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Gumma SD, Elotla SF, Ibrahim OY, Rizkalla NH. Nutrients patterns and attention deficit hyperactivity disorder among Egyptian children: a sibling and community matched case-control study. Eur J Clin Nutr 2024; 78:64-71. [PMID: 37752197 PMCID: PMC10774123 DOI: 10.1038/s41430-023-01345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Attention Deficit Hyperactive Disorder (ADHD) diagnosis has been growing among children, with great public health concern. The relationship between nutrient intake pattern and ADHD remains unclear. AIM To identify the nutrient intake patterns and its association with ADHD in children. SUBJECTS AND METHODS The study involved 146 children with ADHD, 141 control sibling, and 146 community controls. ADHD diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) criteria following the assessment by the long-form Conner's Scale. Dietary intakes were assessed using a semi-quantitative food frequency questionnaire. Nutrients patterns were identified using the principal component analysis (PCA). RESULTS ADHD children have significantly higher mean total energy intake than community controls and siblings (8867.9, 4481.9 and 7308.2 KJ, respectively, p < 0.001). Four nutrient patterns extracted by the PCA explained 75.9% of the total variance. Lower tertiles of "predominantly calcium-phosphorus; pattern 1" and "predominantly-vitamins; pattern 3" were significantly associated with increasing odds of ADHD, compared to community controls (p for trend: 0.002 and 0.005, respectively), while the same associations were noted in "predominantly-vitamins" and "predominantly Zinc-Iron; pattern 2" when compared to siblings (p for trend: <0.001 and <0.001, respectively). However, Higher tertiles of macronutrients; pattern 4" were associated with increased ADHD odds, compared to either community controls or siblings (p for trend: 0.017 and <0.001, respectively). CONCLUSION Lower intakes of nutrients patterns of minerals and vitamins, and higher intakes of macronutrients were associated with increased likelihood of ADHD in children.
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Affiliation(s)
- Samia Dahshan Gumma
- Department of Public Health, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Sally Fawzy Elotla
- Department of Public Health, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| | - Omneya Youssef Ibrahim
- Department of Neuropsychiatry, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Nadia Hosny Rizkalla
- Department of Public Health, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Zhang H, Li J, Li Y, Xu F, Wang M, Lin X, Li Y, Yang C, Cao Z, Xia W, Xu S. Sex-specific associations of early postnatal blood copper levels with neurodevelopment at 2 years of age. J Trace Elem Med Biol 2022; 74:127072. [PMID: 36174460 DOI: 10.1016/j.jtemb.2022.127072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 08/12/2022] [Accepted: 09/11/2022] [Indexed: 11/24/2022]
Abstract
Copper (Cu) is an essential trace element; however, it can be harmful in excess. Previous studies have shown that prenatal Cu levels may affect childhood neurodevelopment; however, studies focused on early postnatal Cu levels are limited. We studied 843 children born in Wuhan City and investigated the associations between early life Cu levels and neurodevelopment in 2-year-old children. Blood samples collected from children at 12 and 24 months of age were used to analyze Cu levels. Neurodevelopment was scored using the Bayley Scale of Children at 24 months of age. We found that a higher Cu level at 12 months of age was positively associated with mental development index (MDI) in boys (β = 6.75, 95 %CI: 1.12, 12.38). Further non-linear analysis showed an inverted U-shape association between Cu level at 20 months and PDI in boys, indicating that Cu levels may have an optimal concentration for neurodevelopment (p for overall association = 0.01, p for non-linear association < 0.01). In addition, all meaningful results mentioned above were observed only in boys, and a statistically significant sex-related modifying effect was observed (p < 0.05). In conclusion, this study repeated measures early life Cu levels and suggested sex-specific associations between early life Cu levels and neurodevelopment in 2-year-old children.
