Gogou M, Kolios G
2nd Department of Pediatrics, University General Hospital AHEPA, Thessaloniki.
Laboratory of Pharmacology, Medical School of Democritus University of Thrace, Alexandroupolis, Greece.
Psychiatriki. 2020 Jan-Mar;31(1):57-69. doi: 10.22365/jpsych.2020.311.57.
Autism is a neurodevelopmental disorder associated with significant social and financial burden. In recent years there has been an increasing interest in the use of dietary interventions as a complementary therapeutic option for these patients. The aim of this systematic review is to provide literature data about the effect of specific dietary interventions on clinical aspects of children with autism. For this reason, a literature search was conducted using Pubmed as the medical database source. No year-of-publication restriction was placed. Prospective studies conducted in pediatric populations and evaluating changes in clinical aspects of autism were considered. Types of dietary interventions evaluated in these studies included amino acids, fatty acids, vitamins/minerals, as well as specific diets (free of gluten/casein, ketogenic). The underlying mechanism of action of nutritional interventions in this pediatric population mainly includes regulation of neurotransmitters levels, as well as modification of gut microbiota. More specifically, Ν-acetylcysteine was shown to exert a beneficial effect on symptoms of irritability. This beneficial effect could be attributed to its antiglutamergic and antioxidative properties. With regards to fatty acids, it is known that they are involved in dopamine and serotonin metabolism, while low values of fatty acids have been reported in serum of patients with various neuropsychiatric disorders. However, their administration in children with autism did not make any difference in terms of clinical aspects of the disease. On the other hand, available literature data about effect of D-cycloserine, dimethylglycine and vitamins/minerals was either few or controversial. In parallel, we were able to identify in literature clinical studies showing a beneficial effect of gluten/casein-free and ketogenic diet on clinical phenotype of autism. Finally, it should be highlighted that no moderate or serious adverse events were reported in any of the above nutritional interventions. In general, current literature data is encouraging. Nevertheless, more randomized clinical trials are needed to more clearly confirm the effect of specific dietary interventions on clinical aspects of autism.
自闭症是一种与巨大社会和经济负担相关的神经发育障碍。近年来，人们越来越关注将饮食干预作为这些患者的一种辅助治疗选择。本系统评价的目的是提供有关特定饮食干预对自闭症儿童临床方面影响的文献数据。因此，我们以PubMed作为医学数据库来源进行了文献检索。未设置出版年份限制。纳入了在儿科人群中进行的、评估自闭症临床方面变化的前瞻性研究。这些研究中评估的饮食干预类型包括氨基酸、脂肪酸、维生素/矿物质以及特定饮食（无麸质/无酪蛋白、生酮饮食）。营养干预对该儿科人群的潜在作用机制主要包括调节神经递质水平以及改变肠道微生物群。更具体地说，N-乙酰半胱氨酸已被证明对易怒症状有有益作用。这种有益作用可能归因于其抗谷氨酸能和抗氧化特性。关于脂肪酸，已知它们参与多巴胺和血清素代谢，而各种神经精神疾病患者的血清中脂肪酸水平较低。然而，在自闭症儿童中给予脂肪酸对疾病的临床方面没有任何影响。另一方面，关于D-环丝氨酸、二甲基甘氨酸和维生素/矿物质作用的现有文献数据要么很少，要么存在争议。同时，我们在文献中发现了一些临床研究，表明无麸质/无酪蛋白饮食和生酮饮食对自闭症临床表型有有益作用。最后，应该强调的是，上述任何营养干预均未报告中度或严重不良事件。总体而言，当前的文献数据令人鼓舞。然而，需要更多的随机临床试验来更明确地证实特定饮食干预对自闭症临床方面的影响。
