No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
A pilot study to evaluate nutritional influences on gastrointestinal symptoms and behavior patterns in children with Autism Spectrum Disorder
Abstract
One in 110 children in the US have autism spectrum disorder (ASD), a debilitating and life-long disorder that affects the health, relationships, and learning of affected children. Existing research on the etiology, contributing factors, and treatment for ASD is limited and controversial. Studies suggest that GI symptoms are related to behavior issues in children with ASD, which may be improved by a gluten-free, casein-free (GFCF) diet.
To evaluate the relationship between a GFCF diet and gastrointestinal symptoms and behavior patterns in children with ASD.
Cross-sectional design in which parents completed an online survey regarding general health, diet (adapted food-frequency questionnaire (FFQ)), gastrointestinal symptoms, and behavior patterns of their children with ASD.
Scores on the Gastrointestinal Symptoms Rating Scale (GSRS) and Childhood Autism Rating Scale (CARS).
Seven of thirteen children (median age 9years) were on a GFCF diet, consuming significantly fewer gluten- and casein-containing foods than those not on a GFCF diet. GSRS and CARS scores did not differ significantly according to diet. Parents of all the children on a GFCF diet reported improved GI symptoms and behavior patterns.
This study provides evidence that the adapted FFQ is an effective tool for evaluating adherence to a GFCF diet. Continued well-controlled research is necessary to elucidate the gut-brain relationship in ASD.
... In addition, eight original studies were found [44][45][46][47][48][49][50][51] (see Table 3). Six of these eight original studies were intervention studies of moderate or weak quality [44][45][46][47]50,51] and two were observational studies following children who were already on a GFCF diet [48,49]. ...
... In addition, eight original studies were found [44][45][46][47][48][49][50][51] (see Table 3). Six of these eight original studies were intervention studies of moderate or weak quality [44][45][46][47]50,51] and two were observational studies following children who were already on a GFCF diet [48,49]. In three of the six intervention studies beneficial effects on the Childhood Autism Rating Scale (CARS) score and behavior as noted by parents were reported [47,50,51]. ...
... It is, however, important to note that these three studies did not include a control group. In the two observational studies parents reported an improvement in the behavior of their children after the start of a GFCF diet on respectively the CARS [49] and characteristic ASD behaviors and social behaviors [48]. This improvement was significantly better than those that did not eliminate gluten and casein completely [48], but not significantly better than those that were not on a GFCF diet. ...
Autism spectrum disorder (ASD) is characterized by impairments in social interaction, communication skills, and repetitive and restrictive behaviors and interests. Even though there is a biological basis for an effect of specific nutrition factors on ASD symptoms and there is scientific literature available on this relationship, whether nutrition factors could play a role in ASD treatment is unclear. The goal of the current literature review was to summarize the available scientific literature on the relation between nutrition and autism spectrum disorder (ASD) symptoms in childhood, and to formulate practical dietary guidelines. A comprehensive search strategy including terms for ASD, nutrition factors (therapeutic diets, dietary patterns, specific food products, fatty acids and micronutrients) and childhood was developed and executed in six literature databases (Cinahl, Cochrane, Ovid Embase, PsycInfo, PubMed and Web of Science). Data from meta-analyses, systematic reviews and original studies were qualitatively summarized. A total of 5 meta-analyses, 29 systematic reviews and 27 original studies were retrieved that focused on therapeutic diets, specific food products, fatty acids and micronutrients and ASD symptoms during childhood. Results of the available studies were sparse and inconclusive, and hence, no firm conclusions could be drawn. There is currently insufficient evidence for a relation between nutrition and ASD symptoms in childhood, making it impossible to provide practical nutrition guidelines; more methodological sound research is needed.
... In 16 van deze studies lag de focus op diëten [97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112] (zie Bijlage 1, Tabel 10), in 13 studies op vetzuren [55, [109][110][111][112][113][114][115][116][117][118][119][120] (zie Bijlage 1, Tabel 12) en in 17 studies op micronutriënten [4,7,8,[109][110][111][112]117,118,[121][122][123][124][125][126][127][128] (zie Bijlage 1, Tabel 14). Additioneel werden zes losse studies gevonden die in geen enkele meta-analyse of systematische review waren opgenomen, waarin gekeken werd naar de relatie tussen diëten en ASS tijdens de kindertijd [129][130][131][132][133][134] (zie Bijlage 1, Tabel 11), drie losse studies met betrekking tot vetzuren [135][136][137] (zie Bijlage 1, Tabel 13) en negen met betrekking tot micronutriënten [138][139][140][141][142][143][144][145][146] (zie Bijlage 1, Tabel 15). ...
... Verder werd in sommige studies alleen advies gegeven met betrekking tot het volgen van een GFCF-dieet, waarbij het onduidelijk is in hoeverre daadwerkelijk volledige eliminatie van gluten en caseïne door deelnemers bereikt werd. Additioneel werden vijf losse studies gevonden [129][130][131][132][133] (zie Bijlage 1, Tabel 11). Het ging om drie interventiestudies, alle drie van zwakke kwaliteit [129,132,133], en twee studies waarbij personen die al een GFCF-dieet volgden werden bestudeerd [130,131]. ...
... Additioneel werden vijf losse studies gevonden [129][130][131][132][133] (zie Bijlage 1, Tabel 11). Het ging om drie interventiestudies, alle drie van zwakke kwaliteit [129,132,133], en twee studies waarbij personen die al een GFCF-dieet volgden werden bestudeerd [130,131]. In alle drie de interventiestudies werden gedragsverbeteringen gerapporteerd. ...
Voeding en psychische gezondheid gedurende de levensloop. Synthese van wetenschappelijke kennis en inventarisatie van toepassing in de praktijk
Anke Oenema | Dennis de Ruijter | Inge van der Wurff | Renate de Groot | Claudia Vingerhoets | Therese van Amelsvoort | Bart Rutten | Sandra Mulkens | Sebastian Köhler | Annemie Schols
... [196] [201,202,203,204,205] (Gluten/casein free diet alone or combined with prebiotic Bimuno® galactooligosaccharide supplementation) reduction of abdominal pain and bowel movement, changes in microbiota composition; (integrated with prebiotic) increase of Lachnospiraceae bacteria, changes of fecal and urine metabolite levels; improvement in anti-social behavior. [197] (Gluten/casein free diet or ketogenic diet) improvement in ASD symptoms, with the ketogenic diet group showing better cognition and sociability scores. ...
... Similarly, another small study, accounting for 15 children with ASD (aged 2−16 years) assigned to a 12-week gluten and casein free diet, showed no statistically significant differences in autism rating scale, language and communication, or urinary peptide levels; although, parents of these children reported some behavioral improvements [204]. Parallel observations (i.e., no differences between gluten/casein free and control diet in GI Symptoms Rating Scale and CARS) were reported in another study on 19 ASD children (mean age 9 years) [205]. Considering divergences in study findings and the generally small cohorts of ASD patients enrolled in these studies, large-scale studies are needed to confirm the actual efficacy and safety of exclusion dietary interventions in ASD children. ...
... Furthermore, there are some indications that overall dietary interventions, such as gluten free and casein free (exclusion) diet and ketogenic diet, with or without supplementation of prebiotics, may beneficially affect gut microbiota composition and metabolism, possibly ameliorating psychological traits associated with ASD [197,[200][201][202]. However, considering the limited number of studies (all characterized by overall low numbers of participants) and some divergent findings [203][204][205], further investigation is needed to confirm the real efficacy and safety of such dietary interventions in ASD, as confirmed also by recent meta-analyses [28,29]. ...
In the last decade, the prevalence of autism spectrum disorders (ASD) has dramatically escalated worldwide. Currently available drugs mainly target some co-occurring symptoms of ASD, but are not effective on the core symptoms, namely impairments in communication and social interaction, and the presence of restricted and repetitive behaviors. On the other hand, transplantation of hematopoietic and mesenchymal stem cells in ASD children has been shown promising to stimulate the recruitment, proliferation, and differentiation of tissue-residing native stem cells, reducing inflammation, and improving some ASD symptoms. Moreover, several comorbidities have also been associated with ASD, such as immune dysregulation, gastrointestinal issues and gut microbiota dysbiosis. Non-pharmacological approaches, such as dietary supplementations with certain vitamins, omega-3 polyunsaturated fatty acids, probiotics, some phytochemicals (e.g., luteolin and sulforaphane), or overall diet interventions (e.g., gluten free and casein free diets) have been considered for the reduction of such comorbidities and the management of ASD. Here, interventional studies describing pharmacological and non-pharmacological treatments in ASD children and adolescents, along with stem cell-based therapies, are reviewed.
... These microorganisms produce toxins that interact with neuron synapses. [12] Dysbiosis can also result from excessive antibiotic use. [6] Also, disruption in the mucosal lining of the gut and abnormal carbohydrate digestive enzyme activity lead to malabsorption of large proteins such as gluten, gliadin and casein, which may cause infl ammation and are believed to act like neuropeptides and alter neurologic function. ...
... [6] Also, disruption in the mucosal lining of the gut and abnormal carbohydrate digestive enzyme activity lead to malabsorption of large proteins such as gluten, gliadin and casein, which may cause infl ammation and are believed to act like neuropeptides and alter neurologic function. [12] Neuropeptides have adverse effects on attention, brain maturation, social interactions and learning. [13] These peptides bind to opioid receptors and, by modulating opioid levels in the brain, impair the central nervous system, a theory known as the "opioid peptide excess". ...
... There is no enough evidence to support gluten and casein free diet. [36,37] Harris and Card [12] reported the improvement of gastrointestinal symptoms and behavior patterns in children on a gluten and casein free diet. However, the Gastrointestinal Symptoms Rating Scale (GSRS) and Childhood Autism Rating Scale (CARS) scores did not support this association. ...
Purpose: The objectives of this study were to measure markers of celiac disease before and after implementing a gluten free diet and also evaluating its association with autism severity. Methods: The present randomized clinical trial was accomplished over 80 subjects diagnosed with Autism Spectrum Disorders (ASD) by the Autism Diagnostic Interview-Revised (ADI-R). Participants were randomly divided into Gluten Free Diet (GFD) and regular diet groups for 6 weeks. Immunological markers consisting of IgA, tTGIgA, tTGIgG and EMAIgG were measured. Findings: In this study, 6 patients were tTGIgA positive. In the GFD group, tTGIgA decreased insignificantly (from 3.62 +/- 4.25 to 3.41 +/- 3.51 U/ml; P < 0.05) while it increased significantly (from 2.80 +/- 3.54 to 3.96 +/- 4.10 U/ml; P < 0.05) in the regular diet group. Conclusion: These results suggest an underlying immune reactivity to gluten in a subset of children with ASD; however, celiac disease (CD) was not detected in any of the cases. Further investigations are necessary to clarify the possible relationship between ASD and celiac disease.
... These microorganisms produce toxins that interact with neuron synapses. [12] Dysbiosis can also result from excessive antibiotic use. [6] Also, disruption in the mucosal lining of the gut and abnormal carbohydrate digestive enzyme activity lead to malabsorption of large proteins such as gluten, gliadin and casein, which may cause infl ammation and are believed to act like neuropeptides and alter neurologic function. ...
