Multicomponent Nutritional Intervention Improves Growth and Feeding in Children With Autism: Pilot Study From Vietnam

• 56 children with autism spectrum disorder (ASD) completed a 12-week multicomponent nutritional intervention in a single-arm pilot study in Vietnam.

• Significant improvements in weight-for-age, height-for-age, and BMI-for-age Z-scores were observed, particularly in younger children.

• Serum zinc, ferritin, and hemoglobin levels increased significantly; feeding behaviors and dietary quality also improved.

• No serious adverse events were reported, and study retention was 100%.

• The findings support the need for randomized controlled trials to confirm benefits.

Background

Children with autism spectrum disorder (ASD) often exhibit severe food selectivity, restricted dietary variety, and micronutrient deficiencies that can impair growth and nutritional status. In low- and middle-income countries, where resources for specialized nutritional support are limited, the evidence base for integrated interventions remains sparse. A new exploratory pilot study from Vietnam, published in Pediatric Reports, tested a 12-week multicomponent nutritional intervention in 56 children with ASD and reports improvements in growth, biomarkers, and feeding behaviors.

How the Study Was Conducted

Researchers recruited 56 children (mean age 59.0 ± 22.3 months, 80.4% male) from five community centers in Nghe An Province. The single-arm, pre-post design included a 12-week intervention comprising three components: caregiver nutrition education, individualized dietary counseling, and a daily multi-micronutrient supplement. Anthropometric indicators (weight, height, body mass index), biochemical markers (serum zinc, ferritin, hemoglobin, albumin), feeding behaviors, and dietary intake were assessed at baseline and after 12 weeks. Paired statistical tests were used to evaluate pre-post changes, and multivariable linear regression examined factors associated with growth response. All 56 participants completed the study, yielding 100% retention.

What the Study Found

Anthropometric changes

Among children younger than 60 months, mean Weight-for-Age Z-score (WAZ) increased from -0.66 to -0.28, and mean Height-for-Age Z-score (HAZ) increased from -1.18 to -0.97 (both p < 0.001). In children aged 60 months and older, mean HAZ increased from -0.87 to -0.58 (p < 0.001), and Body Mass Index-for-Age Z-score (BAZ) increased from -0.20 to 0.06 (p = 0.006). Weight-for-Height Z-score (WHZ) changes in the younger group did not reach statistical significance. Regression analysis indicated that lower baseline anthropometric status was associated with greater gains in WAZ and HAZ.

Figure 1. Shifts in Weekly Food Group Consumption. Note: *** indicates that p < 0.001.

Figure 2. Absolute Changes in Daily Nutrient Intake. Note: *** indicates p < 0.001.

Biomarkers

Serum zinc levels rose from a mean of 10.29 to 11.72 µmol/L (p = 0.001), ferritin from 31.74 to 34.79 ng/mL (p = 0.001), and hemoglobin from 122.73 to 124.77 g/L (p = 0.002). Albumin remained unchanged.

Feeding behaviors and dietary intake

Structured assessments revealed substantial improvements in mealtime behaviors. Prolonged food-holding and sensory-based food refusal declined, while meal completion and eating efficiency increased. High dietary selectivity decreased, and the proportion of children eating a varied diet rose. Weekly consumption of vegetables and fruits increased from 2.42 to 3.74 times per week, animal-source proteins from 3.51 to 4.51 times, and plant-based proteins (tofu, nuts) rose nearly fivefold from 0.52 to 2.47 times per week. Consumption of unhealthy sweets and snacks dropped from 2.46 to 1.16 times per week. Daily nutrient intake profiles showed broad increases in macro- and micronutrients, with the largest relative gains in vitamin C and dietary fiber.

Safety and Tolerability

The intervention was well tolerated. No serious adverse events or intervention-related safety concerns were reported. Caregiver compliance with counseling sessions and supplement administration was high, as monitored by food diaries and monthly supplement audits.

Limitations

The study is limited by its single-arm, non-randomized design, which cannot establish causality. The small sample and lack of a control group preclude definitive conclusions about efficacy. The intervention was short (12 weeks), and long-term follow-up is absent. Results from a single province in Vietnam may not generalize to other regions or populations. All outcomes were exploratory; no multiplicity adjustments were applied.

Implications and Next Steps

Despite its limitations, this pilot study provides encouraging signals that a community-based multicomponent nutritional intervention is feasible and may improve growth, micronutrient status, and feeding behaviors in children with ASD in a resource-constrained setting. The authors advocate for future randomized controlled trials with larger samples, longer follow-up, and active control groups to confirm and extend these preliminary findings.

References

1. Phan NDT, Do TTT, Nguyen TV, Trinh NB, Ngo HG, Ho HT, Le TTT, Ngo HT. Multicomponent Nutritional Support for Children with Autism Spectrum Disorder: An Exploratory Pilot Study in Vietnam. Pediatr Rep. 2026;18(4):97. doi:10.3390/pediatric18040097. PMID: 42496475; PMCID: PMC13398004.