Malnutrition and Obesity in Children With ADHD

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.

Nutrients patterns and attention deficit hyperactivity disorder among Egyptian children: a sibling and community matched case-control study

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.

Processed Food-Sweets Patterns and Related Behaviors with Attention Deficit Hyperactivity Disorder among Children: A Case-Control Study

BACKGROUND

Previous studies have focused on the associations between core symptoms and dietary intake in children with attention deficit hyperactivity disorder (ADHD). However, few studies have explored how dietary patterns and behaviors relate to the risk of ADHD. The aim of our study is to explore the associations between dietary patterns and behaviors and the risk of ADHD, which could provide evidence for follow-up and treatments for children with ADHD.

METHODS

We conducted a case-control study, including 102 children diagnosed with ADHD and 102 healthy children. The food frequency questionnaire (FFQ) and the children's eating behavior questionnaire (CEBQ) were used to investigate food consumption and eating behaviors. We applied exploratory factor analysis for constructing dietary patterns, and the factor scores were adopted for log-binomial regression to assess the associations between how dietary patterns and eating behaviors affect the risk of ADHD.

RESULTS

We extracted five dietary patterns with a cumulative contribution rate of 54.63%. Processed food-sweets scores revealed positive associations with an increased risk of ADHD (OR = 1.451, 95% CI: 1.041-2.085). Moreover, processed food-sweets tertile 3 was associated with an increased risk of ADHD (OR = 2.646, 95% CI: 1.213-5.933). In terms of eating behaviors, the group with a higher score relating to a desire to drink was also positively correlated with the risk of ADHD (OR = 2.075, 95% CI: 1.137-3.830).

CONCLUSIONS

In the treatment and follow-up of children with ADHD, dietary intake and eating behaviors should be considered.

Changes in Eating Behaviors Following Taste Education Intervention: Focusing on Children with and without Neurodevelopmental Disorders and Their Families: A Randomized Controlled Trial

Fussy-eating children often display problematic behaviors around mealtimes, such as irritation, opposition, or may even throw tantrums. This may lead to reduced food variety and poor nutritional profiles, which may increase parents' worries about their children's diet, particularly when the children also have neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD). To investigate the effect of Taste Education on problematic mealtime behaviors, 81 children aged 8-12 years, with ND (n = 33) and without (n = 48), and their parents, participated in a 7-week Taste Education intervention. Children were matched on age, sex, and ND, and allocated at random into Immediate-intervention and Delayed-intervention groups. Parents completed the Meals in Our Household Questionnaire (MiOH). To examine changes in MiOH-scores, repeated-measures analysis-of-variance with time-points were used, with condition as factors (Immediate intervention and Delayed intervention). Baseline measures were adjusted for, and a robust linear mixed-model was fitted. Results showed superior outcomes for Intervention compared to waiting on all measures of MiOH, with stable effects through six-month follow-up. Differences were non-significant between children with and without ND. The Taste Education program suggests a promising, simple, and non-intrusive way to reduce children's problematic mealtime behaviors in the long term.

Nutrient intake, dietary patterns, and anthropometric variables of children with ADHD in comparison to healthy controls: a case-control study

BACKGROUND

Poor health behaviors and variables are recently more documented in attention-deficit hyperactivity disorder (ADHD) lifestyle which might be relevant to the pathophysiology of this disorder. The objective of this case-control study was to assess the nutrient intake, dietary patterns, and anthropometric variables in children with ADHD compared to normal peers.

METHOD

One hundred children diagnosed with ADHD were included and compared to 100 healthy, sex-matched normal children as the control group. Anthropometric indices, macronutrients, and micronutrients were measured and compared in both groups.

RESULTS

ADHD children were significantly consuming more simple sugars, tea, ready-made meals but less protein, vitamin B1, vitamin B2, vitamin C, zinc and calcium compared to the control group. The body mass index (BMI) and waist circumference of children with ADHD were significantly higher and were related to the severity and type of the disease.

CONCLUSION

Unhealthy eating behavior is more frequent in children with ADHD, compared to normal children which might warrant lifestyle intervention in this disorder.

