[Gliadomorphin, casomorphin, and intestinal fatty acid binding protein in children with autism spectrum disorders].

Diet therapy for autism spectrum disorders (ASD) remains one of the most popular alternative therapies. despite conflicting opinions regarding the effectiveness of the dietary approach. According to the theory of exorphin intoxication, gluten and casein peptides enter the bloodstream through the mucous membrane of the small intestine, penetrate the blood-brain barrier and affect the neurons of the cerebral cortex. The wellknown hypothesis of the relationship between autism and gluten intolerance is based on this theory. The aim of this work was to study the correlation between the blood concentration of intestinal fatty acid - binding protein (I-FABP) and gliadomorphin and casomorphin as markers of opioid intoxication, depending on the use of diet therapy in children with ASD. Material and methods. The study included 85 patients aged 3 to 15 years with an established diagnosis of ASD. The first group consisted of 36 children who followed a gluten-free diet (GFD) for at least 6 months, 3 of them also followed a casein-free diet (CFD), the second group included 49 patients with ASD who had no dietary restrictions. The concentration of I-FABP, gliadomorphin, and casomorphin in the blood serum was determined by enzyme immunoassay in all patients. Results. In children with ASD who followed GDD, the average values of the studied parameters were significantly lower than in patients with ASD who have no dietary restrictions: gliadomorphine - 0.98±1.27 vs 1.68±0.97 ng/ml, casomorphine - 1.62± 0.76 vs 2.37±0.53 pg/ml, I-FABP - 156.2±102.16 vs 528.26±255.95 pg/ml (p0.01). In patients with ASD using diet therapy, there was a significant increase in gliadomorifin (r=0.64, p=0.0001) and casomorphin (r=0.53, p=0.001) with an increase in I-FABP. In children with ASD, not adhering GFD, there was also an increase in blood gliadomorphin (r=0.30, p=0.036) with an increase in I-FABP level; this trend was not observed relative to casomorphin (r=-0.0050, p=0.973). Perhaps, with the expansion of the sample, this pattern will also be observed in children who are on a regular diet. Conclusion. When including diet therapy in the therapeutic treatment of autism, it is necessary to take into account the individual intolerance to gluten and casein, conduct additional examinations in order to specify the nature of the intolerance and the need to prescribe a diet.

[Gluten-free diet in the treatment of extra-intestinal forms of gluten intolerance].

Following a gluten-free diet is recommended by clinical guidelines in the presence of gluten intolerance. However, due to the variety of clinical picture of various forms of intolerance, the elimination of gluten occurs not always timely. There are also diseases that classic treatment regimen does not include diet therapy, however, studies have confirmed the effectiveness of its use. The aim of the research - to study current data on the effectiveness of a gluten-free diet for extra-intestinal manifestations of gluten intolerance. Material and methods. Literature data concerning the effectiveness of including a gluten-free diet in the treatment of various diseases according to the PubMed and eLIBRARY portal were studied. Results. Modern data on the forms of gluten intolerance and their clinical manifestations are presented. The results of both randomized studies and individual clinical cases of gluten intolerance that occurred under the guise of other diseases are presented. A clinical case of an acute onset of the disease - celiac crisis, accompanied by acute diarrheal syndrome with subsequent malabsorption and progressive loss of body weight, anasarca and electrolyte disorders is considered. Neurological and psycho-neurological manifestations of celiac disease are described, including current data on the results of including a glutenfree diet in the treatment of autism spectrum disorders. The question of using dietary therapy for autism remains controversial to nowadays. The article outlines the arguments of supporters and opponents of excluding gluten in this pathology. Particular attention is paid to the diagnosis of gluten intolerance in patients with hematological disorders. The significance of a complete survey to identify celiac disease and timely diet therapy of the disease under stunted growth in children, after excluding other causes of malabsorption and even in the presence of negative serological markers of celiac disease is shown. The article also contains information on the pathology of kidneys and reproductive system, which were leveled only after the exclusion of gluten from the diet. Conclusion. The presented cases demonstrate a wide variety of clinical forms of gluten intolerance, examples of diagnostic search and dynamics of the clinical picture with the timely appointment of a gluten-free diet are given.

[Frequency of determining markers of casein's inhability and gluten in children with disorders of autistic spectrum].

The most optimal approach to the problem of managing children with autism spectrum disorders (ASD) is a complex one that involves a pediatric gastroenterologist, a nutritionist, a neurologist, a psychiatrist. Currently, there are studies that confirm the effectiveness of diet in the correction of neuropsychiatric status and gastroenterological disorders in ASD. Evidence supporting the therapeutic value of diets is limited and inconclusive. Diet therapy should be used only if food allergy or gluten or casein intolerance is diagnosed. Aim. To study the frequency of detection of markers of gluten and casein intolerance in children with ASD. Material and methods. The study involved 51 children (39 boys and 12 girls) aged 3 to 15 years with a diagnosis of ASD. Among the study participants, 20 children used gluten-free diet and casein-free diet for more than 6 months. The material for the study was venous blood taken from the elbow vein in the morning on an empty stomach. Determination of specific IgG-antibodies to casein and gliadin, IgA-antibodies to deamidized gliadin peptides was carried out by enzyme immunoassay. The level of total IgA to exclude selective deficiency was also determined. Results and discussion. Most children with ASD (79.5%) had increased levels of specific IgG antibodies to casein. The increase in IgG antigliadin antibodies was determined in 19.3% of children who do not follow a gluten-free diet, and antibodies to deamidized gliadin Ig peptides were not detected in any patient. Gluten intolerance in children with ASD is characterized by sensitivity to it and occurs in 40-50%. Conclusion. According to the literature and the results of own studies, some children with ASD have gluten and casein intolerance. Before the appointment of diet therapy for children with ASD, it is necessary to conduct a survey to clarify the nature of intolerance and the choice of optimal tactics of diet therapy.

