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Hosseini SM, Panahi-Azar A, Sheybani-Arani M, Morovatshoar R, Mirzadeh M, Salimi Asl A, Naghdipour Mirsadeghi M, Khajavi-Mayvan F. Vitamins, minerals and their maternal levels' role in brain development: An updated literature-review. Clin Nutr ESPEN 2024; 63:31-45. [PMID: 38907995 DOI: 10.1016/j.clnesp.2024.05.011] [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: 07/17/2023] [Revised: 03/26/2024] [Accepted: 05/16/2024] [Indexed: 06/24/2024]
Abstract
One's neurobehavioural and mental health are built during the exact and complex process of brain development. It is thought that fetal development is where neuropsychiatric disorders first emerged. Behavioural patterns can change as a result of neuropsychiatric illnesses. The incidence is rising quickly; nevertheless, providing exceptional care remains a significant challenge for families and healthcare systems. It has been demonstrated that one of the main factors causing the transmission of these diseases is maternal exposure. Through physiologic pathways, maternal health and intrauterine exposures can affect brain development. Our attention has been focused on epigenetic factors, particularly in the gestational environment, which may be responsible for human neurodegenerative diseases since our main mental development occurs during the nine months of intrauterine life. After thoroughly searching numerous databases, this study examined the effect of fat-soluble vitamins, water-soluble vitamins, and minerals and their maternal-level effect on brain development.
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Affiliation(s)
| | - Ava Panahi-Azar
- Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | | | - Reza Morovatshoar
- Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Mahdieh Mirzadeh
- Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Ali Salimi Asl
- Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Misa Naghdipour Mirsadeghi
- Department of Gynecology, School of Medicine, Reproductive Health Research Center, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
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Fiani D, Engler S, Fields S, Calarge CA. Iron Deficiency in Attention-Deficit Hyperactivity Disorder, Autism Spectrum Disorder, Internalizing and Externalizing Disorders, and Movement Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:451-467. [PMID: 37147046 DOI: 10.1016/j.chc.2022.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This article reviews the role of iron in brain development and function, with a focus on the association between iron deficiency (ID) and neuropsychiatric conditions. First, we describe how ID is defined and diagnosed. Second, the role of iron in brain development and function is summarized. Third, we review current findings implicating ID in a number of neuropsychiatric conditions in children and adolescents, including attention deficit hyperactivity disorder and other disruptive behavior disorders, depressive and anxiety disorders, autism spectrum disorder, movement disorders, and other situations relevant to mental health providers. Last, we discuss the impact of psychotropic medication on iron homeostasis.
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Affiliation(s)
- Dimitri Fiani
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 8080 N Stadium Dr. Ste 180.35, Houston, TX 77054, USA. https://twitter.com/dimitrifiani
| | - Solangia Engler
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Sherecce Fields
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Chadi Albert Calarge
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 8080 N Stadium Dr. Ste 180.35, Houston, TX 77054, USA; Department of Pediatrics, Baylor College of Medicine, 1102 Bates Avenue, Ste 790, Houston, TX 77030, USA.
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Elmehy DA, Elmansory BM, Gamea GA, Abdelhai DI, Abd-Elsalam SM, Salamah AM, Ata DS, Mahmoud EF, Ibrahim HA, Salama AM. Parasitic infections as potential risk factors for attention deficit hyperactivity disorder (ADHD) in children. J Parasit Dis 2023; 47:82-92. [PMID: 36910322 PMCID: PMC9998788 DOI: 10.1007/s12639-022-01542-x] [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: 08/21/2022] [Accepted: 10/12/2022] [Indexed: 11/27/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) represents a mysterious neuropsychiatric alarming concern due to indefinite etiopathogenesis among children. Notably, the studies which investigated the correlation between ADHD and parasitic infections are insufficient. Therefore, this research aimed to assess the correlation between ADHD and some tissue dwelling and intestinal parasitic infections in children. The study was conducted on 200 children, including 100 children suffering from ADHD (Group I) and 100 healthy children as a control group (Group II). All caregivers fulfilled predesigned sociodemographic form and Conners parent rating scale (CPRS-48) questionnaire. Blood samples were collected to determine hemoglobin level as well as relative eosinophilic count. The presence of anti-Toxoplasma IgG and anti-Toxocara IgG in serum by Enzyme-Linked Immunosorbent Assay (ELISA) was further investigated. Also, micronutrients as zinc, iron, and copper levels were measured. Schistosoma antigen was investigated in urine samples. Stool samples were subjected to direct wet smear, concentration technique and modified Ziehl-Neelsen (MZN) staining for coccidian parasites detection. Cryptosporidium parvum, Giardia lamblia and Entamoeba histolytica antigens were investigated in stool samples. Group I expressed more liability to sociodemographic risk factors, decreased levels of Hb, iron, zinc, and copper with statistically significant difference (P < 0.001). Comparison between Group I and Group II regarding the detected parasitic infections exhibited statistically significant difference except Schistosoma antigen positivity which expressed no statistical significance. The present study concluded that the parasitic infections with their consequences are potential risk factors in children with ADHD indicating that their early diagnosis and treatment may help in ADHD prevention.
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Affiliation(s)
- Dalia A. Elmehy
- Department of Medical Parasitology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Basma M. Elmansory
- Department of Medical Parasitology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ghada A. Gamea
- Department of Medical Parasitology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina I. Abdelhai
- Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Abeer M. Salamah
- Department of Pediatrics, Faculty of Medicine, Kafr El Shiekh University, Kafr El Shiekh, Egypt
| | - Dina S. Ata
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Eman F. Mahmoud
- Department of Physiology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hoda A. Ibrahim
- Department of Medical Biochemistry, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amina M. Salama
- Department of Medical Parasitology, Faculty of Medicine, Tanta University, Tanta, Egypt
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McWilliams S, Singh I, Leung W, Stockler S, Ipsiroglu OS. Iron deficiency and common neurodevelopmental disorders—A scoping review. PLoS One 2022; 17:e0273819. [PMID: 36173945 PMCID: PMC9522276 DOI: 10.1371/journal.pone.0273819] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background A wealth of human and experimental studies document a causal and aggravating role of iron deficiency in neurodevelopmental disorders. While pre-, peri-, and early postnatal iron deficiency sets the stage for the risk of developing neurodevelopmental disorders, iron deficiency acquired at later ages aggravates pre-existing neurodevelopmental disorders. Yet, the association of iron deficiency and neurodevelopmental disorders in childhood and adolescence has not yet been explored comprehensively. In this scoping review, we investigate 1) the association of iron deficiency in children and adolescents with the most frequent neurodevelopmental disorders, ADHD, ASD, and FASD, and 2) whether iron supplementation improves outcomes in these disorders. Method Scoping review of studies published between 1994 and 2021 using “iron deficiency / iron deficiency anemia” AND “ADHD” OR “autism” OR “FASD” in four biomedical databases. The main inclusion criterion was that articles needed to have quantitative determination of iron status at any postnatal age with primary iron markers such as serum ferritin being reported in association with ADHD, ASD, or FASD. Results For ADHD, 22/30 studies and 4/4 systematic reviews showed an association of ADHD occurrence or severity with iron deficiency; 6/6 treatment studies including 2 randomized controlled trials demonstrated positive effects of iron supplementation. For ASD, 3/6 studies showed an association with iron deficiency, while 3/6 and 1/1 systematic literature review did not; 4 studies showed a variety of prevalence rates of iron deficiency in ASD populations; 1 randomized controlled trial found no positive effect of iron supplementation on behavioural symptoms of ASD. For FASD, 2/2 studies showed an association of iron deficiency with growth retardation in infants and children with prenatal alcohol exposure. Conclusion Evidence in favor of screening for iron deficiency and using iron supplementation for pediatric neurodevelopmental disorders comes primarily from ADHD studies and needs to be further investigated for ASD and FASD. Further analysis of study methodologies employed and populations investigated is needed to compare studies against each other and further substantiate the evidence created.
