Effects of nutritional supplementation on social impairment and behavioral dysregulation in autism spectrum disorder: a network meta-analysis

Autism spectrum disorder (ASD) is characterized by core deficits in social interaction, often accompanied by behavioral challenges such as irritability and hyperactivity. In recent years, various nutritional supplements have been employed to alleviate ASD-related symptoms, yet the relative efficacy of different interventions remains unclear. This study employs network meta-analysis to compare the effects of distinct nutritional supplementation strategies on impaired social functioning and behavioral disorders in ASD. Systematically searched PubMed, Embase, Web of Science, and Cochrane Library databases for randomized controlled trials (RCTs) from indexing to December 20, 2025. Studies evaluating the effects of nutritional supplements on social functioning, irritability, and hyperactivity symptoms in children with ASD were included. A network meta-analysis using a random-effects model was conducted to calculate mean differences (MD) and 95% credible intervals (CrI). Interventions were ranked using SUCRA values. Data analysis was performed using R version 4.5.0. A total of 16 RCTs involving 736 children with ASD were included. The results of the network meta-analysis indicate that in terms of social functioning, Omega-3 MD = − 2.29 (− 3.52, − 1.07) and Vitamin D (VD) MD = − 2.89 (− 5.08, − 0.72) were associated with lower scores compared to UT, and both were superior to probiotics (Omega-3 vs. Probiotic: MD = − 1.74; VD vs. Probiotic: MD = − 2.34). For social functioning, the network estimates suggested that VD and omega-3 may be associated with lower symptom scores compared with usual treatment; however, these estimates were based on sparse and imprecise evidence. SUCRA rankings were calculated as exploratory indicators only and were not used to draw definitive conclusions regarding clinical superiority. For irritability, omega-3 and probiotics showed potentially favorable network estimates, whereas no clear intervention effect was observed for hyperactivity. Current evidence does not support recommending any nutritional supplement over usual treatment for children with ASD. Although some network estimates suggested possible benefits for social functioning and irritability, these findings were limited by non-significant direct evidence, small sample sizes, sparse networks, heterogeneity, and imprecision. No clear effect was observed for hyperactivity. Further large, well-designed RCTs are needed. Not applicable.