Autism spectrum disorder: a systematic review about nutritional aspects and gut-brain axis

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Marli do Carmo Cupertino
Michely Baptistele Resende
Isabela de Freitas Veloso
Camila Abreu de Carvalho
Vitor Ferreira Duarte
Guilherme Alves Ramos


The number of individuals diagnosed with autism spectrum disorder (ASD) had an evident increase in the last decade. The primary symptoms exhibited amongst these patients were mostly digestive and neurological disorders; with nutritional interventions being one of the most promising therapies to assuage this clinical symptomology. As such, following the PRISMA guidelines, we systematically reviewed the research studies apropos of the ASD patients manifesting said digestive disorders, to comprehend how dietary behavior can influence the etiopathogenesis and clinical manifestations of the disease, with primary focus on the gut-brain axis. From a comprehensive and structured search through electronic databases, 23 studies were retrieved and admitted in this review. The inclusion criteria defined that there be original articles consociating ASD with nutritional disorders and/or with the gut-brain axis. These studies analyzed the composition of the intestinal flora of diagnosed patients, subsequently discerning cases of varying imbalances. Alterations in the gene expression of the proteins involved in the digestion and absorption of food, the mucous barrier and the intestinal permeability were described. Accordingly, restrictive diets and the modulation of the microbiota by administering specific anti- & probiotics were initially identified as promissory therapies. In conclusion, the gut-brain axis was observed to be a determinant factor in both the etiology and clinical symptomology of ASD - though it is still debatable the correlation of intestinal alterations with neurological changes. At present, there is no concrete scientific proof accrediting to restrictive diets and the use of specific anti- & probiotics, as successful treatments for ASD.


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Cupertino, M. do C., Resende, M. B., Veloso, I. de F., Carvalho, C. A. de, Duarte, V. F., & Ramos, G. A. (2019). Autism spectrum disorder: a systematic review about nutritional aspects and gut-brain axis. ABCS Health Sciences, 44(2).
Review Articles


1. Organização Mundial de Saúde (OMS). Autism spectrum disorders. Disponível em: Acesso em: 2 jan. 2018.

2. Pulikkan J, Maji A, Dhakan DB, Saxena R, Mohan B, Anto MM, et al. Gut Microbial Dysbiosis in Indian Children with Autism Spectrum Disorders. Microb Ecol. 2018.

3. Campion D, Ponzo P, Alessandria C, Saracco GM, Balzola F. Role of microbiota in the autism spectrum disorders. Minerva Gastroenterol Dietol. 2018.

4. Kalbassi S, Bachmann SO, Cross E, Roberton VH, Baudouin SJ. Male and female mice lacking neuroligin-3 modify the behavior of their wild-type littermates. eNeuro. 2017;4(4):145-17.

5. Lázaro C, Pondé M, Rodrigues LEA. Opioid peptides and gastrointestinal symptoms in autism spectrum disorders. Rev Bras Psiquiatr. 2016;38(3):243-6.

6. Theije CG, Wu J, Silva SL, Kamphuis PJ, Garssen J, Korte SM, et al. Pathways underlying the gut-to-brain connection in autism spectrum disorders as future targets for disease management. Eur J Pharmacol. 2011;668(Suppl 1):S70-80.

7. Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol. 2015;28(2):203-9.

8. Kim N, Yun M, Oh YJ, Choi HJ. Mind-altering with the gut: Modulation of the gut-brain axis with probiotics. J Microbiol. 2018;56(3):172-82.

9. Doenyas C. Dietary interventions for autism spectrum disorder: New perspectives from the gut-brain axis. Physiol Behav. 2018;194:577-82.

10. Cereser ND, Costa FMR, Rossi Júnior OD, Silva DAR, Sperotto VR. Botulismo de origem alimentar. Ciênc Rural. 2008;38(1):280-7.

11. Inoue R, Sakaue Y2, Sawai C, Sawai T, Ozeki M, Romero-Pérez GA, et al. A preliminary investigation on the relationship between gut microbiota and gene expressions in peripheral mononuclear cells of infants with autism spectrum disorders. Biosci Biotechnol Biochem. 2016;80(12):2450-8.

12. George B, Leena ML, Nair MKC. Autism spectrum disorders-aetiopathogenesis. J Clin Diag Res. 2018;12(7):SE1-5.

13. Lefebvre, Beggiato A, Bourgeron T, Toro R. Neuroanatomical Diversity of Corpus Callosum and Brain Volume in Autism: Meta-analysis, Analysis of the Autism Brain Imaging Data Exchange Project, and Simulation. Biol Psychiatry. 2015;78 (2):126-34.

14. Curran EA, O'Neill SM, Cryan JF, Kenny LC, Dinan TG, Khashan AS, et al. Research Review: Birth by caesarean section and development of autism spectrum disorder and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Child Psychol Psychiatry. 2015;56(5):500-8.

15. Ouss-Ryngaert L, Alvarez L, Boissel A. Autism and prematurity: state of the art for the clinical geneticista. Arch Pediatr. 2012;19(9):970-5.

16. Santini E, Huynh TN, MacAskill AF, Carter AG, Pierre P, Ruggero D, et al. Exaggerated translation causes synaptic and behavioural aberrations associated with autism. Nature. 2013;493(7432):411-5.

