Feeding Symptoms, Dietary Patterns, and Growth inYoung Children With Autism Spectrum Disorders

WHATS KNOWN ON THIS SUBJECT: Children with ASDs are oftenreported to have limited food preferences and behavioraldifculties associated with feeding. However, the age of onset offeeding symptoms and the impact on diet and growth are poorlyunderstood.

WHAT THIS STUDY ADDS: Using prospectively reported data theauthors found that children with ASDs showed feeding symptomsfrom infancy and had a less varied diet from 15 months of age,but energy intake and growth were not impaired.

abstractOBJECTIVE: To investigate the feeding, diet and growth of young chil-dren with autism spectrum disorders (ASD).

METHOD: Data on feeding and food frequency were collected by ques-tionnaires completed at 6, 15, 24, 38 and 54 months by participants inthe Avon Longitudinal Study of Parents and Children. A food varietyscore was created, and the content of the diet was calculated at 38 m.The feeding and dietary patterns of 79 children with ASD were com-pared with 12 901 controls.

RESULTS: Themedian ages of ASD children were 28months at referraland 45 months at diagnosis. ASD infants showed late introduction ofsolids after 6 months (p .004) and were described as slow feedersat 6 months (p .04). From 1554 months ASD children were consis-tently reported to be difcult to feed (p .001) and very choosy(p .001). From 15 months, the ASD group had a less varied diet thancontrols, were more likely to have different meals from their motherfrom 24 months, and by 54 months 8% of ASD children were taking aspecial diet for allergy.

ASD children consumed less vegetables, salad and fresh fruit, but alsoless sweets and zzy drinks. At 38 months intakes of energy, total fat,carbohydrate and protein were similar, but the ASD group consumedless vitamins C (p .02) and D (p .003). There were no differences inweight, height or BMI at 18 months and 7 years, or in hemoglobinconcentrations at 7 years.

CONCLUSIONS: ASD children showed feeding symptoms from infancyand had a less varied diet from 15 months, but energy intake andgrowth were not impaired. Pediatrics 2010;126:e337e342

AUTHORS: Alan Emond, MD, Pauline Emmett, PhD, ColinSteer, MSc, and Jean Golding, PhD

Centre for Child and Adolescent Health, Department ofCommunity Based Medicine, University of Bristol, Bristol, UnitedKingdom

KEY WORDSautism, autism spectrum disorders, feeding, diet, pervasivefeeding disorder, ALSPAC

ABBREVIATIONSASDautism spectrum disorderALSPACAvon Longitudinal Study of Parents and ChildrenORodds ratioCIcondence interval

www.pediatrics.org/cgi/doi/10.1542/peds.2009-2391

doi:10.1542/peds.2009-2391

Accepted for publication Apr 27, 2010

Address correspondence to Jean Golding, PhD, Centre for Childand Adolescent Health, Barley House, Oakeld Grove, Bristol BS82BN, United Kingdom. E-mail: jean.golding@bristol.ac.uk

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright 2010 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE: The authors have indicated they haveno nancial relationships relevant to this article to disclose.

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Autism spectrum disorders (ASDs) arecharacterized by impairments in so-cial interaction and communicationand stereotypical and repetitive behav-iors. People with ASDs are often resis-tant to change and have a narrowrange of interests, which can extend tothe foods they like.1 Children with ASDsare often reported to have unusual eat-ing patterns with a restricted range offood choices.2 However, the differ-ences are not only a result of impair-ments intrinsic to the child with anASD; a questionnaire survey of parentsof children with ASDs revealed thatfamily food preferences seemed to in-uence food selection more than thediagnostic characteristics of autism.3

Other feeding symptoms have alsobeen reported. A retrospective study ofchildren with ASDs revealed that vom-iting, reux, colic, and failure to feedwere more common in those with As-perger syndrome than in those withother autism disorders.4

Much of the published literature hasbeen based on small clinical sampleswith no control group, and some haveused retrospectively collected data onfeeding. We have used a population-based cohort to investigate feedingpatterns, diet, and growth of childrenwith ASDs and used prospectively re-ported data collected before the diag-nosis of an autism disorder had beenmade.

