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Saad K, Shabaan I, Hassan AEMM, Ezzat M, Abouzed MA, Hamed Y, Ibrahim MFM, Gad EF. Gluten-Free, Casein-Free Diet for Children with Autism Spectrum Disorder: A Case-Controlled Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S905-S908. [PMID: 38595631 PMCID: PMC11001083 DOI: 10.4103/jpbs.jpbs_1074_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/05/2023] [Accepted: 11/11/2023] [Indexed: 04/11/2024] Open
Abstract
Background and Objectives Numerous therapeutic and dietary interventions have been examined in the last thirty years for pediatric patients diagnosed with autism spectrum disorder (ASD). Our interventional study aimed to assess the effectiveness of the gluten-free, casein-free (GFCF) diet in a cohort of Egyptian children with ASD. Materials and Methods The present clinical trial was conducted as a prospective 12-month, open-label, case-controlled interventional study. Thirty-six ASD children who were newly diagnosed and had not taken any prior psychiatric or rehabilitation therapy were included in this study. The patients were randomly assigned into two groups: group A, which received the GFCF diet, and group B, which served as the control group and was not restricted to food containing gluten and casein for 12 months. All patients were followed up for 1 year. Results Following the implementation of the GFCF diet in group A, significant improvements in CARS scores were observed compared to group B after 6-month and 1-year follow-up periods. Conclusions The introduction of the GFCF diet could be helpful and promising for autistic children. Conclusive evidence regarding the effectiveness of the GFCF diet remains a subject of controversy. Nonetheless, our study contributes some evidence supporting its potential benefits for children with ASD. It is recommended that future research on the GFCF diet employ a more sophisticated research design, incorporating a consistent baseline measure that can effectively assess the therapeutic effects of these interventions for individuals with ASD.
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Affiliation(s)
- Khaled Saad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Islam Shabaan
- Department of Psychiatry, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | | | - Mohamed Ezzat
- Department of Pediatrics, Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | - Mohamed A. Abouzed
- Department of Psychiatry, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Yasser Hamed
- Department of Neurology Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Eman F. Gad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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da Silva FGS, e Vairo FP, de Souza CFM, Schwartz IVD. Attention-deficit hyperactivity disorder in Brazilian patients with phenylketonuria. Acta Neurol Belg 2020; 120:893-899. [PMID: 29981005 DOI: 10.1007/s13760-018-0972-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
Recent studies have shown that patients with phenylketonuria (PKU), even with the early diagnosis and continuous treatment, may have symptoms of attention-deficit hyperactivity disorder (ADHD) and that the prevalence of ADHD in this population would be higher than in the general population. This study aims to determine the prevalence of ADHD in a sample of PKU patients from Southern Brazil. Patients were prospectively assessed by clinical interviews, neurological examination, and application of the MTA-SNAP-IV scales for patients aged 5-17 years and the Adult Self-Report Scale for patients over 17 years. Thirty-one patients (mean age = 17.4; early diagnosis = 27) were followed. Patients with ADHD and younger than 17 years had a median Phe in the last 6 months of life higher than those without the diagnosis of ADHD (ADHD patients = 617.1 µmol/L, no-ADHD patients 393.2 µmol/L, and p = 0.03). There was a predominantly hyperactive/impulsivity clinical presentation of ADHD (n = 4/5 patients), which differs from that reported elsewhere in the literature. Future studies are essential to better define the clinical presentation of ADHD in these patients and further elucidate its pathophysiology.
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Bjørklund G, Meguid NA, El-Bana MA, Tinkov AA, Saad K, Dadar M, Hemimi M, Skalny AV, Hosnedlová B, Kizek R, Osredkar J, Urbina MA, Fabjan T, El-Houfey AA, Kałużna-Czaplińska J, Gątarek P, Chirumbolo S. Oxidative Stress in Autism Spectrum Disorder. Mol Neurobiol 2020; 57:2314-2332. [PMID: 32026227 DOI: 10.1007/s12035-019-01742-2] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023]
Abstract
According to the United States Centers for Disease Control and Prevention (CDC), as of July 11, 2016, the reported average incidence of children diagnosed with an autism spectrum disorder (ASD) was 1 in 68 (1.46%) among 8-year-old children born in 2004 and living within the 11 monitoring sites' surveillance areas in the United States of America (USA) in 2012. ASD is a multifaceted neurodevelopmental disorder that is also considered a hidden disability, as, for the most part; there are no apparent morphological differences between children with ASD and typically developing children. ASD is diagnosed based upon a triad of features including impairment in socialization, impairment in language, and repetitive and stereotypic behaviors. The increasing incidence of ASD in the pediatric population and the lack of successful curative therapies make ASD one of the most challenging disorders for medicine. ASD neurobiology is thought to be associated with oxidative stress, as shown by increased levels of reactive oxygen species and increased lipid peroxidation, as well as an increase in other indicators of oxidative stress. Children with ASD diagnosis are considered more vulnerable to oxidative stress because of their imbalance in intracellular and extracellular glutathione levels and decreased glutathione reserve capacity. Several studies have suggested that the redox imbalance and oxidative stress are integral parts of ASD pathophysiology. As such, early assessment and treatment of antioxidant status may result in a better prognosis as it could decrease the oxidative stress in the brain before it can induce more irreversible brain damage. In this review, many aspects of the role of oxidative stress in ASD are discussed, taking into account that the process of oxidative stress may be a target for therapeutic interventions.