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Affiliation(s)
- Hongling Zhang
- Wuchang University of Technology, Wuhan, Hubei, PR China
| | - Juxiao Li
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
| | - Fenghua Xu
- Institute of Environmental Health, Wuhan Centers for Disease Prevention & Control, Wuhan, Hubei 430024, PR China.
| | - Meng Wang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xiaofang Lin
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Ying Li
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Chenhui Yang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Zhongqiang Cao
- Wuhan Medical & Healthcare Center for Women and Children, Wuhan 430000, Hubei, People's Republic of China
| | - Wei Xia
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Shunqing Xu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
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Tung PW, Burt A, Karagas M, Jackson BP, Punshon T, Lester B, Marsit CJ. Prenatal exposure to metal mixtures and newborn neurobehavior in the Rhode Island Child Health Study. Environ Epidemiol 2022; 6:e194. [PMID: 35169672 PMCID: PMC8835549 DOI: 10.1097/ee9.0000000000000194] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/05/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prenatal exposure to metals can affect the developing fetus and negatively impact neurobehavior. The associations between individual metals and neurodevelopment have been examined, but little work has explored the potentially detrimental neurodevelopmental outcomes associated with the combined impact of coexisting metals. The objective of this study is to evaluate prenatal metal exposure mixtures in the placenta to elucidate the link between their combined effects on newborn neurobehavior. METHOD This study included 192 infants with available placental metal and NICU Network Neurobehavioral Scale data at 24 hours-72 hours age. Eight essential and nonessential metals (cadmium, cobalt, copper, iron, manganese, molybdenum, selenium, zinc) detected in more than 80% of samples were tested for associations with atypical neurobehavior indicated by NICU Network Neurobehavioral Scale using logistic regression and in a quantile g-computation analysis to evaluate the joint association between placental metal mixture and neurobehavioral profiles. RESULTS Individually, a doubling of placental cadmium concentrations was associated with an increased likelihood of being in the atypical neurobehavioral profile (OR = 2.39; 95% CI = 1.05 to 5.71). In the mixture analysis, joint effects of a quartile increase in exposure to all metals was associated with 3-fold increased odds of newborns being assigned to the atypical profile (OR = 3.23; 95% CI = 0.92 to 11.36), with cadmium having the largest weight in the mixture effect. CONCLUSIONS Prenatal exposure to relatively low levels of a mixture of placental metals was associated with adverse newborn neurobehavior. Examining prenatal metal exposures as a mixture is important for understanding the harmful effects of concomitant exposures in the vulnerable populations.
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Affiliation(s)
- Pei Wen Tung
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA
| | - Amber Burt
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA
| | - Margaret Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | | | - Tracy Punshon
- Department of Biological Sciences, Dartmouth College, Hanover, NH
| | - Barry Lester
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
- The Brown Center of the Study of Children at Risk, Brown University, Providence, RI
| | - Carmen J. Marsit
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA
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Turan S, Tunctürk M, Çıray RO, Halaç E, Ermiş Ç. ADHD and Risk of Childhood Adiposity: a Review of Recent Research. Curr Nutr Rep 2021; 10:30-46. [PMID: 33400254 DOI: 10.1007/s13668-020-00346-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Attention deficit/hyperactivity disorder (ADHD) is considered as a risk factor for childhood adiposity and obesity. Studies on ADHD have provided limited data concerning the connections between eating habits, body mass index, and obesity. The purpose of this review was to examine the current literature regarding recent cohort and cross-sectional studies to determine the links between ADHD and childhood adiposity. RECENT FINDINGS Studies in this review were classified into dietary features, nutritional status, neuroimaging findings, genetic overlapping, behavioral, cognitive, and neurocognitive aspects that play a role in mediating and moderating the relationship between ADHD and obesity. While ADHD, childhood adiposity, and overweight/obesity co-occur in children and adolescents, this relationship is largely explained by a variety of multidirectional factors.
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Affiliation(s)
- Serkan Turan
- Department of Child and Adolescent Psychiatry, Tekirdağ State Hospital, Tekirdağ, Turkey.
