The sex-specific association between autistic traits and eating behavior in childhood: An exploratory study in the general population

Abstract

Children with Autism Spectrum Disorder (ASD) often exhibit problematic eating behaviors, an observation mostly based on male dominated, clinical ASD study samples. It is, however, important to evaluate both children with an ASD diagnosis and children with subclinical autistic traits as both often experience difficulties. Moreover, considering the suggestion of a possible girl-specific ASD phenotype, there is a need to determine whether autistic traits are related with problematic eating behaviors in girls as well. This study explores the sex-specific association between autism (both autistic traits and diagnosed ASD) and eating behavior in middle childhood in Generation R, a prospective population-based cohort from fetal life onwards. We collected parental reports of autistic traits at six years (Social Responsiveness Scale) and of eating behavior at ten years (Children's Eating Behaviour Questionnaire). In this cohort of 3559 children, autistic traits at six years were associated with more Picky Eating, Emotional Eating and Food Responsiveness in later childhood (e.g. adjusted B for Picky Eating = 0.07; 95% CI: 0.03, 0.11). Stratified analyses showed that in girls, autistic traits were associated with more Emotional Overeating and Emotional Undereating (e.g. adjusted B for Emotional Undereating = 0.12; 95% CI: 0.04, 0.20), while no associations were found for boys. Results comparing children with and without an ASD diagnosis in the cohort largely confirm these associations (e.g. in girls, adjusted B for Emotional Undereating = 0.72; 95% CI: 0.01, 1.42). Our results point to a sex-specific association between autism and eating behavior in middle childhood. Also, our study is the first study to show that autistic traits are associated with emotionally based eating problems in girls and possibly represent part of a girl-specific ASD phenotype.

Increased emotional eating behaviors in children with autism: Sex differences and links with dietary variety

“…Oswald et al, 2016) are not the likely underlying driving factor. Thus, the current findings extend results from a recent study suggesting that sex moderates the association between autistic traits and emotional eating in the general population of children, with a positive association in TD girls but no association in TD boys (van’t Hof et al, 2020). Interestingly, previous studies that employed self-ratings of emotional eating found increased emotional eating in adolescent girls and women relative to adolescent boys and men (e.g.…”

“…The first (Kral et al, 2015) included 4- to 6-year-old children with ASD ( n = 25) who had similar, albeit elevated, ratings of both emotional over-eating and emotional under-eating compared to TD controls ( n = 30). The second, more recent study (van’t Hof et al, 2020) was primarily focused on associations between autistic traits and eating behavior during middle childhood; nevertheless, they also found no differences in emotional eating between their sample of children with ASD ( n = 45) and a very large control group ( n > 3500). However, both studies included participants from constrained age ranges and recruited relatively small samples of children with ASD (with particularly limited numbers of girls with ASD), which limited the ability to detect small to medium effect size differences between groups.…”

“…Nevertheless, although there is an increasing recognition of the importance of examining sex differences in ASD, eating behaviors have rarely been the focus of these studies. One recent study has shown that greater autistic traits at age 6 years in predominantly TD girls from the general population were predictive of increased emotional eating at age 10, whereas this association was not observed in same-age predominantly TD boys from the same sample (van’t Hof et al, 2020). Therefore, this study will extend this previous investigation to the clinical level to examine possible sex differences in emotional eating among children with ASD.…”

Young Adults with High Autistic-Like Traits Displayed Lower Food Variety and Diet Quality in Childhood

“…Therefore, a child with ASD who is also low in iron may find it more difficult to communicate and behave in a socially acceptable manner (Ranjan and Nasser 2015). Diet is also a powerful modulator for influencing the composition of the gut microbiome (Tomova et al 2020). Emerging evidence suggests that nutritional intervention in children with ASD may improve immune status and GI function by altering the intestinal microbiota (Tomova et al 2020).…”

“…Diet is also a powerful modulator for influencing the composition of the gut microbiome (Tomova et al 2020). Emerging evidence suggests that nutritional intervention in children with ASD may improve immune status and GI function by altering the intestinal microbiota (Tomova et al 2020). More research is required to investigate improvements in autistic-like traits with dietary intervention.…”