Harvard Medical School, Massachusetts General Hospital for Children, Boston, MA 02114, USA.
Clin Ther. 2013 May;35(5):578-83. doi: 10.1016/j.clinthera.2013.04.011.
Autism is now a common condition with a prevalence of 1 in 88 children. There is no known etiology. Speculation about possible treatments for autism or autism spectrum disorders (ASD) has included the use of various dietary interventions, including a gluten-free diet.
The goal of this article was to review the literature available evaluating the use of gluten-free diets in patients with autism to determine if diet should be instituted as a treatment.
A literature review was performed, identifying previously published studies in which a gluten-free diet was instituted as an autism treatment. These studies were not limited to randomized controlled trials because only 1 article was available that used a double-blind crossover design. Most publish reports were unblinded, observational studies.
In the only double-blind, crossover study, no benefit of a gluten-free diet was identified. Several other studies did report benefit from gluten-free diet. Controlling for observer bias and what may have represented unrelated progress over time in these studies is not possible. There are many barriers to evaluating treatment benefits for patients with autism. Gluten sensitivity may present in a variety of ways, including gastrointestinal and neurologic symptoms. Although making a diagnosis of celiac disease is easier with new serology and genetic testing, a large number of gluten-sensitive patients do not have celiac disease. Testing to confirm non-celiac gluten sensitivity is not available.
A variety of symptoms may be present with gluten sensitivity. Currently, there is insufficient evidence to support instituting a gluten-free diet as a treatment for autism. There may be a subgroup of patients who might benefit from a gluten-free diet, but the symptom or testing profile of these candidates remains unclear.
自闭症现在是一种常见的疾病，发病率为每 88 名儿童中有 1 名。其病因尚不清楚。对于自闭症或自闭症谱系障碍（ASD）的可能治疗方法的推测包括使用各种饮食干预措施，包括无麸质饮食。
本文的目的是回顾评估自闭症患者使用无麸质饮食的可用文献，以确定是否应将饮食作为治疗方法。
进行了文献回顾，确定了之前发表的研究，其中将无麸质饮食作为自闭症的治疗方法。这些研究不限于随机对照试验，因为只有 1 篇文章使用了双盲交叉设计。大多数发表的报告都是非盲、观察性研究。
在唯一的双盲、交叉研究中，无麸质饮食没有带来益处。其他几项研究确实报告了无麸质饮食的益处。不可能控制这些研究中的观察者偏见和随着时间的推移可能无关的进展。评估自闭症患者治疗益处存在许多障碍。麸质敏感性可能以多种方式表现出来，包括胃肠道和神经系统症状。尽管使用新的血清学和基因检测更容易诊断乳糜泻，但许多麸质敏感患者没有乳糜泻。目前尚无确认非乳糜泻性麸质敏感性的检测方法。
麸质敏感性可能会出现多种症状。目前，尚无足够的证据支持将无麸质饮食作为自闭症的治疗方法。可能有一部分患者可能受益于无麸质饮食，但这些患者的症状或检测特征仍不清楚。
