Latar belakang: Walaupun etiologi autistic spectrum disorder (ASD) belum diketahui dengan jelas, berbagai jenis terapi telah ditawarkan. Salah satu terapi yang paling popular adalah diet bebas glutein dan casein (Gluten Free and Casein Free - GFCF).Metode: Dilakukan pencarian literatur secara terstruktur melalui internet pada Pubmed dan Cochrane library. Judul dan abstrak sitasi yang ditemukan kemudian ditapis berdasarkan kriteria seleksi yang telah ditentukan sebelumnya. Critical appraisal dilaksanakan berdasarkan kriteria standar mengenai relevansi, validitas, dan levels of evidence.Hasil: Berdasarkan relevansinya, hanya empat dari dua belas artikel yang bisa digunakan. Satu berupa systematic review dan tiga randomized controlled trial (RCT). Ditemukan beberapa masalah pada metodologi yang bisa menimbulkan risiko over-estimasi pada efek seperti teknik randomisasi yang kurang baik dan drop-out selektif. Jumlah subjek yang kecil dan waktu intervensi yang pendek juga bisa menimbulkan risiko under-estimasi. Perbaikan minimal maupun sedang ditemukan pada beberapa luaran yang diukur seperti gejala autistik secara keseluruhan, isolasi sosial, serta kemampuan dalam berkomunikasi dan berinteraksi. Perbedaan yang tidak bermakna juga ditemukan pada beberapa luaran seperti perilaku individu serta fungsi kognitif dan motorik.Kesimpulan: Penelitian yang ada saat ini belum dapat memberikan bukti yang cukup kuat dan terpercaya untuk menyarankan penggunaan diet GFCFs sebagai terapi pada pasien autisme. (Med J Indones 2011; 20:114-8).
Abstract
Background: Even though the etiology of autistic spectrum disorder (ASD) has not been clearly known, various types of therapies have been offered. One of the most popular therapies is Gluten Free and Casein Free Diet â?? GFCF diet.Methods: A structured internet literature search was conducted using Pubmed and Cochrane library. Titles and abstracts were screened using predetermined selection criteria. Critical appraisal was conducted based on standard criteria for relevance, validity, and levels of evidence.Results: Based on relevance, only four out of twelve selected articles can be used; one is a systematic review and three randomized controlled trials (RCTs). Several methodological problems which could lead to over-estimation of the effect were found in the studies including poor randomization and selective drop-out. Risk of under-estimation of report due to small number of participants and in-adequate duration of intervention was also found. Small to moderate improvement were found in some outcome measured including overall autistic traits, social isolation, and the ability in communication and interaction. However, insignifi cant differences also found in some area such as individualâ??s behavior, cognitive and motor function.Conclusion: Available studies fail to provide suffi ciently credible and strong evidence to recommend the practice of GFCF diet in treating autism. (Med J Indones 2011; 20:114-8) |
