Gluten- and casein-free diets for autistic spectrum disorder
Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group
Published Online: 23 APR 2008
Assessed as up-to-date: 1 APR 2007
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Millward C, Ferriter M, Calver SJ, Connell-Jones GG. Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD003498. DOI: 10.1002/14651858.CD003498.pub3.
- Publication Status: Edited (no change to conclusions)
- Published Online: 23 APR 2008
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.
Data collection and analysis
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.
Plain language summary
Gluten and casein-free diets for autism spectrum disorder
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.
An extensive literature search was carried out to identify any randomised control trials of gluten and/or casein free diet as an intervention to improve behaviour, cognitive and social functioning in individuals with autism. Only three papers reporting on two randomised control trial were identified, two small scale trials the first with ten participants in each arm of the trial and the second with fifteen participants recruited into the trial. The results for the first study indicated that a combined gluten and casein free diet reduced autistic traits and the second study showed no significant difference in outcome measures between the diet group and the control group. This is an important area of investigation and large scale, good quality randomised control trials are needed. None of the studies reported on adverse outcomes or potential disbenefits.
There is evidence of widespread use by parents of complementary and alternative therapies (CAM) including exclusion diets for their children with autism. Despite this, there is a lack of evidence to support the use of gluten and/or casein free diet as an effective intervention for persons with autism and also a lack of research on potential harms and disbenefits of such diets. Despite the problems of maintaining the integrity of such diets in the community it is possible to carry out randomised control trials to address these questions and more and adequately powered trials are needed in this area.
泛自閉症障礙 (autistic spectrum disorder) 者之無麩質及無酪蛋白飲食
我們搜尋了以下的電子資料庫的摘要，包括: Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2003年), PsycINFO (1971年至2003年5月), EMBASE (1974年至2003年5月), CINAHL (1982年至2003年5月), MEDLINE (1986年至2003年5月), ERIC (1965年至2003年), LILACS (至2003年) 以及Cochrane Complementary Medicine Field Specialised Register (2004年1月) 。我們也檢視回顧的參考書目來找出可能適合的研究試驗。
此一納入的試驗 (20位個案) 報告4個方面的結果。不出所料，在這樣一個小規模的研究，其中的三項結果(認知技巧，語言能力和運動能力)顯示廣泛的信賴區間跨越無效果線 (line of nil effect) 。然而，對於第四項結果，自閉症特徵的減少，顯示出同時無麩質和酪蛋白的飲食有明顯有益的治療效果。
此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。