A Review of the Efficacy of the Dietary Intervention in Autism Spectrum Disorder

Zainab Taha; Khalid A.  Abdalhai

doi:10.3889/oamjms.2021.5743

Authors

Zainab Taha Department of Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
Khalid A. Abdalhai Department of Psychiatry, International University of Africa, Sudan

DOI:

https://doi.org/10.3889/oamjms.2021.5743

Keywords:

Autism spectrum disorder, Vitamin supplementation, Dietary intervention

Abstract

BACKGROUND: Autism spectrum disorder (ASD) is an early-onset neurodevelopmental disorder with 1 in 68 children prevalence. The key symptoms of ASD include social deficits, verbal and non-verbal communication deficits, and restricted, repetitive patterns of behavior, interests, or activities. For unknown reasons, gastrointestinal symptoms are related to ASD. The aim of the current paper is to review the available literature on dietary interventions in children with ASD and provide up-to-date evidence.

METHODS: Searches in online databases, using the search terms’ dietary intervention, “autism spectrum disorders,” and “autism” were conducted. The search targeted publications ranging from 2010 to 2020.

RESULTS: Twenty-six studies with different study designs which evaluated the effectiveness of specific dietary interventions in children with ASD were included in our review. Several dietary interventions were of popular practice in the management of children with ASD, including elimination (gluten-/casein-free diet and oligoantigenic diet), modification (modified ketogenic diet), supplementation (minerals, vitamins, omega 3, and omega 6), and exclusion (food additives). Studies showed different results with varying degrees of evidence. Overall, data were inadequate to make accurate conclusions.

CONCLUSION: There is little evidence to support the use of dietary interventions for children with ASD. Additional high-quality studies and further research are, therefore, needed.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5™. 5th ed. Arlington, VA: American Psychiatric Association; 2013. https://doi.org/10.1007/springerreference_179660

Al-Mamri W, Idris AB, Dakak S, Al-Shekaili M, Al-Harthi Z, Alnaamani AM, et al. Revisiting the prevalence of autism spectrum disorder among Omani children: A multicentre study. Sultan Qaboos Univ Med J. 2019;19:e305. https://doi.org/10.18295/squmj.2019.19.04.005 PMid:31897313

Zablotsky B, Black LI, Maenner MJ, Schieve LA, Blumberg SJ, et al. Estimated prevalence of autism and other developmental disabilities following questionnaire changes in the 2014 National Health Interview Survey. Natl Health Stat Report. 2015;87:1-20. PMid:26632847

Devlin B, Scherer SW. Genetic architecture in autism spectrum disorder. Curr Opin Genet Dev. 2012;22(3):229-37. PMid:22463983

Rasalam A, Hailey H, Williams JH, Moore SJ, Turnpenny PD, Lloyd DJ, et al. Characteristics of fetal anticonvulsant syndrome associated autistic disorder. Dev Med Child Neurol. 2005;47(8):551-5. https://doi.org/10.1017/s0012162205001076 PMid:16108456

Xiang AH, Wang X, Martinez MP, Page K, Buchanan TA, Feldman RK, et al. Maternal Type 1 diabetes and risk of autism in offspring. JAMA. 2018;320(1):89-91. https://doi.org/10.1001/jama.2018.7614 PMid:29936530

Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE, et al. The epidemiology of autism spectrum disorders. Annu Rev Public Health 2007;28:235-58. https://doi.org/10.1146/annurev.publhealth.28.021406.144007 PMid:17367287

Trajkovski V. Health Condition in Persons with Autism Spectrum Disorders. J ReAttach Ther Dev Divers. 2019;1(2):112-24.

