In a handful of high-quality studies, a potential association has been suggested between celiac disease (CD) and autism spectrum disorder (ASD), according to a study published in the Journal of Pediatric Gastroenterology and Nutrition.
The incidence of CD and ASD has been increasing over the last several decades. Children with ASD are more likely to follow a gluten-free diet (the only treatment for celiac disease), than those without ASD. Therefore, researchers performed a systematic literature review of MEDLINE and ENBASE without limits placed on year or language, assessing the research investigating the association between CD and ASD.
Observational studies reporting on the occurrence of CD among patients with ASD and/or the occurrence of ASD among patients with CD were included. Study quality was assessed using an adapted Newcastle-Ottawa Quality Assessment Scale, and due to substantial heterogeneity between studies, a meta-analysis was not performed.
The researchers identified 298 unique citations and of those articles, 17 evaluated the association between CD and ASD. Of those articles, 13 observed samples of patients with ASD, and 6 observed samples of patients with CD. They found that overall, most studies had small sample sizes and reported no evidence for an association between the two conditions. However, a limited number of population-based studies of higher quality suggested a potential association between CD and ASD.
The authors concluded, “Most studies assessing an association between CD and ASD are at risk for systematic and/or random error.” They added, “Future studies should recruit larger sample sizes, include precise definitions of CD and ASD, and exclude patients with ASD on a gluten-free diet.”
Quan J, Panaccione N, Jeong J, et al. Association between celiac disease and autism spectrum disorder: a systematic review. JPGN. 2021;72(5):704–711. doi: 10.1097/MPG.0000000000003051