METHODS

The Avon Longitudinal Study of Parentsand Children (ALSPAC) is a longitudinalcohort study that follows the healthand development of children who hadan expected date of delivery betweenApril 1991 and December 1992 and re-sided in the Avon area of southwestEngland at the time of their birth.

Mothers (n 14 541) enrolled duringpregnancy, and those pregnancies re-sulted in 14 062 live births, of whom13 971 survived their rst 5 years.5 Full

details of the questionnaires used, thebiological samples retained, the exam-inations, and observations of the chil-dren are available on the ALSPAC Website.6 Ethical approval for the studywas obtained from the ALSPAC Law andEthics Committee and the local re-search ethics committees.

Identication of Cases of ASD

The children within the ALSPAC with adiagnosis of ASD by the age of 11 yearswere identied from 2 independentsources: (1) the clinical records of allchildren in the cohort investigated fora suspected developmental disorderby amultidisciplinary assessment; and(2) the national educational databasein England (Pupil Level Annual SchoolCensus [PLASC]), which identied allchildren in state schools (90% ofchildren) who needed special educa-tional provision because of ASDs in2003. Details of the methods used inthe identication of ASDs and the de-mographic characteristics of the au-tistic children in the ALSPAC cohorthave already been reported.7 A total of86 children were identied, giving aprevalence of 62 per 10 000 childrenaged 11 years. There were 30 childrenwith classical childhood autism, 15with atypical autism, and 23 with As-perger syndrome; 18 of the ASD casescould not be classied. Themedian ageof referral was 28 months, and the me-dian age of diagnosis of childhood au-tism was 45 months.

Feeding and Dietary Data

Questions on the childs feeding andthe frequency with which differentfoods were eaten were included inquestionnaires completed by the maincaregiver at 6, 15, 24, 38, and 54months. A food-variety score was cre-ated from the food-frequency ques-tionnaires: a total of 56 different foodsand drinks were included, and thenumber of times never was reportedwas summed to give the food-variety

score. The higher the score, the lessvariety in the diet.

The content of the diet was assessedfrom the food-frequency questionnairecompleted by the caregiver when thechild was 38 months of age.

Growth Data

Weight and height measurements col-lected by health visitors as part of rou-tine preschool-aged child health sur-veillance were extracted from the AvonChild Health Computer database. At theage of 7 years, all children in theALSPAC were invited to a special re-search clinic at which they wereweighed and measured.

Hemoglobin Data

Children who attended the ALSPAC re-search clinic at 7 years of age had ve-nous blood samples taken for hemo-globin analysis by the HemoCue (L.E.West, Ltd, Barking, United Kingdom)method (n 5859).

Statistical Analyses

Logistic regression was used to ana-lyze associations between ASDs andfeeding patterns by using Stata 9.2(Stata Corp, College Station, TX). Be-cause of the strong association be-tween gender and ASDs (odds ratio[OR]: 6.40 [95% condence interval(CI): 3.4212.14]), analyses were ad-justed for gender. A linear relationshipwas assumed for continuous variables(food-variety score and dietary in-takes). Effect sizes were reported for a1-SD increase. Categorical variables(feeding patterns) were dichotomizedaccording to the worst versus the restof the categories. Repeated measuresat different ages were analyzed simul-taneously in a combined analysis but,for clarity, are reported separately. Inthese combined analyses, additionaladjustment was made for age, and dif-ferences in effects across time wereassessed through an interaction test.

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RESULTS

Data on feeding and dietary patternswere available for 79 children withASDs and 12 901 controls. Actual num-bers varied for each explanatory vari-able and were in the range of 64 to 74for children with ASDs and 9550 to12 249 for controls.