Cermak SA, Curtin C, Bandini LG. Food selectivity and sensory sensitivity in children with autism spectrum disorders. J Am Dietetic Assoc. 2010;110(2):238-46. https://doi.org/10.1016/j.jada.2009.10.032 PMid:20102851

Ghaleiha A, Asadabadi M, Mohammadi MR, Shahei M, Tabrizi M, Hajiaghaee R, et al. Memantine as adjunctive treatment to risperidone in children with autistic disorder: A randomized, double-blind, placebo-controlled trial. Int J Neuropsychopharmacol. 2013;16(4):783-9. https://doi.org/10.1017/s1461145712000880 PMid:22999292

Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M, et al. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry 2014;53:237-57. https://doi.org/10.1016/j.jaac.2013.10.013 PMid:24472258

Kałużna-Czaplińska J, Jóźwik-Pruska J. Nutritional strategies and personalized diet in autism-choice or necessity? Trends Food Sci Technol 2016;49:45-50. https://doi.org/10.1016/j.tifs.2016.01.005

Rubenstein E, Schieve L, Bradley C, DiGuiseppi C, Moody E, Thomas K, et al. The prevalence of gluten free diet use among preschool children with autism spectrum disorder. Autism Res 2018;11:185-93. https://doi.org/10.1002/aur.1896 PMid:29155492

Doenyas C. Dietary interventions for autism spectrum disorder: New perspectives from the gut-brain axis. Physiol Behav 2018;194:577-82. https://doi.org/10.1016/j.physbeh.2018.07.014 PMid:30036560

Ristori MV, Quagliariello A, Reddel S, Ianiro G, Vicari S, Gasbarrini A, et al. Autism, gastrointestinal symptoms and modulation of gut microbiota by nutritional interventions. Nutrients. 2019;11(11):2812. https://doi.org/10.3390/nu11112812 PMid:31752095

Siafis S, Çıray O, Schneider-Thoma J, Bighelli I, Krause M, Rodolico A, et al. Placebo response in pharmacological and dietary supplement trials of autism spectrum disorder (ASD): Systematic review and meta-regression analysis. Mol Autism. 2020;11(1):1-19. https://doi.org/10.1186/s13229-020-00372-z PMid:32847616

Karhu E, Zukerman R, Eshraghi RS, Mittal J, Deth RC, Castejon AM, et al. Nutritional interventions for autism spectrum disorder. Nutr Rev. 2020;78(7):515-31. https://doi.org/10.1093/nutrit/nuz092 PMid:31876938

Gogou M, Kolios G. Are therapeutic diets an emerging additional choice in autism spectrum disorder management? World J Pediatr. 2018;14(3):215-23. https://doi.org/10.1007/s12519-018-0164-4 PMid:29846886

Cekici H, Sanlier N. Current nutritional approaches in managing autism spectrum disorder: A review. Nutr Neurosci 2019;22(3):145-55. https://doi.org/10.1080/10284 15x.2017.1358481 PMid:28762296

Faras H, Al Ateeqi N, Tidmarsh L. Autism spectrum disorders. Ann Saudi Med. 2010;30(4):295-300. https://doi.org/10.4103/0256-4947.65261 PMid:20622347

Marti LF. Dietary interventions in children with autism spectrum disorders-an updated review of the research evidence. Curr Clin Pharmacol. 2014;9(4):335-49. https://doi.org/10.2174/15748847113086660074 PMid:24050740

Whiteley P, Rodgers J, Shattock P. Feeding Patterns in Autism. Autism. 2000;4:207-11. https://doi.org/10.1177/1362361300004002008

Emond A, Emmett P, Steer C, Golding J. Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics. 2010;126(2):e337-42. https://doi.org/10.1542/peds.2009-2391 PMid:20643716

Sanctuary MR, Kain JN, Angkustsiri K, German JB. Dietary considerations in autism spectrum disorders: The potential role of protein digestion and microbial putrefaction in the gut-brain axis. Front Nutr. 2018;5:40. https://doi.org/10.3389/fnut.2018.00040 PMid:29868601

Horvath K, Papadimitriou JC, Rabsztyn A, Drachenberg C, Tildon JT. Gastrointestinal abnormalities in children with autistic disorder. J Pediatr. 1999;135(5):559-63. https://doi.org/10.1016/s0022-3476(99)70052-1 PMid:10547242

Reichelt KL, Knivsberg AM. Can the pathophysiology of autism be explained by the nature of the discovered urine peptides? Nutr Neurosci. 2003;6(1):19-28. https://doi.org/10.1080/1028415021000042839 PMid:12608733

