Comprehensive evaluation of the effectiveness of gluten-free casein-free diet in children with delayed psycho-speech development

Objective. To justify the significance of using a gluten-free casein-free diet (GFCF diet) in children with delayed psycho-speech development (DPSD) and to study its effect on the somatic and neuropsychological status of these patients. Patients and methods. This randomized, open-label, prospective trial involved 105 children (71 boys and 34 girls) with DPSD between the ages of 1 year 6 months and 6 years 7 months. Children were divided into two groups: group 1 included 53 children who received the GFCF diet; group 2 – 52 children who ate regular meals. Children were examined at the beginning of observation, after 6 and 12 months. We used the Integrative Medicine Assessment Scale (IMAS) 1 and 2, Childhood Autism Rating Scale, Autism Treatment Evaluation Checklist (ATEC), Integrative Medicine Patients Parent Scale. Laboratory and instrumental examinations included blood tests for antibodies IgA, IgM, IgG, IgE, Anti-tTG IgA, Anti-tTG IgG, Anti-EMA, stool tests for calprotectin and zonulin, ultrasound imaging of the abdomen, kidney, heart, transcranial Doppler ultrasound of brain vessels, and magnetic resonance imaging of the brain if necessary. All children were examined by a neurologist, psychiatrist, geneticist, and surdologist. Results. A significant effectiveness of the GFCF diet in children with DPSD, including autism spectrum disorders, was justified. It was shown that the number of children without stereotypic movement disorders, as well as without digestive problems, increased by 1.5 and 2.3 times in the group of patients receiving diet therapy compared to the group without dietary correction after 6 and 12 months from the beginning of observation; the proportion of highly expressed stereotypies decreased by 2.3 times after 6 months. According to the ATEC scale, the number of children with severe disorders was 2.2 and 2.9 times lower after 6 and 12 months, respectively; according to the somatic status assessment scale (IMAS), the total score was 1.25 times lower. Conclusion. The GFCF diet has a positive effect on the neuropsychological and somatic status of children with DPSD. Children with DPSD have non-celiac gluten sensitivity, in which adherence to the diet allows to alleviate gastrointestinal and neurological manifestations. Key words: anti-tissue transglutaminase antibodies, autism, gluten-free diet, delayed psycho-speech development