Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Apr 8;80(5):1237-1246.
doi: 10.1093/nutrit/nuab073.

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

Liuliu Quan  1 , Xinjie Xu  2 , Yonghong Cui  3 , Heze Han  1 , Robert L Hendren  4 , Lidan Zhao  1   5 , Xin You  1   5   6   7
Affiliations
Meta-Analysis

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

Liuliu Quan et al. Nutr Rev. .

Abstract

Context: It has been suggested that a gluten-free and casein-free (GFCF) diet may alleviate the symptoms of autism spectrum disorder (ASD) and facilitate neurodevelopment of children with ASD. Studies to date have been inconclusive.

Objective: This study aimed to evaluate (through quantitative meta-analysis) the efficacy and safety of a GFCF diet for children with ASD. To our knowledge, this is the first time such an analysis has been carried out.

Data sources: Eight electronic databases were searched, from the establishment of each database up to March 27, 2020: PubMed, Web of Science, Embase (Ovid), PsycINFO (Ovid), Cochrane Library, CNKI, Wanfang, and VIP databases.

Data extraction: Two authors independently performed the data extraction and risk-of-bias assessment.

Data analysis: A quantitative meta-analysis was performed with standard procedures by using Stata SE 15 software. Within the total of 8 studies, with 297 participants, 5 studies reported significant reductions in stereotypical behaviors [standard mean difference (SMD) = -0.41, 95% confidence interval (CI): -0.68 to -0.15], and 3 studies reported improvements in cognition (SMD = -0.46, 95% CI: -0.91 to -0.01) following GFCF dietary intervention . No statistically significant changes were observed in other symptomatic categories (all P > 0.05).

Conclusion: The current meta-analysis 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. Additional studies on a larger scale are warranted.

Systematic review registration: PROSPERO registration no. CRD42020177619.

Keywords: autism spectrum disorder (ASD); dietary intervention; gluten-free diet and casein-free diet (GFCF); meta-analysis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The flowchart for study selection in the meta-analysis.
Figure 2
Figure 2
Meta-analysis results and scales for stereotypical behaviors. Abbreviations: ADOS, Autism Diagnostic Observation Scale; CBCL, Child Behavior Checklist; CI, confidence interval; GARS, Gilliam Autism Rating Scale; Movement ABC, Movement Assessment Battery for Children; SMD, standard mean difference.
Figure 3
Figure 3
Meta-analysis results and scales for cognition. Abbreviations: CI, confidence interval; CPRS, Children’s Psychiatric Rating Scale; SMD, standard mean difference; VABS, Vineland Adaptive Behavior Scale.
Figure 5
Figure 5
Meta-analysis results and scales for communication. Abbreviations: ADOS, Autism Diagnostic Observation Scale; CI, confidence interval; GARS, Gilliam Autism Rating Scale; MSEL, Mullen Scales of Early Learning; SCQ, Social Communication Questionnaire; SMD, standard mean difference.
Figure 4
Figure 4
Meta-analysis results and scales for social behaviors . Abbreviations: ADOS, Autism Diagnostic Observation Scale; CBCL, Child Behavior Checklist; CI, confidence interval; GARS, Gilliam Autism Rating Scale; SMD, standard mean difference.
See this image and copyright information in PMC

References

    1. Delobel-Ayoub M, Saemundsen E, Gissler M, et al.Prevalence of autism spectrum disorder in 7–9-year-old children in Denmark, Finland, France and Iceland: a population-based registries approach within the ASDEU project. J Autism Dev Disord. 2020;50:949–959. - PubMed
    1. Tachibana Y, Miyazaki C, Ota E, et al.A systematic review and meta-analysis of comprehensive interventions for pre-school children with autism spectrum disorder (ASD). PLoS One. 2017;12:e0186502. - PMC - PubMed
    1. Ameis SH, Kassee C, Corbett-Dick P, et al.Systematic review and guide to management of core and psychiatric symptoms in youth with autism. Acta Psychiatr Scand. 2018;138:379–400. - PubMed
    1. Knivsberg AM, Reichelt KL, Høien T, et al.A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002;5:251–261. - PubMed
    1. Nazni P, Wesely EG, Nishadevi V.. Impact of casein and gluten free dietary intervention on selected autistic children. Iran J Pediatr. 2008;18:244–250.

Publication types