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 Occurrence of Overweight and Obesity in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder According to Three Different Diagnostic Criteria for Obesity

Objective: This study aimed to assess the prevalence of overweight and obesity in the group of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) according to three different diagnostic criteria for obesity. The effect of ADHD treatment on the risk of obesity was controlled. Materials and Methods: The study group consisted of 58 subjects aged from 8 to 17 years with ADHD. Control group consisted of 62 healthy age- and sex-matched children and adolescents. Overweight and obesity were assessed according to International Obesity Task-Force (IOTF), World Health Organization (WHO) and European Childhood Obesity Group (ECOG) criteria. Results: There was a significantly higher incidence of obesity in ADHD group according to WHO (ADHD vs. Control: 17.2% vs. 3.2%, p = 0.01) and IOTF criteria (ADHD vs. Control: 10.3% vs. 1.6%, p = 0.04), but no significant difference according to ECOG criteria. There was significantly higher occurrence of overweight (20.7% vs. 12.8%, p < 0.001), obesity (10.3% vs. 3.5%, p < 0.001), and overweight and obesity (31.0% vs. 16.3%, p < 0.001) in the ADHD group compared to the Polish population. The analysis did not show a statistically significant relationship between the amount of taken psychostimulant and the occurrence of overweight and obesity. Conclusions: The prevalence of overweight and obesity in the group of ADHD children and adolescents varies depending on the choice of diagnostic criteria. At the same time, it is significantly more frequent than in the general population. We suggest that future studies should give a clear rationale for the selection of cutoff points to minimize errors that could confound data analysis and interpretation.

Obesity and ADHD: Exploring the role of body composition, BMI polygenic risk score, and reward system genes

The association between obesity and attention-deficit hyperactivity disorder (ADHD) has been extensively reported in the literature. However, the potential mechanisms underlying this association are not completely understood. This study aimed to evaluate the association between body composition and ADHD and explore the possible genetic mechanisms involved. We used data from the 1982 Pelotas (Brazil) Birth Cohort at age 30-year follow-up (N = 3630). We first used logistic regression analysis to test whether body mass index (BMI), fat mass (FM), and fat-free mass (FFM) were associated with ADHD. We further tested the association between BMI polygenic risk score (BMI-PRS) and ADHD and the role of the genes upregulated in the reward system using a gene-set association approach. BMI (odds ratio [OR] = 1.05; 95% confidence interval [CI], 1.00-1.09; p = 0.038) and FM (OR = 1.04; 95% CI, 1.00-1.07; p = 0.043) were associated with ADHD. The BMI-PRS was associated with ADHD (using p-value threshold (P_T) = 0.4; OR = 1.65; 95% CI, 1.02-2.65) at a nominal level. In gene-set analysis, the reward system genes were associated with BMI in subjects with a high BMI-PRS score, considering P_T = 0.4 (p = 0.014). The results suggest that BMI genetic components, especially those genes related to the reward system, may be involved in this association.

ADHD and Risk of Childhood Adiposity: a Review of Recent Research

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.

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.

Methylphenidate and Reduced Overweight in Children With ADHD

Objective: The objective of this study was to investigate odds ratios of overweight/obesity in children with ADHD and to compare the change in body mass index (BMI) after initiation of methylphenidate treatment in normal versus overweight/obese children. Method: This population-based study included 724 children (<18 years), of whom 197 were girls. Odds ratios for overweight and obesity were calculated, comparing the study group with a reference group from the same area. After initiation of methylphenidate treatment, changes in BMI were assessed for up to 3 years. Results: Children with ADHD had an odds ratio of 1.87 (95% confidence interval [CI]: [1.60, 2.19]) for overweight/obesity. A decrease in BMI standard deviation score was identified 1 to 3 years into treatment. The decrease was beneficially greater in overweight/obese as compared with normal weight children-mean (SD) -0.64 (0.80) versus -0.39 (0.68); p = .001-and greater in girls. Conclusion: Medication with methylphenidate may facilitate favorable weight development in children with ADHD and overweight/obesity.

Adult characteristics of survivors of early life malnutrition in an impoverished population

BACKGROUND & AIMS

To determine the characteristics of adults who survived early life malnutrition (ELM) and the possible associated factors. The setting is an impoverished community in Kenya. The coastal region of Kenya has a high prevalence of acute protein-energy-malnutrition and stunting.

METHODS

Observational cross-sectional survey where 872 skeletally mature adults of African origin, were surveyed in a period of three months. A discrimination tool to detect ELM survivors was created. Personal, historical and family data were collected in a semi-structured questionnaire. Various observations and body measurements were done. The subjects were grouped into two, those with ELM (Group1), and those without (Group2).

RESULTS

Group1 had 242 participants, 49.8% males, mean age of 49.1 ± 8.7 years. Group2 had 630 participants, 48.3% males, mean age 41.0 ± 9.7 years. The phenotypic characteristics included height, BMI, and head circumference (P < 0.05). Developmental characteristics were duration of schooling, occupation and income (P < 0.001). Factors associated with malnutrition were County of origin, parental education, parental occupation, and family size (P < 0.001).

CONCLUSIONS

There are discernible phenotypic and developmental characteristics associated with adult survivors of ELM. The predisposing factors for ELM are location of birth, parental education and occupation, and family size.

Body dissatisfaction and weight control behaviour in children with ADHD: a population-based study

Although attention-deficit/hyperactivity disorder (ADHD) is associated with eating disorders (EDs), it is unclear when ED risk emerges in children with ADHD. We compared differences in body dissatisfaction and weight control behaviour in children with/without ADHD aged 12-13 years concurrently, and when aged 8-9 and 10-11 years, to determine when risk emerges. We also examined differences by ADHD medication status at each age. This study uses waves 1-5 from the Longitudinal Study of Australian Children (n = 2323-2972). ADHD (7.7%) was defined at age 12-13 years by both parent- and teacher-reported SDQ Hyperactivity-Inattention scores > 90th percentile, parent-reported ADHD diagnosis and/or ADHD medication treatment. Children reported body dissatisfaction and weight control behaviour at 8-9, 10-11 and 12-13 years. Children with ADHD had greater odds of body dissatisfaction at ages 8-9 and 12-13 years. Comorbidities drove this relationship at 8-9 but not at 12-13 years [adjusted odds ratio (AOR): 1.6; 95 % CI 1.1-2.4; p = 0.01]. At 12-13 years, children with ADHD had greater odds of both trying to lose and gain weight, regardless of BMI status. Comorbidities drove the risk of trying to lose weight in ADHD but not of trying to gain weight (AOR 2.3; 95% CI 1.1-4.6; p = 0.03), which is likely accounted for by ADHD medication treatment. ADHD moderately increases body dissatisfaction risk in children aged 8-9 and 12-13 years. Clinicians should monitor this and weight control behaviour throughout mid-late childhood, particularly in children with comorbid conditions and those taking ADHD medication, to reduce the likelihood of later ED onset.

DSM-5 eating disorder symptoms in adolescents with and without attention-deficit/hyperactivity disorder: A population-based study

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) is associated with increased eating disorder symptoms, yet little research examining this association has taken a diagnostic approach using a population-based sample. This cross-sectional study examined differences in DSM-5 eating disorder symptoms and partial-syndrome diagnoses at 14-15 years of age in adolescents with and without ADHD in a population-based sample.

METHOD

This study uses data from waves 1, 5 and 6 of the Longitudinal Study of Australian Children (N = 2,672). ADHD (6.9%) was defined at 12-13 years of age by both parent- and teacher-reported hyperactivity-inattention scores ≥90th percentile on the Strengths and Difficulties Questionnaire, parent-reported ADHD diagnosis, and/or ADHD medication treatment. Adolescents reported eating disorder symptoms at 14-15 years of age via the Branched Eating Disorders Test.

RESULTS

Boys with ADHD had greater odds of regular objective binge eating than boys without ADHD (OR: 9.4; 95% CI: 1.7-52.8; p = .01). Groups did not differ in prevalence of any other eating disorder symptoms or partial-syndrome diagnoses.

DISCUSSION

Boys with ADHD appear to be at a greater risk of regular binge eating classified by DSM-5 criteria at 14-15 years of age. Overall, the risk for eating disorder symptoms and partial-syndrome diagnoses in adolescents with ADHD does not appear to be high at 14-15 years of age when using DSM-5 criteria with population-based sampling.

Children's Attention-Deficit/Hyperactivity Disorder Symptoms Predict Lower Diet Quality but Not Vice Versa: Results from Bidirectional Analyses in a Population-Based Cohort

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.

Psychostimulants: Influence on Body Mass Index and Height in a Pediatric Population with Attention-Deficit/Hyperactivity Disorder?

OBJECTIVES

Attention-deficit/hyperactivity disorder (ADHD) is often treated with psychostimulants. Psychostimulants' adverse effects on body mass index standard deviation score (BMI-sds) and height in children/adolescents with ADHD have been reported. However, literature is inconsistent, and it is unclear whether the observed effects are dosage- and/or BMI-dependent. Therefore, the aim of this retrospective observational study is to evaluate the influence of psychostimulants on BMI-sds and height-sds in a pediatric cohort with ADHD from an outpatient clinic, and to study the correlation between psychostimulant dosage and BMI-sds and height-sds change.

METHOD

Participants ≤18 years of age diagnosed with ADHD who started with psychostimulants (methylphenidate) were studied. Changes in BMI-sds and height-sds over an 18-month treatment period were assessed in subgroups according to baseline BMI-sds, gender, and age. Furthermore, correlations between BMI-sds, height-sds, and psychostimulant dose were studied.

RESULTS

In total, 298 participants [median age 9.8 years, height-sds 0.0, BMI-sds 0.5, psychostimulant dosage 0.5 (0.2-1.4) mg/kg/day] were analyzed, with an underweight, overweight, and obesity prevalence of 5%, 21%, and 7%, respectively. After 18 months of treatment a significant decline in BMI-sds (-0.4) and height-sds (-0.2) was observed. These effects were consistent in all subgroups except for no change in BMI-sds in the underweight subgroup and no change in height-sds in the overweight subgroup. Medication dosage was weakly correlated with change in BMI-sds [r = -0.3 (-0.9 to +0.5); p < 0.01] and height-sds [r = -0.2 (-0.4 to -0.1); p = 0.01].

CONCLUSION

After 18 months of psychostimulant treatment, a significant decline in BMI-sds and height-sds was observed. However, the correlation with psychostimulant dosage was weak, and the decline was not observed in all subgroups. Therefore, further studies on the etiology of BMI-change are warranted, particularly with regard to the ADHD symptoms.

On the positive association between candy and fruit gum consumption and hyperactivity in children and adolescents with ADHD

Objective: The purpose of the present study was the analysis of the association between consumption of candy and fruit gums, diagnosis of attention deficit hyperactivity disorder (ADHD), and behavioural problems. Methods: In total, 1,187 children and adolescents of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analyzed. Results: It was observed that children and adolescents with ADHD as compared to healthy controls (HC) reported to consume more frequently and higher amounts of candy and fruit gums and that hyperactivity was associated with frequent candy and fruit gum consumption. Conclusions: Because with the present design no conclusions on causality or directionality of the found associations could be drawn, results are discussed quite broadly in the light of several previously published interpretations, also to serve as a generator for further research. One more innovative speculation is that children and adolescents with ADHD may consume more frequently candy and fruit gums in order i) to compensate for their higher needs of energy resulting from hyperactive behaviour and/or ii) to compensate for the ADHD-typical deficits in the "reward cascade".

Plasma Leptin, Adiponectin, Neuropeptide Y Levels in Drug Naive Children With ADHD

OBJECTIVE

ADHD is one of the most common childhood psychiatric disorders. Research indicates that there is some link between obesity/overweight and ADHD, though the mechanism of this association remains uncertain. It is the aim of the present study to explore the association between ADHD, obesity, and plasma leptin, neuropeptide Y (NPY), and adiponectin levels.

METHOD

Thirty-six patients diagnosed with ADHD were included in the study. The control group consisted of 40 healthy children and adolescents who had similar age and gender features with the patient group. Plasma leptin, adiponectin, NPY levels were measured, and body mass index (BMI), weight for height, and standard deviation scores (SDS) of height, weight, and BMI were calculated.

RESULTS

No significant difference was found between patients and healthy children in terms of BMI and BMI percentile. Participants were classified into three groups according to their weight to height values. There was no significant difference between the two groups, but 10% of the control group and 30.6% of the ADHD group were classified as overweight, which was 3 times higher than the control group. The adiponectin plasma level was significantly lower and leptin/adiponectin (L/A) ratio was significantly higher in the ADHD group. There was no significant difference between serum NPY levels. In the ADHD group, the mean leptin plasma level was high, but was not statistically significant.

CONCLUSION

We think that a low adiponectin level and high L/A ratio may be the underlying mechanism of the obesity in ADHD patients.

A Review: Associations Between Attention-deficit/hyperactivity Disorder, Physical Activity, Medication Use, Eating Behaviors and Obesity in Children and Adolescents

In the past few years we have become increasingly aware of strong associations between obesity and ADHD. Both conditions are major public health issues, affecting children, adolescents and adults alike.

OBJECTIVE

This review seeks to (1) examine prior research on the association between ADHD and obesity in children and adolescents; (2) discuss mechanisms and consequent behavioral attributes to gain understanding of the path association between ADHD and obesity, (3) review studies examining the role of physical activity, medication, eating behavior and gender on the relationship between ADHD and obesity in children and adolescents.

METHOD

PubMed, CINAHL and PsycINFO databases were used to search for studies whose subjects were children and adolescents, ages 0-17 years and whose publication years were from 2000 to 2016. After screening 31 studies were included in the review.

RESULTS

The literature suggests that there is a significant association between ADHD and obesity. Further, the inattentive and impulsive behaviors that characterize ADHD could contribute to dis-regulated eating behaviors and a lack of motivation to engage in physical activity. In addition, it is proposed that medication, gender and physical activity play a role in mediating and moderating the relationship between ADHD and obesity.

Attention-deficit/hyperactivity disorder symptom clusters differentially predict prenatal health behaviors in pregnant women

OBJECTIVE

To date, most investigations of mental health in pregnant women have focused on depression or substance use. This study aimed to (a) delineate the relationships between symptoms of attention-deficit/hyperactivity disorder (ADHD) and prenatal health behaviors and (b) explore whether the symptom clusters of ADHD differentially predict prenatal health behaviors (e.g., physical strain, healthy eating, prenatal vitamin use).

METHOD

A total of 198 pregnant women (mean age = 27.94 years) completed measures of ADHD symptoms, prenatal health behaviors, and depression.

RESULTS

Inattention, hyperactivity, and impulsivity/emotional lability all evidenced significant relationships with the prenatal health behaviors, each differentially predicting different prenatal health behaviors.

CONCLUSION

As decreased engagement in adequate prenatal health behaviors puts both the mother and fetus at risk for negative birth outcomes, future research should work to develop a brief ADHD screen to be used in obstetric clinics and should investigate these relationships within a sample of women with a diagnosis of ADHD.

ADHD, Lifestyles and Comorbidities: A Call for an Holistic Perspective - from Medical to Societal Intervening Factors

The review examines Attention Deficit Hyperactivity Disorder (ADHD in its Child and Adult form) and its various presentations (Hyperactive Impulsive, Inattentive, and Combined) with a particular focus on environmental (incl. social factors), lifestyles and comorbidities. It is argued that ADHD is best understood in a holistic and interactive context and a vast empirical literature is presented to illustrate the point: Environmental factors include stress in general as well as exposure to toxins (phthalates, bisphenol A). Social factors are illustrated by effects of social deprivation and seduction to unhealthy lifestyles. Maternal lifestyle during pregnancy is pointed out (particularly her exposure to nicotine, alcohol, caffeine, and drugs, even seemingly benign medications like acetaminophen), which all tend to be related to ADHD. Family environment is discussed with respect to protective effect of (mainly authoritative and autocratic) parenting styles. Societal factors include mainly economic and political issues: income inequality and poverty (low SES is an ADHD risk factor) and a growing moral dilemma between a humanistic effort to globally spread the knowledge of ADHD and the medicalization and commercialization of the disorder. The second part of the review is devoted to ADHD related lifestyles and resulting comorbidities (e.g., food addiction and obesity, substance abuse, electronic media dependencies and conduct and personality disorders). Although ADHD is a neurodevelopmental disorder, its assessment and treatment are also linked to environmental, behavioral and social factors and their interactions.

