We establish the asymptotic zero distribution for polynomials generated by a four-term recurrence relation with varying recurrence coefficients having a particular limiting behavior. The proof is based on ratio asymptotics for these polynomials. We can apply this result to three examples of multiple orthogonal polynomials, in particular Jacobi-Pinneiro, Laguerre I and the example associated with modified Bessel functions. We also discuss an application to Toeplitz matrices.