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DOI: 10.1055/s-0041-110207
Ernährungstherapie bei Autismus-Spektrum-Störungen im Kindes- und Jugendalter: wie ist die Evidenz?
Nutritional Therapy for Children and Adolescents with Autism Spectrum Disorders: What is the Evidence?Publication History
Publication Date:
23 December 2015 (online)
![](https://www.thieme-connect.de/media/klinpaed/201602/lookinside/thumbnails/0847_10-1055-s-0041-110207-1.jpg)
Zusammenfassung
Hintergrund: Autismus-Spektrum-Störungen (ASS) zählen zu den tiefgreifenden Entwicklungsstörungen des Kindes- und Jugendalters. Neben genetischen Einflüssen scheinen auch Umweltfaktoren zur ASS-Pathogenese beizutragen. Angehörige von Kindern und Jugendlichen mit ASS fragen oft nach bestimmten Diätformen, um die ASS-Symptomatik zu lindern. Ziel dieser Übersichtsarbeit ist die evidenzbasierte Bewertung der verfügbaren Daten zu ernährungstherapeutischen Interventionen bei Kindern und Jugendlichen mit ASS; die behandelnden Ärzte sollen so in die Lage versetzt werden, entsprechende Diäten fundiert beurteilen zu können.
Methodik: Unter Anwendung definierter Ein- und Ausschlusskriterien wurde eine systematische Literaturrecherche in PubMed, Cinahl und The Cochrane Library durchgeführt; eingeschlossen wurden nur Studien, die nach 1999 publiziert wurden. Die Studienqualität wurde entsprechend mit CONSORT-, STROBE- und PRISMA-Checklisten bewertet.
Ergebnisse: Es konnten 12 randomisiert-kontrollierte Studien und 2 nicht-kontrollierte Studien in die Auswertung einbezogen werden (n=971). Die Wirksamkeit der häufig angewendeten Gluten-/Casein-freien Diäten (GFCF) ist nicht belegt, und entsprechende valide prädiktive Parameter existieren ebenfalls nicht.
Schlussfolgerung: Auf Grundlage der verfügbaren Daten lassen sich keine evidenzbasierten Empfehlungen für ernährungstherapeutische Interventionen bei Kindern und Jugendlichen mit ASS ableiten. Zukünftige Studien müssen klären, ob einzelne Patienten-Subgruppen dennoch von bestimmten Diätformen profitieren könnten.
Abstract
Background: Autism spectrum disorders (ASDs) are a group of developmental disabilities in childhood and adolescence. Beside genetic predisposition also environmental influences may contribute to the ASD pathogenesis. Family members of children and adolescents with ASD often ask for specific diets to alleviate ASD-associated symptoms. The aim of this review is to provide evidence-based data on nutritional interventions for children and adolescents with ASD, thus enabling practitioners to competently assess these diets.
Methods: Applying defined inclusion and exclusion criteria, a systematic literature research in PubMed, Cinahl and The Cochrane Library was conducted. Studies published earlier than 1999 were excluded. Study quality was assessed by using the CONSORT, STROBE or PRISMA checklist, respectively.
Results: 12 randomised controlled studies and 2 non-controlled studies could be included in the evaluation (n=971). There is no proven efficacy of the widely used gluten-free casein-free diets (GFCF), and no respective predictive marker has been proven significant.
Conclusion: Based on available data, no evidence based recommendations regarding nutritional interventions for children and adolescents with autism spectrum disorders can be made. Future studies need to clarify whether particular patients may yet benefit from certain diets.