Marsden RE, Francis J, Garner I. Use of GFCF diets in children with ASD. An investigation into parents’ beliefs using the theory of planned behaviour. J Autism Dev Disord. 2019;49(9):3716- 31. https://doi.org/10.1007/s10803-019-04035-8 PMid:31165958

Moon K, Rao SC, Schulzke SM, Patole SK, Simmer K, et al. Longchain polyunsaturated fatty acid supplementation in preterm infants. Cochrane Database Syst Rev. 2016;12:Cd000375. https://doi.org/10.1002/14651858.cd000375.pub3 PMid:27995607

Coury DL, Ashwood P, Fasano A, Fuchs G, Geraghty M, Kaul A, Mawe G, et al. Gastrointestinal conditions in children with autism spectrum disorder: Developing a research agenda. Pediatrics. 2012;130(Suppl 2):S160-8. https://doi.org/10.1542/peds.2012-0900n PMid:23118247

de Magistris L, Familiari V, Pascotto A, Sapone A, Frolli A, Iardino P, et al. Alterations of the intestinal barrier in patients with autism spectrum disorders and in their first-degree relatives. J Pediatr Gastroenterol Nutr. 2010;51(4):418-24. https://doi.org/10.1097/mpg.0b013e3181dcc4a5 PMid:20683204

Strati F, Cavalieri D, Albanese D, De Felice C, Donati C, Hayek J, et al. New evidences on the altered gut microbiota in autism spectrum disorders. Microbiome. 2017;5(1):24. https://doi.org/10.1186/s40168-017-0242-1 PMid:20683204

Lazaro CP, Ponde MP, Rodrigues LE. Opioid peptides and gastrointestinal symptoms in autism spectrum disorders. Braz J Psychiatry. 2016;38(3):243-6. https://doi.org/10.1590/1516-4446-2015-1777 PMid:27304256

Shattock P, Kennedy A, Rowell F, Berney T. Role of neuropeptides in autism and their relationships with classical neurotransmitters. Brain Dysfunct. 1990;3((5-6)):328-45.

Shattock P, Whiteley P. Biochemical aspects in autism spectrum disorders: Updating the opioid-excess theory and presenting new opportunities for biomedical intervention. Expert Opin Ther Targets. 2002;6(2):175-83. https://doi.org/10.1517/14728222.6.2.175 PMid:12223079

Ly V, Bottelier M, Hoekstra PJ, Vasquez AA, Buitelaar JK, Rommelse NN, et al. Elimination diets’ efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. Eur Child Adolesc Psychiatry. 2017;26(9):1067-79. https://doi.org/10.1007/s00787-017-0959-1 PMid:28190137

Çöpür M, Çöpür S. Autism spectrum disorders and gluten/ casein free diet treatment: A systematic review (1990-2016). Int J Nutr. 2017;2(4):7. https://doi.org/10.14302/issn.2379-7835.ijn-17-1710

Sathe N, Andrews JC, McPheeters ML, Warren ZE. Nutritional and dietary interventions for autism spectrum disorder: A systematic review. Pediatrics. 2017;139:e20170346. https://doi.org/10.1542/peds.2017-0346 PMid:28562286

Tye C, Runicles AK, Whitehouse AJ, Alvares GA, et al. Characterizing the interplay between autism spectrum disorder and comorbid medical conditions: An integrative review. Front Psychiatry. 2019;9:751. https://doi.org/10.3389/fpsyt.2018.00751 PMid:30733689

Lee RW, Corley MJ, Pang A, Arakaki G, Abbott L, Nishimoto M, et al. A modified ketogenic gluten-free diet with MCT improves behavior in children with autism spectrum disorder. Physiol Behav. 2018;188:205-11. https://doi.org/10.1016/j.physbeh.2018.02.006 PMid:29421589

Stafstrom CE, Rho JM. The ketogenic diet as a treatment paradigm for diverse neurological disorders. Front Pharmacol. 2012;3:59. https://doi.org/10.3389/fphar.2012.00059 PMid:22509165