Attention-Deficit/Hyperactivity Disorder (ADHD) and Obesity: Update 2016

While psychiatric comorbidities of attention-deficit/hyperactivity disorder (ADHD) have been extensively explored, less attention has been paid to somatic conditions possibly associated with this disorder. However, mounting evidence in the last decade pointed to a possible significant association between ADHD and certain somatic conditions, including obesity. This papers provides an update of a previous systematic review on the relationship between obesity and ADHD (Cortese and Vincenzi, Curr Top Behav Neurosci 9:199-218, 2012), focusing on pertinent peer-reviewed empirical papers published since 2012. We conducted a systematic search in PubMed, Ovid, and Web of Knowledge databases (search dates: from January 1st, 2012, to July 16th, 2016). We retained a total of 41 studies, providing information on the prevalence of obesity in individuals with ADHD, focusing on the rates of ADHD in individuals with obesity, or reporting data useful to gain insight into possible mechanisms underlying the putative association between ADHD and obesity. Overall, over the past 4 years, an increasing number of studies have assessed the prevalence of obesity in individuals with ADHD or the rates of ADHD in patients with obesity. Although findings are mixed across individual studies, meta-analytic evidence shows a significant association between ADHD and obesity, regardless of possible confounding factors such as psychiatric comorbidities. An increasing number of studies have also addressed possible mechanisms underlying the link between ADHD and obesity, highlighting the role, among others, of abnormal eating patterns, sedentary lifestyle, and possible common genetic alterations. Importantly, recent longitudinal studies support a causal role of ADHD in contributing to weight gain. The next generation of studies in the field should explore if and to which extent the treatment of comorbid ADHD in individuals with obesity may lead to long-term weight loss, ultimately improving their overall well-being and quality of life.

Attention-deficit/hyperactivity disorder (ADHD) and being overweight/obesity: New data and meta-analysis

BACKGROUND

Literature has suggested that ADHD may be associated with increased risk of obesity. If so, this would have important clinical implications.

OBJECTIVE

To clarify the size of the association between ADHD and obesity and to evaluate key moderators of the association including medication, gender, age, and psychiatric comorbidity.

METHOD

Two preliminary studies are presented to supply critical additional data for the meta-analysis: a two-year longitudinal study of an ADHD case-control sample of 313 children aged 7-11, and a national survey study of 45,309 families in the United States using the 2012 National Survey of Children's Health. Formal meta-analysis was then conducted. The identification procedure yielded 43 studies, reporting 225 comparisons or effect sizes, studying 703,937 participants An overall effect size was estimated with a random effects model (after pooling within study using a modified fixed effects model). Effect size was then examined in relation to medication, gender, age, and psychiatric comorbidity.

RESULTS

The new study of children revealed no reliable association of ADHD and body mass index at any age or time point. In the national survey, ADHD was associated with obesity only in adolescent girls but not in children or boys; this effect was statistically accounted for by covarying of depression and conduct disorder. In the meta-analysis, the composite effect size was OR=1.22 (95% CI=1.11-1.34); 22 studies provided effects with medication controlled, yielding a composite effect size of OR=1.30 (95% CI=1.12-1.50). Pooled across age the association without covariates was reliable in females (OR=1.19 [1.01-1.41]) but not males (OR=1.10 [0.95-1.23]) although males and females did not statistically differ. Pooled across gender, the association was significantly larger in adults (>18years) (OR=1.37 [1.19-1.58]) than in youth (OR=1.13 [1.00-1.27]), p=.04.

CONCLUSIONS

ADHD has a small overall association with obesity, but this effect is moderate in adults. The effect is likely to be of no clinical significance in children, possible clinical significance in adolescent girls with comorbid disorders, and of clinical relevance by adulthood.

Association between binge eating and attention-deficit/hyperactivity disorder in two pediatric community mental health clinics

OBJECTIVE

Attention-Deficit/ Hyperactivity Disorder (ADHD) has been linked with obesity; however its relationship with binge eating (BE) is less clear. We aimed to explore the associations among ADHD, weight, and BE in pediatric mental health clinics.

METHOD

We retrospectively reviewed consecutive intakes in two pediatric mental health clinics (N = 252). BE was assessed using the C-BEDS scale. Associations between ADHD, BE, and BMI-z score were assessed via regression.

RESULTS

Mean age was 10.8 (3.7 SD) years. Twelve percent (n = 31) had BE. The association between ADHD and BE was statistically significant (OR 16.1, p < .001), and persisted after adjusting for comorbid diagnoses, medications, demographic variables, and clinic. There was a statistically significant association between ADHD and BMI z-scores (β = 0.54, p < .001). After adjusting for BE, the relationship between ADHD and BMI z-scores was attenuated (β = 0.35, p = .025), and the coefficient for BE was decreased (β = 0.75, p = .001). Although stimulant use was associated with a three-fold increase in odds of BE (OR 3.16, p = .006), stimulants were not associated with greater BMI-z scores (β = 0.18, p = .32).

DISCUSSION

There was a significant association between ADHD and BE in two pediatric mental health clinics. Although these data are cross-sectional, and cannot be used to make causal inferences, these findings are compatible with the hypothesis that BE partially mediates the association between ADHD and BMI z-scores. In mental health clinics, children with ADHD may present as overweight or obese. Further, children with ADHD may exhibit BE. Future prospective studies should elucidate the complex relationships among ADHD, weight, stimulants, and BE.

Availability of state-based obesity surveillance data on high school students with disabilities in the United States

The aim of this study was to assess the availability of public health surveillance data on obesity among American children with disabilities in state-based surveillance programs. We reviewed annual cross-sectional datasets in state-level surveillance programs for high school students, implemented 2001-2011, for the inclusion of weight and height and disability screening questions. When datasets included a disability screen, its content and consistency of use across years were examined. We identified 54 surveillance programs with 261 annual datasets containing obesity data. Twelve surveillance programs in 11 states included a disability screening question that could be used to extract obesity data for high school students with disabilities, leaving the other 39 states with no state-level obesity data for students with disabilities. A total of 43 annual datasets, 16.5 % of the available datasets, could be used to estimate the obesity status of students with disabilities. The frequency of use of disability questions varied across states, and the content of the questions often changed across years and within a state. We concluded that state surveillance programs rarely contained questions that could be used to identify high school students with disabilities. This limits the availability of data that can be used to monitor obesity and related health statuses among this population in the majority of states.

Prevalence of obesity in attention-deficit/hyperactivity disorder: study protocol for a systematic review and meta-analysis

INTRODUCTION

An increasing number of clinical and epidemiological studies suggest a possible association between attention-deficit/hyperactivity disorder (ADHD) and obesity/overweight. However, overall evidence is mixed. Given the public health relevance of ADHD and obesity/overweight, understanding whether and to what extent they are associated is paramount to plan intervention and prevention strategies. We describe the protocol of a systematic review and meta-analysis aimed at assessing the prevalence of obesity/overweight in individuals with ADHD versus those without ADHD.

METHODS AND ANALYSIS

We will include studies of any design (except case reports or case series) comparing the prevalence of obesity and/or overweight in children or adults with and without ADHD (or hyperkinetic disorder). We will search an extensive number of databases including PubMed, Ovid databases, Web of Knowledge and Thomson-Reuters databases, ERIC and CINAHL. No restrictions of language will be applied. We will also contact experts in the field for possible unpublished or in press data. Primary and additional outcomes will be the prevalence of obesity and overweight, respectively. We will combine ORs using random-effects models in STATA V.12.0. The quality of the study will be assessed primarily using the Newcastle-Ottawa Scale. Subgroup meta-analyses will be conducted according to participants' age (children vs adults) and study setting (clinical vs general population). We will explore the feasibility of conducting meta-regression analyses to assess the moderating effect of age, gender, socioeconomic status, study setting, geographic location of the study (low-income, middle-income countries vs high-income countries), definition of obesity, method to assess ADHD, psychiatric comorbidities and medication status.

ETHICS AND DISSEMINATION

No ethical issues are foreseen. The results will be published in a peer-reviewed journal and presented at national and international conferences of psychiatry, psychology, obesity and paediatrics.

REGISTRATION

PROSPERO-National Institute of Health Research (NIHR) Prospective Register of Systematic Reviews (CRD42013006410).