Intervention Review

Gluten- and casein-free diets for autistic spectrum disorder

  1. Claire Millward2,
  2. Michael Ferriter1,*,
  3. Sarah J Calver3,
  4. Graham G Connell-Jones4

Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Published Online: 23 APR 2008

Assessed as up-to-date: 1 APR 2007

DOI: 10.1002/14651858.CD003498.pub3


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.

Author Information

  1. 1

    Nottinghamshire Healthcare NHS Trust, Literature and Evidence Research Unit (LERU), Institute of Mental Health, Woodbeck, Nottinghamshire, UK

  2. 2

    Derbyshire Children's Hospital, Department of Clinical Psychology, Derby, UK

  3. 3

    24 Norton Road, Child & Family Consultation Services, Essex, UK

  4. 4

    Mansfield Road, Annesley House, Annesley, Nottinghamshire, UK

*Michael Ferriter, Literature and Evidence Research Unit (LERU), Institute of Mental Health, Nottinghamshire Healthcare NHS Trust, The Clair Chilvers Centre, Rampton Hospital, Woodbeck, Nottinghamshire, DN22 OHU, UK. Michael.Ferriter@nottshc.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2008

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

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.

Search methods

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.

Selection criteria

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.

Main results

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.

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

泛自閉症障礙 (autistic spectrum disorder) 者之無麩質及無酪蛋白飲食

有人認為,麩質和酪蛋白所含的胜?可能與自閉症的起源有關。自閉症的生理和心理現象也許可以用這些胜?相關的鴉片類作用過盛來解釋。之前的研究報告自閉症個案的尿液和腦脊髓液中有異常的胜?濃度。如果這是事實,無麩質、無酪蛋白、或是兩者皆無的飲食,應可減少自閉症相關的症狀。

目標

為決定無麩質和/或酪蛋白的飲食對於改善自閉症個案的行為、認知和社會功能之效果。

搜尋策略

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。

選擇標準

所有包含將泛自閉症障礙的個案的飲食去除麩質或酪蛋白,或同時去除麩質和酪蛋白的方案之隨機對照試驗。

資料收集與分析

我們將電子資料庫搜尋所得的研究摘要加以閱讀及評估,以確定它們是否符合納入之標準。不同的作者群由這些確認出來的研究中,再獨立選出合適的研究。由於只有一個試驗符合納入的標準,沒有辦法運算統合分析,因此以描述的形式呈現資料。

主要結論

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。

作者結論

這是一個重要的研究領域,需要大規模、品質佳的隨機對照試驗。

翻譯人

本摘要由成功大學附設醫院黃惠群翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

廣泛的文獻搜索只發現一個以無麩質和/或酪蛋白的飲食為介入方式來改善自閉症個案的行為、認知和社會功能的隨機對照試驗。這個試驗是小規模的,只有10人參加治療組,10人參加對照組。結果顯示,同時無麩質和無酪蛋白的飲食可減少一些自閉症特徵。這是一個重要的研究領域,需要大規模、品質佳的隨機對照試驗。