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Literatur
- 1 Adams CM. Patient Report: Autism Spectrum Disorder Treated With Camel Milk. GAHMJ 2013; 2: 78-80
- 2 Adams JB, Holloway C. Pilot Study of a Moderate Dose Multivitamin/Mineral Supplement for Children with Autistic Spectrum Disorder. J Altern Complement Med. 2004 10. 1033-1039
- 3 Adams JB, Tapan A, McDonough-Means S et al. Effect of a vitamin/mineral supplement on children and adults with autism. BMC Pediatrics 2011; 11: 1-30
- 4 Al-Ayadhi LY, Elamin NE. Camel Milk as a Potential Therapy as an Antioxidant in Autism Spectrum Disorder (ASD). eCAM 2013; ID 602834
- 5 American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association; Arlington VA: 2013
- 6 Amminger GP, Berger GE, Schäfer MR et al. Omega-3 fatty acids supplementation in children with autism: A double-blind randomized, placebocontrolled pilot study. Biol Psychiatry 2007; 61: 551-553
- 7 Arnold GL, Hyman SL, Mooney RA et al. Plasma Amino Acids Profiles in Children with Autism: Potential Risk of Nutritional Deficiencies. J Autism Dev Disord 2003; 33: 449-454
- 8 Bashir S, Al-Ayadhi LY. Effect of camel milk on thymus and activation-regulated chemokine in autistic children: double-blind study. Pediatr Res 2014; 75: 559-563
- 9 Bent S, Bertoglio K, Ashwood P et al. A pilot randomized controlled trial of omega-3 fatty acids for autism spectrum disorder. J Autism Dev Disord 2011; 41: 545-554
- 10 Bölte S, Willfors C, Berggren S et al. The Roots of Autism and ADHD Twin Study in Sweden (RATTS). Twin Res Hum Genet 2014; 17: 164-176
- 11 Burgess JR, Stevens L, Zhang W et al. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Am J Clin Nutr 2000; 71: 327-330
- 12 Cass H, Gringras P, March J et al. Absence of urinary opioid peptides in children with autism. Arch Dis Child 2008; 93: 745-750
- 13 Chen Y, Swanson RA. The glutamate transporters EAAT2 and EAAT3 mediate cysteine uptake in cortical neuron cultures. J Neurochem 2003; 84: 1332-1339
- 14 Das UN. Autism as a disorder of deficiency of brain-derived neurotrophic factor and altered metabolism of polyunsaturated fatty acids. Nutrition 2013; 29: 1175-1185
- 15 El-Ansary A, Al-Ayadhi LY. Neuroinflammation in autism spectrum disorders. J. Neuroinflammation 2012; 9: 265
- 16 Elder JH, Shankar M, Shuster J et al. TheGluten-Free, Diet In Autism: Results of A Preliminary Double Blind Clinical Trial. J Autism Dev Disord 2006; 36: 413-420
- 17 El-Fakharany EM, Sánchez L, Al-Mehdar HA et al. Effectiveness of human, camel, bovine and sheep lactoferrin on the hepatitis C virus cellular infectivity: comparison study. Virol J 2013; 10: 199
- 18 Elm vE, Altman DG, Egger M et al. Das Strengthening the Reporting of Observational Studies in Epidemiology (STROBE-) Statement. Leitlinien für das Berichten von Beobachtungsstudien. Internist (Berl) 2008; 6: 688-693
- 19 Goldani AAS, Downs SR, Widjaja F et al. Biomarkers in autism. Front Psychiatry 2014; 5: 100
- 20 Golnik AE, Ireland M. Complementary alternative medicine for children with autism: a physician survey. J Autism Dev Disord 2009; 39: 996-1005
- 21 Green J, Gilchrist A, Burton D et al. Social and psychiatric functioning in adolescents with Asperger syndrome compared with conduct disorder. J Autism Dev Disord 2000; 30: 279-293
- 22 Harris C, Card B. A pilot study to evaluate nutritional influences on gastrointestinal symptoms and behavior patterns in children with Autism Spectrum Disorder. Complement Ther Med 2012; 20: 437-440
- 23 Hediger ML, England LJ, Molloy CA et al. Reduced Bone Cortical Thickness in Boys with Autism or Autism Spectrum Disorder. J Autism Dev Disord 2008; 38: 848-856
- 24 Herbert MR, Buckley JA. Autism and dietary therapy: case report and review of the literature. J Child Neurol 2013; 28: 975-982
- 25 Hole K, Bergslien H, Jørgensen HA et al. A peptide-containing fraction in the urine of schizophrenic patients which stimulates opiate receptors and inhibits dopamine uptake. Neuroscience 1979; 4: 1883-1893
- 26 Hsu CL, Lin DCY, Chen CL et al. The Effects of A Gluten and Casein-free Diet in Children with Autism: A Case Report. Chang Gung Med J 2009; 32: 459-465
- 27 Israngkun PP, Newman HAI, Patel ST et al. Potential biochemical markers for infantile autism. Neurochem Pathol 1986; 5: 51-70
