Comparative Study of Different Diet Modalities in Management of Autism

Abstract

SUMMARY A utism spectrum disorders (ASD) include a complex neurodevelopmental condition characterized by abnormal social interaction, Verbal and nonverbal communication, and limited interest in the surrounding environment associated with stereotyped and repetitive behaviors (Giulivi et al., 2010). Recently, KGD use has been advocated in a number of neurological disorders prompting a newfound interest in its possible therapeutic use in autism spectrum disorders (ASD) (Napoli et al., 2014 b). KGD is a nutritional approach constituted by high-fat content with adequate protein amount for growth but insufficient levels of carbohydrates for metabolic needs, thus forcing the body to primarily use fat as a fuel source (Freeman et al., 2006). The gluten-free and casein-free diet (GFCF diet) is a popular dietary intervention used by families of people with ASDs in the effort to lessen core symptoms of ASDs and/or gastrointestinal problems like bloating, diarrhea, and discomfort that may impact behavior. Gluten is a peptide found in grains such as barley, rye, and wheat that provides elasticity to baked goods. Casein is a peptide found in all milk and milk products (Hyman, 2013). GFCF can ameliorate core and peripheral symptoms and improve developmental outcome in some cases of ASD. Although not fully affirmative, the majority of published studies indicate statistically significant positive changes to symptom presentation following dietary intervention (Whiteley et al., 2013). Our study was conducted on 45 autistic children, their mean age was 5.29 years and ranges from 3 to 8 years. Thirty three of them were males (73.3%) and 12 females (26.7%). They were divided into 3 groups, each group included 15 patients, the first group received KGD, the second group received GFCF diet and the third group served as controls and received no diet. To date, this is the first study designed to compare different diet regimens in ASD. In group I who received KGD, 5 patients (33.3%) dropped out of the study due to poor compliance to the diet regimen. As regards the remaining 10 patients, there’s a significant improvement in autism symptoms after receiving the diet as judged by autism scores (CARS and ATEC) with p value < 0.05. The mean of CARS score pre diet was 41.7 compared to 33.7 post diet with 18.95% decrease and that of ATEC score was 58 pre diet compared to 44 post diet with 21.52% decrease. Regarding CARS grade, no patients were classified as mild grade pre diet compared to 4 patients (40%) post diet. It was moderate in 6 patients (40%) pre diet compared to only 2 patients (20%) post diet. It was severe in 9 patients (60%) pre diet compared to only 4 patients (40%) post diet. Regarding the ATEC subscales, there was a statistically significant improvement in speech (decreased by 23.43%), sociability (decreased by 17.96%) and cognitive awareness (decreased by 28.09%). Behavior decreased by 7.24% but without statistically significant improvement. As regards group II who received GFCF diet, there was a significant improvement in autism symptoms before and after receiving the diet as noticed by autism scores (CARS and ATEC) with p value < 0.05. The mean of CARS score pre diet was 39.17 compared to 34.27 post diet with 11.47% decrease and that of ATEC score pre diet was 64.13 compared to 42.13 post diet with 18.49% decrease. As regards CARS grade, there were no patients classified as mild grade pre diet in comparison to 2 patients (13.3%) post diet. It was moderate in 3 patients (20%) pre diet compared to 10 patients (66.7%) post diet. It was severe in 12 patients (80%) pre diet compared to only 3 patients (20%) post diet. As regards ATEC subscales, there was a statistically significant improvement in speech (decreased by 20.99%) and behavior (decreased by 22.26%). Sociability and cognitive awareness decreased by 0.46% and 10.87% respectively but without statistically significant improvement. When comparing both groups who received KGD and GFCF diet, both were effective but with no statistical difference between them.