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Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Toften 24, 8610, Mo i Rana, Norway.
| | - Nagwa A Meguid
- Research on Children with Special Needs Department, National Research Centre, Giza, Egypt
- CONEM Egypt Child Brain Research Group, National Research Center, Giza, Egypt
| | - Mona A El-Bana
- CONEM Egypt Child Brain Research Group, National Research Center, Giza, Egypt
- Medical Biochemistry Department, National Research Centre, Giza, Egypt
| | - Alexey A Tinkov
- Yaroslavl State University, Yaroslavl, Russia
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
- IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Khaled Saad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
- CONEM Upper Egypt Pediatric Research Group, Assiut University, Assiut, Egypt
| | - Maryam Dadar
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Maha Hemimi
- Research on Children with Special Needs Department, National Research Centre, Giza, Egypt
- CONEM Egypt Child Brain Research Group, National Research Center, Giza, Egypt
| | - Anatoly V Skalny
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
- IM Sechenov First Moscow State Medical University, Moscow, Russia
- Federal Research Centre of Biological Systems and Agro-technologies of the Russian Academy of Sciences, Orenburg, Russia
- Taipei Medical University, Taipei, Taiwan
| | - Božena Hosnedlová
- CONEM Metallomics Nanomedicine Research Group (CMNRG), Brno, Czech Republic
- Faculty of Pharmacy, Department of Human Pharmacology and Toxicology, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Rene Kizek
- CONEM Metallomics Nanomedicine Research Group (CMNRG), Brno, Czech Republic
- Faculty of Pharmacy, Department of Human Pharmacology and Toxicology, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Joško Osredkar
- Institute of Clinical Chemistry and Biochemistry (KIKKB), Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Mauricio A Urbina
- Departamento de Zoología, Facultad de Ciencias Naturales y Oceanográficas, Universidad de Concepción, Concepción, Chile
| | - Teja Fabjan
- Institute of Clinical Chemistry and Biochemistry (KIKKB), Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Amira A El-Houfey
- CONEM Upper Egypt Pediatric Research Group, Assiut University, Assiut, Egypt
- Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt
- Department of Community Health Nursing, Sabia University College, Jazan University, Jizan, Saudi Arabia
| | - Joanna Kałużna-Czaplińska
- Institute of General and Ecological Chemistry, Department of Chemistry, Technical University of Lodz, Lodz, Poland
- CONEM Poland Chemistry and Nutrition Research Group, Lodz University of Technology, Lodz, Poland
| | - Paulina Gątarek
- Institute of General and Ecological Chemistry, Department of Chemistry, Technical University of Lodz, Lodz, Poland
- CONEM Poland Chemistry and Nutrition Research Group, Lodz University of Technology, Lodz, Poland
| | - Salvatore Chirumbolo
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
- CONEM Scientific Secretary, Verona, Italy
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Rohlman DS, Ismail A, Bonner MR, Abdel Rasoul G, Hendy O, Ortega Dickey L, Wang K, Olson JR. Occupational pesticide exposure and symptoms of attention deficit hyperactivity disorder in adolescent pesticide applicators in Egypt. Neurotoxicology 2019; 74:1-6. [PMID: 31077682 DOI: 10.1016/j.neuro.2019.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Exposure to environmental chemicals, including organophosphorus pesticides, is associated with behavioral disorders such as attention deficit hyperactivity disorder (ADHD). However, the impact of occupational pesticide exposure on ADHD development in adolescents has not been examined. OBJECTIVE We examined the association between exposure to chlorpyrifos and ADHD symptoms among adolescents in Egypt. METHODS Adolescent pesticide applicators and non-applicators, 12-21 years old, participated in a 10-month longitudinal study examining health effects from pesticide exposure. Repeated urine and blood samples were collected at various time points during the 10-months to assess biomarkers of chlorpyrifos exposure (urinary trichloro-2-pyridinol or TCPy) and effect (blood acetyl cholinesterase activity and butyryl cholinesterase activity). Parents from a subset of the cohort (N = 64) completed the Short Form of Conners' Parent Rating Scale - Revised. Poisson regressions were used to examine the associations between the number of ADHD symptoms and occupation and biomarkers. RESULTS Pesticide applicators had significantly more symptoms of ADHD than participants in the non-applicator group. Urinary TCPy levels were associated with increased symptoms, demonstrating a dose-response effect. Applicators with ADHD reported applying pesticides for more hours during the application season and had greater cumulative TCPy levels than participants without ADHD. One fourth of all applicators met the criteria for an ADHD diagnosis (having 6 or more reported symptoms). CONCLUSIONS This study provides preliminary evidence of an association between occupational exposure to chlorpyrifos and ADHD symptoms among adolescent pesticide applicators in spite of its limited small sample size. There is a critical need to investigate the susceptibility of children and adolescents to repeated occupational and environmental exposures to pesticides because the developing brain may be uniquely sensitive to the neurotoxic effects of these agents.
