Avaliação dietética em estudos com crianças e adolescentes com transtorno do espectro autista: Revisão sistemática de literatura

Abstract

The eating difficulties presented by individuals with autism spectrum disorder (ASD), such as food refusal and limited food repertoire, directly influence the adequacy of nutritional intake and body weight changes. There is no consensus among the studies on which methods should be applied in the collection and analysis of food intake data for these patients. In this context, the aime of this study was to review the literature to clarify how the dietary intake of children and adolescents with ASD has been evaluated in clinical and epidemiological studies and to critically analyze the quality of the applied dietary data collection and analysis protocols. A systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered in the International Prospective Register of Systematic Reviews (CRD42020190229) was performed. Searches were conducted in the PubMed, PsycINFO, SciELO, and Web of Science databases. The search was initially conducted in October 2020 and updated in December 2021. Observational and clinical studies evaluating food intake in patients with ASD (≤19 years) were included, and reviews, abstracts, or editorial letters were excluded. The methodological evaluation of the dietary assessment was performed applying the Strengthening the Reporting of Observational Studies in Epidemiology - Nutritional Epidemiology (STROBE-nut) criteria. Ninety-four studies were included, the majority were cross- sectional in design (n=61). The most frequent dietary instruments were the food record (n=51) and the food frequency questionnaire (n=42). Most studies (n=54) used closed questions and were not validated for the population and analyzed the intake of calories (n=50) and the intake of nutrients (n=59). Forty-eighty studies analyzed food items or food groups. Food characteristics associated with ASD were investigated by analysis of food variety (n=15), food refusal (n=13), food repertoire (n=3) and daily high consumption of certain food items (n=2). Furthermore, 15 studies evaluated dietary selectivity. The mean score on the STROBE-nut was 12.5 (5.5-17.5) and the items related to the reporting of the application protocol and the validation of the dietary instruments were not met in most studies (≥67%). Most studies applied nonvalidated instruments and/or obtained low scores in the evaluation of the report of items related to the food intake investigation protocol. It is emphasized that future research should be meticulous in developing its methodologies, in order to improve evidence related to the nutritional aspects of patients with ASD.