... [6] Also, disruption in the mucosal lining of the gut and abnormal carbohydrate digestive enzyme activity lead to malabsorption of large proteins such as gluten, gliadin and casein, which may cause infl ammation and are believed to act like neuropeptides and alter neurologic function. [12] Neuropeptides have adverse effects on attention, brain maturation, social interactions and learning. [13] These peptides bind to opioid receptors and, by modulating opioid levels in the brain, impair the central nervous system, a theory known as the "opioid peptide excess". ...
... There is no enough evidence to support gluten and casein free diet. [36,37] Harris and Card [12] reported the improvement of gastrointestinal symptoms and behavior patterns in children on a gluten and casein free diet. However, the Gastrointestinal Symptoms Rating Scale (GSRS) and Childhood Autism Rating Scale (CARS) scores did not support this association. ...
Background
Genetic and environmental factors are both responsible for the etiology of autism spectrum disorders (ASD). Although epidemiological studies have been conducted to clarify the association between restriction diets and ASD, the conclusion remains unclear. This study was undertaken to investigate the effect of gluten free diet (GFD) on gastrointestinal symptoms and behavioral indices in children with ASD.
Methods
In this randomized clinical trial, 80 children diagnosed with ASD by the Autism Diagnostic Interview-Revised (ADI-R) were assigned into GFD (n=40) and regular diet (RD) (n=40) groups for 6 weeks. At the beginning and end of the intervention, the ROME Ш questionnaire for evaluating gastrointestinal symptoms and Gilliam Autism Rating Scale 2 questionnaire (GARS-2) for assessing psychometric properties were completed.
Results
Of the 80 children, 53.9% had gastrointestinal abnormalities. In the GFD group, the prevalence of gastrointestinal symptoms decreased significantly (P<0.05) after intake of GFD (40.57% vs. 17.10%) but increased insignificantly in the RD group (42.45% vs. 44.05%). GFD intervention resulted in a significant decrease in behavioral disorders (80.03±14.07 vs. 75.82±15.37, P<0.05) but an insignificant increase in the RD group (79.92±15.49 vs. 80.92±16.24).
Conclusion
This study suggested that GFD may be effective in controlling gastrointestinal symptoms and ASD behaviors.
... 8 On the other hand, a number of studies have reported no significant change in the symptoms of ASD, throwing into question the beneficial effects of a GFCF diet for ASD. [9][10][11][12] Currently, most studies on the effects of a GFCF diet in ASD have been observational clinical trials or case reports, with mixed results. In addition, some safety issues for the GFCF diet, such as nutritional deficiency, are a concern, limiting its clinical application. ...
... 34 Previous studies have observed remarkable statistical improvements in various behaviors in ASD children, 35,36 whereas some other studies have suggested that there was no significant difference between the diet group and control group or between pre-diet and afterdiet in individuals with ASD. 9,10 The result of the current meta-analysis also revealed a narrative description of reduction of GI symptoms. Pennesi et al 37 showed that a GFCF diet was associated with a significant improvement in ASD behaviors, in physiological symptoms in the subgroup with GI symptoms (especially constipation and diarrhea), and in the subgroup with allergy symptoms, and that the benefits were more distinct in those who stuck to a strict GFCF diet for more than 6 months. ...
Context:
It has been suggested that a gluten-free and casein-free (GFCF) diet may alleviate the symptoms of autism spectrum disorder (ASD) and facilitate neurodevelopment of children with ASD. Studies to date have been inconclusive.
Objective:
This study aimed to evaluate (through quantitative meta-analysis) the efficacy and safety of a GFCF diet for children with ASD. To our knowledge, this is the first time such an analysis has been carried out.
Data sources:
Eight electronic databases were searched, from the establishment of each database up to March 27, 2020: PubMed, Web of Science, Embase (Ovid), PsycINFO (Ovid), Cochrane Library, CNKI, Wanfang, and VIP databases.
Data extraction:
Two authors independently performed the data extraction and risk-of-bias assessment.
Data analysis:
A quantitative meta-analysis was performed with standard procedures by using Stata SE 15 software. Within the total of 8 studies, with 297 participants, 5 studies reported significant reductions in stereotypical behaviors [standard mean difference (SMD) = -0.41, 95% confidence interval (CI): -0.68 to -0.15], and 3 studies reported improvements in cognition (SMD = -0.46, 95% CI: -0.91 to -0.01) following GFCF dietary intervention. No statistically significant changes were observed in other symptomatic categories (all P > 0.05).
Conclusion:
The current meta-analysis showed that a GFCF diet can reduce stereotypical behaviors and improve the cognition of children with ASD. Though most of the included studies were single-blind, the benefits of a GFCF diet that have been indicated are promising. Additional studies on a larger scale are warranted.
Systematic review registration:
PROSPERO registration no. CRD42020177619.
... Zudem erfüllte diese Studie grundlegende methodische Anforderungen gemäß CONSORT-Checkliste [40] nicht. Anhand einer Online-Umfrage konnten Harris & Card zeigen, dass zwar eine GFCF-Diät bei Kindern mit ASS ohne objektiven Effekt auf die Stärke gastrointestinaler Beschwerden oder des autistischen Verhaltens (CARS) ist, dass aber gleichzeitig sämtliche Eltern, deren Kinder eine GFCF-Diät durchführten, eine subjektiv verbesserte Symptomatik beschreiben [22]. Die subjektiven Einschätzungen der Eltern erscheinen daher nicht zuverlässig und beruhen vermutlich eher auf unrealistischen Erwartungen und Wunschvorstellungen. Dies könnte die weite Verbreitung entsprechender Diätformen zumindest teilweise erklären. ...
... Non-Responder reagieren [52]. Dies könnte erklären, weshalb verschiedene Fallberichte über positive Effekte existieren [22,24,26] und sich in GFCF-Studien bei einzelnen Studienteilnehmern oft deutlich positive Effekte zeigen, während für das Gesamtkollektiv keine Signifikanz erreicht werden kann. Ein Indikator dieser individuellen metabolischen Konstitution könnten die variablen Urin-Peptidmuster sein, die möglicherweise einen Ansatz für die diättherapeutische Prädikation liefern könnten [32,41,51]. ...
Hintergrund: Autismus-Spektrum-Störungen (ASS) zählen zu den tiefgreifenden Entwicklungsstörungen des Kindes- und Jugendalters. Neben genetischen Einflüssen scheinen auch Umweltfaktoren zur ASS-Pathogenese beizutragen. Angehörige von Kindern und Jugendlichen mit ASS fragen oft nach bestimmten Diätformen, um die ASS-Symptomatik zu lindern. Ziel dieser Übersichtsarbeit ist die evidenzbasierte Bewertung der verfügbaren Daten zu ernährungstherapeutischen Interventionen bei Kindern und Jugendlichen mit ASS; die behandelnden Ärzte sollen so in die Lage versetzt werden, entsprechende Diäten fundiert beurteilen zu können.
Methodik: Unter Anwendung definierter Ein- und Ausschlusskriterien wurde eine systematische Literaturrecherche in PubMed, Cinahl und The Cochrane Library durchgeführt; eingeschlossen wurden nur Studien, die nach 1999 publiziert wurden. Die Studienqualität wurde entsprechend mit CONSORT-, STROBE- und PRISMA-Checklisten bewertet.
Ergebnisse: Es konnten 12 randomisiert-kontrollierte Studien und 2 nicht-kontrollierte Studien in die Auswertung einbezogen werden (n=971). Die Wirksamkeit der häufig angewendeten Gluten-/Casein-freien Diäten (GFCF) ist nicht belegt, und entsprechende valide prädiktive Parameter existieren ebenfalls nicht.
Schlussfolgerung: Auf Grundlage der verfügbaren Daten lassen sich keine evidenzbasierten Empfehlungen für ernährungstherapeutische Interventionen bei Kindern und Jugendlichen mit ASS ableiten. Zukünftige Studien müssen klären, ob einzelne Patienten-Subgruppen dennoch von bestimmten Diätformen profitieren könnten.
... Indeed, nutrition has an undeniable impact on reducing symptoms and behavioural issues in individuals diagnosed with autism, controlling associated medical conditions, and addressing deficiencies in certain elements. The implementation of proper nutrition strategies by families plays an important role in the positive development of the quality of life for individuals with autism (Aktitiz et al., 2019;Girli et al., 2016;Harris & Card, 2012;Merdan & Çetin, 2020;Uçar & Samur, 2017). ...
The aim of the research is to reveal the results of the intervention with a physical activity and nutrition program adapted to autistic individuals with eating problems. Among the single-subject research models, the multiple probe model across behaviors with a single initial probe phase was used. The population of the research consists of adolescent individuals with mild autism and obesity problems. The sample of the research consists of one (1) person determined by simple random sampling method among the families who voluntarily agreed to participate in the research. The research lasted twenty-eight (28) weeks. The data obtained were recorded by weighing before starting the study, every week after the start of the study, and the week when the study ended. The data obtained at the end of the application was analyzed by showing it on a graph. The data obtained was converted into point scores and turned into a line graph to reveal the change that occurred. It was observed that there were significant changes in the weight of the individual participating in the research over the weeks. Considering the results obtained, it can be said that the exercise and diet programs implemented during the research were effective.
... 8 The GSRS questionnaire was also used by Harris et al. in conducting research on gastrointestinal disorders in children with autism. 9 We found 9(45%) children who were malnourished and 11(55%) children who were in good nutrition based on measurements of body weight, height/length, and BMI. Similar results are not much different from research in Italy which shows BMI/child age cerebral palsy with a percentile < 5 of 52%. ...
Background: One of the causes of malnutrition that often occurs is gastrointestinal disorders. The existence of anatomical and physiological abnormalities in the gastrointestinal tract is the main cause. This study aimed to assess the relationship between gastrointestinal disorders and the incidence of malnutrition in children with cerebral palsy in the WKCP community Yogyakarta, Indonesia. Methods: A cross-sectional analytic observational study involving 20 cerebral palsy subjects who met the inclusion and exclusion criteria. The data collection technique is by consecutive sampling. The type of data used in the research uses a questionnaire gastrointestinal symptoms rating scale (GSRS). Data status anthropometry has also been collected. Data analysis using SPSS with chi-square. Results: The mean age of the subjects was 8.9 ± 4.1 years. The male gender (60%) is greater than the female. The comparison of good nutritional status and malnutrition is not much different, namely 55%:45%, respectively. The percentage of children experiencing severe gastrointestinal symptoms is 25%. The most common gastrointestinal disorders are constipation (65%) and upper dysmotility disorders (60%). In the results of this study, there was no relationship between gastrointestinal disorders and the incidence of malnutrition (p=0.069). Conclusion: In this study, there was no significant relationship between gastrointestinal disorders and malnutrition in children with cerebral palsy. However, gastrointestinal disorders increase the morbidity and mortality of children with cerebral palsy, so it must be an important concern.
... Each response ranges from 1 (no symptom) to 7 (most severe) forming sub-scores for each domain and a total score where higher scores indicate more severe symptoms [21,22]. While the GSRS was not specifically designed for CD it has been used in CD research [23,24], foremost on adult patients, and more occasionally in children and adolecents [25][26][27]. ...