No group differences were apparent inmaternal diet during pregnancy,breastfeeding rates, or infant food-variety score at 6 months. In infancy,the children subsequently diagnosedwith ASDs were more likely than con-trols to have late acceptance of solidfood (P .004) and to be described bytheir mothers as slow feeders (P .02) (Table 1).

Between 15 and 54 months of age, thechildren with ASDs were consistentlyreported to be difcult to feed (P .001) and very choosy (P .001). Re-sults of combined analyses suggested

that these differences were present at15 months. From 15 months, the chil-dren with ASDs had a signicantly lessvaried diet, which became progres-sively more different than controlswith increasing age (interaction P .002). The diet was least varied in chil-drenwith classical autism (Fig 1). At 38months the food-variety score wasnormally distributed, with a mean of21 (SD: 6; range: 248).

By 24 months of age, the children withASDs were more likely to be having adifferent diet than the rest of their fam-ily, and by 54 months 8% of the chil-dren with ASDs were taking a specialdiet for allergy, compared with 2% ofcontrols (OR: 3.41 [95% CI: 1.358.63];P .01). Children with ASDs weremuch more likely than controls toshow pica behavior at 38 and 54months (Table 1).

The food-frequency data showed that,compared with controls, the childrenin the ASD group ate fewer vegetables,salads, and fresh fruit but also con-sumed fewer sweets and zzy drinks.The derived dietary data at 38 months(Table 2) revealed no differences be-tween children with ASDs and controlchildren in the reported intake of en-ergy, total fat, carbohydrate, proteins,and minerals, but the group of chil-drenwith ASDs had less variety in theirdiet (higher variety score). The detailsof the diet are contained in the Appen-dix, which shows that the dietary con-tent of children with classical autism,atypical autism, and Asperger syn-drome were similar. Compared withcontrols, children with ASDs con-sumed less vitamin C (P .007) andvitamin D (P .004) and more iodine(P .01), but estimates were impre-cise because of small sample sizeswithin some groups.

There were no group differences be-tween children with ASDs and controlsin mean weight, height, or BMI at 18months and 7 years. Although childrenwithASDshadslightly lowermeanhemo-globin levels (122.7 vs 124.5 g/L), this dif-ference was not signicant (P .320).

DISCUSSION

The results of this prospective studyshow that children on the autism spec-trum demonstrated feeding symptomsfrom infancy and had a progressivelyless varied diet from 15 months of age.However, energy intake and growth

0.00.51.01.52.02.53.03.54.0

6 mo 15 mo 24 mo 38 mo

Classical autismOther types of ASDs

Odd

s ra

tio

age

a a

b

FIGURE 1Food-variety score and type of ASD (odds ratiofor a 1-SD increase). ap .05, bp .01.

TABLE 1 Feeding Symptoms in Children With ASDs and Controls up to 54 Months

Children WithASDs, % (n)

Controls, % (n) OR (95% CI) P

Slow feeding1 mo 47.3 (35) 40.0 (4894) 1.35 (0.852.14) .206 mo 40.6 (28) 30.7 (3497) 1.66 (1.022.69) .04Pooled estimate 1.49 (1.062.08) .02Interaction with age .55

Acceptance of solids03 mo 61.8 (42) 72.8 (8183) 0.60 (0.351.03) 4 mo 29.4 (20) 23.2 (2606) 1 (reference) 5 mo 8.8 (6) 4.0 (451) 1.93 (0.774.87) .004

Very difcult to feed15 mo 8.1 (6) 3.4 (374) 2.71 (1.166.31) .0224 mo 15.5 (11) 4.5 (467) 3.67 (1.917.05) .00138 mo 11.9 (8) 5.1 (515) 2.40 (1.145.07) .0254 mo 26.2 (17) 10.0 (961) 2.90 (1.665.07) .001Pooled estimate 2.92 (2.084.09) .001Interaction with age .86

Very choosy15 mo 9.5 (7) 5.4 (595) 1.92 (0.874.21) .1024 mo 20.0 (14) 9.5 (979) 2.45 (1.364.43) .00338 mo 28.4 (19) 14.5 (1451) 2.23 (1.303.81) .00354 mo 37.5 (24) 13.9 (1324) 3.47 (2.085.79) .001Pooled estimate 2.55 (1.913.40) .001Interaction with age .54

Pica38 mo 12.3 (8) 2.3 (226) 6.09 (2.8513.01) .00154 mo 12.5 (8) 0.7 (68) 21.37(9.5947.61) .001Pooled estimate 9.82 (5.6617.03) .001Interaction with age .03

indicates not applicable.

