National Academy Press.Google Scholar
  31. Jensen, H. H., Nusser, S. M., Riddick, H., & Sands, L. (1991). A critique of two methods for assessing the nutrient adequacy of diets. Journal of Nutrition Education and Behavior, 24(3), 123–129.Google Scholar
  32. Juneja, M., Sharma, S., & Mukherjee, S. B. (2010). Sensitivity of the autism behavior checklist in Indian autistic children. Journal of Developmental and Behavioral Pediatrics, 31(1), 48–49.Google Scholar
  33. Karanth, P., Shaista, S., & Srikanth, N. (2010). Efficacy of communication DEALL—an indigenous early intervention program for children with autism spectrum disorders. Indian Journal of Pediatrics, 77(9), 957–962.Google Scholar
  34. Kedesdy, J. H., & Budd, K. S. (1998). Childhood feeding disorders: Biobehavioral assessment and intervention (pp. 208–216). Baltimore: Paul H Brookes Publishing.Google Scholar
  35. Keen, D. V. (2008). Childhood autism feeding problems and failure to thrive in early infancy. European Child & Adolescent Psychiatry, 17, 209–216.Google Scholar
  36. Krishnamurthy, V. (2008). A clinical experience of autism in India. Journal of Developmental & Behavioral Pediatrics, 29, 331–333.Google Scholar
  37. Lainhart, J. E., Bigler, E. D., Bocian, M., Coon, H., Dinh, E., Dawson, G., et al. (2006). Head circumference and height in autism: A study by the collaborative program of excellence in autism. American Journal of Medical Genetics, 140A, 2257–2274.Google Scholar
  38. Lakshmi, P., Geetha, A. (2011). Level of trace elements (copper, zinc, magnesium and selenium) and toxic elements (lead and mercury) in the hair and nail of children with autism. Biological Trace Element Research, 142(2), 148–158.Google Scholar
  39. Latif, A., Heinz, P., & Cook, R. (2002). Iron deficiency in autism and Asperger syndrome. Autism, 6, 103–114.Google Scholar
  40. Ledford, J. R., & Gast, D. L. (2006). Feeding problems in children with autism spectrum disorders: A review. Focus on Autism and Other Developmental Disabilities, 21(3), 153–166.Google Scholar
  41. Levy, S., Souders, M. C., Ittenbach, R. F., Giarelli, E., Mulberg, A., & Pinto-Martin, J. (2007). Relationship of dietary intake to gastrointestinal symptoms in children with autistic spectrum disorders. Biological Psychiatry, 61, 492–497.Google Scholar
  42. Lindsay, R. L., Arnold, L. E., Aman, M. G., Vitiello, B., Posey, D. J., McDougle, C. J., et al. (2006). Dietary status and impact of risperidone on nutritional balance in children with autism: a pilot study. Journal of Intellectual and Developmental Disability, 31, 204–209.Google Scholar
  43. Malhi, P., & Singhi, P. (2011). Follow up of children with autism spectrum disorders: Stability and change in diagnosis. Indian Journal of Pediatrics, 78(8), 941–945.Google Scholar
  44. Malhotra, S., Chakrabarti, S., Gupta, N., Kumar, P., & Gill, S. (2003). Pervasive developmental disorders and its subtypes: Socio-demographic and clinical profile. German Journal of Psychiatry, 6(2), 33–39.Google Scholar
  45. Malhotra, S., Rajender, G., Bhatia, M. S., & Singh, T. B. (2010). Effects of picture exchange communication system on communication and behavioural anomalies in autism. Indian Journal of Psychological Medicine, 32(2), 141–143.Google Scholar
  46. Malhotra, S., & Vikas, A. (2005). Pervasive developmental disorders: Indian scene. Journal of Indian Association for Child and Adolescent Mental Health, 1, 5.Google Scholar
  47. Manjunatha, K. R., Narayanan, H. S., Rao, B. S. S. R., Srinath, S., & Girimaji, S. R. (1989). Cryptogenetic investigations in autistic children: A preliminary study on the detection of fragile X chromosome. NIMHANS Journal, 7(2), 163–167.Google Scholar
  48. Marí-Bauset, S., Zazpe, I., Marí, A., Llopis, A., & Morales, M. (2014). Evidence of the gluten free and casein free diet in autism spectrum disorders (ASDs): A systematic review. Journal of Child Neurology. Scholar
  49. Marí-Bauset, S., Llopis-González, A., Zazpe-García, I., Marí-Sanchis, A., & Morales-Suárez-Varela, M. (2015). Nutritional status of children with autism spectrum disorders (ASDs): A case–control study. Journal of Autism and Developmental Disorders, 45(1), 203–212.Google Scholar