[Markers of gluten intolerance in children with autism spectrum disorders and Down'syndrome]. / Markery neperenosimosti gliutena u detei s rasstroistvami autisticheskogo spektra i sindromom Dauna.

AIM: To study serological and genetic markers of gluten intolerance in children and teenagers with autism spectrum disorders (ASD) and Down's syndrome (DS). MATERIAL AND METHODS: Thirty-three children with ASD (group 1) and 8 with DS (group 2), aged from 2.5 to 15 years, were examined. There were 27 boys and 6 girls in group1, 5 boys and 3 girls in group 2. Most of the children were on a regular diet and only 4 children with ASD kept gluten-free diet (GFD). Using ELI method antibodies to gliadin IgG (AntiGliadin IgG), antibodies to deamidated peptides of gliadin IgA (AntiDGP IgA), immunoglobulin A (IgA) were identified. Haplotypes HLA-DQ2 and DQ8 were determined using PCR. RESULTS: AntiGliadin IgG were identified in 12.1% (4) patients of group 1, with the exception of patients on GFD in 13.8%, and in 50% patients of group 2. One child with ASD had selective IgA deficiency. Haplotypes predisposing to celiac disease had 41.9% of patients of group 1 and 37.5% of patients of group 2. In ASD, the distribution of genotypes was as follows: DQ2 (64.3%), DQ8 (28.6%), DQ2/DQ8 (7.1%,). In DS, all patients had haplotype DQ2. AntiDGP IgA were not identified in both groups. CONCLUSION: The predominant form of gluten intolerance in children with ASD and DS is sensitivity to gluten, which can be identified in 40-50% of patients. Celiac disease, an autoimmune form of gluten intolerance, can be diagnosed in single cases, although predisposition to it is identified in 41.9% - 37.5% patients with ASD and DS, respectively. Before the start of GFD, laboratory tests should be made to identify forms of gluten intolerance and the use of GFD.

[Efficient products from amaranth in a gluten-free nutrition of children with gluten intolerance].

The aim of the investigation was to evaluate the tolerability and effectiveness of the inclusion of products from amaranth to the regular children's diet during long glutenfree diet (GFD) therapy. The study included 37 children aged from 1 year to 17 years, the experience of compliance with a GFD was from 6 months to 16 years. Patients underwent an assessment of nutritional status: indicators of physical development by WHO percentile tables; clinical (erythrocytes, hemoglobin, leukocytes, lymphocytes, granulocytes) and biochemical (protein, albumin, iron, ionized calcium, selenium, copper) blood indicators. After that, children diet was supplemented with products from amaranth, which they constantly ate for 9-12 months. Quality and compliance difficulties of GFD were also examined using specially designed questionnaire filled in by parents. After 9-12 months of optimized GFD the examination of children and parents questioning was repeated. Long-term regular usage of amaranth products in GDB was accompanied by an improvement of indicators of nutritional status of patients: decrease in the number of children with underweight from from 16.25 to 10.8% and increase in the patients with normal body weight from 51.4 to 56.8%; reduction in the number of children with abnormal low rise from 10.8 to 5.4%, an increase of children with an average growth from 59.5 to 67.6%. The relative number of children with a decreased level of ionized calcium in the blood serum decreased from 37.8 to 10.8%. Normalization of decreased blood serum levels of iron, copper and zinc was observed in all patients who had a deficiency of these trace elements, in 13.5, 8 and 16.2% of children respectively. Difficulties in complying with the strict diet therapy are mainly social in nature. Products of amaranth tested in the course of the study were well tolerated, allergic and dyspeptic reactions were not noted. 89.2% of parents commented positively on the new gluten-free amaranth products.

[Amaranth flour: characteristics, comparative analysis, application possibilities].

Amaranth flour--a product of amaranth seeds processing--is a valuable industrial raw material that has an unique chemical composition and may be used for nutrition of people suffering from intolerance to traditional cereals protein, including celiac disease patients. The research aim was to study the composition of amaranth flour of two types compared with semolina which is traditionally used for nutrition by Russian population, as well as to compare the composition of milk amaranth flour porridge with milk semolina porridge. The composition of amaranth whole-ground flour and amaranth flour of premium grade processed from amaranth seeds grown in Voronezh region has been researched. It is to be noted that protein content in amaranth flour was 10.8-24.3% higher than in semolina, and its biological value and NPU-coefficient were higher by 22.65 and 46.51% respectively; lysine score in amaranth flour protein of premium grade came up to 107.54%, and in semolina protein only 40.95%. The level of digestible carbohydrates, including starch, was lower in amaranth flour than in semolina by 2.79-12.85 and 4.76-15.85% respectively, while fiber content was 15.5-30 fold higher. Fat content in amaranth flour of premium grade was 2,4 fold lower than in whole-ground amaranth flour but it was 45% higher than in semolina. The main advantage of amaranth flour protein compared to wheat protein is the predominance of albumins and globulins and a minimal content of prolamines and alpha-gliadin complete absence. The specifics of chemical composition allow the amaranth flour to be recommended for being included into nutrition of both healthy children and adults and also celiac disease patients.