| | - Mustafa Tunctürk
- Department of Child and Adolescent Psychiatry, Bakirkoy Mazhar Osman Psychiatric Hospital, Istanbul, Turkey
| | - Remzi Oğulcan Çıray
- Department of Child and Adolescent Psychiatry, Dokuz Eylül University Medical Faculty, Izmir, Turkey
| | - Eren Halaç
- Department of Child and Adolescent Psychiatry, Dokuz Eylül University Medical Faculty, Izmir, Turkey
| | - Çağatay Ermiş
- Department of Child and Adolescent Psychiatry, Dokuz Eylül University Medical Faculty, Izmir, Turkey
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5
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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: 31] [Impact Index Per Article: 7.8] [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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6
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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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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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8
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Mian A, Jansen PW, Nguyen AN, Bowling A, Renders CM, Voortman T. Children's Attention-Deficit/Hyperactivity Disorder Symptoms Predict Lower Diet Quality but Not Vice Versa: Results from Bidirectional Analyses in a Population-Based Cohort. J Nutr 2019; 149:642-648. [PMID: 30915449 DOI: 10.1093/jn/nxy273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/07/2018] [Accepted: 10/05/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND As an adjuvant for medication, dietary changes focused on specific nutrients have been proposed to prevent or reduce attention-deficit/hyperactivity disorder (ADHD) symptoms. However, whether an overall healthy dietary pattern is associated with ADHD symptom severity during childhood remains unclear. Furthermore, it is not clear what the direction of this association is. OBJECTIVES We aimed to examine the association between dietary patterns and ADHD symptoms in school-aged children. In addition, we aimed to identify the temporal direction of this association-that is, whether dietary patterns predict ADHD symptoms or vice versa. METHODS We analyzed data from 3680 children participating in the Generation R Study, a prospective cohort in Rotterdam, Netherlands. ADHD symptoms were assessed with parent-report questionnaires at ages 6 and 10 y using the Child Behavior Checklist. Dietary intake was assessed at the age of 8 y with a validated food-frequency questionnaire. We computed a diet quality score reflecting adherence to dietary guidelines. We examined bidirectional associations of diet quality with ADHD symptom scores using multivariable linear regression analysis and cross-lagged modeling. RESULTS Linear regressions showed that more ADHD symptoms at age 6 y were associated with a lower diet quality score at age 8 y (SD score = -0.08; 95% CI: -0.11, -0.05) but that diet quality at age 8 y was not associated with ADHD symptoms at age 10 y. Cross-lagged models confirmed a unidirectional relation from ADHD symptoms to diet quality but not vice versa. Associations did not differ by overweight status or between boys and girls. CONCLUSION Our study suggests that children with more ADHD symptoms may be at higher risk of an unhealthy diet but that overall diet quality does not affect ADHD risk.
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Affiliation(s)
- Annemiek Mian
- Departments of Epidemiology, Rotterdam, Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Pauline W Jansen
- Departments of Child and Adolescent Psychiatry/Psychology, Rotterdam, Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, Netherlands
| | - Anh N Nguyen
- Departments of Epidemiology, Rotterdam, Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, Netherlands
| | - April Bowling
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA.,Department of Health Sciences, Merrimack College, North Andover, MA
| | - Carry M Renders
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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9
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Yazici KU, Yazici IP, Ustundag B. Increased Serum Hepcidin Levels in Children and Adolescents with Attention Deficit Hyperactivity Disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:105-112. [PMID: 30690945 PMCID: PMC6361043 DOI: 10.9758/cpn.2019.17.1.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 12/27/2022]
Abstract
Objective In this study, we aimed to evaluate the serum hepcidin levels in attention deficit hyperactivity disorder (ADHD) patients that were newly diagnosed with no history of psychotropic drugs. Methods A total of 70 ADHD patients and 69 healthy controls were enrolled in our study. During the diagnosis, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version were applied. The sociodemographic data form, Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale, and Conners’ Rating Scales-Revised: Long Form were used for the clinical evaluation. Serum hepcidin levels were measured and compared between the groups. Results No significant difference between the groups in terms of age (p=0.533) and gender (p=0.397) was determined. In addition, the groups did not differ significantly for the other sociodemographic variables recorded. Serum hepcidin levels were found to be significantly higher in the patients with ADHD than healthy controls (p=0.019). Conclusion To the best of our knowledge, this study is the first to evaluate the total serum hepcidin levels in ADHD patients. Our study findings may suggest that high levels of hepcidin may cause iron dysregulation in ADHD patients. However, further studies are required to establish a definite conclusion.
