title: Gluten and casein supplementation does not increase symptoms in children with autism spectrum disorder.
abstract: OBJECTIVE
  A gluten- and casein-free diet is often given to children with autism spectrum disorder (ASD). We aimed to determine the effect of gluten and casein supplementation on maladaptive behaviour, gastrointestinal symptom severity and intestinal fatty acids binding protein (I-FABP) excretion in children with ASD.
  
  
  METHODS
  A randomised, controlled, double-blind trial was performed on 74 children with ASD with severe maladaptive behaviour and increased urinary I-FABP. Subjects were randomised to receive gluten-casein or a placebo for seven days. We evaluated maladaptive behaviour before and after supplementation, using I-FABP excretion, the approach withdrawal problem composite subtest of the Pervasive Developmental Disorder Behavior Inventory and the Gastrointestinal Symptom Severity Index.
  
  
  RESULTS
  The mean approach withdrawal problem composite score was significantly higher before supplementation than after, both in the placebo and in the gluten-casein group. However, the mean difference was not significant and may have been caused by additional therapy. There was no significant difference in gastrointestinal symptoms and urinary I-FABP excretion.
  
  
  CONCLUSIONS
  Administrating gluten-casein to children with ASD for one week did not increase maladaptive behaviour, gastrointestinal symptom severity or urinary I-FABP excretion. The effect of prolonged administration or other mechanisms of enterocyte damage in ASD should be explored.
authors.affiliation: Department of Child Health, Medical School, University of Indonesia, Jakarta, Indonesia.
authors.forename: Hardiono D
authors.initials: HD
authors.lastname: Pusponegoro
authors.affiliation: Department of Child Health, Medical School, University of Indonesia, Jakarta, Indonesia.
authors.forename: Sofyan
authors.initials: S
authors.lastname: Ismael
authors.affiliation: Department of Child Health, Medical School, University of Indonesia, Jakarta, Indonesia.
authors.forename: Agus
authors.initials: A
authors.lastname: Firmansyah
authors.affiliation: Department of Child Health, Medical School, University of Indonesia, Jakarta, Indonesia.
authors.forename: Sudigdo
authors.initials: S
authors.lastname: Sastroasmoro
authors.affiliation: Department of Paediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Vandenplas
mesh_terms: D000067877:Autism Spectrum Disorder / Q000175:diagnosis / Q000652:urine; D002364:Caseins / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002653:Child Behavior Disorders / Q000209:etiology; D002675:Child, Preschool; D019587:Dietary Supplements; D004311:Double-Blind Method; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D005983:Glutens / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D002364:Caseins; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; D005983:Glutens
keywords: Autism spectrum disorder; Casein-free diet; Gluten-free; Intestinal fatty acids binding protein; Maladaptive behaviour