Sugar-Sweetened Beverage Consumption Is Adversely Associated with Childhood Attention Deficit/Hyperactivity Disorder

Exploring the link between toxic metal exposure and ADHD: a systematic review of pb and hg

INTRODUCTION

Attention-Deficit/Hyperactivity Disorder (ADHD) is a recognized neurodevelopmental disorder with a complex, multifactorial origin. Lead (Pb) and mercury (Hg) are highly toxic substances that can potentially impair brain development and have been implicated in the development of ADHD. This systematic review aims to analyze the epidemiological literature regarding the association between Pb and Hg exposure and the diagnosis of ADHD.

METHODS

From November 1983 to June 2, 2023, a comprehensive search was conducted in multiple databases and search engines, including PubMed, Web of Science, Scopus, and Google Scholar. Observational studies (case-control, cohort, and cross-sectional) measuring Pb and Hg levels in various biological samples (blood, hair, urine, nail, saliva, teeth, and bone) of children with ADHD or their parents and their association with ADHD symptoms were included.

RESULTS

Out of 2059 studies, 87 met the inclusion criteria and were included in this systematic review. Approximately two-thirds of the 74 studies investigating Pb levels in different biological samples reported associations with at least one subtype of ADHD. However, most studies examining Hg levels in various biological samples found no significant association with any ADHD subtype, although there were variations in exposure periods and diagnostic criteria.

CONCLUSION

The evidence gathered from the included studies supports an association between Pb exposure and the diagnosis of ADHD, while no significant association was found with Hg exposure. Importantly, even low levels of Pb were found to elevate the risk of ADHD. Further research is needed to explore the comprehensive range of risk factors for ADHD in children, considering its significance as a neurodevelopmental disorder.

The association between junk foods consumption and attention deficit hyperactivity disorder in children and adolescents: a systematic review and meta-analysis of observational studies

The adverse effects of junk foods on the risk of attention deficit hyperactivity disorder (ADHD) symptoms were reported in several studies. In this meta-analysis, the association between junk food consumption and the risk of ADHD was investigated in children and adolescents. A comprehensive systematic search was conducted to find all relevant literature via four databases, including PubMed, Web of Science, Scopus, and Google scholar, up to September 2022. Two independent authors screened all documents based on inclusion criteria. The overall effect sizes and related 95% confidence interval (CI) were pooled with the random effect approach. Subgroup analysis was done to measure potential sources of heterogeneity between studies. The quality of the included studies was evaluated with The Newcastle-Ottawa scale (NOS). Nine observational studies with 58,296 children /adolescents were eligible to be include in the meta-analysis. According to the random effect model, there was a positive relation between the consumption of junk foods and ADHD symptoms (odds ratio (OR): 1.24, 95%CI 1.15-1.34, P < 0.001, I2: 37.4%, P = 0.085). A similar significant positive association was shown in the subgroups analysis by different junk foods (sweetened beverages/soft drinks, sweets/candies, and other types of junk foods). This meta-analysis finding demonstrated that consuming junk foods, especially sweetened beverages/soft drinks, and sweets/candies is associated with ADHD symptoms.

"Food faddists and pseudoscientists!": Reflections on the history of resistance to ultra-processed foods

The term 'ultra-processed food' emerged in the 1980s, mostly used in reference to highly-processed convenience foods and snacks, often energy-dense, poor in nutrients, and inclusive of various synthetic additives such as emulsifiers, colors, artificial sweeteners, and/or flavor enhancers. Concern over such foods was part of the growing holistic and environmental health movements of the 1970-80s; yet, those who raised alarm about the encroachment of ultra-processed foods were often labeled, especially by industry and their powerful allies, as 'food faddists' and 'pseudoscientists'. Today, the topic of ultra-processed foods is generating massive personal, public, and planetary health interest. However, other than discussing the history of the NOVA food classification system, a useful tool that has allowed researchers to more accurately separate foods based on processing, most lay media and academic articles are ahistorical. That is, there is a tendency to present the term ultra-processed food(s) as a relatively new entrance into the lexicon, and by default, the idea that health-related pushback on ultra-processed foods is a relatively new phenomenon. This omission overlooks decades of determined advocacy and clinical work, much of it by pioneers within the holistic medicine (now integrative, functional, and lifestyle medicine) movement. Here in this reflection paper, the authors will use historical research and reporting to fill in the historical gap and articulate the saliency of why it matters.

Heavy Metal and Thiol/Disulfide in Children with Attention-Deficit and Hyperactivity Disorder

Background

In the etiology of attention-deficit and hyperactivity disorder (ADHD), oxidative stress and heavy metal exposure are still controversial topics. In this study, our goal was to examine heavy metal levels and oxidative balance in newly diagnosed patients with ADHD and reveal whether heavy metal levels have an effect on the oxidation balance.

Methods

The study included 35 patients with newly diagnosed ADHD and 31 healthy control groups of similar age and gender. Participants' parents or caregivers completed a semi-structured questionnaire regarding their children's breastfeeding and prenatal and postnatal smoking exposures. The levels of heavy metals lead (Pb), mercury (Hg), and cadmium were measured with inductively coupled plasma optical emission spectroscopy, and a unique automated spectrophotometric approach was used to quantify serum total thiol, native thiol, and disulfide quantities and ratios.