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Affiliation(s)
- Scout McWilliams
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Ishmeet Singh
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Wayne Leung
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Sylvia Stockler
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Division of Biochemical Diseases, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Osman S. Ipsiroglu
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Divisions of Child & Adolescent Psychiatry, Developmental Pediatrics and Respirology, Department of Pediatrics, Sleep/Wake-Behaviour Clinic at Sleep Program, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
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Topal Z, Tufan AE, Karadag M, Gokcen C, Akkaya C, Sarp AS, Bahsi I, Kilinc M. Evaluation of peripheral inflammatory markers, serum B12, folate, ferritin levels and clinical correlations in children with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Nord J Psychiatry 2022; 76:150-157. [PMID: 34232109 DOI: 10.1080/08039488.2021.1946712] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM The aim of the current study is to compare serum B12, folate, and ferritin levels and peripheral inflammatory indicators between children with Autism Spectrum Disorders (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and healthy controls (HC) and to evaluate the correlation of those with symptoms. MATERIALS AND METHODS A total of 203 children were evaluated (ASD = 72; ADHD = 61; HC = 70). Diagnoses of ASD and ADHD were ascertained according to Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL). Control group was chosen among the healthy children who applied to general pediatrics outpatient clinic. Gilliam Autism Rating Scale-2 is used to assess autistic symptoms and Atilla Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale is used for ADHD symptoms. RESULTS Neutrophil levels (p = 0.014) and neutrophil/lymphocyte ratio (NLR) (p = 0.016) were higher in the ADHD and ASD groups compared to HC. Neutrophil values explained 70.1% of the variance across groups while NLR explained a further 29.9% of the variance. NLR significantly correlated with social interaction problems in ASD (r = 0.26, p = 0.04). There were no significant differences between groups in terms of vitamin B12, folate and ferritin levels. CONCLUSION Our results may support involvement of inflammation in the underlying pathophysiology of neurodevelopmental disorders. However, these parameters should be analyzed in a wider population to clarify the effect on the etiology and symptomatology of neurodevelopmental disorders.
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Affiliation(s)
- Zehra Topal
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet Karadag
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Cem Gokcen
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Canan Akkaya
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ayse Sevde Sarp
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ilhan Bahsi
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Metin Kilinc
- Department of Pediatrics, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Anand B, Sireesha C. Lower serum ferritin levels and higher inattentiveness in attention deficit hyperactivity disorder in a case–control study. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The Role of Iron and Zinc in the Treatment of ADHD among Children and Adolescents: A Systematic Review of Randomized Clinical Trials. Nutrients 2021; 13:nu13114059. [PMID: 34836314 PMCID: PMC8618748 DOI: 10.3390/nu13114059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 12/18/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder common from childhood to adulthood, affecting 5% to 12% among the general population in developed countries. Potential etiological factors have been identified, including genetic causes, environmental elements and epigenetic components. Nutrition is currently considered an influencing factor, and several studies have explored the contribution of restriction and dietary supplements in ADHD treatments. Iron is an essential cofactor required for a number of functions, such as transport of oxygen, immune function, cellular respiration, neurotransmitter metabolism (dopamine production), and DNA synthesis. Zinc is also an essential trace element, required for cellular functions related to the metabolism of neurotransmitters, melatonin, and prostaglandins. Epidemiological studies have found that iron and zinc deficiencies are common nutritional deficits worldwide, with important roles on neurologic functions (poor memory, inattentiveness, and impulsiveness), finicky appetite, and mood changes (sadness and irritability). Altered levels of iron and zinc have been related with the aggravation and progression of ADHD. Objective: This is a systematic review focused on the contribution of iron and zinc in the progression of ADHD among children and adolescents, and how therapies including these elements are tolerated along with its effectiveness (according to PRISMA guidelines). Method: The scientific literature was screened for randomized controlled trials published between January 2000 to July 2021. The databases consulted were Medline, PsycINFO, Web of Science, and Google Scholar. Two independent reviewers screened studies, extracted data, and assessed quality and risk of bias (CONSORT, NICE, and Cochrane checklists used). Conclusion: Nine studies met the eligibility criteria and were selected. Evidence was obtained regarding the contribution of iron-zinc supplementation in the treatment of ADHD among young individuals. The discussion was focused on how the deficits of these elements contribute to affectation on multiple ADHD correlates, and potential mechanisms explaining the mediational pathways. Evidence also suggested that treating ADHD with diet interventions might be particularly useful for specific subgroups of children and adolescents, but further investigations of the effects of these diet interventions are needed.
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Robberecht H, Verlaet AAJ, Breynaert A, De Bruyne T, Hermans N. Magnesium, Iron, Zinc, Copper and Selenium Status in Attention-Deficit/Hyperactivity Disorder (ADHD). Molecules 2020; 25:molecules25194440. [PMID: 32992575 PMCID: PMC7583976 DOI: 10.3390/molecules25194440] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 12/21/2022] Open
Abstract
In this study, we critically review the literature concerning the relation of Mg, Fe, Zn, Cu and Se and attention-deficit/hyperactivity disorder (ADHD). Elemental status is estimated using peripheral blood parameters, hair, urine, daily intake and response to supplementation. The observed associations between concentration levels of the elements Mg, Fe, Zn, Cu and Se and ADHD symptoms are contradictory. This is partly due to the heterogeneity and complexity of the disorder. As a trend, lower ferritin and zinc levels can be observed. However, this correlation is not causative, as illustrated by placebo-controlled trials reporting conflicting evidence on the efficacy of supplementation. Well-defined studies on changes in concentration levels of the elements in relation to ADHD symptoms before and after treatment with therapeutics it will be possible to shed more light on the significance of these elements in this behavioral disorder. The discussion on whether a change in concentration of an element is cause or consequence of ADHD is not within the scope of this article.
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Skalny AV, Mazaletskaya AL, Ajsuvakova OP, Bjørklund G, Skalnaya MG, Chao JCJ, Chernova LN, Shakieva RA, Kopylov PY, Skalny AA, Tinkov AA. Serum zinc, copper, zinc-to-copper ratio, and other essential elements and minerals in children with attention deficit/hyperactivity disorder (ADHD). J Trace Elem Med Biol 2020; 58:126445. [PMID: 31869738 DOI: 10.1016/j.jtemb.2019.126445] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/07/2019] [Accepted: 12/05/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Essential trace elements and minerals play a significant role in neurodevelopment. Although certain studies demonstrated impaired essential trace element and mineral status in children with ADHD, the existing data are insufficient. The objective of the present study was to assess serum trace element and mineral levels in children with ADHD. METHODS Serum trace element and mineral levels in 68 children with ADHD and 68 neurotypical controls were assessed using ICP-MS at NexION 300D (PerkinElmer Inc., USA) equipped with ESI SC-2 DX4 autosampler (Elemental Scientific Inc., USA). RESULTS Serum Cr, Mg, and Zn levels in children with ADHD were 21 % (p = 0.010), 4 % (p = 0.005), and 7 % (p = 0. 001) lower as compared to the healthy controls, respectively. In turn, serum Cu/Zn values were 11 % higher than those in the control group. Age and gender had a significant impact on serum element levels in ADHD. Particularly, preschool children were characterized by significantly increased Cu (+8 %; p = 0.034), and Cu/Zn (+19 %; p < 0.001) values, whereas serum Zn (-9 %; p = 0.004) level was decreased. In primary school-aged children only 6 % (p = 0.007) lower Mg levels were observed. Both boys and girls with ADHD were characterized by 8 % (p = 0.016) lower serum Zn levels and 10 % (p = 0.049) higher Cu/Zn values when compared to neurotypical girls. Boys with ADHD also had significantly higher Cu/Zn, exceeding the respective control values by 12 % (p = 0.021), predominantly due to a 7 % (p = 0.035) decrease in serum Zn. Serum Mg levels were also found to be significantly lower than those in neurotypical children by 5 % (p = 0.007). In adjusted regression models serum Cr (β=-0.234; p = 0.009) and Cu/Zn (β = 0.245; p = 0.029) values were significantly associated with ADHD, respectively. Two-way ANOVA revealed a significant impact of ADHD on Cr, Mg, Zn, and Cu/Zn, whereas age was associated with Cu, I, Mg, Mo, and Cu/Zn, whereas gender accounted only for variability in serum Mn levels. Principal component analysis (PCA) also revealed significant contributions of Mg, Zn, and Cu/Zn values to ADHD variability. CONCLUSIONS Hypothetically, the observed decrease of essential trace elements, namely Mg and Zn, and elevation of Cu/Zn may significantly contribute to the risk of ADHD or its severity and/or comorbidity.
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Affiliation(s)
- Anatoly V Skalny
- Yaroslavl State University, 150003, Yaroslavl, Russia; IM Sechenov First Moscow State Medical University (Sechenov University), 119146, Moscow, Russia; RUDN University, Moscow, Russia; Taipei Medical University, Taipei, Taiwan
| | | | - Olga P Ajsuvakova
- Yaroslavl State University, 150003, Yaroslavl, Russia; IM Sechenov First Moscow State Medical University (Sechenov University), 119146, Moscow, Russia
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo I Rana, Norway
| | - Margarita G Skalnaya
- IM Sechenov First Moscow State Medical University (Sechenov University), 119146, Moscow, Russia; RUDN University, Moscow, Russia
| | | | | | | | - Philippe Yu Kopylov
- IM Sechenov First Moscow State Medical University (Sechenov University), 119146, Moscow, Russia
| | - Andrey A Skalny
- Yaroslavl State University, 150003, Yaroslavl, Russia; RUDN University, Moscow, Russia
| | - Alexey A Tinkov
- Yaroslavl State University, 150003, Yaroslavl, Russia; IM Sechenov First Moscow State Medical University (Sechenov University), 119146, Moscow, Russia.