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Affiliation(s)
- Kemal Utku Yazici
- Department of Child and Adolescent Psychiatry, Firat University Medical Faculty, Elazig, Turkey
| | - Ipek Percinel Yazici
- Department of Child and Adolescent Psychiatry, Firat University Medical Faculty, Elazig, Turkey
| | - Bilal Ustundag
- Department of Biochemistry, Firat University Medical Faculty, Elazig, Turkey
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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: 20] [Impact Index Per Article: 4.0] [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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Sha'ari N, Manaf ZA, Ahmad M, Rahman FNA. Nutritional status and feeding problems in pediatric attention deficit-hyperactivity disorder. Pediatr Int 2017; 59:408-415. [PMID: 27805287 DOI: 10.1111/ped.13196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 08/02/2016] [Accepted: 09/30/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children with attention deficit-hyperactivity disorder (ADHD) may be at risk of nutrient deficiency due to the inability to sit through meals. This comparative cross-sectional study was therefore carried out to determine the nutritional status and feeding problems of ADHD children aged 4-12 years. METHODS Sociodemographic data, anthropometric measurements and 3 day dietary intake record were collected from 54 ADHD children and 54 typical development (TD) children. The Behavioral Pediatrics Feeding Assessment Scale was used to assess feeding problems. RESULTS Mean subject age was 8.6 ± 2.1 years. On anthropometric assessment, 11.1% of the ADHD children had wasting, while 1.9% had severe wasting. In contrast, none of the TD children had wasting. Approximately 5.6% of the ADHD children had stunting, as compared with 3.7% of the TD children, while none of the TD children had severe stunting compared with 3.7% of the ADHD children. More than half of the ADHD children had mid-upper arm circumference (MUAC) below the 5th percentile, indicating undernutrition, compared with only 35.2% of TD children. More than one-third of the ADHD children had feeding problems compared with 9.3% of TD children. There was a significant negative relationship between the ADHD children's feeding problems and bodyweight (r = -0338, P = 0.012), body mass index (r = -0322, P = 0.017) and MUAC (r = -0384, P = 0.004). CONCLUSION Almost half of the ADHD children had suboptimal nutrition compared with 11.1% of the TD children. It is imperative to screen ADHD children for nutritional status and feeding problems to prevent negative health impacts later on.
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Affiliation(s)
- Norsuhaila Sha'ari
- Department of Dietetics and Food Service, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Dietetic Department, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Mahadir Ahmad
- Health Psychology Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Fairuz Nazri Abd Rahman
- Psychiatry Department, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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12
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Elbaz F, Zahra S, Hanafy H. Magnesium, zinc and copper estimation in children with attention deficit hyperactivity disorder (ADHD). EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2017. [DOI: 10.1016/j.ejmhg.2016.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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13
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Ríos-Hernández A, Alda JA, Farran-Codina A, Ferreira-García E, Izquierdo-Pulido M. The Mediterranean Diet and ADHD in Children and Adolescents. Pediatrics 2017; 139:peds.2016-2027. [PMID: 28138007 DOI: 10.1542/peds.2016-2027] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Although attention-deficit/hyperactivity disorder (ADHD) has been related to nutrient deficiencies and "unhealthy" diets, to date there are no studies that examined the relationship between the Mediterranean diet and ADHD. We hypothesized that a low adherence to a Mediterranean diet would be positively associated with an increase in ADHD diagnosis. METHODS A total of 120 children and adolescents (60 with newly diagnosed ADHD and 60 controls) were studied in a sex- and age-matched case-control study. ADHD diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Energy, dietary intake, adherence to a Mediterranean diet, and familial background were measured. Logistic regression was used to determine associations between the adherence to a Mediterranean diet and ADHD. RESULTS Lower adherence to a Mediterranean diet was associated with ADHD diagnosis (odds ratio: 7.07; 95% confidence interval: 2.65-18.84; relative risk: 2.80; 95% confidence interval: 1.54-5.25). Both remained significant after adjusting for potential confounders. Lower frequency of consuming fruit, vegetables, pasta, and rice and higher frequency of skipping breakfast and eating at fast-food restaurants were associated with ADHD diagnosis (P < .05). High consumption of sugar, candy, cola beverages, and noncola soft drinks (P < .01) and low consumption of fatty fish (P < .05) were also associated with a higher prevalence of ADHD diagnosis. CONCLUSIONS Although these cross-sectional associations do not establish causality, they raise the question of whether low adherence to a Mediterranean diet might play a role in ADHD development. Our data support the notion that not only "specific nutrients" but also the "whole diet" should be considered in ADHD.
