Associations between Attention-Deficit Hyperactivity Disorder (ADHD) Treatment and Patient Nutritional Status and Height

Effect of methylphenidate on height in pediatric attention-deficit hyperactivity disorder patients: a systematic review and meta-analysis

Methylphenidate (MPH), a first-line treatment for attention-deficit hyperactivity disorder (ADHD) management, has been the focus of debate for decades regarding its effect on growth. The aim of this PRISMA meta-analysis was to determine the effect of MPH on height in children/adolescents with ADHD and its predictive factors based on literature reports. Available full-text articles were systematically reviewed to identify clinical studies of pediatric ADHD patients with height Z-score (HZS) data for monotherapy MPH-treated and non-treated groups. We estimated standardized mean differences (SMDs) of HZS or its changes from baseline (ΔHZS) between groups, then identified associated factors through subgroup analyses and meta-regression. For before-after treatment studies, the paired standard errors of ΔHZS were re-estimated to demonstrate in the forest plot. Risk of bias was analyzed using the Newcastle-Ottawa Scale. Among the 29 eligible studies, 26 reported ΔHZS with self-control groups, and ΔHZS or absolute HZS were compared to other external controls in 11 studies. A significant reduction was observed between post-MHP and pre-MPH use, with high heterogeneity (SMD =  - 0.40; 95% confidence interval = [ - 0.54,  - 0.27]; I2 = 91%). The study region, ADHD subtype, and stimulant-naïve status of patients at baseline may modify the effect on HZS. Because of the high clinical heterogeneity in observational studies, clinicians should consider the negative effect of MPH on height in ADHD patients by determining whether patients fulfill appropriate high-risk criteria. Further well-designed longitudinal studies are required to better quantify this effect, especially with prolonged treatment.

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.

Anthropometric status of preschoolers and elementary school children with ADHD: preliminary results from the EPINED study

BACKGROUND

A current area of research interest is the association between ADHD and weight status. This paper aimed to describe the anthropometric status of school children with ADHD, considering age and clinical presentation (inattentive, hyperactive-impulsive, or combined), compared with control children.

METHODS

Participants came from the "Epidemiological Research Project on Neurodevelopmental Disorders" and consisted of 198 preschoolers (41 with ADHD) and 389 elementary school children (163 with ADHD). ADHD was diagnosed using DSM-5 criteria. Anthropometric measurements were taken at various anatomical points, and height, weight, and body composition were also measured.

RESULTS

In preschoolers, an association was found between hyperactive-impulsive ADHD and greater height and lower waist-to-height ratio. In elementary school children, regardless of the medication, combined ADHD was associated with smaller head, hip, arm, and thigh circumferences and lower weight, height, and BMI. A total of 19.7% of them were underweight. In contrast, children with inattentive and hyperactive/impulsive presentations presented the highest percentage of overweight/obesity (56%).

CONCLUSION

The anthropometric status of the school children with ADHD showed differences in terms of age and presentation. Preschoolers with hyperactive-impulsive ADHD are taller, and elementary school children with combined ADHD are shorter and smaller than their age-matched control peers.

IMPACT

The anthropometric status of the school children with ADHD showed differences in terms of age and presentation. Preschoolers with hyperactive-impulsive ADHD are taller than their control peers. Elementary school children with combined ADHD, regardless of the pharmacological treatment, are shorter and smaller than their control peers. Medication may anthropometrically affect the height of children with inattentive presentation. Anthropometric and dietary monitoring should be recommended to parents of children with ADHD, with and without medication.

[Physical growth and dietary characteristics of children with attention deficit hyperactivity disorder: a cross-sectional study]

OBJECTIVES

To investigate the physical growth and dietary characteristics of children with attention deficit hyperactivity disorder (ADHD), and to analyze their relationship with core symptoms of ADHD.

METHODS

A total of 268 children who were newly diagnosed with ADHD in Children's Hospital of Nanjing Medical University from June to December 2020 were included in the ADHD group, and 102 healthy children who underwent physical examination during the same period were selected as the control group. Physical evaluations and dietary surveys were conducted for both groups. ADHD diagnosis and scoring were performed according to the Diagnostic and Statistical Manual of Mental Disorders (5th edition). Factor analysis, Spearman correlation analysis, and mediation analysis were used to study the relationship between core symptoms of ADHD, dietary patterns, and physical growth.

RESULTS

The rate of overweight/obesity in the ADHD group was significantly higher than that in the control group (35.8% vs 21.6%, P<0.05). Three dietary patterns were extracted from the food frequency questionnaire: vegetarian dietary pattern, traditional dietary pattern, and snack/fast food pattern. The factor score for the snack/fast food pattern in the ADHD group was higher than that in the control group (P<0.05). There was a significant positive correlation between ADHD symptom scores, snack/fast food pattern factor scores, and body fat percentage (P<0.05). The mediation analysis showed that the snack/fast food pattern played a partial mediating role in the relationship between ADHD symptom scores and body fat percentage, with a mediation proportion of 26.66%.

CONCLUSIONS

The rate of overweight/obesity in children with ADHD is higher than that in non-ADHD children. Core symptoms of ADHD are related to dietary patterns and physical growth, with the snack/fast food pattern playing a partial mediating role in the relationship between core symptoms of ADHD and physical growth.

Prevalence of obesity in treated and untreated patients with attention deficit hyperactivity disorder: A meta-analysis

OBJECTIVES

To discuss and summarize the scholarly published literature on the difference in obesity rate in treated and untreated attention deficit hyperactivity disorder (ADHD) patients to evaluate the influence of ADHD medication on weight status in these individuals.

METHODS

PubMed, Cochrane Library, and Google Scholar databases were searched for eligible articles from January to December 2020 using the following medical subject headings (MeSH) terms: "attention deficit hyperactivity disorder and other hyperactivity disorders", "obesity and overweight", "obesity treatment".

RESULTS

A total of 19,449 study participants included in selected 8 studies were assessed with respect to the prevalence of obesity in medicated and unmedicated subgroups of ADHD patients. The total number of ADHD patients with the prescribed medication was 10,279, while the number of unmedicated ADHD patients was 9,170. The odds ratio was 0.65 with a 95% confidence interval of 0.50 to 0.84 favoring regular medical treatment for management of obesity in case of patients with ADHD.

CONCLUSION

The prevalence of obesity observed in treated ADHD patients was significantly lower compared to that in unmedicated patients. This result suggests that the treatment is not only important for controlling ADHD manifestations but is also associated with lower body mass index. Therefore, further prospective studies with large sample size are required for controlling the confounding factors such as comorbidities and medication status.

Half of the children with overweight or obesity and attention-deficit/hyperactivity disorder reach normal weight with stimulants

AIM

Treatment of childhood obesity is often insufficient and may be aggravated by high co-occurrence of attention-deficit/hyperactivity disorder (ADHD). We aimed to investigate whether children with overweight or obesity normalised in weight when receiving stimulant treatment for ADHD.

METHODS

Growth data of 118 children were obtained from medical records at outpatient paediatric and children's psychiatric services in the Gothenburg area, Sweden. The children were diagnosed with ADHD and were between 6 and 17 years at the start of stimulant treatment. The pre-treatment data act as an internal control where every child is their own control.

RESULTS

At the start of treatment, 74 children had normal weight and 44 had either overweight or obesity. During the year with stimulants, the mean (SD) body mass index (BMI) in standard deviation score (SDS) decreased significantly: -0.72 (0.66) compared with 0.17 (0.43) during the year before treatment (p < 0.01). After one year with treatment, 43% of those with overweight or obesity had reached normal weight.

CONCLUSIONS

Stimulant treatment for ADHD yields significant weight loss. In children with overweight or obesity and ADHD, this is an important finding showing additional benefit in terms of weight management.

Impact of CNS Stimulants for Attention-Deficit/Hyperactivity Disorder on Growth: Epidemiology and Approaches to Management in Children and Adolescents

Central nervous system stimulants are established treatments for pediatric attention-deficit/hyperactivity disorder with robust efficacy data. Reductions in appetite, weight, and growth velocity are some of the most common concerns regarding the long-term use of central nervous system stimulants in developing children. They are associated with suppression of weight and body mass index in childhood. However, both weight and body mass index often progressively increase over adolescence at rates faster than those seen in non-attention-deficit/hyperactivity disorder youth to the degree that attention-deficit/hyperactivity disorder is associated with elevated body mass index by the end of adolescence regardless of medication use. The capacity of central nervous system stimulants to slow growth was identified 50 years ago. Recent work has established that the growth deficits accumulate during the first 2 years of use and may persist provided medication is used. Early initiation coupled with persistent use through adolescence is most likely to be associated with clinical impactful growth suppression. There has been limited formal investigation of treatments for stimulant-associated reductions in weight and height. The most robust evidence exists for drug holidays improving weight gain. Observational studies suggest that limiting lifetime exposure or discontinuing medication is associated with greater adult height. Additional research is needed to identify the causal mechanisms driving the observed slowing in growth as well as the identification of predictors of clinically impactful growth suppression.

Prevalence and Correlates of Attention-Deficit Hyperactivity Disorder in a Diverse, Treatment-Seeking Pediatric Overweight/Obesity Sample

OBJECTIVE

Attention-deficit hyperactivity disorder (ADHD) and obesity are highly prevalent, impairing, and costly conditions, affecting about 10% of children each. Research indicates heightened prevalence of childhood obesity among youth with ADHD. However, more research is needed, examining comorbid ADHD among youth with overweight/obesity (OV/OB) from diverse demographic backgrounds and effects on medically relevant behaviors. The aim of the current study was to examine the prevalence of ADHD in a racially diverse sample of youth in a weight management clinic. Furthermore, we examined the effects of race, rurality, and ADHD on weight status and health behaviors in this under-researched population.

METHOD

Participants included 1003 patients (Mage = 12.55; 58% female; 67% Black/African American; MBMI Z-Score = 2.54; 98.6% with obesity) in a pediatric weight management clinic serving a rural and urban/suburban area in the southern United States. Parent-reported demographics, ADHD diagnosis, and child health behaviors were recorded.

RESULT

In total, 17.6% (n = 177) of the sample had an ADHD diagnosis. ADHD status interacted with race to predict standardized body mass index (BMIz), and rurality predicted higher BMIz. Children with comorbid ADHD had significantly more meals per day and fewer active days compared with children with OV/OB without ADHD.

CONCLUSION

ADHD prevalence was higher in this diverse sample of children seeking obesity treatment (17.6%) compared with the prevalence nationally (9%-10%) and in other obesity samples. Comorbid ADHD was related to higher weight status among racial minority youth and increased engagement in unhealthy lifestyle behaviors often targeted in weight management treatment. It is critical to screen for ADHD in pediatric specialty clinics and assess healthy lifestyle behaviors.

ADHD and Drug Holidays: Effects on Anthropometric Changes during Methylpenidate Treatment

OBJECTIVES

The current study evaluated the long-term effects of methylphenidate (MPH) discontinuation on growth parameters in Turkish children and adolescents with attention-deficit/hyperactivity disorder (ADHD).

EXPERIMENTAL DESIGN

432 children and adolescents (aged 6-18 years) with ADHD receiving MPH for at least 1 year between March 2012 and January 2019 were included in a retrospective cohort study. We analyzed weight, height, and body mass index (BMI) standard deviation z scores (SDS) of groups that either did (ADHD-C) or did not (ADHD-DC) discontinue MPH. Growth parameters were converted to z scores as normative values for the Turkish population to compare the measurements at baseline and the last follow-up visit by using the paired sample t-test.

PRINCIPAL OBSERVATIONS

In patients from the ADHD-C group, statistically significant negative correlations were found between age at starting MPH and differences in weight and height SDS between baseline and follow-up. Children had a greater reduction in weight and height compared to adolescents. When we evaluated the differences in pre-and post-treatment growth factors, we found no significant differences between the groups in terms of growth parameters.

CONCLUSIONS

Our data showed that chronic use of MPH was likely responsible for changes in height and weight parameters.

Clinical approaches to minimize iatrogenic weight gain in children and adolescents

Clinical providers may underestimate the role of management of diseases that can occur with obesity, termed co-morbid conditions, distinct from disease that arise as a result of obesity, co-morbidities. Many of these conditions are associated with iatrogenic weight gain, and can interfere with weight loss outcomes in children and adolescents with obesity. Management of co-morbid conditions, and thoughtful selection of medications associated with weight neutrality or weight loss may increase the effectiveness of obesity treatment strategies. The aim of this commentary is to summarize the literature and discuss considerations for obesity treatment in the context of the more complicated patient, which often requires strategic management of co-morbid conditions and minimizing iatrogenic weight gain.

Attention Deficit Hyperactivity Disorder: Association With Obesity and Eating Disorders

Attention deficit hyperactivity disorder (ADHD) is one of the most common treatable psychiatric illnesses that affect all age groups from children to adults. Most commonly it is diagnosed in childhood or during teenage years. It can affect the mental and physical health of an individual and disrupt normal academic, career, and social functioning. The quality of life of the individual is affected; thus if diagnosed and treated, the results are good. Obesity and eating disorders are one of the comorbidities associated with ADHD and can lead to various other health problems. This study was done to find out the association between ADHD, obesity, eating disorders, and the effect of medication. We collected data from various studies through multiple electronic databases such as PubMed and Google Scholar. We found 8610 relevant articles and finally narrowed it down to 30 using various criteria. An association was found between ADHD, obesity, and eating disorders, although the mechanism linking ADHD, obesity, and eating disorders still remains unclear according to most studies. Some studies say ADHD medication helps in losing gained weight; some say they do not affect the weight.