Objectives:
Celiac disease (CD) is a common yet largely underdiagnosed disease. This study aimed to test the feasibility of incorporating a non-targeted CD screening in a pediatric outpatient setting and evaluate its short-term impact on children with serological evidence of disease.
Methods:
Over five months, 500 children (aged 2-17 years) attending a general pediatric outpatient clinic in Gothenburg, Sweden, were enrolled and surveyed for current symptoms, quality of life, and background characteristics; 481 children were screened for tissue-transglutaminase antibodies (tTGA); repeated tTGA-positivity was defined as CD autoimmunity (CDA). Children with CDA were investigated for CD and for one year monitored for changes in symptoms, and quality of life.
Results:
Eleven of 481 (2.3%) screened children had CDA. Children with CDA were younger (median 3.8 years) than those without CDA (8.8 years). No other major between-group differences were reported in background characteristics, symptoms, or quality of life. The screening was well-accepted by the families/participants. During 1-year follow-up, 8 of 11 children with CDA were diagnosed with CD. Children with screening-detected CD reported no significant changes in symptoms and quality of life and the dietary adherence rate was good.
Conclusions:
Non-targeted screening for CD was feasible in a general pediatric outpatient setting. While hampered by small sample size, our results are in line with previous screening studies indicating that symptoms do not differentiate CDA from non-CDA children. Also, among an overall minimal-symptomatic group of children, diagnosing CD and installation of treatment did not significantly change their well-being during 1-year follow-up.
... Gluten-free diets (Ghalichi et al., 2016), caseinfree diets (Lucarelli et al., 1995), and ketogenic diets (El-Rashidy et al., 2017) have been verified to have positive effects on ASD symptoms. However, another study reported no significant differences in RRBs (Harris and Card, 2012;Navarro et al., 2015). So, there are still uncertainties about the effects of dietary approaches. ...
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by deficits in social communication, social interaction, and repetitive restricted behaviors (RRBs). It is usually detected in early childhood. RRBs are behavioral patterns characterized by repetition, inflexibility, invariance, inappropriateness, and frequent lack of obvious function or specific purpose. To date, the classification of RRBs is contentious. Understanding the potential mechanisms of RRBs in children with ASD, such as neural connectivity disorders and abnormal immune functions, will contribute to finding new therapeutic targets. Although behavioral intervention remains the most effective and safe strategy for RRBs treatment, some promising drugs and new treatment options (e.g., supplementary and cell therapy) have shown positive effects on RRBs in recent studies. In this review, we summarize the latest advances of RRBs from mechanistic to therapeutic approaches and propose potential future directions in research on RRBs.
... Two of these 14 referrals later saw families of the patient report a "transformation" following adoption of the GFD diet ("One family described a 90% improvement and another family described an 'awakening' from a different level of consciousness"). A small comparison study [95] of children with ASD who were and were not following the GCFD reported that 7 of 13 children with ASD were already on a GCFD when recruited (outcome measures did not differ significantly from the 6 of 13 who were not on the diet, however parents of all children on the GCFD reported that it had improved symptoms and behaviour). Babinska et al. [20] found 20.7% of children and adolescents with ASD to follow a diet which in some way restricted gluten (either GFD or GCFD); it was not found that the following of speciality diet correlated with GI symptom severity. ...
An expanding body of literature is examining connections between Autism Spectrum Disorder (ASD) and dietary interventions. While a number of specialist diets have been suggested as beneficial in ASD, gluten has received particularly close attention as a potentially exacerbating factor. Reports exist suggesting a beneficial effect of the gluten-free diet (GFD) in ameliorating behavioural and intellectual problems associated with ASD, while epidemiological research has also shown a comorbidity between ASD and coeliac disease. However, both caregivers and clinicians have expressed an uncertainty of the value of people with ASD going gluten-free, and as the GFD otherwise receives considerable public attention a discussion which focuses specifically on the interaction between ASD and gluten is warranted. In this review we discuss the historical context of ASD and gluten-related studies, and expand this to include an overview of epidemiological links, hypotheses of shared pathological mechanisms, and ultimately the evidence around the use and adoption of the GFD in people with ASD.
... Por lo anterior la dieta libre de gluten y caseína se considera una intervención eficaz para mejorar los síntomas característicos del TEA, obteniendo disminución de la hiperactividad, y los problemas gastrointestinales (GI) que incluyen diarrea, constipación, distensión, dolor abdominal, pirosis, heces fétidas, presencia de moco, sangre o con restos alimentarios, esteatorrea, flatulencia, eructos y reflujo gastroesofágico (Villatoro M. et al, 2015) (Toh C., M. y Allen V. E., 2015) ( Harris C. and Card B. 2012). Debido a esto, el objetivo de este estudio Evaluar el efecto de una dieta sin gluten y caseína que permita disminuir los signos y síntomas gastrointestinales en los niños con diagnóstico de TEA. . ...
Introducción: Los trastornos del espectro autista, presentan alteraciones gastrointestinales tales como diarrea, flatulencia, reflujo gastroesofágico y constipación las cuales se han relacionado con el consumo de dietas con gluten y caseína. Objetivo: Evaluar el efecto de la dieta sin gluten y caseína sobre síntomas gastrointestinales en niños con trastornos del espectro autista. Material y Métodos: Previo consentimiento del padre o tutor se evaluaron niños de 3 a 12 años de edad, aplicando una historia nutricional con datos antropométricos y dietéticos por frecuencia alimentaria; la permeabilidad intestinal se evaluó por el cuestionario de signos y síntomas gastrointestinales “brea King the vicious cycle”, intestinal health trhough diet, al inicio y final de la intervención durante 10 semanas. Donde se proporcionó menú semanal de acuerdo a recomendaciones calóricas por edad con alimentos libres de gluten y caseína. Los datos se analizaron por estadística descriptiva y pruebas no paramétricas utilizando Chi2 de dos variables, test de McNemar y prueba de Friedman utilizando el paquete estadístico SPSS versión 24.0. Resultados: Del total de 26 sujetos, 77% de género masculino y 23% femenino, con media de edad 7.6 + 2.6 años, se observó una disminución del consumo de alimentos con gluten y caseína a menos de tres veces por semana, lo cual aminora la presencia de distención abdominal, diarrea, flatulencia. Siendo la permeabilidad intestinal estadísticamente significativa (≤0.05) después de 10 semanas de intervención. Conclusiones: La disminución en el consumo de alimentos con gluten y caseína disminuye síntomas gastrointestinales asociados a permeabilidad intestinal.
... The GSRS has been used in several studies of children with ASD [49] but the language used is complicated and overly clinical, and it was originally designed for use in adults to screen for irritable bowel syndrome and peptic ulcer disease [42]. However, at the time of study initiation, the GSRS was considered the best questionnaire available for capturing the anticipated five domains in GI symptomatology: abdominal pain, reflux, indigestion, diarrhea, and constipation and has since been used in a number of ASD studies [50][51][52][53]. Overall, GI symptoms improved over time in most of the participants. ...
Autism Spectrum Disorder (ASD) is a developmental disorder characterized by impaired communication and social interaction. Children with ASD are frequently diagnosed with gastrointestinal (GI) issues, including inflammatory bowel disease (IBD), gastroesophageal reflux, abdominal pain, diarrhea, and constipation, although the association between ASD and GI conditions is unclear. Underlying nutritional deficiencies are more common in children with ASD, and increase the risk of them developing medical conditions secondary to the behavioral diagnosis. This objective of this study was to examine the use of an elemental diet (ED) in the treatment of gastrointestinal disease in 5 children with ASD ages 2-21 years of age. In the study participants, the ED was well-tolerated with improvements in anthropometric measures, nutritional markers, and/or GI functioning reported after 12 weeks of intervention. Further research to advance the development of specific evidence-based guidelines in the management and treatment of gastrointestinal concerns in the ASD population is warranted.
... Another study [112] reported that, compared to controls, children with ASD had higher levels of casein-speci c antibodies, and their ASD symptoms seemed to improve after 8 weeks on the cow's milk elimination diet. However, some studies have shown no signi cant differences in intestinal permeability and behavioral symptoms between individuals who were on a gluten-/casein-free diet and those who were not [113,114]. A systemic review by the Cochrane group suggested that there is little hard evidence for the effectiveness of casein-and gluten-free diets in ASDs, but that only large-scale, randomized trials would yield more conclusive data [115]. ...
This chapter reviews the literature surrounding autism spectrum disorders (ASD) and their relation to gastrointestinal (GI), behavioral, neurological, and immunological functioning. Individuals with ASD often have poor GI health, including bowel motility issues, autoimmune and/or other adverse responses to certain foods, and lack of necessary nutrient absorption. These issues may be caused or exacerbated by restrictive behavioral patterns (e.g., preference for sweet and salty foods and/or refusal of healthy foods). Those individuals with GI issues tend to demonstrate more behavioral deficits (e.g., irritability, agitation, hyperactivity) and also tend to have an imbalance in overall gut microbiome composition, thus corroborating several studies that have implicated brain–gut pathways as potential mediators of behavioral dysfunction.
... Glutensiz ve kazeinsiz diyet verilen grupta görülen semptomlarda belirgin olarak azalma görülmüştür (Whiteley ve diğerleri, 2010). Harris ve Card'ın yaptığı çalışmada da benzer şekilde glutensiz ve kazeinsiz diyetteki tüm çocukların GİS semptomları ve davranışlarında iyileşme olduğu bildirilmiştir(Harris ve Card, 2012). ...
Yaygınlığı
giderek artan otizm spektrum bozuklukları; sosyal etkileşimde belirgin farklı
tutumlar, takıntılı ve tekrarlanan davranışlar, motor becerileri iyi
kullanamama gibi birçok semptom ile karakterize nörolojik bir hastalıktır.
Otizmde anormal beslenme alışkanlıkları, besin tüketiminde seçicilik ve gastrointestinal
sistem problemleri gibi beslenme problemleri de görülmektedir. Ayrıca otizmde mikrobiyota
da sağlıklı bireylere göre farklıdır. Bu nedenle görülen semptomları azaltmak
için beslenme tedavilerinin uygulanması elzemdir. Vitamin ve mineral
takviyeleri, probiyotik takviyesi,
ketojenik diyet, glutensiz kazeinsiz diyet en çok tercih edilen ve otizmde
görülen semptomları azalttığı gösterilen beslenme tedavilerindendir. Bu derlemede,
otizmde görülen beslenme ile ilgili sorunlar ve güncel beslenme tedavilerinin
etkisini araştıran yayınlar değerlendirilerek
özetlenmiştir.
... Some studies have shown that children with ASD may be deficient in micro-and macronutrients (12)(13)(14)(15), as well as iron (16), which could result from altered GI function and/or potentially impact GI symptoms. Furthermore, many parents and caretakers have employed the use of gluten-and casein-free (GFCF) diets (17) that seem to have mixed effects on core ASD symptoms (18) and GI symptoms (19)(20)(21)(22)(23) in ASD. In addition, many families also administer omega-3 fatty acids in the hope of deriving benefit, but the results from randomized, placebo-controlled clinical trials of omega-3 supplementation in ASD are also mixed in most cases (24,25). ...