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Affiliation(s)
| | - José A Alda
- ADHD Unit, Child and Adolescent Psychiatry Department, Hospital Sant Joan de Deu, Barcelona, Spain; and
| | | | - Estrella Ferreira-García
- ADHD Unit, Child and Adolescent Psychiatry Department, Hospital Sant Joan de Deu, Barcelona, Spain; and.,Personality, Evaluation, and Psychological Treatment, University of Barcelona, Barcelona, Spain
| | - Maria Izquierdo-Pulido
- Departments of Nutrition, Food Science, and Gastronomy, and .,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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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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Kern JK, Geier DA, Sykes LK, Geier MR, Deth RC. Are ASD and ADHD a Continuum? A Comparison of Pathophysiological Similarities Between the Disorders. J Atten Disord 2015; 19:805-27. [PMID: 23074304 DOI: 10.1177/1087054712459886] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The objective of this study was to review and compare the similarities between autism spectrum disorder (ASD) and ADHD with regard to symptomatology, neurological deficits, metabolic and endocrine-related conditions, and brain pathology. METHOD A comprehensive review of the relevant research literature was carried out. RESULTS A number of important similarities between ASD and ADHD were identified, including recent increases in prevalence, male-biased incidence, shared involvement of sensory processing, motor and impulse control, abnormal patterns of neural connectivity, and sleep disturbances. Studies suggest involvement of androgen metabolism, impaired methylation, and heavy metal toxicity as possible contributing factors for both disorders. CONCLUSION ASD and ADHD share a number of features and pathophysiological conditions, which suggests that the two disorders may be a continuum and have a common origin.
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Affiliation(s)
- Janet K Kern
- Institute of Chronic Illnesses, Inc., Silver Spring, MD, USA University of Texas Southwestern Medical Center at Dallas, TX, USA
| | - David A Geier
- Institute of Chronic Illnesses, Inc., Silver Spring, MD, USA
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16
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Himmerich H, Erbguth F. [Nutrition and dietary supplements in psychiatric diseases]. DER NERVENARZT 2015; 85:1512-20. [PMID: 25421417 DOI: 10.1007/s00115-014-4163-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Nutrition and specific nutritional supplements can have prophylactic or therapeutic properties with respect to certain psychiatric disorders. A traditional Mediterranean diet, for example, seems to have prophylactic benefits against depression and dementia, whereas overeating and obesity increase the risk for both.Although evidence for nutritional supplements in the treatment of psychiatric disorders is not sufficient for general recommendations, data from observational studies and randomized controlled trials (RCT) seem to point to their use for specific indications. Folate, S-adenosylmethionine (SAM) and eicosapentaenoic acid (EPA), for instance, seem to have antidepressant properties, zinc may be beneficial in attention deficit hyperactivity disorder (ADHD), vitamin B6 (pyridoxine) could reduce extrapyramidal side effects of antipsychotics and N-acetylcysteine (NAC) seems to be effective against negative symptoms, abnormal movements and akathisia in schizophrenia.Psychiatric disorders, in turn, may lead to deficiency of mineral nutrients and vitamins. For instance, vitamin B1 (thiamine) deficiency is common in alcohol-dependent patients and should therefore be considered during withdrawal treatment. Although vitamin malnutrition is uncommon in developed countries, vitamin deficiency syndromes, such as pernicious anemia or Wernicke's encephalopathy are still relevant differential diagnoses.Some psychopharmacological drugs may additionally change the nutritional habits of the patients in an unfavorable way leading to weight gain and obesity and the risk for further psychiatric problems.
