Body Mass Indices of Girls with and without ADHD: Developmental Trajectories from Childhood to Adulthood

Risk of Overweight and Obesity in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis

This study was performed to explore the association between attention-deficit/hyperactivity disorder (ADHD) and the risk of overweight/obesity in both children and adolescents. The PubMed, Web of Science, and Cochrane Library databases were searched for relevant studies published before July 12, 2022. Studies with data for calculating the odds ratio (OR) of childhood overweight/obesity and ADHD were included. The literature value was assessed by the cross-sectional evaluation criteria proposed by the Agency for Healthcare Research and Quality (AHRQ). All analyses were conducted using StataSE 11 and RevMan 5.3 software with random-effects models. This review included a total of 16 studies covering 14,981 cases and 128,916 controls.According to the meta-analysis, children with ADHD had a significant risk for co-occurring overweight and obesity [OR 1.56; 95% confidence intervals (CI) 1.32-1.85], especially boys (OR 1.45; 95% CI 1.10-1.90), people in Asia (OR 3.25; 95% CI 1.70-6.21) and Europe (OR 1.85; 95% CI 1.61-2.12), and patients not using medication (OR 1.54; 95% CI 1.22-1.94).ADHD has a significant association with overweight and obesity in both children and adolescents, which may be altered by factors such as geography, gender, and medication use. Timely treatment should be provided to children and adolescents diagnosed with ADHD to inhibit the emergence of overweight and obesity.

Hyperactivity in preschool age is associated with higher fat-free mass and healthy lifestyle behaviours five years later: A longitudinal study of Swedish children

BACKGROUND

There is evidence for a link between hyperactivity and obesity, especially among older children. Both conditions seem to be multifactorial in origin and hypotheses of common underlying issues, such as emotional dysregulation, have been suggested. However, studies of the co-occurrence of the two conditions in younger age groups have been inconclusive.

OBJECTIVES

We aimed to study the longitudinal associations of psychological strengths and difficulties at 4 years of age with health behaviours, body composition, physical fitness, and cardiovascular disease (CVD) risk factors 5 years later.

METHODS

Parents of 226 4-year-old children filled out the Strengths and Difficulties Questionnaire (SDQ). At 9 years of age, we assessed health behaviours, physical fitness, body composition, and CVD risk factors. Associations were examined with linear regression models that were adjusted for sex, age of the child at 9, and maternal education.

RESULTS

In the adjusted models, hyperactivity at 4 was associated with higher fat-free mass (β = 0.18, p = 0.007) and lower levels of sedentary behaviour (β -0.14, p = 0.043) at 9 years. Furthermore, greater emotional problems at 4 were associated with lower intake of fruit and vegetables (β -0.14, p = 0.038) at 9 years. However, there were no statistically significant associations between psychological difficulties and fat-mass index.

CONCLUSIONS

Our novel data provide no evidence of an association between hyperactivity in preschool age and obesity or obesity-related behaviours in school age. Future studies examining how psychological factors relate to obesity development should consider a developmental perspective.

Attention-deficit/hyperactivity disorder symptoms and subsequent cardiometabolic disorders in adults: investigating underlying mechanisms using a longitudinal twin study

BACKGROUND

Emerging research suggests that attention-deficit/hyperactivity disorder (ADHD) increases the risk for cardiovascular (CVDs) and metabolic disorders (i.e., cardiometabolic disorders) in adulthood. Yet, available studies are scarce and have mainly been focused on individuals receiving clinical ADHD diagnoses. We aimed to investigate the prospective associations of ADHD symptoms in young and mid-adulthood with subsequent cardiometabolic disorders and the underlying mechanisms.

METHODS

We studied 10,394 twins from the Swedish Twin Registry (STR), born between 1958 and 1985 without previous medical history of cardiometabolic disorders. They provided self-assessment of ADHD symptoms (score range 0-36) via a validated, DSM-IV-based scale in a web-based questionnaire/telephone interview within the Study of Twin Adults: Genes and Environment (STAGE), in 2005-2006 (aged 19-47 years), and were followed until the end of 2018 (33-59 years) to identify incident clinical diagnoses/medication prescriptions for cardiometabolic disorders acquired from Swedish national registers. We used Cox regression models to investigate the associations between ADHD symptoms score and cardiometabolic outcomes, with and without adjustment for relevant covariates, and a co-twin control design to study familial confounding.

RESULTS

A one-unit increase in the level of ADHD symptoms was associated with a 2% increase in the rate of CVDs (hazard ratio [HR] = 1.02, 95% confidence interval 1.01-1.04) and a 3% increase in the rate of metabolic disorders (HR = 1.03, 1.02-1.05), after adjusting for birth year and sex. The associations were no longer significant after adjusting for educational attainment, lifestyle factors, and comorbid psychiatric disorders. The associations remained significant after adjusting for familial factors shared by dizygotic twin pairs but became nonsignificant after adjusting for factors shared by monozygotic twin pairs. However, the strength of the associations attenuated significantly in monozygotic twins compared to dizygotic twins for CVDs only, suggesting genetic confounding.