Background: Many individuals with autism spectrum disorder (ASD) have significant gastrointestinal (GI) symptoms, but their etiology is currently unknown. Dietary interventions are common in children and adolescents with ASD, including diets with increased omega-3 fatty acids or diets free of gluten and/or casein, which may also impact GI symptoms and nutrition. However, little is known about the relationship between nutritional intake and GI symptomatology in ASD. The objective of this study was to assess the relationships between GI symptoms, omega-3 intake, micronutrients, and macronutrients in children with ASD. Methods: A total of 120 children diagnosed with ASD participated in this multisite study. A food frequency questionnaire was completed by the patient’s caretaker. The USDA Food Composition Database was utilized to provide nutritional data for the food items consumed by each participant. GI symptomatology was assessed using a validated questionnaire on pediatric gastrointestinal symptoms. Results: There were no significant associations between GI symptoms and the amount of omega-3 fatty acids and/or other micro- and macronutrients contained in the diet. Conclusions: This study suggests that dietary variations do not appear to drive GI symptoms, nor do GI symptoms drive dietary variations in those with ASD, although causation cannot be determined with this observational assessment. Furthermore, there may be other factors associated with lower GI tract symptoms in ASD, such as increased stress response.
... This model recalls the mechanisms involved in HE, where gut-derived substances also induce an inflammatory response and can cross the BBB and cause cognitive impairment. In ASD, casein and gluten-derived peptides passing through the altered intestinal barrier have been suggested to play a pathogenetic role [220] , potentially eliciting inflammatory responses both at a systemic and CNS level, where these peptides are believed to act as neuropeptides and alter neurological functions [221] . ...
Hepatic encephalopathy (HE) is a common and serious neuropsychiatric complication of cirrhosis, acute liver failure, and porto-systemic shunting. HE largely contributes to the morbidity of patients with liver disease, severely affecting the quality of life of both patients and their relatives and being associated with poor prognosis. Its presentation is largely variable, manifesting with a broad spectrum of cognitive abnormalities ranging from subtle cognitive impairment to coma. The pathogenesis of HE is complex and has historically been linked with hyperammonemia. However, in the last years, it has become evident that the interplay of multiple actors, such as intestinal dysbiosis, gut hyperpermeability, and neuroinflammation, is of crucial importance in its genesis. Therefore, HE can be considered a result of a dysregulated gut-liver-brain axis function, where cognitive impairment can be reversed or prevented by the beneficial effects induced by "gut-centric" therapies, such as non-absorbable disaccharides, non-absorbable antibiotics, probiotics, prebiotics, and fecal microbiota transplantation. In this context dietary modifications, by modulating the intestinal milieu, can also provide significant benefit to cirrhotic patients with HE. This review will provide a comprehensive insight into the mechanisms responsible for gut-liver-brain axis dysregulation leading to HE in cirrhosis. Furthermore, it will explore the currently available therapies and the most promising future treatments for the management of patients with HE, with a special focus on the dietary approach.
... From a physiopathological point of view, dysbiosis associated to impaired GI permeability has been suggested as a potential trigger involved in production of toxins capable of interaction with neuron synapses and in absorption of large proteins such as gluten, gliadin, and casein, which may cause inflammation, with possible adverse effects at a systemic level, including the central nervous system, where these peptides are believed to act like neuropeptides, and thus altering the normal neurological functioning (11,12). Dietary interventions are often employed, up to around 40% of children with ASD, in particular the gluten/casein-free diet (GCFD) (13). ...
Objectives:
A correlation between autism spectrum disorders (ASDs) and gastrointestinal (GI) problems, and a possible link between gluten consumption and ASD have been increasingly reported. Gluten/casein-free diet (GCFD) is often undertaken, with conflicting results. This study aimed at evaluating the distribution of human leukocyte antigen (HLA)-DQ2/DQ8 typing among patients with ASD with GI symptoms, together with its correlation with duodenal histology and response to GCFD.
Methods:
Between 2002 and 2015 all patients with ASD with GI symptoms referred to our outpatient clinic, displaying clinical, laboratory, or ultrasound findings suggestive of organic disease, underwent endoscopy, celiac disease (CD) serum antibodies testing and HLA-DQ2/DQ8 genotyping. Patients were prescribed a 6-month GCFD, and then clinically reassessed.
Results:
Among 151 enrolled patients, 134 (89%) were negative for CD-specific antibodies; 72 (48%) were positive for HLA-DQ2/DQ8; and 56 (37%) showed duodenal microscopic inflammation. Clinical improvement was observed in non-CD patients irrespective of the rigorous or partial adherence to the diet, being the difference nonstatistically significant. Response to diet was related to the presence of histological duodenal alterations at baseline (odds ratio 11.323, 95% confidence interval 1.386-92.549 for Marsh 2 pattern), but not to HLA-DQ2/DQ8 positivity (odds ratio 1.120, 95% confidence interval 0.462-2.716).
Conclusions:
Our data suggest that children with ASD with GI symptoms have a high prevalence of duodenal intraepithelial lymphocytic infiltration, which seems to be linked to a mechanism other than autoimmune response to gluten consumption. Alteration of duodenal histology, but not the HLA-DQ2/DQ8 status, was associated with clinical response to the diet.
... Observational studies reported alleviation of GI problems and/or improved behavioural traits with GFCF, but associations between restricted diet and symptoms are not always apparent [8][9][10]. Some studies evaluating mood and behaviour showed significant improvements in behavioural traits [11,12], while others reported no differences after treatment [13][14][15]. ...
Background:
Different dietary approaches, such as gluten and casein free diets, or the use of probiotics and prebiotics have been suggested in autistic spectrum disorders in order to reduce gastrointestinal (GI) disturbances. GI symptoms are of particular interest in this population due to prevalence and correlation with the severity of behavioural traits. Nowadays, there is lack of strong evidence about the effect of dietary interventions on these problems, particularly prebiotics. Therefore, we assessed the impact of exclusion diets and a 6-week Bimuno® galactooligosaccharide (B-GOS®) prebiotic intervention in 30 autistic children.
Results:
The results showed that children on exclusion diets reported significantly lower scores of abdominal pain and bowel movement, as well as lower abundance of Bifidobacterium spp. and Veillonellaceae family, but higher presence of Faecalibacterium prausnitzii and Bacteroides spp. In addition, significant correlations were found between bacterial populations and faecal amino acids in this group, compared to children following an unrestricted diet. Following B-GOS® intervention, we observed improvements in anti-social behaviour, significant increase of Lachnospiraceae family, and significant changes in faecal and urine metabolites.
Conclusions:
To our knowledge, this is the first study where the effect of exclusion diets and prebiotics has been evaluated in autism, showing potential beneficial effects. A combined dietary approach resulted in significant changes in gut microbiota composition and metabolism suggesting that multiple interventions might be more relevant for the improvement of these aspects as well as psychological traits.
Trial registration:
NCT02720900 ; registered in November 2015.
... With regard to other types of studies about the effect of gluten/casein-free diet on autism, we were able to identify cross-sectional and retrospective studies in literature. According to Harris et al. no significant changes in scores on Gastrointestinal Symptoms Rating Scale and Childhood Autism Rating Scale were detected in children with autism before and after implementation of the diet, although parents report improved gastrointestinal and behavioral patterns [47]. Similarly, about one-third of parents report significant improvement on the autism spectrum disorder core symptoms in a recent retrospective study, while Pennesi et al. suggest that the presence of specific gastrointestinal symptoms in children with autism (e.g., food allergies) is associated with a better response in gluten/casein-free diet [48,49]. ...
Background:
A nutritional background has been recognized in the pathophysiology of autism and a series of nutritional interventions have been considered as complementary therapeutic options. As available treatments and interventions are not effective in all individuals, new therapies could broaden management options for these patients. Our aim is to provide current literature data about the effect of therapeutic diets on autism spectrum disorder.
Data source:
A systematic review was conducted by two reviewers independently. Prospective clinical and preclinical studies were considered.
Result:
Therapeutic diets that have been used in children with autism include ketogenic and gluten/casein-free diet. We were able to identify 8 studies conducted in animal models of autism demonstrating a beneficial effect on neurophysiological and clinical parameters. Only 1 clinical study was found showing improvement in childhood autism rating scale after implementation of ketogenic diet. With regard to gluten/casein-free diet, 4 clinical studies were totally found with 2 of them showing a favorable outcome in children with autism. Furthermore, a combination of gluten-free and modified ketogenic diet in a study had a positive effect on social affect scores. No serious adverse events have been reported.
Conclusion:
Despite encouraging laboratory data, there is controversy about the real clinical effect of therapeutic diets in patients with autism. More research is needed to provide sounder scientific evidence.
... Researchers have found that parents may report improvements despite a lack of statistically significant findings across measures (Elder et al., 2006). Harris and Card (2012) found that the behavior patterns and GI symptoms of children on a GFCF diet did not differ significantly from those not on the GFCF diet. However, when asked, 100% of parents with children on the GFCF diet reported both GI symptoms and behavior had improved on the diet. ...
This chapter explores various diet- and nutrition-based treatments for children diagnosed with autism spectrum disorder (ASD) as well as their appeal. While little evidence of efficacy has appeared, these approaches continue to be widely popular among parents and many clinicians. The prevalence of diet-based treatments remains high, even in cases where diet-based treatment can be dangerous for children with ASD. This chapter discusses the current status of research and recommendations for future research and current use.
... All studies selected described the application of a gluten-and casein-free diet and the comparison of the ASD related symptoms before and after application of the diet. As stated above, the majority of them found positive results and are quite different with regard to the geographical location, which demonstrates the broad spectrum of interest in the subject (8, [24][25][26][27][28][29]. Some articles (8, 25, 26) did not refer the method used to assess adherence and compliance to the diet, so it becomes difficult to evaluate the veracity of the facts, since in some cases eating disorder symptoms can occur in these children, such as stealing food, which is justified because these children do not understand why they cannot eat everything. ...
The hypothesis that the symptoms of autism spectrum disorders can be affected by excluding foods containing gluten and casein has generated considerable interest among researchers. A review of the literature describing the results of gluten- and casein-free diet as a therapeutic intervention was performed. Based on an analysis of PubMed® citations using the search terms ["casein" OR "gluten" AND "autism"], 64 articles were listed, 7 of which met our inclusion criteria. All, but one, of the papers supported a positive effect for a gluten- and casein-free diet for cases of autism, where symptoms were duly mitigated. Only a few studies have experimentally assessed the potential effectiveness of a gluten- and casein-free diet for cases of autism and the existing studies are based on small sample sizes and on short term treatment duration. Further controlled studies are required to clarify the role of a gluten- and casein-free diet for cases of autism spectrum disorders.
... Despite the low level of consensus, several treatments based on the assumed relationship between GI issues and ASD symptomatology have become popular. Studies have been conducted to evaluate the effectiveness of such treatments (e.g., gluten-free casein-free, ketogenic diet) and the results are typically inconclusive (Harris and Card 2012;Hyman et al. 2016;Johnson et al. 2011;Mari-Bauset et al. 2014;Mulloy et al. 2010;Zhang et al. 2013). ...
