the effects of a gluten-free/casein-free diet on behavioral indices in children with autism spectrum disorder: a systematic review and meta-analysis

Introduction: autism is a neurological disorder that has seen an increase in prevalence in recent years. it is hypothesized that diet may influence mental health and improve the behavioral symptoms of autism. objectives: the purpose of this study is to examine the effects of gluten-free and casein-free diets on children with autism. data sources: international databases such as google scholar, pubmed, cochrane, and science direct were searched using keywords including autism, gluten-free, casein, diet, and autistic disorder, without any time restriction. study selection: ultimately, 8 articles were selected for the final analysis. data extraction: the study revealed that gluten-free/casein-free (gf/cf) diets had a significantly positive effect on the behavior index of autistic children. in terms of the behavior index, the effect size was a standard mean difference (smd) of -0.27 (p = 0.001) with a 95% confidence interval (ci) of -0.424 to -0.116. a meta-analysis comparing intervention and control groups indicated that the gf/cf diet had an effect size of smd = -0.27 (p = 0.001) with a 95% ci of -0.429 to -0.112 on the behavior index. results: the results of these studies were synthesized using the fixed effects model of meta-analysis with stata version 14. conclusions: given the positive impact of the gf/cf diet on improving the behavior of autistic children, this dietary approach can be considered as a means to enhance behavioral symptoms in these children.