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Blood and hair zinc levels in children with attention deficit hyperactivity disorder: A meta-analysis. Asian J Psychiatr 2020; 47:101805. [PMID: 31704595 DOI: 10.1016/j.ajp.2019.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 01/05/2023]
Abstract
We summarized the observational studies on the correlation between zinc and attention deficit hyperactivity disorder (ADHD) since 1986, extracted relevant data for meta-analysis to determine the relationship between zinc and ADHD. We searched PubMed, Scopus, Cochrane Library, EMBASE (included EMBASE and Medline), Web of Science and Clinical Trials.gov databases from inception to April 8, 2019. We assessed the blood zinc, hair zinc and ADHD by combined the standardized mean difference (SMD) and 95% confidence interval (CI). Statistical analysis was performed using Stata 14.0. We included 11 studies for meta-analysis. Of these, 8 studies comprising 1311 participants reported blood zinc and 3 studies comprising 206 participants reported hair zinc. The zinc levels in blood (SMD: -0.91, 95% CI: -1.88-0.07, P(SMD) < 0.068), and hair (SMD: 1.42, 95% CI: -4.49-7.33, P(SMD) = 0.638) not significantly compare ADHD with controls. Nevertheless, high heterogeneity (I2 > 97.3%) emerged among the included studies. The subgroup analysis showed that the heterogeneity of samples >100 group was significantly reduced. The sensitivity analysis found that the results changed significantly after excluding the only cross-sectional study. In conclusion, our meta-analysis showed that there was no statistically significant difference in blood zinc and hair zinc levels between ADHD children and adolescents compared with healthy children and adolescents.
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11
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Dynamical properties of elemental metabolism distinguish attention deficit hyperactivity disorder from autism spectrum disorder. Transl Psychiatry 2019; 9:238. [PMID: 31551411 PMCID: PMC6760156 DOI: 10.1038/s41398-019-0567-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/30/2019] [Indexed: 12/21/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are neurodevelopmental conditions of overlapping etiologies and phenotypes. For ASD, we recently reported altered elemental metabolic patterns in the form of short and irregular zinc and copper cycles. Here, we extend the application of these biomarkers of prenatal and early postnatal elemental metabolism to distinguish between individuals diagnosed with ADHD and/or ASD and neurotypical controls. We recruited twins discordant for ADHD, ASD and other neurodevelopmental diagnoses from national twin studies in Sweden (N = 74) diagnosed according to DSM-5 clinical consensus and standardized psychiatric instruments. Detailed temporal profiles of exposure to 10 metals over the prenatal and early childhood periods were measured using tooth biomarkers. We used recurrence quantification analysis (RQA) to characterize properties of cyclical metabolic patterns of these metals. Regularity (determinism) and complexity (entropy) of elemental cycles was consistently reduced in ADHD for cobalt, lead, and vanadium (determinism: cobalt, β = -0.03, P = 0.017; lead, β = -0.03, P = 0.016; and vanadium, β = -0.03, P = 0.01. Entropy: cobalt, β = -0.13, P = 0.017; lead, β = -0.18, P = 0.016; and vanadium, β = -0.15, P = 0.008). Further, we found elemental pathways and dynamical features specific to ADHD vs ASD, and unique characteristics associated with ADHD/ASD combined presentation. Dysregulation of cyclical processes in elemental metabolism during prenatal and early postnatal development not only encompasses pathways shared by ADHD and ASD, but also comprise features specific to either condition.
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Magula L, Moxley K, Lachman A. Iron deficiency in South African children and adolescents with attention deficit hyperactivity disorder. J Child Adolesc Ment Health 2019; 31:85-92. [DOI: 10.2989/17280583.2019.1637345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Luzuko Magula
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Karis Moxley
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Anusha Lachman
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
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13
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Mohammad AB, Mohammad SHK, Mohammad MK, Khan AS, Al-Hajjaj MS. Quantification of Trace Elements in Different Dokha and Shisha Tobacco Products using EDXRF. J Anal Toxicol 2019; 43:e7-e22. [PMID: 30462216 DOI: 10.1093/jat/bky095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/28/2018] [Accepted: 10/23/2018] [Indexed: 11/14/2022] Open
Abstract
The present study aims to quantify trace metals in different dokha (medwakh) and shisha tobacco products available in local markets. Recent research has shown that these products have higher amounts of nicotine and tar compared to various other tobacco products. No specific data are available on the concentration of trace elements in dokha (medwakh) and shisha tobacco products in the Middle East and North Africa (MENA) region. Harmful health effects due to the toxicity of these elements in tobacco and its smoke have not been adequately emphasized. Concentrations of trace elements were extensively studied using HORIBA XGT-7200 EDXRF fluorescence absorption spectroscopy. The mean concentrations of aluminum, calcium, chromium, copper, iron, magnesium, manganese, nickel, potassium, strontium and zinc in 13 dokha products in μg/g were 406.92 ± 41.72, 14703.27 ± 271.73, 11.73 ± 2.12, 25.58 ± 2.63, 753.85 ± 14.87, 5306.54 ± 134.94, 82.31 ± 4.55, 25.58 ± 2.50, 2212.12 ± 39.04, 816.92 ± 15.26 and 35.96 ± 2.63, respectively; and those in the three shisha products in μg/g were 244.83 ± 25.11, 8235.77 ± 144.51, 3.40 ± 0.38, 22.77 ± 4.50, 569.13 ± 10.22, 2096.20 ± 130.69, 72.13 ± 7.13, 27.67 ± 5.31, 4467.50 ± 168.06, 320.20 ± 6.03 and 36.40 ± 3.57, respectively. In our study, the quantified trace metal concentrations in dokha and shisha tobacco using the EDXRF method were ten times higher than the LODs. The percentage of RSD was <10%, validating the precision of the method. Tobacco smoking is a major source of consumption of toxic elements, not only in the smoker but also in non-smokers through passive smoking. In dokha (medwakh) and shisha tobacco products, compared with cigarettes, Ni levels were significantly higher, Cr, Cu and Zn levels were higher, and Fe levels were similar, while Al and Mn levels were lower. The dokha and shisha tobacco products have no filters; many toxic metals can quickly enter the lungs and cause different pulmonary diseases and oral infections. Tobacco smoking causes lung and oral cancers, chronic obstructive pulmonary disease and cardiovascular diseases.
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Affiliation(s)
| | | | | | - Abdus Sayeed Khan
- Department of Physics, University Laboratories, Khalifa University, Abu Dhabi, UAE
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Yang R, Zhang Y, Gao W, Lin N, Li R, Zhao Z. Blood Levels of Trace Elements in Children with Attention-Deficit Hyperactivity Disorder: Results from a Case-Control Study. Biol Trace Elem Res 2019; 187:376-382. [PMID: 29909491 DOI: 10.1007/s12011-018-1408-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022]
Abstract
Some trace elements may participate in the pathogenesis of attention-deficit hyperactivity disorder (ADHD). This study aimed to investigate the trace element status of zinc (Zn), copper (Cu), iron (Fe), magnesium (Mg), and lead (Pb) in children with ADHD, and to compare them with normal controls. Associations between examined elements and SNAP-IV rating scores of ADHD symptoms were also assessed. Four hundred nineteen children with ADHD (8.8 ± 2.1 years) and 395 matched normal controls (8.9 ± 1.7 years) were recruited in the study. The concentrations of Zn, Fe, Cu, Mg, and Pb in the whole blood were measured by atomic absorption spectrometry. Lower zinc levels (P < 0.001) and the number out of normal ranges (P = 0.015) were found in children with ADHD when compared with the normal control group. The difference remained when adjusting the factor of BMI z-score. No significant between-group differences were found in levels of other elements. Zinc levels were negatively correlated with parent-rated scores of inattentive subscale of SNAP-IV (r = - 0.40) as well as with total score of SNAP-IV (r = - 0.24). Other significant associations were not observed. The present results indicated that there were alterations in blood levels of zinc, which was associated with the symptom scores of ADHD.
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Affiliation(s)
- Rongwang Yang
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, No.57, Zhuganxiang Road, Hangzhou, Zhejiang Province, China.
| | - Yanyi Zhang
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, No.57, Zhuganxiang Road, Hangzhou, Zhejiang Province, China
| | - Weijia Gao
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, No.57, Zhuganxiang Road, Hangzhou, Zhejiang Province, China
| | - Nannan Lin
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, No.57, Zhuganxiang Road, Hangzhou, Zhejiang Province, China
| | - Rong Li
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, No.57, Zhuganxiang Road, Hangzhou, Zhejiang Province, China
| | - Zhengyan Zhao
- Department of Child Health Care, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Unal D, Çelebi F, Bildik HN, Koyuncu A, Karahan S. Vitamin B12 and haemoglobin levels may be related with ADHD symptoms: a study in Turkish children with ADHD. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1459005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Dilek Unal
- School of Medicine, Department of Child and Adolescent Psychiatry, Bülent Ecevit University, Zonguldak, Turkey
| | - Fahri Çelebi
- Child and Adolescent Psychiatry Department, Zonguldak Women and Children Hospital, Zonguldak, Turkey
| | | | | | - Sevilay Karahan
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
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Panahandeh G, Vatani B, Safavi P, Khoshdel A. The effect of adding ferrous sulfate to methylphenidate on attention-deficit/hyperactivity disorder in children. J Adv Pharm Technol Res 2017; 8:138-142. [PMID: 29184845 PMCID: PMC5680621 DOI: 10.4103/japtr.japtr_45_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children with several complications. This study was conducted to investigate the effect of adding ferrous sulfate to methylphenidate in decreasing ADHD symptoms. This study was a double-blind, randomized clinical trial. In this study, 42 nonanemic children with ADHD and serum ferritin below 30 mg/ml were enrolled according to convenience sampling and randomly assigned to two groups of 21 each, cases and controls. The two groups were matched for age and sex. The case group was administered with ferrous sulfate 5 mg/kg in addition to methylphenidate up to 1 mg/kg and the control group with methylphenidate alone. The scores on child symptoms inventory-4 (CSI-4) were recorded at baseline and after 2 months of treatment. Data were analyzed by t-test, Pearson's correlation coefficient, and repeated measures ANOVA in SPSS 16. The scores on CSI-4 decreased significantly at month 2 in both groups (P < 0.001). The scores on attention deficit and hyperactivity subscales of the CSI-4 were significantly lower in the case group than the control group (P < 0.05). The total score on CSI-4 decreased more markedly in the case group (P < 0.04). Use of ferrous sulfate plus methylphenidate can be effective in reducing ADHD symptoms in nonanemic children with low serum ferritin.
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Affiliation(s)
- Gholamreza Panahandeh
- Department of Pediatrics, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Bahareh Vatani
- Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Parvin Safavi
- Department of Psychiatry, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Abolfazl Khoshdel
- Department of Pediatrics, Shahrekord University of Medical Sciences, Shahrekord, Iran
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DEMİRCİ K, YILDIRIM BAŞ F, ARSLAN B, SALMAN Z, AKPINAR A, DEMİRDAŞ A. The Investigation of Symptoms and Diagnoses of Adult-Attention Deficit/ Hyperactivity Disorder in Women with Iron Deficiency Anemia. Noro Psikiyatr Ars 2017; 54:72-77. [PMID: 28566963 PMCID: PMC5439476 DOI: 10.5152/npa.2016.12464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/17/2015] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION The aim of this study was to investigate symptoms and diagnoses of Adult-Attention Deficit/Hyperactivity Disorder (ADHD) in women with iron deficiency anemia, to evaluate relationship between ADHD with clinical features and to compare with the women without iron deficiency anemia. METHODS Eighty-three newly diagnosed iron deficiency anemia patients and 70 healthy controls were included in this study. All participants were assessed using a sociodemographic form, Structured Clinical Interview I (SCID-I), Wender Utah Rating Scale (WURS); Moreover, participants having WURS scores 36 and above were also assessed using the Adult ADD/ADHD Evaluation Scale and interviewed according to DSM-5 criteria. RESULTS In the study, 22.9% of patients with iron deficiency anemia and 12.9% of healthy controls were found to have WURS scores 36 and above. Fifteen patients (18.1%) in iron deficiency anemia group and two patients (2.9%) in control group had adult ADHD, when they were evaluated with Adult ADD/ADHD Evaluation Scale and interviewed according to DSM-5 criteria (p=0.007). The patients with iron deficiency anemia had significantly higher WURS scores compared to controls (p=0.002). The levels of iron and ferritin had negative correlation (r=-0.166, p<0.05; r=-0.255, p<0.01, respectively) and the levels of serum iron binding capacity had positive correlation (r=0.255, p<0.01) with the scores of WURS. CONCLUSION The prevalence of adult ADHD is higher than those reported for general population in patients with iron deficiency anemia. Early diagnose and treatment of adult ADHD may positively contribute to the patients with iron deficiency anemia.
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Affiliation(s)
- Kadir DEMİRCİ
- Department of Psychiatry, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Funda YILDIRIM BAŞ
- Department of Family Medicine, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Bahriye ARSLAN
- Department of Family Medicine, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Zeliha SALMAN
- Department of Family Medicine, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Abdullah AKPINAR
- Department of Psychiatry, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Arif DEMİRDAŞ
- Department of Psychiatry, Süleyman Demirel University School of Medicine, Isparta, Turkey
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Wang Y, Huang L, Zhang L, Qu Y, Mu D. Iron Status in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. PLoS One 2017; 12:e0169145. [PMID: 28046016 PMCID: PMC5207676 DOI: 10.1371/journal.pone.0169145] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/07/2016] [Indexed: 12/19/2022] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children. However, the pathogenesis of ADHD remains unclear. Iron, an important trace element, is implicated in brain function and dopaminergic activity. Recent studies have investigated the association between iron deficiency and ADHD, but the results are inconsistent. Methods A systemic search of MEDLINE, EMBASE, Web of Science and Cochrane Library databases was supplemented by manual searches of references of key retrieved articles. Study quality was evaluated using the Newcastle-Ottawa Scale. The standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated using a random-effects model. H2 and I2 were used to evaluate the heterogeneity, and sensitivity, subgroup and meta-regression analyses were conducted to explore the reason of heterogeneity. Results The search yielded 11 studies published before July 25, 2016. Of these, 10 studies, comprising 2191 participants and 1196 ADHD cases, reported serum ferritin levels, and six studies, comprising 617 participants and 369 ADHD cases, reported serum iron levels. Serum ferritin levels were lower in ADHD cases (SMD = -0.40, 95% CI = -0.66 to -0.14). However, we found no correlation between serum iron levels and ADHD (SMD = -0.026, 95% CI = -0.29 to 0.24). Meta-regression analysis indicated that publication year, age, gender, sample size, and Hb levels did not significantly influence the pooled estimates of serum ferritin. Conclusion Lower serum ferritin rather than serum iron is associated with ADHD in children.
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Affiliation(s)
- Yan Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Lan Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Li Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Department of Pediatrics, University of California, San Francisco, California, United States of America
- * E-mail:
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Oner P, Oner O, Cop E, Munir KM. Effect of Ferritin on Short-Term Treatment Response in Attention Deficit Hyperactivity Disorder. KLINIK PSIKOFARMAKOLOJI BULTENI = BULLETIN OF CLINICAL PSYCHOPHARMACOLOGY 2016; 22:325-331. [PMID: 28804252 PMCID: PMC5551506 DOI: 10.5455/bcp.20120403015900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Several studies have shown that iron deficiency and ferritin levels are associated with parent and teacher Attention Deficit Hyperactivity Disorder (ADHD) ratings. Although there are conflicting results, it has also been reported that iron supplementation may help to decrease ADHD symptoms. When all these previous studies are taken into account, it is clear that a large study investigating the effects of iron deficiency and ferritin levels on routine pharmacological treatment of ADHD with stimulants would be helpful to elucidate this treatment from a clinical point of view. METHODS A total of 345 subjects with combined or predominantly hyperactive-impulsive (PHI) subtypes of ADHD were included. All diagnoses were based on the DSM-IV criteria and ascertained by direct interviews conducted by the authors, who are experienced child psychiatrists certified in the use of the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) semi-structured interview. The two treatment response criteria were: 1) 25% or more decrease in pre-treatment Conners Parent Rating Scale (CPRS) and Conners Teacher Rating Scale (CTRS) Hyperactivity (HA) and Total Problems scores; 2) CPRS and CTRS HA scores lower than the cut-off point ("very improved"). RESULTS A total of 255 (73.9%) patients were on OROS-methylphenidate (OROS-MPH) and 90 (26.1%) were on immediate release methylphenidate (IR-MPH). The mean±sd of OROS-MPH and IR-MPH doses were 28.8±8.1 and 20.9±7.1 mg, respectively. More than half (52.5%) of the subjects were previously drug-naive at treatment inception. Two hundred and seventy eight (80.6%) subjects had combined subtype ADHD and the remainder had predominantly hyperactive-impulsive subtype. Only 60 (17.4%) of the subjects had no comorbid disorders, while 38.3% had one comorbid disorder, 32.8% had two comorbid disorders, and 11.6% had three or more comorbid disorders. The most frequent comorbidity was Oppositional Defiant Disorder/Conduct Disorder (ODD/CD, 51.6%), followed by Learning Disabilities (LD, 35.4%) and Anxiety Disorders (AD, 15.9%). Logistic regression analysis showed that subjects with comorbid ODD/CD and LD were less likely to respond to treatment. Ferritin levels and iron deficiency were not associated significantly with outcomes. CONCLUSIONS In a large sample of subjects with combined or predominantly hyperactive-impulsive subtypes of ADHD, after controlling for several factors, we found that neither iron deficiency (ferritin <12 ng/ml) nor ferritin levels were associated with less favorable short-term treatment outcomes with stimulants. Subjects with comorbid ODD/CD and LD were less likely to have a 25% or more decrease in CTRS Total score. The presence of ODD/CD was also a negative predictor of treatment response in terms of CPRS Total and HA scores. The lack of a negative treatment response in ADHD subjects with iron deficiency and lack of a negative association with ferritin levels suggest that the relationship between iron metabolism and ADHD, a highly heterogeneous disorder, may be more complicated than previously believed.
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Affiliation(s)
- Pinar Oner
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Childrens’ Hospital, Ankara - Turkey
- Fogarty International Center Mental Health and Developmental Disabilities Program, Children’s Hospital, Boston, MA, USA
| | - Ozgur Oner
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Childrens’ Hospital, Ankara - Turkey
- Fogarty International Center Mental Health and Developmental Disabilities Program, Children’s Hospital, Boston, MA, USA
| | - Esra Cop
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Childrens’ Hospital, Ankara - Turkey
| | - Kerim M. Munir
- Fogarty International Center Mental Health and Developmental Disabilities Program, Children’s Hospital, Boston, MA, USA
- Children’s Hospital, Boston; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
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Firouzkouhi Moghaddam M, Rakhshani T, Khosravi M. Effectiveness of Methylphenidate Supplemented by Zinc, Calcium, and Magnesium for Treatment of ADHD Patients in the City of Zahedan. ACTA ACUST UNITED AC 2016. [DOI: 10.17795/semj40019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Alexander K C Leung
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, #200, 233-16th Avenue North West, Calgary, Alberta T2M 0H5, Canada.
| | - Kam Lun Hon
- Department of Paediatrics, Chinese University of Hong Kong, 6/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong, China
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Zaalberg A, Wielders J, Bulten E, van der Staak C, Wouters A, Nijman H. Relationships of diet-related blood parameters and blood lead levels with psychopathology and aggression in forensic psychiatric inpatients. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2016; 26:196-211. [PMID: 25827608 DOI: 10.1002/cbm.1954] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 10/28/2014] [Accepted: 01/20/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Earlier studies have suggested associations between diet-related blood parameters and both aggression and psychopathological symptoms, but little is known about this in forensic psychiatric inpatients. AIM This article aims to explore the levels of diet-related blood parameters and their relationship to aggressive behaviour and/or psychopathology among Dutch forensic psychiatric inpatients. METHODS Minerals, vitamins, lead and fatty acid levels were measured in blood samples from 51 inpatients, well enough to consent and participate in the study, from a possible total of 99. Levels of aggression and psychopathology were assessed using questionnaires, observation instruments and clinical data. Associations between blood parameters and behavioural measures were calculated. RESULTS Low average levels of vitamin D3 and omega (ω)-3 fatty acids were found, with nearly two-thirds of the patients having below recommended levels of D3 , while vitamin B6 levels were high. Magnesium, iron, zinc, copper and lead were overall within reference values, but copper/zinc ratios were high. Several significant associations between levels of fatty acid measures and both aggression and psychopathology were observed. CONCLUSION In our sample of forensic psychiatric inpatients, fatty acids - but not mineral or vitamin levels - were associated with aggression and psychopathology. A potentially causal link between fatty acids and aggression could be tested in a randomised, placebo-controlled trial of fish oil supplements. General health of such patients might be improved by better vitamin D status (increased sun exposure and/or supplement use) and better ω-3 fatty acid status (oily fish or fish oil consumption), but discouraging unnecessary self-prescription of B vitamins where necessary. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ap Zaalberg
- Research and Documentation Centre (WODC), Ministry of Security and Justice, PO Box 20301, 2500 EH, The Hague, The Netherlands
| | - Jos Wielders
- Meander Medical Centre, Amersfoort, The Netherlands
| | - Erik Bulten
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Forensic Psychiatric Centre "Pompekliniek", Nijmegen, The Netherlands
| | - Cees van der Staak
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Anouk Wouters
- Division of Ortho- and Forensic Psychiatry, "Altrecht" Mental Health Institute, Den Dolder, The Netherlands
| | - Henk Nijman
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Division of Ortho- and Forensic Psychiatry, "Altrecht" Mental Health Institute, Den Dolder, The Netherlands
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Iron Deficiency Parameters in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. Child Psychiatry Hum Dev 2016; 47:259-69. [PMID: 26092605 DOI: 10.1007/s10578-015-0562-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study is to compare iron deficiency parameters in patients with stimulant-naive attention-deficit/hyperactivity disorder (ADHD) and healthy controls, to investigate whether there are differences among the ADHD presentations, and to evaluate the relationship between ADHD symptom severity and serum ferritin levels. In addition, ADHD-Predominantly Inattentive (ADHD-PI) patients with restrictive hyperactivity/impulsivity symptoms were evaluated as a separate group with "restrictive inattention presentation" (ADHD-Rest) and were compared with other groups. Patients with ADHD-Rest are typically defined as having six or more symptoms of inattention and fewer than three symptoms of hyperactivity/impulsivity. A total of 200 ADHD cases consisting of 100 ADHD-Combine (ADHD-C) and 100 ADHD-PI and a total of 100 healthy control cases were included in the study. The Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version was performed in a semi-structured interview during the diagnosis. The Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale, the Conners' Rating Scale-Revised: Long Form (Parent-Teacher) (CPRSR:L, CTRS-R:L) were used for clinical evaluation. Hemogram, serum iron, iron binding capacity and serum ferritin levels were assessed. There were no significant differences between the ADHD patients and the healthy control cases in terms of iron deficiency parameters. Further, there were no significant differences among the ADHD presentations in terms of the same parameters, nor were there any significant differences when the groups were examined after the identification of the ADHD-Rest. The CPRS-R:L Hyperactivity and the CTRS-R:L Hyperactivity scores were negatively correlated with serum ferritin level in the ADHD group. To our knowledge, our current study is the first to compare serum ferritin levels in ADHD-Rest with other presentations of ADHD, and included the largest number of patients that were classified by ADHD presentations. Elucidation of these findings is important for both the etiology and treatment of ADHD.
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Salehi B, Mohammadbeigi A, Sheykholeslam H, Moshiri E, Dorreh F. Omega-3 and Zinc supplementation as complementary therapies in children with attention-deficit/hyperactivity disorder. J Res Pharm Pract 2016; 5:22-6. [PMID: 26985432 PMCID: PMC4776543 DOI: 10.4103/2279-042x.176561] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: The aim of this study is to evaluate the effect of zinc and omega-3 supplements as adjunctive drugs in the treatment of attention-deficit/hyperactivity disorder (ADHD) of children. Methods: This study is a randomized, double-blind clinical trial conducted on 150 children aged 6–15 years old that diagnosed as new cases of ADHD. Study subjects were evaluated for 8 weeks. Besides of drug of choice (methylphenidate) for the ADHD, patients received placebo in the control group (n = 50), zinc sulfate in second group (n = 50), and omega-3 (n = 50) in third group. Clinical improvement was checking by Conners’ Parent and Teacher Rating Scales before and in 2nd, 4th, and 8th week of treatment. Results were analyzed with SPSS version 16 software. Findings: In this study, mean scores of Conners’ scale showed significant improvement during treatment in the zinc group compared to control group in children that affected to attention-deficit disorder subtype of ADHD (P = 0.02). Moreover, in omega-3 group, better clinical response was seen than other groups (P < 0.05). However, there was no significant difference between omega-3 group compared to placebo group in the mean scores of Conners’ scale (P = 0.89). Conclusion: Zinc supplementation accompanied by the main treatment significantly improves symptom of attention-deficit disorder subtype of ADHD. However, omega-3 supplementation was superior to zinc and placebo in the clinical improvement of ADHD.
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Affiliation(s)
- Bahman Salehi
- Department of Psychiatry, Arak University of Medical Sciences, Arak, Iran
| | - Abolfazl Mohammadbeigi
- Department of Epidemiology and Biostatistics, Neurology and Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | | | - Esmail Moshiri
- Department of Anesthesiology, Arak University of Medical Sciences, Arak, Iran
| | - Fatemeh Dorreh
- Department of Pediatric, Arak University of Medical Sciences, Arak, Iran
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Rucklidge JJ, Frampton CM, Gorman B, Boggis A. Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. Br J Psychiatry 2015; 204:306-15. [PMID: 24482441 DOI: 10.1192/bjp.bp.113.132126] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The role of nutrition in the treatment of attention-deficit hyperactivity disorder (ADHD) is gaining international attention; however, treatments have generally focused only on diet restriction or supplementing with one nutrient at a time. AIMS To investigate the efficacy and safety of a broad-based micronutrient formula consisting mainly of vitamins and minerals, without omega fatty acids, in the treatment of ADHD in adults. METHOD This double-blind randomised controlled trial assigned 80 adults with ADHD in a 1:1 ratio to either micronutrients (n = 42) or placebo (n = 38) for 8 weeks (trial registered with the Australian New Zealand Clinical Trials Registry: ACTRN12609000308291). RESULTS Intent-to-treat analyses showed significant between-group differences favouring active treatment on self- and observer- but not clinician-ADHD rating scales. However, clinicians rated those receiving micronutrients as more improved than those on placebo both globally and on ADHD symptoms. Post hoc analyses showed that for those with moderate/severe depression at baseline, there was a greater change in mood favouring active treatment over placebo. There were no group differences in adverse events. CONCLUSIONS This study provides preliminary evidence of efficacy for micronutrients in the treatment of ADHD symptoms in adults, with a reassuring safety profile.
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Affiliation(s)
- Julia J Rucklidge
- Julia J. Rucklidge, PhD, Department of Psychology, University of Canterbury, Christchurch; Chris M. Frampton, PhD, Department of Psychological Medicine, University of Otago, Christchurch; Brigette Gorman, PhD, Department of Psychology, University of Canterbury, Christchurch; Anna Boggis, MD, Canterbury District Health Board, Christchurch, New Zealand
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Cortese S, Angriman M. Attention-deficit/hyperactivity disorder, iron deficiency, and obesity: is there a link? Postgrad Med 2014; 126:155-70. [PMID: 25141253 DOI: 10.3810/pgm.2014.07.2793] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The exact etiopathophysiology of attention-deficit/hyperactivity disorder (ADHD) remains elusive, likely because of its phenotypic heterogeneity. Given the involvement of iron in neurocognitive and behavioral functions, iron deficiency (ID) has been suggested as a possible etiopathophysiological factor in a subsample of individuals with ADHD. Most studies assessing ID in ADHD have focused on serum ferritin, a marker of peripheral iron status. Results from these studies are mixed, and the largest studies failed to find a significant association between ADHD and low serum ferritin levels. However, serum ferritin may be influenced by several conditions, including inflammatory status. Increasing evidence, especially from epidemiological studies, points to a significant association between ADHD and obesity. Interestingly, obesity is associated with a chronic inflammatory status, characterized by ID with normal-to-high serum ferritin levels. This article reviews the literature on iron status in ADHD and on the relationship between ADHD and obesity; discusses a possible link among ADHD, ID, and obesity; and proposes that comorbid obesity contributes to ID, via chronic inflammation, in a subsample of individuals with ADHD. Thus, the comorbidity between ADHD and obesity suggests moving beyond serum ferritin levels and assessing the molecular pathways of chronic inflammation that lead to ID in individuals with ADHD and obesity. In turns, this may pave the way for novel treatment strategies for cognitive and behavioral dysfunctions related to ID in ADHD.
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Affiliation(s)
- Samuele Cortese
- Child Neuropsychiatry Unit, G.B. Rossi Hospital, Department of Life Science and Reproduction, Verona University, Verona, Italy; Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, New York University Langone Medical Center, New York, NY.
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Woo HD, Kim DW, Hong YS, Kim YM, Seo JH, Choe BM, Park JH, Kang JW, Yoo JH, Chueh HW, Lee JH, Kwak MJ, Kim J. Dietary patterns in children with attention deficit/hyperactivity disorder (ADHD). Nutrients 2014; 6:1539-53. [PMID: 24736898 PMCID: PMC4011050 DOI: 10.3390/nu6041539] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/17/2014] [Accepted: 03/28/2014] [Indexed: 11/17/2022] Open
Abstract
The role of diet in the behavior of children has been controversial, but the association of several nutritional factors with childhood behavioral disorders has been continually suggested. We conducted a case-control study to identify dietary patterns associated with attention deficit hyperactivity disorder (ADHD). The study included 192 elementary school students aged seven to 12 years. Three non-consecutive 24-h recall (HR) interviews were employed to assess dietary intake, and 32 predefined food groups were considered in a principal components analysis (PCA). PCA identified four major dietary patterns: the "traditional" pattern, the "seaweed-egg" pattern, the "traditional-healthy" pattern, and the "snack" pattern. The traditional-healthy pattern is characterized by a diet low in fat and high in carbohydrates as well as high intakes of fatty acids and minerals. The multivariate-adjusted odds ratio (OR) of ADHD for the highest tertile of the traditional-healthy pattern in comparison with the lowest tertile was 0.31 (95% CI: 0.12-0.79). The score of the snack pattern was positively associated with the risk of ADHD, but a significant association was observed only in the second tertile. A significant association between ADHD and the dietary pattern score was not found for the other two dietary patterns. In conclusion, the traditional-healthy dietary pattern was associated with lower odds having ADHD.
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Affiliation(s)
- Hae Dong Woo
- Molecular Epidemiology Branch, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Korea.
| | - Dong Woo Kim
- Molecular Epidemiology Branch, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Korea.
| | - Young-Seoub Hong
- Department of Preventive Medicine, College of Medicine, Dong-A University, Dong-A University Hospital, 26, Daesingongwon-ro, Seo-gu, Busan 602-715, Korea.
| | - Yu-Mi Kim
- Department of Preventive Medicine, College of Medicine, Dong-A University, Dong-A University Hospital, 26, Daesingongwon-ro, Seo-gu, Busan 602-715, Korea.
| | - Ju-Hee Seo
- Heavy Metal Exposure Environmental Health Center, Dong-A University, 32, Daesingongwon-ro, Seo-gu, Busan 602-714, Korea.
| | - Byeong Moo Choe
- Department of Psychiatry, College of Medicine, Dong-A University, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 602-715, Korea.
| | - Jae Hong Park
- Department of Psychiatry, College of Medicine, Dong-A University, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 602-715, Korea.
| | - Je-Wook Kang
- Department of Child and Adolescent Psychiatry, College of Medicine, Inje University Busan Paik Hospital, 75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea.
| | - Jae-Ho Yoo
- Department of Pediatrics, College of Medicine, Dong-A University, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 602-715, Korea.
| | - Hee Won Chueh
- Department of Pediatrics, College of Medicine, Dong-A University, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu, Busan 602-715, Korea.
| | - Jung Hyun Lee
- Department of Pediatrics, Kosin University Gospel Hospital, 262, Gamcheon-ro, Seo-gu, Busan 602-702, Korea.
| | - Min Jung Kwak
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, 179, Gudeok-ro, Seo-gu, Busan 602-739, Korea.
| | - Jeongseon Kim
- Molecular Epidemiology Branch, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Korea.
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Rucklidge JJ, Johnstone J, Gorman B, Boggis A, Frampton CM. Moderators of treatment response in adults with ADHD treated with a vitamin-mineral supplement. Prog Neuropsychopharmacol Biol Psychiatry 2014; 50:163-71. [PMID: 24374068 DOI: 10.1016/j.pnpbp.2013.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/18/2013] [Accepted: 12/18/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND To date there has been no research investigating moderators of response to micronutrient treatment of mental illness, specifically baseline nutrient levels. METHOD We conducted analyses of data from a randomized placebo-controlled trial (RCT) of 80 adults (≥16years) with Attention-Deficit/Hyperactivity Disorder (ADHD), whereby participants were treated acutely (8weeks) with micronutrients or placebo followed by an open-label (OL) phase of 8weeks whereby all participants received micronutrients. To ensure that all participants had been exposed to the micronutrients for 8weeks, only those 64 who had adhered to the treatment protocol and completed 8weeks on nutrients were included in the data analysis: 34 from the group that had been randomized to the micronutrient arm, and 30 from the group that had been randomized to the placebo group and hence had only received nutrients in the OL phase. Six outcomes were examined: change in ADHD symptoms (self/clinician), ADHD responder, Clinical Global Impression-Improvement (CGI-I), change in mood, and change in Global Assessment of Functioning (GAF). Demographic, developmental and psychiatric history, current clinical characteristics, and baseline nutrient levels were all considered as putative predictors. RESULTS There were significant changes in all outcome variables after 8weeks exposure to the micronutrients. Among the nutrients recorded at baseline, substantial deficiencies (27%) were only observed for vitamin D. However, other than an association showing that higher iron at baseline was correlated with higher baseline depression scores, baseline nutrient levels were not correlated with baseline psychiatric variables/current clinical characteristics. Regression analyses revealed that higher baseline ferritin and lower baseline copper and vitamin D levels were associated with a better response to treatment for some but not all outcomes. None of the other nutrient levels was found to be associated with outcome, including zinc, vitamin B12, iron, and folate. There were no childhood risk factors, demographic variables or clinical correlates that contraindicated micronutrient treatment; more severe symptoms at baseline and greater number of developmental risk factors predicted greater treatment response. CONCLUSIONS Further research looking at nutrients more broadly is required to confirm these initial observations about ferritin, vitamin D and copper; however, the results suggest that serum nutrient levels have limited value for identifying who will respond to treatment.
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Affiliation(s)
- Julia J Rucklidge
- Department of Psychology, University of Canterbury, Christchurch, New Zealand.
| | - Jeanette Johnstone
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Brigette Gorman
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Anna Boggis
- Canterbury District Health Board, Christchurch, New Zealand
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Liu J, Hanlon A, Ma C, Zhao SR, Cao S, Compher C. Low blood zinc, iron, and other sociodemographic factors associated with behavior problems in preschoolers. Nutrients 2014; 6:530-45. [PMID: 24473235 PMCID: PMC3942715 DOI: 10.3390/nu6020530] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/13/2014] [Accepted: 01/20/2014] [Indexed: 11/16/2022] Open
Abstract
Previous research supports the link among malnutrition, cognitive dysfunction, and behavioral outcomes; however, less research has focused on micronutrient deficiencies. This study investigates whether micronutrient deficiencies, specifically blood zinc and iron levels, will be associated with increased behavior problem scores, including internalizing and externalizing behaviors. 1314 Children (55% boys and 45% girls) from the Jintan Preschool Cohort in China participated in this study. Venous blood samples were collected and analyzed for zinc and iron when the children were 3-5 years old. Behavior problems were measured with the Child Behavior Checklist (CBCL), which was completed by the parents when children were in their last months of preschool (mean age 5.6 years). General linear multivariate modeling was used, with adjustment for important sociodemographic variables. The results indicate that low zinc levels alone (p = 0.024) and combined low zinc and iron levels (p = 0.022) are significantly associated with increased reports of total behavior problems. We did not find an association between low iron and behavior problems. With regards to sociodemographics, living in the suburbs is associated with increased internalizing problems, while higher mother's education and being female were associated with decreased externalizing problems. This study suggests that micronutrient deficiencies and sociodemographic facts are associated with behavior problems in preschoolers.
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Affiliation(s)
- Jianghong Liu
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104, USA.
| | - Alexandra Hanlon
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104, USA.
| | - Chenjuan Ma
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104, USA.
| | - Sophie R Zhao
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104, USA.
| | - Siyuan Cao
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104, USA.
| | - Charlene Compher
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104, USA.
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Cortese S, Angriman M, Lecendreux M, Konofal E. Iron and attention deficit/hyperactivity disorder: what is the empirical evidence so far? A systematic review of the literature. Expert Rev Neurother 2014; 12:1227-40. [DOI: 10.1586/ern.12.116] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abou-Khadra MK, Amin OR, Shaker OG, Rabah TM. Parent-reported sleep problems, symptom ratings, and serum ferritin levels in children with attention-deficit/hyperactivity disorder: a case control study. BMC Pediatr 2013; 13:217. [PMID: 24377840 PMCID: PMC3878403 DOI: 10.1186/1471-2431-13-217] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 12/19/2013] [Indexed: 11/21/2022] Open
Abstract
Background Sleep problems are common among children with attention-deficit/hyperactivity disorder (ADHD). Serum ferritin levels have been associated with the severity of symptoms and sleep disturbances among children with ADHD. This study was conducted to investigate parent-reported sleep problems in a sample of Egyptian children with ADHD and to examine the relationship between their sleep, symptom-ratings, and low serum ferritin levels. Methods Parents of 41 ADHD children, aged 6 to 12 years, filled out the Children’s Sleep Habits Questionnaire (CSHQ) and Conners’ Parent Rating Scale-Revised: Long Version (CPRS-R:L) in Arabic. Serum ferritin levels were determined with an enzyme-linked immunosorbent assay. The parents of the 62 controls filled out the CSHQ. Results The ADHD group showed significantly higher scores in CSHQ subscales and total score. Children with serum ferritin levels <30 ng/mL had more disturbed sleep. There were significant negative correlations between sleep duration subscale, total score of CSHQ, and serum ferritin levels. There were no significant differences in hyperactivity, cognitive problems/inattention, oppositional, or ADHD index subscale scores between children with serum ferritin levels <30 ng/mL and those with serum ferritin levels ≥30 ng/mL. Conclusions Sleep problems are common, and this study suggests an association between low serum ferritin levels and sleep disturbances.
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Affiliation(s)
- Maha K Abou-Khadra
- Department of Pediatrics, Faculty of Medicine, Cairo University, 2 Yousef Fahmy Street, El-Areech Street, Al-Ahram Street, Giza, Egypt.
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Soto-Insuga V, Calleja M, Prados M, Castaño C, Losada R, Ruiz-Falcó M. Utilidad del hierro en el tratamiento del trastorno por déficit de atención e hiperactividad. An Pediatr (Barc) 2013; 79:230-5. [DOI: 10.1016/j.anpedi.2013.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 10/26/2022] Open
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Donfrancesco R, Parisi P, Vanacore N, Martines F, Sargentini V, Cortese S. Iron and ADHD: time to move beyond serum ferritin levels. J Atten Disord 2013; 17:347-57. [PMID: 22290693 DOI: 10.1177/1087054711430712] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE (a) To compare serum ferritin levels in a sample of stimulant-naïve children with ADHD and matched controls and (b) to assess the association of serum ferritin to ADHD symptoms severity, ADHD subtypes, and IQ. METHOD The ADHD and the control groups included 101 and 93 children, respectively. Serum ferritin levels were determined with the enzyme-linked immunosorbent assay method. RESULTS Serum ferritin did not significantly differ between children with ADHD and controls, as well as among ADHD subtypes. Correlations between serum ferritin levels and measures related to IQ or ADHD severity were not significant. CONCLUSION This is the largest controlled study that assessed ferritin levels in stimulant-naïve ADHD children. The findings of this study do not support a significant relationship between serum ferritin levels and ADHD. However, the authors' results based on peripheral measures of iron do not rule out a possible implication of brain iron deficiency in ADHD, grounded on neurobiological hypotheses and preliminary empirical evidence.
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Romanos M, Tiesler CMT, Koletzko S, Berdel D, von Berg A, Hoffmann B, Schaaf B, Herbarth O, Lehmann I, Bauer CP, Stach B, Gerlach M, Schulte-Körne G, Heinrich J. No cross-sectional and longitudinal association of ferritin and symptoms of attention-deficit-/hyperactivity disorder in a large population-based sample of children: results from the GINIplus and LISAplus studies. ACTA ACUST UNITED AC 2013; 5:313-20. [DOI: 10.1007/s12402-013-0108-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 03/22/2013] [Indexed: 11/25/2022]
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Stevens LJ, Kuczek T, Burgess JR, Stochelski MA, Arnold LE, Galland L. Mechanisms of behavioral, atopic, and other reactions to artificial food colors in children. Nutr Rev 2013; 71:268-81. [PMID: 23590704 DOI: 10.1111/nure.12023] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Laura J Stevens
- Department of Nutrition Science; Purdue University; West Lafayette; Indiana; USA
| | - Thomas Kuczek
- Department of Statistics; Purdue University; West Lafayette; Indiana; USA
| | - John R Burgess
- Department of Nutrition Science; Purdue University; West Lafayette; Indiana; USA
| | - Mateusz A Stochelski
- Department of Nutrition Science; Purdue University; West Lafayette; Indiana; USA
| | - L Eugene Arnold
- Department of Psychiatry; Ohio State University; Columbus; Ohio; USA
| | - Leo Galland
- Foundation for Integrated Medicine; New York; New York; USA
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Scassellati C, Bonvicini C, Faraone SV, Gennarelli M. Biomarkers and attention-deficit/hyperactivity disorder: a systematic review and meta-analyses. J Am Acad Child Adolesc Psychiatry 2012; 51:1003-1019.e20. [PMID: 23021477 DOI: 10.1016/j.jaac.2012.08.015] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/25/2012] [Accepted: 08/13/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether peripheral biochemical markers (biomarkers) might differentiate patients with attention-deficit/hyperactivity disorder (ADHD) from non-ADHD individuals. METHOD We conducted a systematic search and a series of meta-analyses of case-control studies comprising studies from 1969 to 2011. RESULTS We identified 210 studies in the following categories: 71 studies of the main metabolites and metabolism enzymes of monoaminergic neurotransmission pathway; 87 studies of environmental risk factors divided into heavy metals (18 studies), substance/chemical exposures (16 studies), and nutritional factors (trace elements: 29 studies; essential fatty acids: 24 studies); 22 studies of the hypothalamic-pituitary-adrenal axis (HPA) pathway; 31 studies indicated with "other". After screening for the availability for meta-analyses of drug naïve/free case-control studies and Bonferroni correction, five comparisons were statistically significant (Norepinephrine [NE], 3-Methoxy-4-hydroxyphenylethylene glycol [MHPG], monoamine oxidase [MAO], Zinc [Zn], cortisol), five of the significant findings found support in studies of response to ADHD medications (NE, MHPG, MAO, b-phenylethylamine [PEA], cortisol), six in studies of symptoms severity (NE, MHPG, MAO, ferritin, Zn, cortisol) and three in studies of neurophysiological or cognitive functioning (lead-ferritin-Zn). No evidence of publication bias was found, whereas significant heterogeneity of effect sizes across studies was found for three of the five biomarkers that differentiated ADHD from control subjects. Suggestive associations were evidenced for neuropeptide Y (NPY), manganese, and dehydroepiandrosterone (DHEA). CONCLUSIONS This study provides evidence for several peripheral biomarkers as being associated with ADHD both in diagnosis and in treatment efficacy. Further studies are warranted to replicate these findings, to assess their specificity for ADHD, and to quantify the degree to which they are sufficiently precise to be useful in clinical settings.
