Context: Individuals with autism spectrum disorder (ASD) often face behavioral challenges during meals, such as food refusal and restricted food consumption, which encompass the concept of food selectivity (FS). The exclusion of food groups such as fruits and vegetables and preferences toward ultraprocessed foods, therefore, can expose this population to an increased risk of developing different types of malnutrition, such as overweight, obesity, and micronutrient deficiencies. Objective: The aim of this systematic review was to assess if FS is a risk factor for poor health outcomes in individuals with ASD, based on findings in the literature published between 2012 and 2023. Data sources: Four databases (PubMed, Embase, Scopus, and Cochrane) were searched for relevant articles. The search was conducted in May 2023. Data extraction: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A checklist was used for data extraction, including descriptive information, study design, study aim, participant information, data collection characteristics, and significant findings. A total of 15 articles were included. Data synthesis: Individuals with ASD and with FS appear to have inadequate weight (particularly conditions of overweight and obesity), increased waist circumference, elevated waist-to-height ratio index, and insufficient nutritional intake, all of which increase their susceptibility to malnutrition. Conclusions: Food selectivity, common in this population, increases the risk of micronutrient deficiencies, gastrointestinal issues, eating disorders, hypertriglyceridemia, overweight, and obesity. However, outcomes vary due to differences in assessment tools and definitions of FS across studies. The lack of standardized methods for evaluating FS complicates the ability to draw consistent conclusions, emphasizing the need for ASD-specific validated tools. Future research should focus on standardizing assessments and exploring long-term health effects and interventions. Systematic Review Registration: PROSPERO registration No. CRD42023435018.

Individuals with autism spectrum disorders (ASD) are often characterized by food-selectivity, food-neophobia and a marked preference for mild flavor, semi-liquid foods with pale colors. Therefore, they adopt a monotonous dietary pattern, and they prefer ultra-processed food, leading to a high risk of developing malnutrition. In Italy, where 75,072 individuals are diagnosed with ASD, center-based services play a crucial role in their daily management. Despite the centrality of nutrition in maintaining a good state of health, even more for vulnerable subjects, no validated protocol at collective catering level has been developed yet. The manuscript presents customized dietary recommendations aimed at managing the meals for individuals with ASD at collective catering service, derived from a non-systematic literature review exploring food behaviors and nutritional needs in individuals with ASD. Simple practical tips for mealtimes, such as eating together, proper seating, lighting, smell control, presenting food in a simple manner and using the same type of tableware at each meal, to meet the needs of individuals with ASD, were described. The proposal could represent a starting point in developing official guidelines aimed at ASD individuals, in collective catering service.Level of Evidence: Level V.

Background: Individuals with autism spectrum disorder (ASD) often exhibit low dietary diversity due to food selectivity, leading to various forms of malnutrition, such as obesity or micronutrient deficiencies. Objective: The main objective of the AUT-MENU project is to improve meal acceptance among individuals with ASD. A secondary goal is to evaluate the effectiveness of a nutrition education course for parents of enrolled participants to reduce food selectivity. Methods: The study is a bicentric intervention conducted in 3 care centers (Pavia and Milan) and 1 secondary school (Rome), involving approximately 200 participants with ASD aged 3 to 35 years. The study consists of an observational phase (T0) and an intervention phase (T1). At T0, biographical data, clinical characteristics, and dietary patterns of participants are collected. Based on T0 findings and existing nutritional recommendations for individuals with ASD, targeted menus are developed and tested. At T1, the same assessment tools used at T0 will be applied to evaluate intervention effects. Additionally, a nutrition education course for caregivers will be implemented between T0 and T1, with a pre- and postcourse knowledge questionnaire to assess its effectiveness. Results: Due to different timelines depending on the centers and schools involved, participant enrollment and data collection will take place at different times between Pavia, Milan, and Rome. In September 2024, enrollment was held in the Pavia and Milan care centers for a total of 74 participants enrolled. In Rome, the enrollment phase has not yet started; activities are expected to be carried out similar to those in Pavia and Milan. Conclusions: The AUT-MENU study is expected to yield significant insights and improvements in meal acceptance among individuals with ASD, particularly through the introduction of targeted menus in collective catering settings both in care centers and schools. Trial Registration: ClinicalTrials.gov NCT06266377; https://clinicaltrials.gov/study/NCT06266377 International Registered Report Identifier (IRRID): DERR1-10.2196/57507