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Affiliation(s)
- H Himmerich
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland,
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Abstract
BACKGROUND Complementary and alternative medicine (CAM) in psychiatry or integrative psychiatry covers a wide range of biological, psychological and mind-body treatments that enhance standard medical practices and patient outcomes. While CAM approaches are popular amongst patients in their practice as well as in self-report because of their ease of use, health professionals have received limited education in these interventions and often are unaware of their patients' use of CAM treatments. METHOD This overview highlights evidence-based CAM treatments for attention deficit hyperactivity disorder (ADHD) including dietary interventions, phytomedicines, mind-body practices and neurofeedback. RESULTS While conventional treatments are the mainstays for ADHD, there are a large number of available treatments that can be used to enhance treatment response. CONCLUSION With improved education and further scientific and clinical research, validated integrative treatments will provide more effective, lower risk and lower cost care for patients with ADHD.
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Affiliation(s)
- Anup Sharma
- University of Pennsylvania School of Medicine, USA
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Macedoni-Lukšič M, Gosar D, Bjørklund G, Oražem J, Kodrič J, Lešnik-Musek P, Zupančič M, France-Štiglic A, Sešek-Briški A, Neubauer D, Osredkar J. Levels of metals in the blood and specific porphyrins in the urine in children with autism spectrum disorders. Biol Trace Elem Res 2015; 163:2-10. [PMID: 25234471 DOI: 10.1007/s12011-014-0121-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/03/2014] [Indexed: 12/27/2022]
Abstract
The aim of the present study was to determine the levels of metals in blood (zinc (Zn), copper (Cu), aluminium (Al), lead (Pb) and mercury (Hg)), as well as the specific porphyrin levels in the urine of patients with autism spectrum disorder (ASD) compared with patients with other neurological disorders. The study was performed in a group of children with ASD (N = 52, average age = 6.2 years) and a control group of children with other neurological disorders (N = 22, average age = 6.6 years), matched in terms of intellectual abilities (Mann-Whitney U = 565.0, p = 0.595). Measurement of metals in blood was performed by atomic absorption spectrometry, while the HPLC method via a fluorescence detector was used to test urinary porphyrin levels. Results were compared across groups using a multivariate analysis of covariance (MANCOVA). In addition, a generalized linear model was used to establish the impact of group membership on the blood Cu/Zn ratio. In terms of blood levels of metals, no significant difference between the groups was found. However, compared to the control group, ASD group had significantly elevated blood Cu/Zn ratio (Wald χ (2) = 6.6, df = 1, p = 0.010). Additionally, no significant difference between the groups was found in terms of uroporphyrin I, heptacarboxyporphyrin I, hexacarboxyporphyrin and pentacarboxyporphyrin I. However, the levels of coproporphyrin I and coproporphyrin III were lower in the ASD group compared to the controls. Due to observed higher Cu/Zn ratio, it is suggested to test blood levels of Zn and Cu in all autistic children and give them a Zn supplement if needed.
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Villagomez A, Ramtekkar U. Iron, Magnesium, Vitamin D, and Zinc Deficiencies in Children Presenting with Symptoms of Attention-Deficit/Hyperactivity Disorder. CHILDREN (BASEL, SWITZERLAND) 2014; 1:261-79. [PMID: 27417479 PMCID: PMC4928738 DOI: 10.3390/children1030261] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 08/12/2014] [Accepted: 08/21/2014] [Indexed: 12/31/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder increasing in prevalence. Although there is limited evidence to support treating ADHD with mineral/vitamin supplements, research does exist showing that patients with ADHD may have reduced levels of vitamin D, zinc, ferritin, and magnesium. These nutrients have important roles in neurologic function, including involvement in neurotransmitter synthesis. The aim of this paper is to discuss the role of each of these nutrients in the brain, the possible altered levels of these nutrients in patients with ADHD, possible reasons for a differential level in children with ADHD, and safety and effect of supplementation. With this knowledge, clinicians may choose in certain patients at high risk of deficiency, to screen for possible deficiencies of magnesium, vitamin D, zinc, and iron by checking RBC-magnesium, 25-OH vitamin D, serum/plasma zinc, and ferritin. Although children with ADHD may be more likely to have lower levels of vitamin D, zinc, magnesium, and iron, it cannot be stated that these lower levels caused ADHD. However, supplementing areas of deficiency may be a safe and justified intervention.
