Nutritional Therapy Interventions in Eating Behavior in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis
Eating. Feeding Behavior. Autism Spectrum Disorder. Nutritional Status. Systematic Review.
Autism Spectrum Disorder is characterized, among other aspects, by alterations in eating behavior, such as selectivity, refusal of new foods, and atypical manifestations during meals, which can compromise the nutritional status of children and adolescents. Food therapy interventions have been used to expand the dietary repertoire and reduce inappropriate behaviors. This study aimed to evaluate the evidence on the types and patterns of changes in eating behavior in children and adolescents with Autism Spectrum Disorder after food therapy interventions. A systematic literature review was conducted, registered on the PROSPERO platform (CRD420251132198), with searches in the PubMed/MEDLINE, CENTRAL, Scopus, EMBASE, Web of Science, ScienceDirect, LILACS, ERIC, PsycINFO, and ProQuest databases. Single-case experimental studies, randomized clinical trials, and quasi-experimental studies involving children and adolescents diagnosed with Autism Spectrum Disorder undergoing food therapy interventions were included. The risk of bias was assessed using the Risk of Bias in N-of-1 Trials, Risk of Bias 2, and Risk of Bias in Nonrandomized Studies of Interventions tools, while the certainty of evidence was analyzed using GRADE. Of the 605 studies identified, 23 were included. Overall, the interventions promoted a significant expansion of food repertoire and acceptance, accompanied by a reduction in atypical eating behaviors, with positive effects observed in different designs. However, methodological limitations, risks of bias, and very low certainty of evidence were frequent, especially in group studies. It is concluded that food therapy interventions show promising results in expanding food consumption and reducing atypical eating behaviors in children and adolescents with Autism Spectrum Disorder, although more methodologically robust studies are needed to strengthen the reliability of the findings.