CONCLUSIONS

ADHD symptom score is associated with a higher risk for cardiometabolic disorders, which may be explained by lower educational attainment, adverse lifestyle factors, and psychiatric comorbidities. Moreover, the associations appear to be partly confounded by shared genetic factors, especially for CVDs. Further research is needed to investigate the identified associations at the level of individual cardiometabolic disorders and to follow-up participants until a more advanced older age.

Shared Genetic Factors Contributing to the Overlap between Attention-Deficit/Hyperactivity Disorder Symptoms and Overweight/Obesity in Swedish Adolescent Girls and Boys

Attention-deficit/hyperactivity disorder (ADHD) and obesity are positively associated, with increasing evidence that they share genetic risk factors. Our aim was to examine whether these findings apply to both types of ADHD symptoms for female and male adolescents. We used data from 791 girl and 735 boy twins ages 16-17 years to examine sex-specific phenotypic correlations between the presence of ADHD symptoms and overweight/obese status. For correlations exceeding .20, we then fit bivariate twin models to estimate the genetic and environmental correlations between the presence of ADHD symptoms and overweight/obese status. ADHD symptoms and height/weight were parent- and self-reported, respectively. Phenotypic correlations were .30 (girls) and .08 (boys) for inattention and overweight/obese status and .23 (girls) and .14 (boys) for hyperactivity/impulsivity and overweight/obese status. In girls, both types of ADHD symptoms and overweight/obese status were highly heritable, with unique environmental effects comprising the remaining variance. Furthermore, shared genetic effects explained most of the phenotypic correlations in girls. Results suggest that the positive association of both types of ADHD symptoms with obesity may be stronger in girls than boys. Further, in girls, these associations may stem primarily from shared genetic factors.

Bidirectional prediction between weight status and executive function in children and adolescents: A systematic review and meta-analysis of longitudinal studies

This study examined the predictability of child weight status on executive function (EF) and vice versa. We searched PubMed, CINAHL, Web of Science, and EMBASE for longitudinal studies conducted in children and adolescents on October 31, 2021. A pairwise meta-analysis was performed using a frequentist random-effects approach. The quality of all included studies was evaluated using Newcastle-Ottawa Scale and GRADE assessments. This study included 18 longitudinal studies (N = 30,101). Overall executive functioning was a significant negative predictor of child weight status (pooled beta coefficient = -0.14; 95% confidence interval [CI] [-0.22 to -0.07]; I²  = 97%). The pooled odds ratio also revealed that high EF children had a significant lower risk for developing overweight/obesity (odds ratio [OR] = 0.72; 95% CI [0.59 to 0.87]; I²  = 72%). Conversely, child weight status was a significant negative predictor of overall executive functioning (pooled beta coefficient = -0.06; 95% CI [-0.12 to -0.01]; I²  = 81%). These results suggest a bidirectional prediction between child weight status and EF. These predictabilities are low but potentially beneficial for implementation in childcare systems.

Non-mental diseases associated with ADHD across the lifespan: Fidgety Philipp and Pippi Longstocking at risk of multimorbidity?

Several non-mental diseases seem to be associated with an increased risk of ADHD and ADHD seems to be associated with increased risk for non-mental diseases. The underlying trajectories leading to such brain-body co-occurrences are often unclear - are there direct causal relationships from one disorder to the other, or does the sharing of genetic and/or environmental risk factors lead to their occurring together more frequently or both? Our goal with this narrative review was to provide a conceptual synthesis of the associations between ADHD and non-mental disease across the lifespan. We discuss potential shared pathologic mechanisms, genetic background and treatments in co-occurring diseases. For those co-occurrences for which published studies with sufficient sample sizes exist, meta-analyses have been published by others and we discuss those in detail. We conclude that non-mental diseases are common in ADHD and vice versa and add to the disease burden of the patient across the lifespan. Insufficient attention to such co-occurring conditions may result in missed diagnoses and suboptimal treatment in the affected individuals.

The Cognitive, Ecological, and Developmental Origins of Self-Disturbance in Borderline Personality Disorder

Self-disturbance is recognized as a key symptom of Borderline Personality Disorder (BPD). Although it is the source of significant distress and significant costs to society, it is still poorly specified. In addition, current research and models on the etiology of BPD do not provide sufficient evidence or predictions about who is at risk of developing BPD and self-disturbance, and why. The aim of this review is to lay the foundations of a new model inspired by recent developments at the intersection of social cognition, behavioral ecology, and developmental biology. We argue that the sense of agency is an important dimension to consider when characterizing self-disturbances in BPD. Second, we address the poorly characterized relation between self-disturbances and adverse life conditions encountered early in life. We highlight the potential relevance of Life-History Theory-a major framework in evolutionary developmental biology-to make sense of this association. We put forward the idea that the effect of early life adversity on BPD symptomatology depends on the way individuals trade their limited resources between competing biological functions during development.