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Affiliation(s)
- Catia Scassellati
- Genetic Unit at the Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Oner P, Oner O, Azik FM, Cop E, Munir KM. Ferritin and hyperactivity ratings in attention deficit hyperactivity disorder. Pediatr Int 2012; 54:688-92. [PMID: 22591427 PMCID: PMC4677666 DOI: 10.1111/j.1442-200x.2012.03664.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Iron is a co-factor of tyrosine hydroxylase which is a critical enzyme in dopamine synthesis. Dopamine has been implicated in the pathophysiology of attention deficit hyperactivity disorder (ADHD). Our objective was to investigate the association of ferritin level with parent and teacher ratings and cognitive measures after controlling for age, sex, ADHD subtype, comorbid conditions, hemoglobin, mean corpuscular volume and reticulocyte distribution width in a large sample. METHODS The study included 713 children and adolescents with ADHD (613 boys; age 7-15 years). Conners' Parent Rating Scale (CPRS) and Conners' Teacher Rating Scale (CTRS) were obtained. In a subgroup of patients we conducted Digit Span, Digit Symbol, Trail-making Tests as measures of attention and executive functioning. RESULTS Multiple regression analysis indicated that CPRS Hyperactivity score was significantly associated with ferritin level (B =-0.12; t =-3.1; P < 0.01). Other CPRS and CTRS scores as well as cognitive measures were not associated with ferritin level. CONCLUSIONS Although it is not possible to make an inference on causality in cross-sectional studies, the results of this largest-scale cross-sectional field study to date suggest that lower ferritin level might be associated with parent-reported hyperactivity after controlling for important confounding factors.
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Affiliation(s)
- Pinar Oner
- Department of Child and Adolescent Psychiatry, Dr Sami Ulus Children's Hospital, Ankara, Turkey
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Parisi P, Villa MP, Donfrancesco R, Miano S, Paolino MC, Cortese S. Could treatment of iron deficiency both improve ADHD and reduce cardiovascular risk during treatment with ADHD drugs? Med Hypotheses 2012; 79:246-9. [DOI: 10.1016/j.mehy.2012.04.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/16/2012] [Indexed: 12/19/2022]
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Cortese S, Azoulay R, Castellanos FX, Chalard F, Lecendreux M, Chechin D, Delorme R, Sebag G, Sbarbati A, Mouren MC, Bernardina BD, Konofal E. Brain iron levels in attention-deficit/hyperactivity disorder: a pilot MRI study. World J Biol Psychiatry 2012; 13:223-31. [PMID: 21585274 DOI: 10.3109/15622975.2011.570376] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Brain iron deficiency has been supposed to be involved in the pathophysiology of ADHD. Available studies assessing iron in ADHD are based on serum ferritin, a peripheral marker of iron status. To what extent serum ferritin correlates with brain iron (BI) is unclear. The main aim of this study was to compare BI, estimated with magnetic resonance imaging (MRI) in the putamen, pallidum, caudate, and thalamus, between children with and without ADHD. The secondary aim was to assess the correlation between serum ferritin and BI levels. METHODS Thirty-six children (18 with and 18 without ADHD, the latter including nine healthy controls and nine psychiatric controls) completed MRI and blood sampling. Brain iron levels were estimated by imaging T2*. RESULTS Children with ADHD showed significantly lower estimated BI in right and left thalamus compared to healthy controls. Estimated BI did not differ significantly between children with ADHD and psychiatric controls. Children with ADHD had significantly lower levels of serum ferritin than healthy as well as psychiatric controls. Serum ferritin and T2* values did not correlate significantly in most regions. CONCLUSIONS Low iron in the thalamus may contribute to ADHD pathophysiology.
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Affiliation(s)
- Samuele Cortese
- Child and Adolescent Psychopathology Unit, Robert Debré Hospital, Paris VII University, Paris, France.
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Mahmoud MM, El-Mazary AAM, Maher RM, Saber MM. Zinc, ferritin, magnesium and copper in a group of Egyptian children with attention deficit hyperactivity disorder. Ital J Pediatr 2011; 37:60. [PMID: 22206662 PMCID: PMC3268715 DOI: 10.1186/1824-7288-37-60] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 12/29/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder is a behavioral syndrome of childhood characterized by inattention, hyperactivity and impulsivity. There were many etiological theories showed dysfunction of some brain areas that are implicated in inhibition of responses and functions of the brain. Minerals like zinc, ferritin, magnesium and copper may play a role in the pathogenesis and therefore the treatment of this disorder. OBJECTIVE This study aimed to measure levels of zinc, ferritin, magnesium and copper in children with attention deficit hyperactivity disorder and comparing them to normal. METHODS This study included 58 children aged 5-15 years with attention deficit hyperactivity disorder attending Minia University Hospital from June 2008 to January 2010. They were classified into three sub-groups: sub-group I included 32 children with in-attentive type, sub-group II included 10 children with hyperactive type and sub-group III included 16 children with combined type according to the DSM-IV criteria of American Psychiatric Association, 2000. The control group included 25 apparently normal healthy children. RESULTS Zinc, ferritin and magnesium levels were significantly lower in children with attention deficit hyperactivity disorder than controls (p value 0.04, 0.03 and 0.02 respectively), while copper levels were not significantly different (p value 0.9). Children with inattentive type had significant lower levels of zinc and ferritin than controls (p value 0.001 and 0.01 respectively) with no significant difference between them as regards magnesium and copper levels (p value 0.4 and 0.6 respectively). Children with hyperactive type had significant lower levels of zinc, ferritin and magnesium than controls (p value 0.01, 0.02 and 0.02 respectively) with no significant difference between them as regards copper levels (p value 0.9). Children with combined type had significant lower levels of zinc and magnesium than controls (p value 0.001 and 0.004 respectively) with no significant difference between them as regards ferritin and copper levels (p value 0.7 and 0.6 respectively). CONCLUSIONS Children with attention deficit hyperactivity disorder had lower levels of zinc, ferritin and magnesium than healthy children but had normal copper levels.
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Affiliation(s)
- Magdy M Mahmoud
- Pediatric department, Minia university, Minia city, Minia, postcode 61111, Egypt
| | | | - Reham M Maher
- Pediatric department, Minia university, Minia city, Minia, postcode 61111, Egypt
| | - Manal M Saber
- Clinical-pathology department, Minia university, Minia city, Minia, postcode 61111, Egypt
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Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most common behavioral disorders in children. Symptoms of ADHD include hyperactivity, low frustration tolerance, impulsivity, and inattention. While the biological pathways leading to ADHD are not clearly delineated, a number of genetic and environmental risk factors for the disorder are recognized. In the early 1970s, research conducted by Dr. Benjamin Feingold found that when hyperactive children were given a diet free of artificial food additives and dyes, symptoms of hyperactivity were reduced. While some clinical studies supported these findings, more rigorous empirical studies conducted over the next 20 years were less positive. As a result, research on the role of food additives in contributing to ADHD waned. In recent years, however, interest in this area has revived. In response to more recent research and public petitions, in December 2009 the British government requested that food manufacturers remove most artificial food dyes from their products. While these strictures could have positive effects on behavior, the removal of food dyes is not a panacea for ADHD, which is a multifaceted disorder with both biological and environmental underpinnings.
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Affiliation(s)
- Robin B Kanarek
- Department of Psychology, Tufts University, Medford, Massachusetts, USA.
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