  50. Martins, Y., Young, R. L., & Robson, D. C. (2008). Feeding and eating behaviors in children with autism and typically developing children. Journal of Autism and Developmental Disorders, 38, 1878–1887.Google Scholar
  51. Mason, J., Deitchler, M., Mathys, E., Winichagoon, P., & Tuazon, M. A. (2004). Lessons from successful micronutrient programs Part III: Program impact. Food and Nutrition Bulletin, 25(1), 53–78. Scholar
  52. Matson, J. L., & Fodstad, J. C. (2009). The treatment of food selectivity and other feeding problems in children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3, 455–461.Google Scholar
  53. Matson, J. L., & Kozlowski, A. M. (2011). The increasing prevalence of autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 418–425.Google Scholar
  54. Matthews, J. (2013). Autism diets: The first step to biomedical intervention and autism recovery. Cambridge: Cambridge University Press.Google Scholar
  55. Mohammad, N. S., Jain, J. M., Chintakindi, K. P., Singh, R. P., Naik, U., & Akella, R. R. (2009). Aberrations in folate metabolic pathway and altered susceptibility to autism. Psychiatric Genetics, 19(4), 171–176.Google Scholar
  56. Moore, E., Crook, T., James, J., Gonzales, D., & Hakkak, R. (2012). Nutrient intake among children with autism. Journal of Nutritional Disorders and Therapy, 2, 3.Google Scholar
  57. Mulloy, A., Lang, R., O’Reilly, M., Sigafoos, J., Lancioni, G., & Rispoli, M. (2011). Addendum to gluten-free and casein-free diets in treatment of autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 5, 86–88.Google Scholar
  58. Naik, U. S., Gangadharan, C., Abbagani, K., Nagalla, B., Dasari, N., & Manna, S. K. (2011).A study of nuclear transcription factor-kappa B in childhood autism. PLoS One, 6(5), e19488.Google Scholar
  59. Narayan, M., Srinath, S., Anderson, G. M., & Meundi, D. B. (1993). Cerebrospinal fluid levels of homovanillic acid and 5-hydroxyindoleacetic acid in autism. Biological Psychiatry, 33(8–9), 630–635.Google Scholar
  60. National Institute of Nutrition (NIN). (2011). Indian council of medical research. Hyderabad: Recommended Dietary Allownces for Indians.Google Scholar
  61. Nizamie, A., Sengupta, U., Mishra, B. R., Praharaj, S. K., & Nizamie, S. H. (2010). Role of early multimodal interventions in a case with autistic regression. Acta Neurol Taiwan, 19(1), 51–56.Google Scholar
  62. Parner, E. T., Schendel, D. E., & Thorsen, P. (2008). Autism prevalence trends over time in Denmark: Changes in prevalence and age at diagnosis. Archives of Pediatrics & Adolescent Medicine, 162(12), 1150–1156.Google Scholar
  63. Raina, S. K., Kashyap, V., Bhardwaj, A. K., Kumar, D., & Chander, V. (2015). Prevalence of autism spectrum disorders among children (1–10 years of age)—findings of a mid-term report from Northwest India. Journal of Postgraduate Medicine, 61(4), 243.Google Scholar
  64. Rudra, A., Belmonte, M. K., Soni, P. K., Banerjee, S., Mukerji, S., & Chakrabarti, B. (2017). Prevalence of autism spectrum disorder and autistic symptoms in a school-based cohort of children in Kolkata, India. Autism Research, 10(10), 1597–1605.Google Scholar
  65. Russell, P. S., Daniel, A., Russell, S., Mammen, P., Abel, J. S., Raj, L. E., & Thomas, N. (2010). Diagnostic accuracy, reliability and validity of Childhood Autism Rating Scale in India. World Journal of Pediatrics, 6(2), 141–147.Google Scholar
  66. Sadowska, J., & Cierebiej, M. (2011). Evaluation of the nutrition manner and nutritional status of children with autism.Preliminaryinvestigations. PediatriaWspo´łczesna. Gastroenterologia, Hepatologia i Z˙ywienieDziecka, 13(3), 155–160.Google Scholar
  67. Schendel, D., & Bhasin, T. K. (2008). Birth weight and gestational age characteristics of children with autism, including a comparison with other developmental disabilities. Pediatrics, 121(6), 1155–1164.Google Scholar
  68. Schreck, K. A., & Williams, K. (2006). Food preferences and factors influencing food selectivity for children with autism spectrum disorders. Research in Developmental Disability, 27, 353–363.Google Scholar