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Affiliation(s)
- Amelia Villagomez
- University of Arizona, 2800 E. Ajo Way Suite 300, Tucson, AZ 85713, USA.
| | - Ujjwal Ramtekkar
- Mercy Children's Hospital, 621 S. New Ballas Road, Suite 693A, Saint Louis, MO 63141, USA.
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Durá-Travé T, Gallinas-Victoriano F. Caloric and nutrient intake in children with attention deficit hyperactivity disorder treated with extended-release methylphenidate: analysis of a cross-sectional nutrition survey. JRSM Open 2014; 5:2042533313517690. [PMID: 25057372 PMCID: PMC4012651 DOI: 10.1177/2042533313517690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives To study calorie and nutrients intake in a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) under treatment with extended-release methylphenidate (MPH-ER), and to analyse the need to design nutrition intervention strategies. Design Observational (case-control). Setting Navarra Hospital Complex, Pamplona, Spain. Participants A total of 100 patients diagnosed with ADHD under treatment with MPH-ER and 100 healthy children (control group). Main outcome measures A nutrition survey was carried out (food intake registration of 3 consecutive school days). Calorie and nutrient intake, as well as nutrition status, were evaluated and compared in both groups. Results Nutritional status in ADHD group was significantly lower (p < 0.05) than in control group. Calorie intake in mid-morning snack, lunch and afternoon snack was significantly higher (p < 0.05) in the control group. Calorie intake in supper was significantly higher (p < 0.05) in the ADHD group. There were no significant differences in breakfast. Total calorie intake, as well as protein, carbohydrates, fat, fibre, calcium, iron, magnesium, zinc, selenium and phosphorous, thiamine, niacin, vitamin B6 and folate intake, in control group was significantly higher than in ADHD group. Conclusions The daily calorie and nutrients intake in patients under treatment with MPH-ER is, generally, lower than in healthy population of similar age. The need to impart programmes of nutrition education simultaneously with multimodal treatment in order to avoid the nutrition consequences of treatment with MPH should be considered.
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Affiliation(s)
- Teodoro Durá-Travé
- Department of Pediatrics, Faculty of Medicine, University of Navarra, Pamplona, Spain ; Department of Pediatrics, Navarra Hospital Complex, Pamplona, Spain
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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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22
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Pfaender S, Grabrucker AM. Characterization of biometal profiles in neurological disorders. Metallomics 2014; 6:960-77. [DOI: 10.1039/c4mt00008k] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This review summarizes the findings on dysregulation of metal ions in neurological diseases and tries to develop and predict specific biometal profiles.
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Affiliation(s)
| | - Andreas M. Grabrucker
- Institute for Anatomy and Cell Biology
- Ulm University
- Ulm, Germany
- WG Molecular Analysis of Synaptopathies
- Neurology Dept
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McKeown C, Hisle-Gorman E, Eide M, Gorman GH, Nylund CM. Association of constipation and fecal incontinence with attention-deficit/hyperactivity disorder. Pediatrics 2013; 132:e1210-5. [PMID: 24144702 PMCID: PMC4530301 DOI: 10.1542/peds.2013-1580] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Functional constipation and fecal incontinence are common childhood gastrointestinal conditions. Both conditions may be associated with behavioral problems. Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral disorder of childhood, characterized by shortened attention span and hyperactivity. We hypothesize that a diagnosis of ADHD increases the risk for functional constipation and fecal incontinence. METHODS A retrospective cohort study of children was performed by using the military health system database. Children of active-duty military personnel, aged 4 to 12 years, from October 2005 to September 2007, were included. ADHD, constipation, and fecal incontinence were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Relative risks and adjusted incidence rate ratios (IRRs) were calculated. A subgroup analysis of subjects receiving medical therapy was performed. RESULTS There were 742,939 children identified in the study, 32,773 (4.4%) of whom had ADHD. Children with ADHD had an increased prevalence of constipation (4.1% of children with ADHD vs 1.5% children without ADHD; P < .001) and fecal incontinence (0.9% of children with ADHD vs 0.15% of children without ADHD; P < .0001). Children with ADHD had more visits than those without ADHD for both constipation (IRR 3.39; 95% confidence interval 2.59-4.43) and fecal incontinence (IRR 7.74; 95% confidence interval 5.01-11.98). Children with ADHD receiving medicinal therapy did not differ significantly from children with ADHD not receiving medicinal therapy on rates of constipation visits (P = .57) or fecal incontinence visits (P = .32). CONCLUSIONS Children with ADHD are significantly more likely to have constipation and fecal incontinence. Medical therapy for ADHD does not impact visit rates for defecation disorders.