17. Knivsberg AM, Reichelt KL, Høien T, Nodland M. A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002;5(4):251-61.

18. Buie T. The relationship of autism and glúten. Clin Ther. 2013;35(5):578-83.

19. Ibrahim SH, Voigt RG, Katusic SK, Weaver AL, Barbaresi WJ. Incidence of gastrointestinal symptoms in children with autism: a population-based study. Pediatrics. 2009;124(2):680-6.

20. Schreck KA, Williams K. Food preferences and factors influencing food selectivity for children with autism spectrum disorders. Res Dev Disabil. 2006;27(4):353-63.

21. Finegold SM, Molitoris D, Song Y, Liu C, Vaisanen ML, Bolte E, et al. Gastrointestinal microflora studies in late-onset autism. Clin Infect Dis. 2002; 35(Suppl 1):S6-16.

22. Wang L, Christophersen CT, Sorich MJ, Gerber JP, Angley MT, Conlon MA. Low relative abundances of the mucolytic bacterium akkermansia muciniphila and bifidobacterium spp. in feces of children with autism. Appl Environ Microbiol. 2011;77(18):6718-21.

23. Adams JB, Audhya T, Geis E, Gehn E, Fimbres V, Pollard EL, et al. Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder-a randomized, controlled 12-month trial. Nutrients. 2018;10(3):E369.

24. Chistol LT, Bandini LG, Must A, Phillips S, Cermak SA, Curtin C. Sensory Sensitivity and Food Selectivity in Children with Autism Spectrum Disorder. J Autism Dev Disord. 2018;48(2):583-91.

25. Schreck KA, Williams K, Smith AF. A comparison of eating behaviors between children with and without autism. J Autism Dev Disord. 2004;34(4):433-8.

26. Williams BL, Hornig M, Buie T, Bauman ML, Cho Paik M, Wick I, et al. Impaired carbohydrate digestion and transport and mucosal dysbiosis in the intestines of children with autism and gastrointestinal disturbances. PLoS One. 2011;6(9):e24585.

27. Lau NM, Green PH, Taylor AK, Hellberg D, Ajamian M, Tan CZ, et al. Markers of celiac disease and gluten sensitivity in children with autism. PLoS One. 2013;8(6):e66155.

28. Navarro F, Pearson DA, Fatheree N, Mansour R, Hashmi SS, Rhoads JM. Are 'leaky gut' and behavior associated with gluten and dairy containing diet in children with autism spectrum disorders? randomized controlled trial. Nutr Neurosci. 2015;18(4): 177-85.

29. Magistris L, Familiari V, Pascotto A, Sapone A, Frolli A, Iardino P, et al. Alterations of the intestinal barrier in patients with autism spectrum disorders and in their first-degree relatives. J Pediatr Gastroenterol Nutr. 2010;51(4);418-24.

30. Kral TV, Souders MC, Tompkins VH, Remiker AM, Eriksen WT, Pinto-Martin JA. Child eating behaviors and caregiver feeding practices in children with autism spectrum disorders. Public Health Nurs. 2015;32(5):488-97.

31. Bandini LG, Anderson SE, Curtin C, Cermak S, Evans EW, Scampini R, et al. Food selectivity in children with autism spectrum disorders and typically developing children. J Pediatr. 2010;157(2):259-64.

32. Curtin C, Hubbard K, Anderson SE, Mick E, Must A, Bandini LG. Food selectivity, mealtime behavior problems, spousal stress, and family food choices in children with and without autism spectrum disorder. J Autism Dev Disord. 2015;45(10): 3308-15.

33. Pennesi CM, Klein LC. Effectiveness of the gluten-free, casein-free diet for children diagnosed with autism spectrum disorder: based on parental report. Nutr Neurosci. 2012;15(2):85-91.

34. Maenner MJ, Arneson CL, Levy SE, Kirby RS, Nicholas JS, Durkin MS. Brief report: association between behavioral features and gastrointestinal problems among children with autism spectrum disorder. J Autism Dev Disord. 2012;42(7):1520-5.

35. Kummer A, Barbosa IG, Rodrigues DH, Rocha NP, Rafael MS, Pfeilsticker L, et al. Frequency of overweight and obesity in children and adolescents with autism and attention deficit/hyperactivity disorder. Rev Paul Pediatr. 2016;34(1):71-7.

36. Adams JB, Johansen LJ, Powell LD, Quig D, Rubin RA. Gastrointestinal flora and gastrointestinal status in children with autism-comparisons to typical children and correlation with autism severity. BMC Gastroenterol. 2011;16(11):11-22.

37. Knivsberg AM, Reichelt KL, Høien T, Nødland M. A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002;5(4);251-61.

38. Fiorentino M, Sapone A, Senger S, Camhi SS, Kadzielski SM, Buie TM, Kelly DL, et al. Blood–brain barrier and intestinal epithelial barrier alterations in autism spectrum disorders. Mol Autism. 2016;7:49.

39. Tomova A, Husarova V, Lakatosova S, Bakos J, Vlkova B, Babinska K, et al. Gastrointestinal microbiota in children with autism in Slovakia. Physiol Behav. 2015;138:179-87.

40. Bennabi M, Gaman A, Delorme R, Boukouaci W, Manier C, Scheid I, et al. HLA-class II haplotypes and Autism Spectrum Disorders. Sci Reports. 2018;8:7639.