Global prevalence of obesity, overweight and underweight in children, adolescents and adults with autism spectrum disorder, attention-deficit hyperactivity disorder: A systematic review and meta-analysis

Individuals with autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD) may have unhealthy bodyweight. This meta-analysis was performed to understand the weight status in individuals with ASD or ADHD. PubMed, Embase, Cochrane and ISI Web of Science databases were searched from inception until June 2020 to identify relevant studies. Prevalence estimates and their 95% confidence intervals (CIs) of obesity, overweight and underweight were separately pooled using random-effects models. A total of 95 studies were included in the meta-analysis. The pooled estimates of the prevalence of obesity, overweight and underweight were 21.8%, 19.8% and 6.4% in individuals with ASD and 14.7%, 20.9% and 4.0% in individuals with ADHD. In subgroup analyses, an increasing trend in the prevalence of unhealthy weight was observed from children aged 2 to 5 years to adults with ASD (obesity: from 16.7% to 31.3%, overweight: from 16.2% to 27.2%, underweight from 5.3% to 8.6%) and from children aged 6 to 12 years to adults with ADHD (obesity: from 13.5% to 19.3%, overweight: from 18.8% to 31.2%). The worrisome epidemic of obesity and overweight in individuals with ASD, ADHD highlighted the need for weight management.

Negative Affectivity and Emotion Dysregulation as Mediators between ADHD and Disordered Eating: A Systematic Review

Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with disordered eating, especially addictive-like eating behavior (i.e., binge eating, food addiction, loss of control overeating). The exact mechanisms underlying this association are unclear. ADHD and addictive-like eating behavior are both associated with negative affectivity and emotion dysregulation, which we hypothesized are mediators of this relationship. The purpose of this systematic review was to review the evidence related to this hypothesis from studies assessing the relationship between childhood or adulthood ADHD symptomatology, negative affectivity, emotion dysregulation and addictive-like eating behavior. The systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. The literature search was conducted in PubMed and PsycINFO (publication date: January 2015 to August 2020; date of search: 2 September 2020). Out of 403 potentially relevant articles, 41 were retained; 38 publications reported that ADHD and disordered eating or addictive-like eating behavior were significantly associated, including 8 articles that suggested a mediator role of negative affectivity or emotion dysregulation. Sixteen publications reported that the association between ADHD symptomatology and disordered eating or addictive-like eating behavior differed according to gender, eating behavior and ADHD symptoms (hyperactivity, impulsivity and inattention). We discuss the practical implications of these findings and directions future research.

Study of disturbed eating behaviors in children with attention deficit hyperactivity disorder

Background

There is emergent evidence that disturbed eating behaviors, including emotional eating and obesity, co-occur with attention deficit hyperactivity disorder (ADHD) in children. The hypothesis that disturbed eating behaviors in ADHD children are related to ADHD symptom severity, so we aimed to examine the link between ADHD symptoms and eating behaviors.

Results

Fifty ADHD children were included, and they completed the Emotional Eating scale adapted for children (ESS-C) to evaluate eating in response to emotions. Parents completed the Children’s Eating Behavior Questionnaire (CEBQ) to assess children’s eating behavior. Multivariable regression analysis was used to detect the most independent factor for higher body mass index (BMI) risk. Higher rates of overweight/obesity were detected among ADHD children than among the normal population. Also, higher Conners global index was associated with higher BMI z scores. Both inattentive and combined types were linked to higher BMI, while hyperactive type with lower BMI. Regarding eating behaviors, a positive association between food approach and BMI, and a negative association between food avoidant and BMI z-scores was found. Similarly, there was a noteworthy positive relation between emotional overeating and BMI. Sixty-eight of ADHD children were high emotional eaters, mainly inattentive and combined types. Others, mainly hyperactive type, were low emotional eaters. Only ESS-C total score was confirmed as an independent factor for higher BMI risk.

Conclusion

Our findings provide evidence that emotional overeating and food approach eating behaviors are common among ADHD children with higher BMI associated with them. Future studies for a better understanding of this overlap will enhance potential interventions.