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Affiliation(s)
- Connor McKeown
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814.
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Durá Travé T, Diez Bayona V, Yoldi Petri ME, Aguilera Albesa S. [Dietary patterns in patients with attention deficit hyperactivity disorder]. An Pediatr (Barc) 2013; 80:206-13. [PMID: 23830679 DOI: 10.1016/j.anpedi.2013.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the dietary patterns in a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) and under treatment with extended-release methylphenidate (MPH-ER). MATERIAL AND METHODS A nutrition survey (food intake recall for three consecutive days) was carried out on 100 patients diagnosed with ADHD and under treatment with MPH-ER, and in 150 healthy children (control group). Calorie and nutrient intake, as well as nutrition status, were evaluated and compared in both groups. RESULTS The mean MPH-ER dose was 1.02 mg/kg/day. Nutritional status in the ADHD group was significantly lower (P < .05) than in control group. The consumption of cereals, meat, pulses and fruits in the control group was significantly higher (P < .05) than in ADHD group. Calorie intake in the mid-morning snack, lunch and afternoon snack was significantly higher (P < .05) in the control group. Calorie intake at supper was significantly higher (P < .05) in the ADHD group. Total calorie intake, as well as protein, carbohydrates, fat, fibre, calcium, iron, magnesium, zinc, selenium and phosphorous, thiamine, niacin, vitamin B6 and folate intake in the control group was significantly higher than in ADHD group. CONCLUSIONS Treatment with MPH-ER substantially modifies the percentage distribution of calorie intake of the different meals. The daily calorie and nutrients intake in patients under treatment with MPH-ER is, generally, lower than in the healthy population of a similar age. Nutrition education should be provided, along with multimodal treatment, to the patients and/or their families.
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Affiliation(s)
- T Durá Travé
- Unidad de Neuropediatría, Complejo Hospitalario de Navarra, Pamplona, España.
| | - V Diez Bayona
- Unidad de Neuropediatría, Complejo Hospitalario de Navarra, Pamplona, España
| | - M E Yoldi Petri
- Unidad de Neuropediatría, Complejo Hospitalario de Navarra, Pamplona, España
| | - S Aguilera Albesa
- Unidad de Neuropediatría, Complejo Hospitalario de Navarra, Pamplona, España
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Froehlich TE, Anixt JS, Loe IM, Chirdkiatgumchai V, Kuan L, Gilman RC. Update on environmental risk factors for attention-deficit/hyperactivity disorder. Curr Psychiatry Rep 2011; 13:333-44. [PMID: 21779823 PMCID: PMC3277258 DOI: 10.1007/s11920-011-0221-3] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurobehavioral disorder affecting 5% to 10% of children. Although considered to be a highly familial disorder, ADHD heritability estimates of 60% to 80% highlight the considerable role that environmental factors may still play in disorder susceptibility. Proposed ADHD environmental risk factors include prenatal substance exposures, heavy metal and chemical exposures, nutritional factors, and lifestyle/psychosocial factors. This paper reviews the literature published in 2010 investigating the association between environmental risk factors and ADHD or related symptomatology. Sources of risk factor exposure and the proposed mechanism by which each exposure is linked to ADHD-related neurobehavioral changes are also reported. Methodologic limitations of the current literature are discussed, and guidelines for future study are proposed. An improved understanding of the role that environmental factors play in ADHD etiology is critical to future ADHD prevention efforts.
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Affiliation(s)
- Tanya E. Froehlich
- Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH 45229, USA
| | - Julia S. Anixt
- Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH 45229, USA
| | - Irene M. Loe
- Stanford University School of Medicine, 750 Welch Road, Suite 315, Palo Alto, CA 94304, USA
| | | | - Lisa Kuan
- Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH 45229, USA
| | - Richard C. Gilman
- Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH 45229, USA
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