Newman JC, Verdin E. Beta-hydroxybutyrate: A signaling metabolite. Annu Rev Nutr. 2017;37:51-76. https://doi.org/10.1146/annurev-nutr-071816-064916 PMid:28826372

Bjorklund G, Waly MI, Al-Farsi Y, Saad K, Dadar M, Rahman M, et al. The role of vitamins in autism spectrum disorder: What do we know? J Mol Neurosci. 2019;67(3):373-87. https://doi.org/10.1007/s12031-018-1237-5 PMid:30607900

Cheng B, Zhu J, Yang T, Guo M, Lai X, Li Q, et al. Vitamin A deficiency increases the risk of gastrointestinal comorbidity and exacerbates core symptoms in children with autism spectrum disorder. Pediatr Res. 2021;89(1):211-6. https://doi.org/10.1038/s41390-020-0865-y PMid:32225174

Qiu S, Li L, Weeber EJ, May JM. Ascorbate transport by primary cultured neurons and its role in neuronal function and protection against excitotoxicity. J Neurosci Res. 2007;85(5):1046-56. https://doi.org/10.1002/jnr.21204 PMid:17304569

Altun H, Kurutaş EB, Şahin N, Güngör O, Fındıklı E. The levels of Vitamin D, Vitamin D receptor, homocysteine and complex B Vitamin in children with autism spectrum disorders. Clin Psychopharmacol Neurosci. 2018;16(4):383. https://doi.org/10.9758/cpn.2018.16.1.383 PMid:30466210

Keim SA, Gracious B, Boone KM, Klebanoff MA, Rogers LK, Rausch J, et al. Omega-3 and omega-6 fatty acid supplementation may reduce autism symptoms based on parent report in preterm toddlers. J Nutr. 2018;148(2):227-35. https://doi.org/10.1093/jn/nxx047 PMid:29490101

Keim SA, Boone KM, Klebanoff MA, Turner AN, Rausch J, Nelin MA, et al. Effect of docosahexaenoic acid supplementation vs placebo on developmental outcomes of toddlers born preterm: A randomized clinical trial. JAMA Pediatr. 2018;172(12):1126-34. https://doi.org/10.1001/jamapediatrics.2018.3082 PMid:30357263

Cheng YS, Tseng PT, Chen YW, Stubbs B, Yang WC, Chen TY, et al. Supplementation of omega 3 fatty acids may improve hyperactivity, lethargy, and stereotypy in children with autism spectrum disorders: A meta-analysis of randomized controlled trials. Neuropsychiatr Dis Treat. 2017;13:2531-43. https://doi.org/10.2147/ndt.s147305 PMid:29042783

James S, Montgomery P, Williams K. Omega-3 fatty acids supplementation for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2011;9(11):Cd007992. https://doi.org/10.1002/14651858.cd007992.pub2 PMid:22071839

Feingold BF. Hyperkinesis and learning disabilities linked to artificial food flavors and colors. Am J Nurs. 1975;75(5):797- 803. https://doi.org/10.1097/00000446-197505000-00021 PMid:1039267

INDI-Irish Nutrition and Dietetic Institute. Autism Spectrum Disorders and Diet in Children. Ashgrove House, Kill Avenue: Dun Laoghaire, Co., Dublin; 2010. Available from: https:// www.indi.ie/diseases,-allergies-and-medical-conditions/ disability/361-diet-and-autism.html.

Pelsser LM, Frankena K, Toorman J, Savelkoul HF, DuboisAE, Pereira RR, et al. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): A randomised controlled trial. Lancet. 2011;377(9764):494-503. https://doi.org/10.1016/s0140-6736(10)62227-1 PMid:21296237

Levy SE, Hyman AL. Complementary and alternative medicine treatments for children with autism spectrum disorders. Child Adolesc Psychiatr Clin. 2015;24(1):117-43. PMid:25455579

Centers for Disease Control and Prevention. Treatment and Intervention Services for Autism Spectrum Disorder. Atlanta, Georgia: Centers for Disease Control and Prevention; 2015.