Dietary Diversity in Children with Autism Spectrum Disorders, Feeding Difficulties, and Sensory Issues Related to Eating-A Case-Control Study.

Background/Objectives: Pediatric feeding disorders are common in children with autism spectrum disorder (ASD) and may result from sensory processing differences, contributing to reduced dietary diversity and increasing the risk of nutritional deficiencies or excessive body weight. This study assessed whether children with ASD exhibit lower dietary diversity than typically developing children. Methods: A clinical case-control study included 181 children aged 2-10 years (ASD: n = 85; controls: n = 96). Children with ASD had a confirmed diagnosis, while controls had no neurodevelopmental disorders. Dietary diversity was assessed using the Dietary Diversity Score (DDS), based on a 24 h dietary recall completed by parents or legal guardians. Foods were classified into nine food groups. DDS was categorized as low (≤4 groups), moderate (5-6), or high (≥7). Results: Mean total DDS was comparable between groups (ASD: 6; controls: 5). Children with ASD consumed legumes and oilseeds more frequently, whereas controls consumed dark green leafy vegetables more often. Low DDS was more prevalent in the ASD group (32.9% vs. 15.6%), while moderate DDS predominated in controls (64.6% vs. 32.9%). High DDS was also more common in children with ASD (34.1% vs. 19.8%), indicating substantial heterogeneity in dietary patterns. Dietary diversity was significantly associated with sensory characteristics, particularly acceptance of food texture and temperature. Conclusions: The study results indicate a heterogeneous nature of dietary diversity among children with ASD, without confirming a generally reduced level. After adjusting for age, sex, and BMI, ASD group membership was associated with DDS scores. Individual and sensory-related dietary factors should be taken into account when addressing nutritional needs.