A systematic review and meta-analysis of the benefits of a gluten-free diet and/or casein-free diet for children with autism spectrum disorder

Quan, Liuliu; Xu, Xinjie; Cui, Yonghong; Han, Heze; Hendren, Robert L.; Zhao, Lu; You, Xin

doi:10.1093/nutrit/nuab073

Cited by 26 publications

(30 citation statements)

References 47 publications

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“…The main result of the meta-analysis showed a positive effect of diet therapy for ASD symptoms [consistent with part of previous reviews ( 25 , 42 )], no correlation with the length of the interventions. Besides, the groups on GFD diets show improvement in social behaviors compared to control groups.…”

Section: Discussionsupporting

confidence: 84%

“…Keller et al ( 24 ) identified six relevant RCTs, and the result showed no effect of a GFCF diet on clinician-reported autism core symptoms, parent-reported functional level, or behavioral difficulties. On the contrary, Quan et al ( 25 ) indicated that a GFCF diet can reduce stereotypical behaviors and improve the cognition of children with ASD within a total of eight studies. Hence, this meta-analysis aimed to reevaluate the efficacy and safety of a GFCF diet, and evaluate the effectiveness of a KD diet for individuals with ASD.…”

Section: Introductionmentioning

confidence: 99%

“…In conclusion, evidence about these diets and autism is scarce, and more studies are necessary to evaluate and support the effectiveness and safety. So far, several studies evaluated the effects of a GFCF diet on individuals with ASD ( 24 , 25 ) with systematic and quantitative analysis. Keller et al ( 24 ) identified six relevant RCTs, and the result showed no effect of a GFCF diet on clinician-reported autism core symptoms, parent-reported functional level, or behavioral difficulties.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Diet Therapies in Children With Autism Spectrum Disorder: A Systematic Literature Review and Meta-Analysis

Huang

Chen

et al. 2022

Front. Neurol.

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ObjectiveAutism Spectrum Disorder is a neurodevelopmental disorder, with a rapid increase in recognition over the past decade. Interest in alternative therapies is growing annually, such as dietary therapies including gluten-free and/or casein-free diet, and the ketogenic diet. However, there is no consensus on the efficacy and safety of dietary therapy in children with ASD up to now. This study aimed to assess the efficacy and safety of these diet interventions for children with ASD based on a meta-analysis of global data.MethodsSeven databases (Cochrane Library, PubMed, EMBASE, Web of Science, VIP, CNKI, and Wanfang) were searched according to the established inclusion criteria, from the inception of the databases to August 18, 2021. The Cochrane Bias risk assessment tool was intended to assess the quality of the included studies. Review Manager 5.4 software was used as an efficacy analysis tool of the included studies, taking the core autistic symptoms and scales of ASD as therapeutic efficacy evaluations.ResultsIn total, 7 RCTs with 338 participants were finally obtained. All studies assessed the association between core autistic symptoms and therapeutic diet, showing a statistically significant effect (standard mean difference (SMD) of −0.51, 95% confidence interval (Cl): −0.81 to −0.21), in which two studies which followed the GFD diet reported significant reductions in social behaviors (SMD of−0.41, 95% Cl: −0.75 to −0.06), showing no correlation with the length of the interventions (P < 0.05). Two studies were performed in KD diet suggested a significant effect in core symptoms (SMD of −0.67, 95% Cl: −1.04 to −0.31). No statistically significant changes were observed in the GFCF diet, GFD diet, cognition, communication, and stereotypical behaviors subgroups (all P > 0.05).ConclusionThe results of a meta-analysis suggest that diet therapies can significantly ameliorate core symptoms of ASD, and GFD diets are conducive to improving social behaviors. Although the results suggest the effectiveness of dietary therapy for ASD, limited by the small sample size of RCTs, more well-designed, and high-quality clinical trials are needed to validate the above conclusions.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021277565.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Diet Therapies in Children With Autism Spectrum Disorder: A Systematic Literature Review and Meta-Analysis

Huang

Chen

et al. 2022

Front. Neurol.