Background/Objectives: Individuals with Autism Spectrum Disorder (ASD) often exhibit low dietary diversity due to Food Selectivity (FS), leading to various forms of malnutrition, such as obesity and/or micronutrient deficiencies. The main objective of the AUT-MENU project is to improve meal acceptance among individuals with ASD. A secondary goal is to evaluate the effectiveness of a nutrition education course for parents of enrolled participants to reduce FS. Methods: The study is a bicentric intervention conducted in three care centers (Northern area, Pavia and Milan) and one secondary school (Southern area, Rome), involving individuals with ASD aged 3 to 35 years. The study consists of an observational phase (T0) and an intervention phase (T1). At T0, biographical data, clinical characteristics, and dietary patterns of participants are collected. Based on T0 findings and existing nutritional recommendations for ASD individuals, targeted menus are developed and tested. At T1, the same assessment tools used at T0 will be applied to evaluate intervention effects. Additionally, a nutrition education course for caregivers will be implemented between T0 and T1, with a pre- and post-course knowledge questionnaire to assess its effectiveness. Results: This paper reports the results from the care centers in the Northern Area. Conclusions: Menu adaptations, developed according to individual preferences and nutritional guidelines, did not significantly modify food consumption but were well tolerated, allowing for an improvement in the nutritional profile of meals without reducing acceptability. These findings support the feasibility of implementing tailored menu strategies in collective catering for individuals with ASD.

Background/Objectives: Childhood obesity represents a pressing global health challenge, demanding coordinated, long-term strategies. Schools and families are pivotal environments for shaping children’s lifestyle behaviors. The LIVELY project aimed to assess overweight/obesity prevalence and associated factors in primary school children, and to implement a multidimensional educational intervention promoting healthy, sustainable lifestyles. Methods: This single-arm study was conducted from October 2023 to October 2024 in a primary school in Milan. The intervention included age and culturally tailored lessons, games, and activities. Anthropometric measures, dietary adherence, and lifestyle habits were assessed before and after the intervention. Satisfaction surveys were administered to children, families, and teachers. Results: The project involved 227 children across 14 classes (mean age 8.9, SD 1.2 years). The prevalence of overweight/obesity was 23.4%. Adherence to the Mediterranean Diet was moderate, limited by low intake of vegetables, nuts, and dairy. Physical activity was low, screen time excessive, and sleep insufficient. No statistically significant improvements in anthropometrics or diet adherence were observed post-intervention, but positive trends emerged for physical activity, sleep, and hydration. Over half of the children passed the nutritional knowledge test. Despite these challenges, high satisfaction levels have been shared by children, parents, and teachers. Conclusions: The limited duration of the intervention and challenges engaging families in a low socio-economic context may have constrained the impact of the program, and caution is advised in generalizing the findings. The LIVELY project highlights the complexity of tackling childhood obesity in multicultural settings and emphasizes the need for longer, continuous, and culturally tailored programs that actively involve families to promote sustainable healthy behaviors.

Purpose: This narrative review aims to conduct a comparative analysis of dietary and non-dietary approaches in the management of weight and disordered eating behaviors (DEBs) in adults with obesity. Methods: Studies were identified from Medline (PubMed), including only English-language manuscripts published from 1998 to 2024. To be included in the review the studies had to be RCTs that compared the effect of dietary and non-dietary approaches on weight loss and DEBs in adults with obesity not being treated with pharmacological treatments. Results: Seven randomized controlled trials (RCTs) reported in 8 manuscripts published between 1998 and 2024 met the inclusion criteria. The sample size ranged from a minimum of 16 subjects to a maximum of 219. All studies involved adult subjects, mainly women, with first-, second-, or third-degree obesity and most subjects had cognitive restriction and/or uncontrolled eating. Dietary approaches were characterized by moderate caloric restriction (CR) and restriction of fat intake. In contrast, non-dietary approaches focused on mindful eating (ME), intuitive eating (IE) and weight neutral (WN) approaches. Of the 7 RCTs included, 5 reported greater weight loss in the diet group compared to the non-diet group; however, only one of these sustained the result at follow-up. In contrast, 4 studies demonstrated greater improvements in DEBs in the non-diet group. Conclusion: CR is essential for weight loss in individuals with obesity, but long-term weight management also hinges on their relationship with food. The psychological improvements reported in non-dietary versus dietary approaches should not be overlooked and can be a starting point for the development of multidisciplinary interventions involving synergistic actions between diet, exercise, and practices to improve DEBs with the goal of reducing the obesity epidemic. Level of evidence Level I, at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies.