Ernährungstherapie bei Autismus-Spektrum-Störungen im Kindes- und Jugendalter: wie ist die Evidenz?

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.

Schlüsselwörter

Autismus - Ernährung - Gluten- und Casein-Eliminationsdiät - Opioidpeptide - Omega-3-Fettsäuren

Key words

autism - nutrition - gluten-free casein-free diet - opioid peptides - omega 3 fatty acids

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