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To determine whether a gluten-free diet (GFD) compared with a gluten-containing diet (GD) influences functioning of children with autism spectrum disorders (ASD), we performed a randomized, controlled, single-blinded trial. Sixty-six children (36–69 months) with ASD, within the normal IQ (> 70) range, who had been on a GFD for at least 8 weeks before enrollment were eligible for inclusion. After an 8-week run-in period on a GFD, the GFD group continued this diet and the GD group consumed at least one normal meal containing gluten per day for 6 months. There were no differences between groups in autistic symptoms, maladaptive behaviors, or intellectual abilities after the intervention. A GFD compared with a GD did not affect functioning of children with ASD. Trial registration ClinicalTrials.gov, number NCT02280746.
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Vol:.(1234567890)
Journal of Autism and Developmental Disorders (2020) 50:482–490
https://doi.org/10.1007/s10803-019-04266-9
1 3
ORIGINAL PAPER
Gluten‑Free Diet inChildren withAutism Spectrum Disorders:
ARandomized, Controlled, Single‑Blinded Trial
AnnaPiwowarczyk1· AndreaHorvath2· EwaPisula3· RafałKawa3· HaniaSzajewska2
Published online: 28 October 2019
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract
To determine whether a gluten-free diet (GFD) compared with a gluten-containing diet (GD) influences functioning of
children with autism spectrum disorders (ASD), we performed a randomized, controlled, single-blinded trial. Sixty-six
children (36–69months) with ASD, within the normal IQ (> 70) range, who had been on a GFD for at least 8weeks before
enrollment were eligible for inclusion. After an 8-week run-in period on a GFD, the GFD group continued this diet and the
GD group consumed at least one normal meal containing gluten per day for 6months. There were no differences between
groups in autistic symptoms, maladaptive behaviors, or intellectual abilities after the intervention. A GFD compared with a
GD did not affect functioning of children with ASD.
Trial registration ClinicalTrials.gov, number NCT02280746.
Keywords Randomized controlled trial· Autism spectrum disorder· Children· Gluten
The gluten-free and/or casein-free (GFCF) diet addresses
the hypothesis that children with autism spectrum disorders
(ASD) absorb peptides as a result of a leaky gut (Whiteley
etal. 1999), thus, use of a GFCF diet may ameliorate behav-
ioral symptoms. Excessive activity of peptides derived from
the metabolism of gluten and casein (Israngkun etal. 1986;
Shattock and Whiteley 2002; Christison and Ivany 2006) is
thought to impair neurotransmission (Knivsberg etal. 1995).
However, data on the efficacy of a GFCF diet as a treat-
ment for ASD in children are limited. Our 2018 systematic
review identified 6 relevant randomized controlled trials
(RCTs) (214 participants) (Piwowarczyk etal. 2018). With
few exceptions, there were no significant differences in ASD
core symptoms between groups, as measured by standard-
ized scales. The remaining differences, if present, referred to
parent-based assessment tools or other developmental/ASD-
related features. We concluded that, overall, there is little
evidence that a GFCF diet is beneficial for the symptoms of
ASD in children. However, methodological limitations in the
included trials may invalidate the results. Furthermore, 4 of
6 of these trials compared a GFCF diet with a “regular” diet
(presumably gluten-containing as there was no reporting on
no specific effort to ensure gluten was consumed) and few
trials included a GFD or GFCF diet run-in/washout period.
Data on the effects of a gluten-free diet (GFD) only are
even more limited. Despite such uncertainty, avoidance of
gluten, initiated by caregivers or clinicians, in preschool
children with ASD is highly prevalent (Rubenstein etal.
2018). Only one previous trial has investigated the effects
of a GFD on gastrointestinal (GI) symptoms and behavio-
ral indices in children with ASD, with results suggesting
that gluten elimination affects these outcomes (Ghalichi
etal. 2016). However, this trial compared a GFD with a
“regular” diet and did not include a GFD run-in period. We,
therefore, aimed to further assess the effect of gluten on the
functioning of children with ASD by comparing use of a
GFD and gluten-containing diet (GD). In accordance with
guidelines (National Institute for Health and Clinical Excel-
lence 2009), each child receiving the GD diet consumed
some gluten-containing foods (e.g., bread, chapattis, pasta,
biscuits, or cakes) in more than one meal every day. In real
* Hania Szajewska
hania@ipgate.pl
1 Department ofPaediatrics withClinical Assessment Unit,
The Medical University ofWarsaw, Zwirki i Wigury 63a,
02-091Warsaw, Poland
2 Department ofPaediatrics, The Medical University
ofWarsaw, Zwirki i Wigury 63A, 02-091Warsaw, Poland
3 Department ofHealth andRehabilitation Psychology,
Faculty ofPsychology, University ofWarsaw, Stawki 5/7,
00-183Warsaw, Poland
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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.
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