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were not impaired. The limitation innumber of foods accepted was mostapparent in children with classical au-tism, but no other differences were ap-parent between different types of au-tism disorders in feeding symptoms,diet, or growth.

The strengths of the study are that thesample is population based, whichprovides a good normal comparativegroup and that feeding data have beencollected prospectively before ASDwas diagnosed. Limitations are thatASDs in the children were diagnosedby clinical teams rather than by astructured research assessment, andthe feeding and dietary data were re-ported by the mother with no objectivevalidation.

The nding that breastfeeding rates ofthe children with ASDs were no differ-ent than those of controls is consistentwith the results of an earlier studyfrom North Dakota.8 The difculty in ac-cepting solids and the description ofslow feeding in infancy could be seenas early symptoms of an autisticchilds difculty in accepting change.Other feeding symptoms such as fuss-iness became more obvious with in-creasing age and are most marked inthe children with classical autism. Therestrictions in types of food acceptedby the child with an ASDwere apparentfrom 15 months of age, often beforereferral for specialist autism assess-ment, and became progressively moreobvious.

A clinical implication of these ndingsis that the possibility of an ASD should

be considered for young children whopresent with feeding problems, perva-sive food refusal, and limited food pref-erences, and appropriate questionsshould be asked about the childs so-cial communication, shared attention,and stereotypic and self-stimulatorybehaviors.

For children who have ASDs and perva-sive eating problems, effective behav-ioral strategies need to address boththe neophobia and sensory sensitivi-ties (color, taste, texture) of the autis-tic child. Tools such as the Brief AutismMealtime Behavior Inventory (BAMBI)9

have been developed to assess feedingproblems in children with ASDs andprovide a useful objective measure tomonitor response to behavioral inter-ventions to improve the range of foodstaken.

Clinicians and parents will be reas-sured by the nding that, despite thelimited food preferences, the childrenwith ASDs took adequate amounts ofenergy from their diet and grew nor-mally. No differences were found be-tween children with ASDs and theirpeers in the balance of carbohydrates,protein, and fats consumed, whichsuggests that satiety mechanisms arenot impaired in ASDs. No differenceswere apparent in minerals in the diet,including iron and calcium. Our resultsare consistent with those of recent de-scriptive studies that also found that,although the parents of children withASDs reported that they were pickyeaters and resisted trying new foods,the measured nutrient intake of the

children with ASDs was similar to thatof age-matched controls.10

With 30 dietary components beingcompared, some associations may behave been a result of chance, so thending that 2 vitaminswere reduced inthe ASD diet needs to be treated withcaution. The lower vitamin C intake isderived from the lower consumption bythe children with ASDs of fruits and veg-etables reported in the food-frequencyquestionnaires. However, the childrenwith ASDs had similar iron intake andhemoglobin levels to those of con-trols. The children with ASDs alsoless frequently accepted dietarysources of vitamin D and had moreiodine in their diet, but the clinicalsignicance of these ndings is un-certain. In comparison, a recentsmaller, detailed study that com-pared 3-day dietary diaries of chil-dren with ASDs and children with typ-ical development11 revealed thatchildren with ASDs consumed morevitamins B6 and E and nondairy pro-tein but less calcium with fewerdairy servings.

