Usual micronutrient intake and food selectivity among Brazilian children and adolescents with autism spectrum disorder: a cross-sectional study.

BACKGROUND: Feeding difficulties, particularly food selectivity, are commonly reported in individuals with autism spectrum disorder (ASD), raising the possibility that these aspects may affect dietary intake, including essential micronutrients. Many studies on this topic fail to adequately adjust for within-person variability, potentially misrepresenting usual nutrient intake. OBJECTIVE: This study evaluates micronutrient adequacy among children and adolescents with ASD with and without food selectivity, based on usual intake estimations. DESIGN: This study used a cross-sectional design and included data collected between July 2021 and April 2025. PARTICIPANTS/SETTING: Data were obtained from 303 participants aged between 2 and 18 years attending the public neuropediatric outpatient clinic of the Federal University of Pelotas, southern Brazil. MAIN OUTCOME MEASURES: Food consumption was obtained from three non-consecutive days of a 24-hour dietary recall, and food selectivity was assessed based on the consumption of food group items and item 10 of the Brief Autism Mealtime Behavior Inventory. STATISTICAL ANALYSES PERFORMED: The distribution of usual micronutrient intake was estimated using the Multiple Source Method® (version 1.0.1), and the resulting values were compared with the corresponding dietary reference intakes. RESULTS: Food selectivity was observed in 77% of the participants. When comparing individuals with and without food selectivity, a high frequency of inadequacy was observed in both groups for copper, potassium, calcium, and retinol, while sodium intake was excessive. Significant differences in usual micronutrient adequacy between the groups were observed only for vitamin C and phosphorus. CONCLUSION: Food selectivity did not substantially differentiate micronutrient adequacy in this sample, and both groups showed relevant inadequacies. These findings highlight the need for routine nutritional screening for all individuals with ASD, regardless of food selectivity status, to ensure accurate evaluation of nutrient intake and better inform nutritional interventions.