  69. Schreck, K. A., Williams, K., & Smith, A. F. (2004). A comparison of eating behaviors between children with and without autism. Journal of Autism and Developmental Disorders, 34, 433–438.Google Scholar
  70. Sen, B., Singh, A. S., Sinha, S., Chatterjee, A., Ahmed, S., Ghosh, S., & Usha, R. (2010). Family-based studies indicate association of engrailed 2 gene with autism in an Indian population. Genes, Brain and Behavior, 9(2), 248–255.Google Scholar
  71. Sharp, W. G., Jaquess, D. L., & Lukens, C. T. (2013). Multi-method assessment of feeding problems among children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 7(1), 56–65.Google Scholar
  72. Shivashankar, N., & Satishchandra, P. (1989). Auditory brainstem responses in autistic children. Nimhans Journal, 7(2), 159–162.Google Scholar
  73. Sitholey, P., Agarwal, V., & Pargaonkar, A. (2009). Rapid and spontaneous recovery in autistic disorder. Indian Journal of Psychiatry, 51(3), 209–211.Google Scholar
  74. Sowmyanath (2014). Feeding problems in children with autism interactive autism network. Baltimore: Kennedy Krieger Institute.Google Scholar
  75. Sreedhar, K. P., & Venkoba Rao, A. (1976). A questionnaire for the detection of early infantile autism. Indian Journal of Psychiatry, 18(4), 266–272.Google Scholar
  76. Srinath, S., Chowdhury, J., Bhide, A. V., Narayanan, H. S., & Shivaprakash, Z. Z. (1989). Descriptive study of infantile autism. NIMHANS Journal, 7(1), 77–81.Google Scholar
  77. Srinivasan, P. (2009). A review of dietary interventions in autism. Annals of Clinical Psychiatry, 21(4), 237–247.Google Scholar
  78. Strock, M. (2007). Autism spectrum disorders (pervasive developmental disorders). Bethesda: National Institute of Mental Health (NIMH).Google Scholar
  79. Sun, C., Xia, W., Zhao, Y., Li, N., Zhao, D., et al. (2013). Nutritional status survey of children with autism and typically developing children aged 4–6 years in Heilongjiang Province, China. Journal of Nutritional Science, 2, e16.Google Scholar
  80. Sun, X., & Allison, C. (2010). A review of the prevalence of Autism Spectrum Disorder in Asia. Research in Autism Spectrum Disorders, 4, 156–167.Google Scholar
  81. Walker, S. P., Wachs, T. D., Grantham-McGregor, S., Black, M. M., Nelson, C. A., & Huffman, S. L., et al. (2011). Inequality in early childhood: Risk and protective factors for early child development. The Lancet, 378, 1325–1338.Google Scholar
  82. Wei, X., Yanjuan, Z., Caihong, S., Jia, W., & Lijie, W. (2010).A preliminary study on nutritional status and intake in Chinese children with autism. European Journal of Pediatrics, 169(10), 1201–1206.Google Scholar
  83. WHO Expert Committee on Prevasive Developmental Disorders. (1992). Eighth report. Geneva: World Health Organization.Google Scholar
  84. Williams, P. G., Dalrymple, N., & Neal, J. (2000).Eating habits of children with autism. Pediatric Nursing, 26, 259–264.Google Scholar
  85. Wing, L., Leekam, S. R., Libby, S. J., Gould, J., & Larcombe, M. (2002). The diagnostic interview for social and communication disorders: Background inter-rater reliability and clinical use. Journal of Child Psychology and Psychiatry, 43, 307–325.Google Scholar
  86. World Health Organization. (1996). Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. American Journal of Human Biology, 8, 786–787.Google Scholar
  87. World Health Organization. (2007). Growth reference, 5–19 years. Retrieved 21 Sept 2017 from
  88. Xia, W., Zhou, Y., Sun, C., Wang, J., & Wu, L. (2010). A preliminary study on nutritional status and intake in Chinese children with autism. European Journal of Pediatrics, 169(10), 1201–1206.Google Scholar
  89. Zimmer, M. H., Hart, L. C., Courtney, P. M., Murray, D. S., Bing, N. M., & Summer, S. (2012). Food variety as a predictor of nutritional status among children with autism. Journal of Autism and Developmental Disorders, 42, 549–556.Google Scholar

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Authors and Affiliations

  1. 1.Department of Studies in Food Science and NutritionUniversity of MysoreMysuruIndia
  2. 2.Department of Food Nutrition and DieteticsMilagres CollegeMangaluruIndia

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