A few autistic children in the ALSPACwere placed on special diets after thediagnosis of ASD had been made, withthe parents citing allergy as the rea-son for the diet, but we did not haveinformation on how food allergy wasdiagnosed. The dietary changes mayhave been made in response to thegastrointestinal symptoms that are re-ported for autistic children1215 or toattempt to improve core autistic be-haviors such as ability to communi-

TABLE 2 Dietary Consumption at 38 Months in Children With ASDs Compared With Controls

ASDs (n 64) Classical Autism (n 23) Atypical Autism (n 11) Asperger Syndrome (n 17)

OR 95% CI P OR 95% CI P OR 95% CI P OR 95% CI P

Variety score 1.84 1.482.29 .001 2.25 1.593.20 .001 1.36 0.782.36 .279 1.95 1.292.96 .002Energy 0.98 0.771.26 .894 0.72 0.451.13 .154 1.14 0.661.97 .638 0.97 0.601.55 .884Total fat 1.01 0.791.29 .926 0.78 0.501.21 .260 1.18 0.692.04 .542 1.00 0.631.60 .997Protein 0.93 0.721.19 .545 0.69 0.441.09 .110 1.19 0.692.07 .531 0.98 0.611.58 .947Carbohydrates 0.97 0.761.24 .837 0.70 0.441.11 .131 1.08 0.621.89 .782 0.91 0.561.48 .715

The variety score is derived from 56 food-frequency questionnaire questions and reects the number of times that never was reported. The logistic regression analyses adjusted forgender. ORs are for a 1-SD increase. Controls: n 9796.

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cate. Although many parents of chil-dren with ASDs do try special dietsfor their children, a recent update ofa Cochrane review on gluten- andcasein-free diets in children withASDs concluded that the evidence forthe efcacy of these diets remainspoor.16

The normal dietary consumption of en-ergy by the children with ASDs in ourstudy is reected in their normalgrowth parameters, consistent withthe literature on growth in childrenwith autism disorders.17 However, insome societies, childrenwith autism areat higher risk of being overweight.18

CONCLUSIONS

Children on the autism spectrum dem-onstrated feeding symptoms from in-fancy and had a less varied diet from15 months of age, but energy intakeand growth were not impaired. Feed-ing behavior in children with ASDs re-ects limited interests and difculty inaccepting change and, in an extremeform, can present as a pervasive eat-ing disorder.

ACKNOWLEDGMENTSThe UK Medical Research Council, theWellcome Trust, and the University ofBristol provide core support for the

ALSPAC. This study was funded by theMedical Research Council: all research-ers on this study are independent fromthe funding body, and there are no com-peting interests to declare. This publica-tion is the work of the authors, and DrsEmond and Steer will serve as guaran-tors for the contents of this article.

We are extremely grateful to all thefamilies who took part, the midwivesfor help in recruiting them, and thewhole ALSPAC team, which includes in-terviewers, computer and laboratorytechnicians, clerical workers, re-search scientists, volunteers, manag-ers, receptionists, and nurses.

REFERENCES

1. Williams PG, Dairymple N, Neal J. Eating hab-its of children with autism. Pediatr Nurs.2000;26(3):259264

2. Ahearne WH, Castine CT, Nault K, Green G. Anassessment of food acceptance in childrenwith autism or pervasive developmentaldisorder-not otherwise specied. J AutismDev Disord. 2001;31(5):505511

3. Schreck KA, Williams K. Food preferencesand food selectivity for children with autis-tic spectrum disorders. Res Dev Disabil.2006;27(4):353363

4. Whitely P. Developmental, behavioural andsomatic factors in pervasive developmentaldisorders: preliminary analysis. Child CareHealth Dev. 2004;30(1):511

5. Golding J, Pembrey M, Jones R; ALSPACStudy Team. ALSPAC: the Avon LongitudinalStudy of Parents and Children. I. Studymethodology. Paediatr Perinat Epidemiol.2001;15(1):7487

6. University of Bristol. Avon LongitudinalStudy of Parents and Children. Available at:www.alspac.bristol.ac.uk. Accessed June 3,2010

7. Williams E, Thomas K, Sidebotham H, Emond

A. The prevalence and characteristics of au-tistic spectrum disorders in the ALSPAC co-hort. Dev Med Child Neurol. 2008;50(9):16