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“…Furthermore, even though there is no conclusive evidence proving an improvement of ASD symptom management in children on the GFCF diet, it is currently one of the most popular interventions [ 16 ]. A gluten-free diet consists in the exclusion of all foods containing wheat, barley, or rye as well as all flours, bread, pasta, and other bakery products made from these cereals; while a casein-free diet is based on avoiding dairy products such as milk, yogurt, cheese, butter, cream, or ice cream, among others [ 17 ]. As expected, we observed a lower consumption of dairy products and cereals with gluten in those autistic children whose were on the GFCF diet, and a lower intake of gluten and casein in the ASD total group (ASD-d + ASD-no diet) in comparison with TD participants.…”

Section: Discussionmentioning

confidence: 99%

Dietary Intake, Nutritional Status and Sensory Profile in Children with Autism Spectrum Disorder and Typical Development

Dubourdieu

Guerendiain

2022

Nutrients

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Children with autism spectrum disorder (ASD) may consume a restricted diet, whether due to sensory sensitivities or an adherence to a gluten and casein free (GCF) diet. Our objective was to analyze dietary intake, nutritional status, and sensory profile in children with and without ASD. A descriptive, cross-sectional study was carried out in 65 children (3–12 years, ASD = 35, typical development (TD) = 30). Short Sensory Profile and food frequency questionnaires were applied. All participants were categorized into normal weight and excess weight, typical sensory performance (TP), and probable + definite difference (PD + DD); and ASD group into GCF dieters (ASD-diet) and non-dieters (ASD-no diet). Children with ASD had a higher intake (gr or ml/d) of vegetable drinks (p = 0.001), gluten-free cereals (p = 0.003), and a lower intake of fish (p < 0.001) than TD ones. The ASD group showed a lower score in total sensory profile score (p < 0.001) than TD group. In the ASD group, those who had PD + DD in their sensory profile consumed fewer dairies (p = 0.019), and more cereals (p = 0.036) and protein foods (p = 0.034) than those with TP. These findings confirm the need to consider the neurodevelopment, sensory profile, and type of diet to improve the ASD child’s nutrition. Further long-term research is needed to explore their impact on health.

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“…Inadequate consumption of dairy products and GFCF diets have been found to be associated with high levels of homocysteine [45,46]. The meta-analysis, conducted by Quan et al [47], 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.…”

Section: Dietary Models In Asdmentioning

confidence: 99%

The importance of nutritional management and education in the treatment of autism

Mandecka

Regulska−Ilow

2022

Rocz Panstw Zakl Hig

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Autism spectrum disorders (ASDs) are an early-onset neurodevelopmental disorders. The key symptoms of ASD include social deficits, verbal and non-verbal communication deficits, and restricted, repetitive patterns of behaviour, interests, or activities. Dietary patterns have been evidenced to be related to maternal nutritional status that might lead to different metabolic conditions, and maternal metabolic dysfunction has been observed to be associated with ASD. Furthermore growing evidence suggests that the gut microbiota has a role in the pathophysiology of ASD. Differences in composition of the gastrointestinal (GI) microbiota in children with ASD compared to unaffected siblings and/or healthy unrelated controls have been reported in various studies. The above-mentioned ASD factors and symptoms can be regulated by proper nutrition. The importance of nutrition and its possible impact on ASD patients is key to integral therapy. According to numerous research studies, various nutritional approaches succeeded in reducing the severity of patients' core ASD symptoms. The numerous options for diet that is used in the ASD therapy, as described in the scientific literature, are related to the problem of choosing an appropriate nutritional treatment. Each nutrition programme needs to be personalised and tailored to an individual patient. The aim of the paper is to review the available literature on dietary interventions in children with ASD and provide up-to-date evidence.

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A systematic review and meta-analysis of the benefits of a gluten-free diet and/or casein-free diet for children with autism spectrum disorder

Cited by 26 publications

References 47 publications

Efficacy and Safety of Diet Therapies in Children With Autism Spectrum Disorder: A Systematic Literature Review and Meta-Analysis

Efficacy and Safety of Diet Therapies in Children With Autism Spectrum Disorder: A Systematic Literature Review and Meta-Analysis

Dietary Intake, Nutritional Status and Sensory Profile in Children with Autism Spectrum Disorder and Typical Development

The importance of nutritional management and education in the treatment of autism

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