- 28 James S, Montgomery P, Williams K. Omega-3 fatty acids supplementation for autism spectrum disorders (ASD). Cochrane Database Syst Rev 2011; 11 CD007992
- 29 Johnson CR, Benjamin L, Handen BL et al. Effects of Gluten Free/Casein Free Diet in Young Children with Autism: A Pilot Study. J Dev Phys Disabil 2011; 23: 213-225
- 30 Julio-Pieper M, Bravo JA, Aliaga E et al. Review article: intestinal barrier dysfunction and central nervous system disorders – a controversial association. Aliment Pharmacol Ther 2014; 40: 1187-1201
- 31 Kamiński S, Cieslińska A, Kostyra E. Polymorphism of bovine beta-casein and its potential effect on human health. J Appl Genet 2007; 48: 189-198
- 32 Knivsberg AM, Reichelt KL, Hoien T et al. A Randomised, Controlled Study of Dietary Intervention in Autistic Syndromes. Nutr Neurosci 2002; 5: 251-261
- 33 de Magistris L, Familiari V, Pascotto A 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: 418-424
- 34 Millward C, Ferriter M, Calver SJ et al. Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev 2008; 2 CD003498
- 35 Neggers YH. Increasing Prevalence, Changes in Diagnostic Criteria, and Nutritional Risk Factors for Autism Spectrum Disorders. ISRN Nutr 2014; ID 514026
- 36 Nye C, Brice A. Combined vitamin B6-magnesium treatment in autism spectrum disorder. Cochrane Database Syst Rev 2005; 4 CD003497
- 37 Ohinata K, Agui S, Yoshikawa M. Soymorphins, novel mu opioid peptides derived from soy beta-conglycinin beta-subunit, have anxiolytic activities. Biosci Biotechnol Biochem 2007; 71: 2618-2621
- 38 Pedersen L, Parlar S, Kvist K et al. Data mining the ScanBrit study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders: Behavioural and psychometric measures of dietary response. Nutr Neurosci 2014; 17: 207-213
- 39 Pennesi CM, Klein CL. Effectiveness of the gluten-free, casein-free diet for children diagnosed with autism spectrum disorder: Based on parental report. Nutr Neurosci 2012; 15: 85-91
- 40 Pittler MH, Blümle A, Meerpohl JJ et al. CONSORT 2010: Aktualisierte Leitlinie für Berichte randomisierter Studien im Parallelgruppen-Design. Dtsch Med Wochenschr 2011; 136: e20-e23
- 41 Reichelt KL, Tveiten D, Knivsberg AM et al. Peptides’ role in autism with emphasis on exorphins. Microb Ecol Health Di 2012; 23: 18958
- 42 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: 175-183
- 43 Stevens L, Zhang W, Peck L et al. EFA Supplementation in Children with Inattention, Hyperactivity, and Other Disruptive Behaviors. Lipids 2003; 38: 1007-1021
- 44 Theoharides TC, Asadi S, Patel AB. Focal brain inflammation and autism. J Neuroinflammation 2013; 10: 46
- 45 Treudler R, Simon JC. Schwere Sojaallergie im Erwachsenenalter. Hautarzt 2012; 63: 307-314
- 46 Trivedi MS, Shah JS, Al-Mughairy S et al. Food-derived opioid peptides inhibit cysteine uptake with redox and epigenetic consequences. J Nutr Biochem 2014; 25: 1011-1018
- 47 Tveiten D, Finvold A, Andersson M et al. Peptides and Exorphins in the Autism Spectrum. Open J Psychiatr. 2014 4. 275-287
- 48 Voigt RG, Mellon MW, Katusic SK et al. Dietary Docosahexaenoic Acid Supplementation in Children With Autism. J Pediatr Gastroenterol Nutr 2014; 58: 715-722
- 49 Wang L, Angley MT, Gerber JP et al. Is urinary indolyl-3-acryloylglycine a biomarker for autism with gastrointestinal symptoms?. Biomarkers. 2009 14. 596-603
- 50 Wesolowski J, Alzogaray V, Reyelt J et al. Single domain antibodies: promising experimental and therapeutic tools in infection and immunity. Med Microbiol Immunol. 2009 198. 157-174
- 51 Whiteley P, Haracopos D, Knivsberg AM et al. The ScanBrit randomised, controlled, singleblind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutr Neurosci 2010; 13: 87-100
- 52 Whiteley P. Nutritional management of (some) autism: a case for gluten- and casein-free diets?. Proc Nutr Soc 2014; Nutrition Society Summer Meeting, University of Glasgow 14-17 July 2014
- 53 Yui K, Koshiba M, Nakamura S et al. Effects of Large Doses of Arachidonic Acid Added to Docosahexaenoic Acid on Social Impairment in Individuals With Autism Spectrum Disorders. J Clin Psychopharmacol 2012; 32: 200-206
- 54 Ziegler A, Antes G, König IR. Bevorzugte Report Items für systematische Übersichten und Meta-Analysen: Das PRISMA-Statement. Dtsch Med Wochenschr 2011; 136: e9-e15