8. Burd L, Fisher W, Kerbeshian J, Vesely B,Durgin B, Reep P. A comparison of breast-feeding rates among children with perva-sive developmental disorder, and controls.J Dev Behav Pediatr. 1988;9(5):247251

9. Lukens CT, Linscheid TR. The Brief AutismMealtime Behavior Inventory (BAMBI). J Au-tism Dev Disord. 2008;38(2):342352

10. Lockner DW, Crowe TK, Skipper BJ. Dietaryintake and parents perception of mealtimebehaviors in preschool-age children withautism spectrum disorder and in typicallydeveloping children. J Am Diet Assoc. 2008;108(8):13601363

11. Herndon AC, DiGuiseppi C, Johnson SL, Leif-erman J, Reynolds A. Does nutritional intakediffer between children with autism spec-trum disorders and children with typicaldevelopment? J Autism Dev Disord. 2009;39(2):212222

12. Sandhu B, Steer C, Golding J, Emond. A Theearly stool patterns of young children withautistic spectrum disorder. Arch Dis Child.2009;94(7):497500

13. Molloy CA, Manning-Courtney P. Prevalenceof chronic gastrointestinal symptoms inchildrenwith autism and autistic disorders.Autism. 2003;7(2):165171

14. Erickson CA, Stigler KA, Corkins MR, PoseyDJ, Fitzgerald JF, McDougle CJ. Gastrointes-tinal factors in autistic disorder: a criticalreview. J Autism Dev Disord. 2005;35(6):713727

15. Ibrahim SH, Voigt RG, Katusic SK, Weaver AL,Barbaresi WJ. Incidence of gastrointestinalsymptoms in children with autism: apopulation-based study. Pediatrics. 2009;124(2):680686

16. Millward C, Ferriter M, Calver S, Connell-Jones G. Gluten- and casein-free diets forautistic spectrum disorder. Cochrane Data-base Syst Rev. 2008;(2):CD003498

17. Curtin C, Bandini LG, Perrin EC, Tybor DJ,Must A. Prevalence of overweight in chil-dren and adolescents with attention decithyperactivity disorder and autism spec-trum disorders: a chart review. BMC Pedi-atr. 2005;5:48

18. Xiong N, Ji C, Li Y, He Z, Bo H, Zhao Y. Thephysical status of children with autism inChina. Res Dev Disabil. 2009;30(1):7076

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APPENDIX Details of the Diet of Children With ASDs at 38 Months Compared With Controls

ASDs (n 64) Classical Autism (n 23) Atypical Autism (n 11) Asperger Syndrome(n 17)