Controversy exists regarding whether gastrointestinal (GI) issues play a role in the symptomatology of autism spectrum disorder (ASD). While some studies have found GI problems to be more prevalent in individuals with ASD, others have reported no such difference. Studies looking at the relationship between GI issues and ASD symptom severity have also had mixed results. The current study examined 112 participants between the age of 17 to 37 months. Participants comprised four groups of 28 children: an ASD and no GI issues group, an ASD with GI problems group, an atypical development and no GI issues group, and an atypical development with GI issues group. The results of the current study suggest that although the prevalence of GI symptoms was higher in participants with ASD than those without, this difference was not significant. The study also found that GI issues were not related to ASD symptom severity or developmental functioning.
... With autism rates rising dramatically in recent years, there is an ever-increasing need to identify remedies for common issues among children with ASD. In a recent pilot study of ASD children on a glutenfree, casein-free diet, caregivers reported improved GI symptoms and behavior patterns [46]. Nutritional supplements may be well-positioned to help with the commonly reported gastrointestinal problems among children with ASD. ...
Children with Autism Spectrum Disorder (ASD) frequently exhibit gastrointestinal (GI) distress. They often have deficiencies of beneficial intestinal microflora, which may lead to inflammation or immune dysfunction, malabsporption, food intolerance, failure to thrive, gas, bloating, constipation or diarrhea. We conducted a survey of caregivers for ASD children with GI distress receiving Delpro®, a nutritional supplement consisting of a mixture of five probiotic strains formulated with the immunomodulator Del-Immune V® (Lactobacillus rhamnosus V lysate). Caregivers assessed ASD signs and symptoms before and after 21 days of treatment using the autism treatment evaluation checklist (ATEC). Almost half of the respondents (48%) reported decreases in diarrhea severity and 52% reported decreases in constipation severity (n=25). Caregivers reported an increase in stool frequency, from one movement every 1.5 days to every 1.3 days, although this change was not statistically significant. Overall, 88% reported a decrease in total ATEC score, signifying an improvement of ASD symptoms. Mean ATEC values decreased from 72.8 prior to treatment to 58.3 following treatment initiation. Participants also had significant improvements in all ATEC domains (speech/language/communication, sociability, sensory/cognitive awareness, and health/physical/ behavior). Since this was a survey of caregivers for ASD children with GI distress receiving Delpro®, there was no control arm of no-treatment or placebo. Accordingly, these survey results need to be validated in controlled clinical trials. These data suggest that probiotic/immunomodulator Delpro® may have significant benefit in the treatment of GI distress and other ATEC signs and symptoms among this population.
... Improvements in gastrointestinal and behavioural symptoms were observed in autistic children on a glutenfree casein-free (GFCF) diet over an eight to twelve month period (Whitely 2010). Similar improvement was not observed for patients on a reduced-gluten diet, nor was improvement observed in a trial of only three months duration (see Table 1) (Harris 2012, Johnson 2011. Other dietary allergies and intolerances also need to be explored and eliminated. ...
... Improvements in social interactiveness, and stereotyped and repetitive behaviours were observed after 24 months (Whiteley 2010). A pilot study in 2012 noted that whilst 100% of parents with a child on a GFCF diet noticed improvements in behaviour and gastrointestinal symptoms, these results were not clinically verifiable (Harris 2012). It is important to note that this study used a reduced gluten and casein diet (8.7 gluten or casein foods per week, compared to 53 for the control) rather than a strict GFDF diet. ...
Autism is a complex condition which affects speech, language, neurodevelopment, sensory perception and social interaction. Until recently the pathophysiology of this condition has been poorly understood. Immunological and neurological research in autistic patients has improved the understanding of autism greatly. It is important that this research filters through to clinical practice, so that appropriate therapies may be employed. Autism requires a multidisciplinary approach to maximise the potential of patients affected by it. As such, it is important that different models of care support each other and do not place undue stress on the patient. Natural therapies can play a key role in supporting the outcomes of other therapies such as psychology, occupational therapy and speech therapy, and by doing so, improve lifelong outcomes.
... Four group observational studies [29][30][31][32] were reviewed that contribute evidence informing more nuanced aspects of future GFCF diet trials; these studies are summarized in Table 5. An observational study by Patel and Curtis 29 incorporated pre-and posttesting of ten children who received a comprehensive, multifaceted treatment regime, which for some children included a GFCF diet. ...
Background:
The gluten free, casein free (GFCF) diet is heralded by strong anecdotal parental reports to greatly improve and even "cure" symptoms of Autism Spectrum Disorders (ASD). Yet to date, little conclusive empirical evidence exists supporting its use.
Objective:
The purpose of this paper is to provide an overview of the state of the recent evidence regarding use of GFCF diet for treatment of individuals with ASD.
Methods:
Five database providers (PubMed, Web of Knowledge, EBSCO, ProQuest, and WorldCat) were used to search 19 databases yielding a total of 491 articles that were published through February 2015. Peer reviewed articles published between 2005 and February 2015 were included for review if study participants were identified as having ASD and investigated the effects of the GFCF diet on ASD behaviors or the relationship between the diet and these behaviors.
Results:
Evaluation of search results yielded 11 reviews, 7 group experimental studies including 5 randomized controlled trials, 5 case reports, and 4 group observational studies published during the last 10 years. These studies represent a marked increase in number of reported studies as well as increased scientific rigor in investigation of GFCF diets in ASD.
Conclusions:
While strong empirical support for the GFCF diet in ASD is currently lacking, studies point to the need for identifying subsets of individuals (e.g., those with documented gastrointestinal abnormalities) who may be the best responders to the GFCF diet. Identifying these subsets is critically needed to enhance rigor in this research area. Until rigorous research supporting use of GFCF diet is reported, clinicians should continue use caution and consider several factors when advising regarding implementation of the GFCF diet for individuals with ASD.
... Autism spectrum disorder (ASD) is characterized by varying degrees of impairment of communication skills and social interaction, and unusual repetitive behaviour [1]. Epidemiological studies have shown that the prevalence of ASD is 116.1 per 10,000 and 3-6 per 1000, with a male-to-female ratio of 4:1 [2,3]. ...
Aim: The present research work was aimed to produce gluten-free and casein free (GFCF) cupcakes for autistic children. Methods: Corn, rice, carrot, orange sweet potato and chickpea flours were used in different blends to formulate C 1 , C 2 , C 3 , P 1 , P 2 , and P 3 , respectively. Chemical, physical, textural and sensory evaluation was performed to assess the nutritional and technological qualities of the cupcakes. Results: The results of the nutritional quality of the cupcakes indicated significant increase in protein, crude fiber, calcium (Ca) and Zinc (Zn) contents and significant decrease in total carbohydrates (TC) and caloric value. While, significant fluctuations in fat and iron (Fe) contents were observed. ß-carotene content ranged from 253.34 to 1569.36 μg/100g cupcake and vitamin A content ranged from 21.11 to 130.78 μg RAE (as ß-carotene). Water content and water activity (a w) measurements predicted the stability and keeping safety and quality of the prepared cupcakes (except for P 2). Texture Profile Analysis (TPA) showed a significant increase in hardness, gumminess and chewiness and a significant decrease in cohesiveness and springiness. While, adhesiveness, showed erratic results. Significant differences were found in appearance, crust and crumb colors, crumb texture, odor and taste of the cupcakes expressed by experienced panelists. The acceptance rating score of C 1 that exhibited the best nutritional and technological qualities was highly ranked for overall liking of the autistic children and two-thirds of them expressed their willingness to eat C 1 again. Conclusion: the usefulness of using different blends of corn, rice, carrot, orange sweet potato and chickpea flours in GFCF cupcake formulations as a valuable food addition to enhance the nutritional and technological qualities of the GFCF cupcakes. The most valuable cupcake sample with the highest acceptability was the C 1 .
... Autism spectrum disorder (ASD) is characterized by varying degrees of impairment of communication skills and social interaction, and unusual repetitive behaviour [1]. Epidemiological studies have shown that the prevalence of ASD is 116.1 per 10,000 and 3-6 per 1000, with a male-to-female ratio of 4:1 [2,3]. ...
Aim: The present research work was aimed to produce gluten-free and casein free (GFCF) cupcakes for autistic children. Methods: Corn, rice, carrot, orange sweet potato and chickpea flours were used in different blends to formulate C 1 , C 2 , C 3 , P 1 , P 2 , and P 3 , respectively. Chemical, physical, textural and sensory evaluation was performed to assess the nutritional and technological qualities of the cupcakes. Results: The results of the nutritional quality of the cupcakes indicated significant increase in protein, crude fiber, calcium (Ca) and Zinc (Zn) contents and significant decrease in total carbohydrates (TC) and caloric value. While, significant fluctuations in fat and iron (Fe) contents were observed. ß-carotene content ranged from 253.34 to 1569.36 μg/100g cupcake and vitamin A content ranged from 21.11 to 130.78 μg RAE (as ß-carotene). Water content and water activity (a w) measurements predicted the stability and keeping safety and quality of the prepared cupcakes (except for P 2). Texture Profile Analysis (TPA) showed a significant increase in hardness, gumminess and chewiness and a significant decrease in cohesiveness and springiness. While, adhesiveness, showed erratic results. Significant differences were found in appearance, crust and crumb colors, crumb texture, odor and taste of the cupcakes expressed by experienced panelists. The acceptance rating score of C 1 that exhibited the best nutritional and technological qualities was highly ranked for overall liking of the autistic children and two-thirds of them expressed their willingness to eat C 1 again. Conclusion: the usefulness of using different blends of corn, rice, carrot, orange sweet potato and chickpea flours in GFCF cupcake formulations as a valuable food addition to enhance the nutritional and technological qualities of the GFCF cupcakes. The most valuable cupcake sample with the highest acceptability was the C 1 .
... Sería importante que su estudio pudiera implementar como parte de la metodología, escalas estandariza-das, que hayan sido utilizadas anteriormente. Por ejemplo, Childhood autism rating scale (CARS) 2,3 , Ecological comunication orientation scale (ECO) 4 , Autism Diagnostic Interview-Revised (ADI-R) 3 para que sus resultados puedan ser comparables con los otros estudios revisados. ...
Sr. Editor: leímos recientemente el atractivo artículo de investigación " Mejora de los síntomas del autismo y evaluación alimentaria nutricional luego de la realiza-ción de una dieta libre de gluten y caseína en un grupo de niños con autismo que acuden a una fundación " 1 . Consideramos que los resultados obtenidos represen-tan una alternativa beneficiosa para la mejora de las manifestaciones tanto clínicas como conductuales en los niños que padecen autismo. Nos gustaría comentar que en base a lo que hemos leído, sus resultados fueron obtenidos mediante la utili-zación de una encuesta de elaboración propia, que por lo que entendemos no está validada. Hemos encontrado otros artículos en los que utilizan diversos instrumentos validados mostrando resultados controversiales. Sería importante que su estudio pudiera implemen-tar como parte de la metodología, escalas estandariza-das, que hayan sido utilizadas anteriormente. Por ejemplo, Childhood autism rating scale (CARS) 2,3 , Ecological comunication orientation scale (ECO) 4 , Autism Diagnostic Interview-Revised (ADI-R) 3 para que sus resultados puedan ser comparables con los otros estudios revisados. Por otro lado, sería interesante incluir exámenes bio-químicos como los Niveles de péptidos en la orina (UPL) 5 recogidos antes y después de aplicar la dieta con el fin de validar su cumplimiento y recoger resulta-dos más objetivos, que no tengan que ver sólo con la percepción de los padres. El fundamento para incluir estos exámenes se basa en lo siguiente, se ha pro-puesto que uno de los factores que desencadenan las alteraciones psicológicas y de comportamiento del es-pectro autista es la acción opiácea de los péptidos de gluten y caseína, los cuales, debido a la disfunción in-testinal presentada, son absorbidos por el intestino y transportados al torrente sanguíneo 6 . De este modo, una parte es excretada por el riñón y los restantes lo-gran atravesar la barrera hematoencefálica, llegando al cerebro en el cual se unen a receptores opiáceos, lo que los torna biológicamente activos y producen inter-ferencias en la transmisión de la información cerebral 2 . Esperamos que las recomendaciones, basadas en la validez y confiabilidad de los instrumentos utilizados, puedan ser tomadas en cuenta con el fin de tener en un futuro estudios estandarizados y comparables que puedan definir si la dieta libre de gluten y caseína es útil para los niños autistas.