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Affiliation(s)
- Diane S Rohlman
- Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA; Oregon Health and Science University, Portland, OR, USA.
| | - Ahmed Ismail
- Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA; Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Matthew R Bonner
- Department of Epidemiology and Environmental Health, State University of New York Buffalo, NY, USA
| | | | - Olfat Hendy
- National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
| | | | - Kai Wang
- Biostatistics, University of Iowa, Iowa City, IA, USA
| | - James R Olson
- Department of Epidemiology and Environmental Health, State University of New York Buffalo, NY, USA; Department of Pharmacology and Toxicology, State University of New York, Buffalo, NY, USA
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Sadek AA, Hassan MH, Mohammed NA. Clinical and neuropsychological outcomes for children with phenylketonuria in Upper Egypt; a single-center study over 5 years. Neuropsychiatr Dis Treat 2018; 14:2551-2561. [PMID: 30323604 PMCID: PMC6179721 DOI: 10.2147/ndt.s176198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Phenylketonuria (PKU) is considered to be a rare inborn error of metabolism but one of the commonest causes of mental retardation if untreated. OBJECTIVES The present study was done to characterize the clinical patterns of PKU and analyze various neuropsychiatric outcomes in PKU children in Sohag Province, Egypt. PATIENTS AND METHODS A prospective cohort study was conducted on 113 PKU patients, diagnosed during the period from 2012 to 2017, at the Pediatric Neurology Clinic of Sohag University Hospital, Upper Egypt. One hundred and ten cases were diagnosed based on clinical suspicion combined with laboratory confirmation by measuring their plasma phenylalanine levels using amino acid analyzer, while 3 cases were detected during neonatal screening. With the exception of the 3 cases detected during neonatal screening, all patients were clinically diagnosed and treated late. Psychometric evaluations of PKU patients were done using intelligence quotient (IQ, Stanford- Binet V), Childhood Autism Rating Scale, and Children's Attention and Adjustment Survey. Dietetic management was applied. The results of neuroimaging (computed tomography or magnetic resonance imaging of the brain) and electroencephalography were included when available. RESULTS The overall results showed that 15.9% had hyperphenylalaninemia, 35.4% had mild to moderate PKU, and classic PKU was diagnosed in 48.7%. Global developmental delay (54.9%) and delayed language (29.2%) were the most frequent presentations. Moderately impaired or delayed overall IQ was present in 77%. While, 83.2% had moderately impaired or delayed verbal IQ, autism was diagnosed in 50.4%. Super average and average probability of attention-deficit hyperactivity disorder was diagnosed in 88.5%. Abnormal neuroimaging (white matter abnormalities and brain atrophy) was the most important significant predictor for poor language and motor developmental outcome (P<0.05). CONCLUSION PKU children had variable neuropsychological outcomes, mainly attention-deficit hyperactivity disorder and impaired verbal IQ, both of which were not related to the initial phenylalanine levels or to duration of dietary therapy, but were significantly related to early dietary intervention.
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Affiliation(s)
- Abdelrahim A Sadek
- Department of Pediatrics, Pediatric Neurology and Psychiatry Unit, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohammed H Hassan
- Medical Biochemistry Department, Faculty of Medicine, South Valley University, Qena, Egypt,
| | - Nesreen A Mohammed
- Public Health and Community Medicine Department, Faculty of Medicine, Sohag University, Sohag, Egypt
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