OR 95% CI P OR 95% CI P OR 95% CI P OR 95% CI P

Calcium 1.04 0.691.57 .842 1.35 0.672.75 .399 0.52 0.191.42 .202 0.92 0.412.06 .843Carotene 0.74 0.560.99 .042 1.12 0.741.69 .603 0.62 0.291.29 .198 0.64 0.351.15 .136Cholesterol 0.89 0.641.22 .467 0.70 0.381.27 .241 1.00 0.492.06 .990 1.60 0.972.62 .065Omega-3 from sh 0.85 0.631.13 .265 0.97 0.621.53 .903 1.04 0.571.88 .903 1.02 0.621.68 .947Docosahexaenoic acid 0.73 0.521.01 .061 0.98 0.621.54 .925 0.77 0.361.64 .494 0.83 0.461.49 .537Eicosapentaenoic acid 0.80 0.591.09 .163 0.96 0.601.52 .847 0.96 0.511.81 .904 0.96 0.571.62 .878Folate 0.74 0.511.07 .111 0.61 0.321.19 .148 1.04 0.452.43 .927 1.13 0.562.29 .725Iodine 1.61 1.122.31 .010 1.42 0.732.74 .303 1.76 0.764.11 .189 2.42 1.284.56 .006Iron 0.93 0.611.42 .733 0.79 0.371.71 .553 1.44 0.563.67 .449 0.78 0.331.82 .566Magnesium 1.20 0.811.77 .358 1.23 0.622.46 .551 1.55 0.643.74 .326 0.95 0.432.06 .889Monounsaturated fat 0.95 0.521.76 .880 1.01 0.342.98 .983 1.36 0.345.43 .665 0.97 0.303.18 .964Niacin 0.81 0.531.23 .319 0.68 0.321.44 .317 1.25 0.493.15 .643 0.97 0.442.16 .943Nonmilk-extrinsic sugar 1.01 0.701.45 .961 0.88 0.441.78 .727 0.97 0.432.21 .946 0.62 0.281.39 .246Fiber 1.12 0.811.54 .490 1.20 0.692.10 .522 1.70 0.863.37 .129 0.84 0.441.62 .606Phosphorus 1.12 0.691.84 .640 1.23 0.512.93 .647 1.10 0.353.44 .871 1.04 0.402.69 .941Polyunsaturated fat 0.87 0.641.20 .399 0.56 0.311.02 .059 1.28 0.652.54 .476 0.82 0.441.51 .519Potassium 0.95 0.591.52 .819 0.95 0.412.20 .909 1.10 0.373.29 .869 0.91 0.362.27 .833Retinol 1.02 0.751.37 .922 0.80 0.411.59 .530 1.46 1.091.96 .012 0.92 0.471.79 .800Riboavin 1.07 0.741.56 .709 1.12 0.582.16 .746 0.89 0.372.16 .792 1.00 0.482.08 .944Saturated fat 1.34 0.852.11 .203 1.87 0.874.01 .110 1.15 0.393.37 .803 1.32 0.553.17 .538Selenium 1.17 0.851.61 .349 1.13 0.632.03 .677 1.49 0.743.02 .263 1.35 0.742.48 .333Sodium 1.02 0.631.66 .930 0.61 0.261.46 .267 2.51 0.857.48 .097 1.63 0.644.14 .308Starch 1.05 0.681.63 .811 0.98 0.432.20 .957 1.04 0.392.75 .941 1.53 0.683.45 .305Sugar 0.92 0.591.43 .698 0.92 0.402.10 .847 0.67 0.241.89 .452 0.51 0.201.27 .148Thiamin 0.77 0.511.15 .206 0.83 0.411.70 .619 0.79 0.312.01 .618 0.70 0.321.55 .378Vitamin C 0.65 0.470.89 .007 0.69 0.411.18 .176 0.87 0.451.69 .679 0.48 0.230.98 .043Vitamin B6 0.58 0.380.89 .012 0.50 0.241.05 .069 0.65 0.241.73 .386 0.85 0.381.92 .702Vitamin B12 0.90 0.651.25 .536 0.84 0.471.51 .557 1.22 0.622.40 .565 1.19 0.672.13 .548Vitamin D 0.63 0.460.86 .004 0.48 0.270.84 .011 0.63 0.301.33 .229 0.95 0.531.70 .866Vitamin E 0.85 0.631.14 .279 0.55 0.300.98 .044 1.13 0.592.18 .713 0.75 0.411.36 .339Zinc 1.02 0.671.58 .911 1.07 0.502.30 .863 1.22 0.453.33 .695 0.92 0.402.13 .844

The variety score is derived from 56 food-frequency questionnaire questions and reects the number of times that never was reported. Logistic regression analyses were adjusted forgender (and energy, except for energy, total fat, protein, and variety). ORs are for a 1-SD increase. Controls: n 9796.

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DOI: 10.1542/peds.2009-2391; originally published online July 19, 2010; 2010;126;e337Pediatrics

Alan Emond, Pauline Emmett, Colin Steer and Jean GoldingAutism Spectrum Disorders

Feeding Symptoms, Dietary Patterns, and Growth in Young Children With

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DOI: 10.1542/peds.2009-2391; originally published online July 19, 2010; 2010;126;e337Pediatrics

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