... Several research suggests gluten-free and casein-free diets for autistic children [24][25][26]. A recent investigations, prove the efficiency of freecasein and free-gluten diet on improvement of autistic children's health status [27,28]. ...
Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments , communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior. Its diagnosis is very difficult and consists of only clinical criteria. The aim of this study is to confirm autism disorder, among three children (2 girls and 1 boy), recruited in a social association of children in a precarious situation, located in Rabat, Morocco, and to evaluate some biological and neurobiological parameters among these children. The confirmation of autistic status is realized using Questionnaire (E2) and the evaluation of biological parameters (organic acids, urinary peptides, toxic metals and essential elements) is done in urine and hair of these children. Obtained children's scores of E2 Questionnaire , is found in the favor of autism. Moreover, abnormal levels of urinary organic acids, urinary peptides, toxic and essential metals are observed.
Investigating gastrointestinal (GI) motility disorders relies on diagnostic tools to assess muscular contractions, peristalsis propagation and the integrity and coordination of various sphincters. Manometries are the gold standard to study the GI motor function but it is increasingly acknowledged that manometries do not provide a complete picture in relation to sphincters competencies and muscle fibrosis. Endolumenal functional lumen imaging probe (EndoFLIP) an emerging technology, uses impedance planimetry to measure hollow organs cross sectional area, distensibility and compliance. It has been successfully used as a complementary tool in the assessment of the upper and lower oesophageal sphincters, oesophageal body, the pylorus and the anal canal. In this article, we aim to review the uses of EndoFLIP as a tool to investigate GI motility disorders with a special focus on paediatric practice. The majority of EndoFLIP studies were conducted in adult patients but the uptake of the technology in paediatrics is increasing. EndoFLIP can provide a useful complementary data to the existing GI motility investigation in both children and adults.
Objectives:
This study examines the prevalence of detectable gluten immunogenic peptides (GIPs) as a proxy for gluten exposure in children with celiac disease on a gluten-free diet in the United States, as estimated by gluten breakdown products excreted in urine and stool.
Methods:
Urine and stool samples were collected in 3 settings (home, gastroenterology clinic, and endoscopy) for pediatric participants (ages 6-21 years old) across 2 medical centers. Commercial ELISA assays were used to quantify the GIPs in each sample.
Results:
GIPs were detected in 4 out of 44 (9.1%) of stool samples and 6 out of 125 (4.8%) of urine samples provided by 84 children. These samples were collected across all settings, and most participants (70%) were asymptomatic at the time of sample collection. For the urine samples collected at the time of endoscopy, all subjects found to have persistent enteropathy had no detectable GIPs (0/12).
Discussion:
GIPs provide an additional method for screening for gluten exposures in individuals with celiac disease on a gluten-free diet, and may be used across multiple settings. We found a low detection rate of GIPs in children. Our finding of undetectable GIPs in individuals with persistent enteropathy may be expected of a single determination under close observation or represent a lack of gluten exposure within the detection window. More research is needed to understand the dynamics of gluten absorption and excretion in the US pediatric population.
We conducted a systematic review of the literature to evaluate the quality of the dietary data and the methods used to obtain them in studies with children and adolescents with ASD. The search of PsycINFO, PubMed, SciELO, and Web of Science using SPIDER strategy retrieved 1975 studies. Data on dietary intake assessment methodologies were extracted. Eighty-nine studies were included. Food records and food frequency questionnaires were the most frequent dietary assessment methods. Overall, studies presented a low quality score. Most of them did not report dietary assessment of bias, description of dietary method application, validity, sensitivity analyses, and statistical adjustments. Future studies must improve the application of dietary assessment methods to advance scientific evidence related to nutrition in ASD.
Introduction:
Autism spectrum disorder (ASD) is a neuropsychiatric disease characterized by deficits in social communication and the presence of restricted interests and repetitive behaviors. This review aims to address the different nutrients that can be included in the diet of patients with ASD to reduce the different signs and symptoms present in this disorder. Different bibliographic sources such as PubMed, MEDLINE, ScienceDirect, Embase, and SciELO were reviewed, using the keywords "Probiotics", "Vitamin B", Vitamin C", "Gluten", "Omega 3" and "Autism Spectrum Disorder". It was found that probiotics and gluten improve gastrointestinal symptoms, and vitamins B6, B9, B12, and C, as well as omega 3, help improve neurobehavioral symptoms, language, and social behavior of children with ASD.
Autism spectrum disorders (ASD) are defined as neurodevelopmental disorders, which are highly variable in nature and do not form a uniform picture, either in terms of symptomatology or depth of the disturbance. Diagnosis of ASD is made for children who show signs of impairment in social interaction, communication and cognitive skills. The exact cause of autism spectrum disorders has not been determined to date. Although there is no cure for ASD, a variety interventions have been proposed. The most commonly used restrictive dietary intervention is the gluten-free casein-free diet (GFCF), which is based on the opioid excess theory. This paper summarizes and discusses research on the core elements of the opioid excess theory in ASD: increased levels of opioid peptides in body fluids in ASD patients, increased intestinal permeability, altered peptidase activity and the effectiveness of GFCF diet in alleviating symptoms of ASD. Furthermore, we discuss the difficulties and their causes in conducting research with ASD patients. The assumptions of the opioid excess theory have neither been definitively confirmed nor disproved. Research in this area should continue, taking into account the highest possible quality standards and the specific needs and abilities of patients with ASD and their families.
La finalidad de este estudio, de corte cualitativo, es conocer la influencia de
una dieta específica como práctica complementaria que mejore la calidad de
vida de niños con Trastorno del Espectro Autista residentes del Partido de San
Miguel en la Provincia de Buenos Aires. Las dietas específicas hacen
referencia a las dietas biomédicas, aquellas que promueven principalmente
una alimentación libre de gluten, caseína y soya, ingredientes que se los han
asociado a los síntomas que presentan las niños con Trastorno del Espectro
Autista (TEA). Ésta modalidad alimentaria consiste en eliminar de la dieta el
gluten, una proteína presente en granos como cebada, centeno y trigo, y en la
avena debido a la contaminación cruzada, y la caseína, una proteína presente
en los productos lácteos. El Trastorno del Espectro Autista se constituye como
un trastorno del neurodesarrollo especialmente resistente. No se plantea en la
actualidad una cura, pero ciertos tratamientos parecerían exhibir una tendencia
hacia la disminución de síntomas y lograr de ese modo llevar una mejor
calidad de vida.
Objetivo: caracterizar o perfil nutricional e identificar a ocorrência de sintomas gastrointestinais na presença de hipersensibilidade alimentar, de crianças e adolescentes atendidos em um centro de referência no sul do Brasil. Método: estudo transversal realizado por meio da aplicação de questionário em um centro educacional para portadores do transtorno do espectro autista, na cidade de Pelotas, RS. Foram coletados dados sociodemográficos, bem como dados antropométricos e informações sobre dietas de exclusão, acompanhamento nutricional e sintomas gastrointestinais dos participantes. Resultados: Participaram do estudo 12 indivíduos, dos quais a maioria era do sexo masculino (75%), criança (91,6%) e da cor branca (91,6%). Metade dos participantes estava com excesso de peso (25% sobrepeso e 25% obesidade), além daqueles que já apresentavam risco de sobrepeso (16,7%), enquanto somente 33,3% estavam eutróficos. Dentre as dietas de exclusão, as mais prevalentes foram lactose (75%), caseína (25%) e glúten (25%), sendo que a maioria (75%) dos alunos não fazia acompanhamento nutricional. Avaliando presença de sintomas gastrointestinais, flatulência (33,3%) foi o mais relatado. Conclusão: destaca-se a importância de um suporte nutricional adequado para este público, uma vez que a maioria da amostra está com risco ou excesso de peso, além da presença de hipersensibilidade alimentar. Deve-se ter atenção no manejo de dietas de exclusão e estratégias para lidar com os sintomas gastrointestinais presentes, uma vez que sua eficácia ainda não possui comprovação científica para todos os casos.
Este estudo teve por objetivo avaliar a associação entre o consumo de glúten e o hábito intestinal de crianças e adolescentes com transtorno do espectro autista. Para tanto, foi realizado um estudo transversal com 30 pessoas com transtorno do espectro autista com idade entre 10 e 18 anos. O consumo de glúten foi avaliado por meio da aplicação de um questionário de frequência alimentar e o hábito intestinal foi avaliado por meio da escala de Bristol. A maioria dos participantes consumia alimentos que contêm glúten. Quase metade dos participantes (46,6%) apresentou constipação ou diarreia e não houve associação entre o hábito intestinal e a frequência do consumo de alimentos que contêm glúten. Assim, o presente estudo não apresentou resultados que confirmem a relação entre o consumo de glúten e o hábito intestinal de crianças e adolescentes com transtorno do espectro autista.
Introducción: El trastorno del espectro autista afecta la interacción social, y la conducta.Diversosestudiosdescriben una variedad de terapias entre ellas la dieta sin gluten y caseína y la suplementación con ácidos grasos omega-3.Objetivo: Evaluar el efecto de una dieta sin gluten y caseína, suplementada con ácidos grasos omega-3 en elTrastorno del Espectro Autista. Materiales y Métodos: Estudio experimental controlado no aleatorio realizado durante ocho semanas valorando15 sujetos en un rango de edad de 3-12 años se realizo evaluación nutricional y la escala de CARS al inicio y final del estudio, se dividieron en tres grupos, grupo A: dieta sin gluten y caseína, grupo B: dieta sin gluten y caseína más suplementación con omega-3 en una dosis de 1.2g/d y grupo C: control sin dieta y sin suplementación. Realizando análisis estadístico con el programaestadístico MEDCALC®.Resultados:Del total de 15 sujetos el 20 % pertenecía al género femenino mientras que el 80 % al sexo masculino con una media de edad de 7 años. Al comparar el comportamiento se observó una diferencia significativa (p=0.0006) en el grupo B.Conclusiones: La dieta sin gluten y caseína y los con ácidos grasos omega-3 puede ser una terapia nutricional efectiva para mejorar el comportamiento.
Children with special health care needs (CSHCN) are a vulnerable population subgroup, but little is known about their oral health, particularly regarding the prevalence and cause of tooth decay. This lack of knowledge is a barrier to progress in terms of developing evidence-based clinical interventions and policies aimed at promoting oral health in CSHCN. This article reviews the oral health literature pertaining to CSHCN, identifies critical knowledge gaps, highlights future research opportunities, and extends clinical recommendations to pediatric health care providers.
Introdução: A dieta sem glúten e sem caseína é uma prática comum no Transtorno do Espectro Autista, mas sem consenso quanto ao seu benefício clínico ou cognitivo. Objetivo: Revisar sistematicamente a literatura que avalia a isenção de glúten e/ou caseína da dieta para indivíduos com Transtorno do Espectro Autista. Materiais e Métodos: Revisão sistemática de literatura analisando estudos originais disponíveis até dezembro/2016 nas bases de dados: PubMed, SciELO, LILACS e BDENF. Os termos usados para a pesquisa foram: autismo, espectro autista, autismo e sem glúten, autismo e dieta livre de caseína. Para melhor direcionamento da busca de dados foi utilizado o método PICO (população, intervenção, comparação e desfecho). Resultados: No total, foram incluídos 22 artigos, sendo 13 ensaios clínicos randomizados, 4 estudos de caso, 4 transversais e 1 coorte. Do total, 15 encontraram uma associação positiva de intervenção para os resultados avaliados e 7 não encontraram associação significativa. Discussão: Foi encontrada grande variabilidade do tamanho amostral, idade, tempo de intervenção, cegamento, controle ou análise dietética mais apurada. Conclusões: não há evidências científicas para apoiar o uso de uma dieta livre de glúten e caseína em pacientes com Transtorno do Espectro Autista. Há necessidade de novos estudos bem delineados, principalmente ensaios clínicos randomizados bem controlados, cegos, com cálculos amostrais que permitam um poder de observação apropriado, para maior segurança nessa prática.
Como citar este artigo: Dias EC, Rocha JS, Ferreira GB, Pena GG. Dieta isenta de glúten e caseína no transtorno do espectro autista: uma revisão sistemática. Rev Cuid. 2018; 9(1): 2059-73. http://dx.doi.org/10.15649/cuidarte.v9i1.485
Recent research into the complex interrelationship between the gastrointestinal and central nervous systems has led to an increased appreciation of the importance of commensal gut microbes to normal gut function and neurobehavioral health. Epidemiological and clinical studies indicate co-morbid gut dysfunction in many individuals with psychiatric or neurodevelopmental disorders. Moreover, animal model studies present promising evidence that microbe-based treatments may alleviate symptoms of disease. Autism spectrum disorder is of particular interest as a highly prevalent neurodevelopmental disorder in which a significant subset of patients present with gastrointestinal problems and in which microbial dysbiosis has been highlighted as a potential contributing factor to gastrointestinal and neuropathological abnormalities. Preclinical studies investigating probiotic treatments for gastrointestinal, neurobiological, and behavioral deficits suggest that a richer understanding of the role of gut microbes in neurodevelopmental disorders may lead to effective new treatments.
Sr. Editor: leímos recientemente el atractivo artículo de investigación " Mejora de los síntomas del autismo y evaluación alimentaria nutricional luego de la realiza-ción de una dieta libre de gluten y caseína en un grupo de niños con autismo que acuden a una fundación " 1 . Consideramos que los resultados obtenidos represen-tan una alternativa beneficiosa para la mejora de las manifestaciones tanto clínicas como conductuales en los niños que padecen autismo. Nos gustaría comentar que en base a lo que hemos leído, sus resultados fueron obtenidos mediante la utili-zación de una encuesta de elaboración propia, que por lo que entendemos no está validada. Hemos encontrado otros artículos en los que utilizan diversos instrumentos validados mostrando resultados controversiales. Sería importante que su estudio pudiera implemen-tar como parte de la metodología, escalas estandariza-das, que hayan sido utilizadas anteriormente. Por ejemplo, Childhood autism rating scale (CARS) 2,3 , Ecological comunication orientation scale (ECO) 4 , Autism Diagnostic Interview-Revised (ADI-R) 3 para que sus resultados puedan ser comparables con los otros estudios revisados. Por otro lado, sería interesante incluir exámenes bio-químicos como los Niveles de péptidos en la orina (UPL) 5 recogidos antes y después de aplicar la dieta con el fin de validar su cumplimiento y recoger resulta-dos más objetivos, que no tengan que ver sólo con la percepción de los padres. El fundamento para incluir estos exámenes se basa en lo siguiente, se ha pro-puesto que uno de los factores que desencadenan las alteraciones psicológicas y de comportamiento del es-pectro autista es la acción opiácea de los péptidos de gluten y caseína, los cuales, debido a la disfunción in-testinal presentada, son absorbidos por el intestino y transportados al torrente sanguíneo 6 . De este modo, una parte es excretada por el riñón y los restantes lo-gran atravesar la barrera hematoencefálica, llegando al cerebro en el cual se unen a receptores opiáceos, lo que los torna biológicamente activos y producen inter-ferencias en la transmisión de la información cerebral 2 . Esperamos que las recomendaciones, basadas en la validez y confiabilidad de los instrumentos utilizados, puedan ser tomadas en cuenta con el fin de tener en un futuro estudios estandarizados y comparables que puedan definir si la dieta libre de gluten y caseína es útil para los niños autistas.
Autism spectrum disorder (ASD) is characterised by deficits in the ability to socialise, communicate and use imagination, and displays of stereotypical behaviour. It is widely accepted that ASD involves a disorder in brain development. However, the real causes of the neurodevelopmental disorders associated with ASD are not clear. In this respect, it has been found that a majority of children with ASD display gastrointestinal symptoms, and an increased intestinal permeability. Moreover, large differences in microbiotic composition
between ASD patients and controls have been reported. Therefore, nutrition-related factors have been hypothesised to play a causal role in the aetiology of ASD and its symptoms. Through a review of the literature, it was found that abnormalities in carbohydrate digestion and absorption could explain some of the gastrointestinal problems observed in a subset of ASD patients, although their role in the
neurological and behavioural problems remains uncertain. In addition, the relationship between an improved gut health and a reduction of symptoms in some patients was evaluated. Recent trials involving gluten-free diets, casein-free diets, and pre- and probiotic, and multivitamin supplementation show contradictive but promising results. It can be concluded that nutrition and other environmental influences might trigger an unstable base of genetic predisposition, which may lead to the development of autism, at least in a
subset of ASD patients. Clear directions for further research to improve diagnosis and treatment for the different subsets of the disorder are provided.
Gastrointestinal (GI) dysfunctions are frequently reported by parents of children with autism spectrum disorders (ASD) and have been recently recognized as a comorbid condition. However, the clinical significance of these GI dysfunctions remains to be delineated. This study describes the clinical characteristics, associated comorbid disorders, and endoscopic and colonoscopic evaluation of GI dysfunction in a cohort of 164 children with ASD evaluated at a pediatric neurology practice. Symptoms of GI dysfunction were prevalent: 49% of the children reported one or more chronic GI complaints, 22% exhibited diarrhea, 26% suffered from constipation. Furthermore 13% of the parents reported their children to suffer from bloating and/or being gassy and while 10% of the parents reported vomiting or gastroesophageal reflux problems. Similar rates of GI symptoms were reported among pre-school and school-aged children. Inflammation of the gut was found in 6 of the 12 subjects who underwent endoscopic and colonoscopic evaluations, however clinical symptoms did not predict the results of the evaluation. GI dysfunction was significantly associated with sleep disorders and food intolerance, but not with irritability or aggressiveness. In summary, GI dysfunction was prevalent in this cohort of children with ASD, observations consistent with the reports of parents and other clinicians. We conclude that the GI dysfunction in ASD requires proper evaluation and treatment. Autism Res 2014, ●●: ●●–●●. © 2014 International Society for Autism Research, Wiley Periodicals, Inc.
Pediatricians have an important role not only in early recognition and evaluation of autism spectrum disorders but also in chronic management of these disorders. The primary goals of treatment are to maximize the child's ultimate functional independence and quality of life by minimizing the core autism spectrum disorder features, facilitating development and learning, promoting socialization, reducing maladaptive behaviors, and educating and supporting families. To assist pediatricians in educating families and guiding them toward empirically supported interventions for their children, this report reviews the educational strategies and associated therapies that are the primary treatments for children with autism spectrum disorders. Optimization of health care is likely to have a positive effect on habilitative progress, functional outcome, and quality of life; therefore, important issues, such as management of associated medical problems, pharmacologic and nonpharmacologic intervention for challenging behaviors or coexisting mental health conditions, and use of complementary and alternative medical treatments, are also addressed.
There is increasing interest in the use of gluten- and casein-free diets for children with autism spectrum disorders (ASDs). We report results from a two-stage, 24-month, randomised, controlled trial incorporating an adaptive 'catch-up' design and interim analysis. Stage 1 of the trial saw 72 Danish children (aged 4 years to 10 years 11 months) assigned to diet (A) or non-diet (B) groups by stratified randomisation. Autism Diagnostic Observation Schedule (ADOS) and the Gilliam Autism Rating Scale (GARS) were used to assess core autism behaviours, Vineland Adaptive Behaviour Scales (VABS) to ascertain developmental level, and Attention-Deficit Hyperactivity Disorder - IV scale (ADHD-IV) to determine inattention and hyperactivity. Participants were tested at baseline, 8, and 12 months. Based on per protocol repeated measures analysis, data for 26 diet children and 29 controls were available at 12 months. At this point, there was a significant improvement to mean diet group scores (time*treatment interaction) on sub-domains of ADOS, GARS and ADHD-IV measures. Surpassing of predefined statistical thresholds as evidence of improvement in group A at 12 months sanctioned the re-assignment of group B participants to active dietary treatment. Stage 2 data for 18 group A and 17 group B participants were available at 24 months. Multiple scenario analysis based on inter- and intra-group comparisons showed some evidence of sustained clinical group improvements although possibly indicative of a plateau effect for intervention. Our results suggest that dietary intervention may positively affect developmental outcome for some children diagnosed with ASD. In the absence of a placebo condition to the current investigation, we are, however, unable to disqualify potential effects derived from intervention outside of dietary changes. Further studies are required to ascertain potential best- and non-responders to intervention. The study was registered with ClincialTrials.gov, number NCT00614198.
We have shown that urine peptide increase is found in autism, and that some of these peptides have a dietary origin. To be explanatory for the disease process, a dietary effect on the brain must be shown to be possible and probable.
Diagnosis was based on DSM-III and DSM-IV criteria. We ran first morning urine samples equivalent to 250 nm creatinine on high-performance liquid chromatography (HPLC) reversed phase C18 columns using trifluoroacetic acid acetonitrile gradients. The elution patterns were registered using 215 nm absorption for largely peptide bonds, 280 nm for aromatic groups, and 325 nm for indolyl components. We referred to a series of published ability tests, including Raven's Progressive Matrices and the Illinois Test of Psycholinguistic Ability, which were administered before and after dietary intervention. The literature was also reviewed to find evidence of a gut-to-brain connection.
In autistic syndromes, we can show marked increases in UV 215-absorbing material eluting after hippuric acid that are mostly peptides. We also show highly significant decreases after introducing a gluten- and casein-free diet with a duration of more than 1 year. We refer to previously published studies showing improvement in children on this diet who were followed for 4 years and a pairwise matched, randomly assigned study with highly significant changes. The literature shows abundant data pointing to the importance of a gut-to-brain connection.
An effect of diet on excreted compounds and behavior has been found. A gut-to-brain axis is both possible and probable.
Self administered questionnaires are becoming popular investigative tools in medical research, yet few reports state the extent of methods used to validate these questionnaires before their general use. A pilot study was therefore carried out to validate a 41 item questionnaire for use in a population screening study for gastrointestinal disease. Participants in the study comprised 69 population controls, 40 patients with benign disease, and 35 patients with gastrointestinal cancer. Acceptability, ease of completion, reliability, and reproducibility of the questionnaire were all assessed. Only one subject refused to complete the questionnaire. Ninety six per cent of the questions were completed by each subject and only one response in 1440 was altered in the reproducibility study. The questionnaire disclosed symptoms similar to those elicited by a clinician and highlighted unreported gastrointestinal symptoms in the control group. Three questions were found to be unreliable and were altered before the questionnaire was put into general use. It is concluded that a pilot study to validate a new questionnaire is simple to perform and necessary to identify unreliable questions.
Symptoms of dyspepsia significantly disrupt patients' lives and reliable methods of assessing symptom status are important for patient management. The aim of the current study was to document the psychometric characteristics of the Gastrointestinal Symptom Rating Scale (GSRS) and the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD) in Afrikaans, German, Hungarian, Italian, Polish and Spanish patients with dyspepsia.
853 patients with symptoms of dyspepsia completed the GSRS, the QOLRAD, the 36-item Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression scale.
The internal consistency reliability of the GSRS was 0.43-0.87 and of the QOLRAD 0.79-0.95. Test-retest reliability of the GSRS was 0.36-0.75 and of the QOLRAD 0.41-0.82. GSRS Abdominal pain domain correlated significantly with all QOLRAD domains in most language versions, and with SF-36 Bodily pain in all versions. QOLRAD domains correlated significantly with the majority of SF-36 domains in most versions. Both questionnaires were able to differentiate between patients whose health status differed according to symptom frequency and severity.
The psychometric characteristics of the different language versions of the GSRS and QOLRAD were found to be good, with acceptable reliability and validity. The GSRS and QOLRAD were found to be useful for evaluating dyspeptic symptoms and their impact on patients' daily lives in multinational clinical trials.
There is growing awareness that primary gastrointestinal pathology may play an important role in the inception and clinical expression of some childhood developmental disorders, including autism. In addition to frequent gastrointestinal symptoms, children with autism often manifest complex biochemical and immunological abnormalities. The gut–brain axis is central to certain encephalopathies of extra-cranial origin, hepatic encephalopathy being the best characterized.
Commonalities in the clinical characteristics of hepatic encephalopathy and a form of autism associated with developmental regression in an apparently previously normal child, accompanied by immune-mediated gastrointestinal pathology, have led to the proposal that there may be analogous mechanisms of toxic encephalopathy in patients with liver failure and some children with autism. Aberrations in opioid biochemistry are common to these two conditions, and there is evidence that opioid peptides may mediate certain aspects of the respective syndromes. The generation of plausible and testable hypotheses in this area may help to identify new treatment options in encephalopathies of extra-cranial origin.
Therapeutic targets for this autistic phenotype may include: modification of diet and entero-colonic microbial milieu in order to reduce toxin substrates, improve nutritional status and modify mucosal immunity; anti-inflammatory/immunomodulatory therapy; and specific treatment of dysmotility, focusing, for example, on the pharmacology of local opioid activity in the gut.
Studies on the gluten-free and/or casein-free (GFCF) dietary intervention for children with autism spectrum disorders (ASDs) suggest that some children may positively respond to implementation of the dietary intervention. Other research suggests that children diagnosed with ASD can be classified into subpopulations based on various factors, including gastrointestinal (GI) abnormalities and immune function.
This study analyzes parental report data collected using a 90-item online questionnaire from 387 parents or primary caregivers of children diagnosed with ASD on the efficacy of the GFCF diet. Parents reported on their child's GI symptoms, food allergy diagnoses, and suspected food sensitivities, as well as the degree and length of their diet implementation.
Overall, diet efficacy among children whose parents reported the presence of GI symptoms, food allergy diagnoses, and suspected food sensitivities included greater improvement in ASD behaviors, physiological symptoms, and social behaviors compared with children whose parents reported none of these symptoms, diagnoses, or sensitivities (P < 0.05). Parental report of strict diet implementation, indicated by complete gluten/casein elimination and infrequent diet errors during and outside of parental care, also corresponded to improvement in ASD behaviors, physiological symptoms, and social behaviors (P < 0.05).
These findings suggest that various intricacies related to diet implementation and GI and immune factors may play a role in differentiating diet responders from diet non-responders and substantiate the importance of further investigations into the various, nuanced factors that influence efficacy of the intervention among children with ASDs.
Anecdotal reports and parent surveys have shown evidence that dietary interventions have had some success in ameliorating the symptoms of autism.
In this paper, key findings that prompt a dietary intervention strategy are reviewed and popular intervention diets are described.
There is a significant body of literature pertinent to dietary interventions in autism from the perspectives of gastroenterology, immunology, and excitotoxicity. Some articles report benefits to patients on standardized rating scales.
This article presents a survey of the literature related to dietary interventions studied in the context of autism as well as various hypotheses on the rationale for dietary interventions. Patients or caregivers increasingly are attempting such interventions. Further studies are needed to establish the efficacy of these diets, the patients who would best benefit from diets, the mechanism of action, and the role of diets in addition to other treatments.
Use of complementary and alternative medicine (CAM) treatments have been increasing for children with autistic spectrum disorder (ASD). In this study, 38 Turkish parents of children with ASD were surveyed related with their use of CAM treatments, experiences, and views for each treatment. They mentioned "Vitamins and minerals", "Special Diet", "Sensory Integration", "Other Dietary Supplements", and "Chelation" as five frequently used CAM treatments. Communication, learning, health, and behavior were the main four areas rated as "improved" after five CAM treatments. Negative sides of treatments were listed as being expensive, difficult to apply, or harmful. The parents' views on some treatments have varied from great improvement to worse. Reported improvements were considerably higher than the negative sides of the treatments.
There is growing awareness that primary gastrointestinal pathology may play an important role in the inception and clinical expression of some childhood developmental disorders, including autism. In addition to frequent gastrointestinal symptoms, children with autism often manifest complex biochemical and immunological abnormalities. The gut-brain axis is central to certain encephalopathies of extra-cranial origin, hepatic encephalopathy being the best characterized. Commonalities in the clinical characteristics of hepatic encephalopathy and a form of autism associated with developmental regression in an apparently previously normal child, accompanied by immune-mediated gastrointestinal pathology, have led to the proposal that there may be analogous mechanisms of toxic encephalopathy in patients with liver failure and some children with autism. Aberrations in opioid biochemistry are common to these two conditions, and there is evidence that opioid peptides may mediate certain aspects of the respective syndromes. The generation of plausible and testable hypotheses in this area may help to identify new treatment options in encephalopathies of extra-cranial origin. Therapeutic targets for this autistic phenotype may include: modification of diet and entero-colonic microbial milieu in order to reduce toxin substrates, improve nutritional status and modify mucosal immunity; anti-inflammatory/immunomodulatory therapy; and specific treatment of dysmotility, focusing, for example, on the pharmacology of local opioid activity in the gut.
This study tested the efficacy of a gluten-free and casein-free (GFCF) diet in treating autism using a randomized, double blind repeated measures crossover design. The sample included 15 children aged 2-16 years with autism spectrum disorder. Data on autistic symptoms and urinary peptide levels were collected in the subjects' homes over the 12 weeks that they were on the diet. Group data indicated no statistically significant findings even though several parents reported improvement in their children. Although preliminary, this study demonstrates how a controlled clinical trial of the GFCF diet can be conducted, and suggests directions for future research.
The use of complementary or alternative treatment approaches in children with autism spectrum disorders (ASDs) is increasing, and the most popular of such approaches are diets that eliminate either gluten or casein, or both. The popularity of these diets indicates a need for more rigorous research into their efficacy. Owing to significant methodological flaws, the currently available data are inadequate to guide treatment recommendations. The purpose of this review is to examine the available trials of gluten/casein diets in children with ASDs regarding the strength of their findings and also concerning points that may be useful in the design of future studies. Seven trials of these diets in ASD are critically reviewed; 6 of these were uncontrolled trials and 1 used a single-blind design. All reported efficacy in reducing some autism symptoms, and 2 groups of investigators also reported improvement in nonverbal cognition. Design flaws in all of the studies weaken the confidence that can be placed in their findings. Careful double-blind, placebo-controlled studies are needed to evaluate whether actual benefit undergirds the diets' popularity and to provide better guidance to clinicians and caregivers. The literature currently available suggests that diets eliminating both gluten and casein (rather than either alone) should be studied first and that outcome measures should include assessments of nonverbal cognition.
It has been suggested that peptides from gluten and casein may have a role in the origins of autism and that the physiology and psychology of autism might be explained by excessive opioid activity linked to these peptides. Research has reported abnormal levels of peptides in the urine and cerebrospinal fluid of people with autism.
To determine the efficacy of gluten and/or casein free diets as an intervention to improve behaviour, cognitive and social functioning in individuals with autism.
The following electronic databases were searched: CENTRAL(The Cochrane Library Issue 2, 2007), MEDLINE (1966 to April 2007), PsycINFO (1971 to April 2007), EMBASE (1974 to April 2007), CINAHL (1982 to April 2007), ERIC (1965 to 2007), LILACS (1982 to April 2007), and the National Research register 2007 (Issue1). Review bibliographies were also examined to identify potential trials.
All randomised controlled trials (RCT) involving programmes which eliminated gluten, casein or both gluten and casein from the diets of individuals diagnosed with an autistic spectrum disorder.
Abstracts of studies identified in searches of electronic databases were assessed to determine inclusion by two independent authors The included trials did not share common outcome measures and therefore no meta-analysis was possible. Data are presented in narrative form.
Two small RCTs were identified (n = 35). No meta-analysis was possible. There were only three significant treatment effects in favour of the diet intervention: overall autistic traits, mean difference (MD) = -5.60 (95% CI -9.02 to -2.18), z = 3.21, p=0.001 (Knivsberg 2002) ; social isolation, MD = -3.20 (95% CI -5.20 to 1.20), z = 3.14, p = 0.002) and overall ability to communicate and interact, MD = 1.70 (95% CI 0.50 to 2.90), z = 2.77, p = 0.006) (Knivsberg 2003). In addition three outcomes showed no significant difference between the treatment and control group and we were unable to calculate mean differences for ten outcomes because the data were skewed. No outcomes were reported for disbenefits including harms.
Research has shown of high rates of use of complementary and alternative therapies (CAM) for children with autism including gluten and/or casein exclusion diets. Current evidence for efficacy of these diets is poor. Large scale, good quality randomised controlled trials are needed.