Results

The rate of smoking during pregnancy was significantly higher in the ADHD group than in the control group (P = .030). Compared to the control group, the native and total thiol levels of children with ADHD were significantly higher (P < .001). Likewise, the ADHD group had significantly higher Hg levels compared to the control group (P = .002). Cadmium levels were substantially greater in the control group compared to the ADHD group (P < .001). However, there was no significant difference between Pb levels in the ADHD and the control group (P = .844).

Conclusion

Exposure to Hg and prenatal smoking may contribute to the development of ADHD in childhood. In response to oxidative stress, the young brains of children with ADHD may enhance their antioxidant levels.

Nutritional Criminology: Why the Emerging Research on Ultra-Processed Food Matters to Health and Justice

There is mounting concern over the potential harms associated with ultra-processed foods, including poor mental health and antisocial behavior. Cutting-edge research provides an enhanced understanding of biophysiological mechanisms, including microbiome pathways, and invites a historical reexamination of earlier work that investigated the relationship between nutrition and criminal behavior. Here, in this perspective article, we explore how this emergent research casts new light and greater significance on previous key observations. Despite expanding interest in the field dubbed 'nutritional psychiatry', there has been relatively little attention paid to its relevancy within criminology and the criminal justice system. Since public health practitioners, allied mental health professionals, and policymakers play key roles throughout criminal justice systems, a holistic perspective on both historical and emergent research is critical. While there are many questions to be resolved, the available evidence suggests that nutrition might be an underappreciated factor in prevention and treatment along the criminal justice spectrum. The intersection of nutrition and biopsychosocial health requires transdisciplinary discussions of power structures, industry influence, and marketing issues associated with widespread food and social inequalities. Some of these discussions are already occurring under the banner of 'food crime'. Given the vast societal implications, it is our contention that the subject of nutrition in the multidisciplinary field of criminology-referred to here as nutritional criminology-deserves increased scrutiny. Through combining historical findings and cutting-edge research, we aim to increase awareness of this topic among the broad readership of the journal, with the hopes of generating new hypotheses and collaborations.

Unhealthy behaviors associated with mental health disorders: a systematic comparative review of diet quality, sedentary behavior, and cannabis and tobacco use

Background

There are well-established literatures documenting the associations between mental disorders and unhealthy behaviors such as poor diet quality, sedentary behavior, and cannabis and tobacco use. Few studies have attempted to understand the respective findings in light of each other, however.

Objective

The purpose of this review was to assemble comparable data for each behavior-disorder association and assess the associations in terms of their overall strength. The review aimed to include a representative, but not exhaustive, range of studies that would allow for explorative comparisons.

Methods

Eligible studies were identified via Pubmed searches and citation searching, restricted to publications no older than 2015 written in English. To obtain comparable data, only studies that reported findings as odds ratios were included, and risk of bias related to study samples, behavioral measurement disparities, and control variables was assessed via sensitivity analyses. Findings for each disorder were compared on the basis of different measures of central tendency.

Results

From 3,682 records, 294 studies were included. The review found evidence of associations between each of the four unhealthy behaviors and psychosis, depression, anxiety, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), while personality disorder was only investigated in relation to cannabis and tobacco use. In overall comparison, the associations were generally of similar strength, and only the association between cannabis use and personality disorder was exceptional in terms of being significantly stronger than its counterparts across disorders and across behaviors. Analyses of bias risk identified some influence from behavioral measurement disparities and lack of adequate statistical control, but findings were generally robust across a range of sensitivity analyses.

Conclusion

This explorative and comparative review found that poor diet quality, sedentary behavior, and cannabis and tobacco use are about equally strongly associated with a range of different mental disorders. Given the general nature of these associations, we should probably understand them to reflect a general and shared etiology. However, the findings in this review should be regarded as tentative until confirmed by more comprehensive investigations.

New form of addiction: An emerging hazardous addiction problem of milk tea among youths

BACKGROUND

Milk tea has experienced tremendous growth in popularity in China, especially among youths. The primary objective of this study is to investigate whether milk tea addiction may have a detrimental impact on youths' mental health, such as anxiety, depression, and suicidal ideation. Additionally, we aim to explore its potential role in influencing various mental health outcomes.

METHODS

A large-scale, cross-sectional study was conducted from 5281 college students in Beijing, China. Participants self-reported depressive, anxiety symptoms, suicidal ideation, and milk tea addiction symptoms including milk tea consumption, dependence, guilty feelings, withdrawal, tolerance, unable to stop, craving, and intention to stop.

RESULTS

Nearly 77 % of participants consumed milk tea at least 6-11 cups in the last year. The confirmatory factor analysis (CFA) supported the one-factor structure of the milk tea addiction scale, developed according to DSM-5 substance use guidelines. Moreover, we found that a higher level of milk tea addiction was significantly associated with a higher risk of depression (b = 0.24, p < 0.001), anxiety (b = 0.21, p < 0.001), and suicidal ideation (b = 0.06, p < 0.001), respectively, after controlling confounding variables, among youths consuming milk tea. The possible mediating role of milk tea addiction between loneliness feelings and mental health outcomes was further addressed.

CONCLUSIONS AND IMPLICATIONS

Our findings highlighted that milk tea consumption might lead to addiction, and it is associated with depression, anxiety, and suicidal ideation. Current findings can assist policymakers in developing regulations such as restricting advertising, providing psycho-education, establishing food hygiene standards for such a prosperous youth-dominant consumption industry while protecting their mental health.

Is the Consumption of Added Sugar from Common Beverages Associated with the Presence of Attention Deficit Hyperactivity Disorder Symptoms in Thai Medical Students?

Attention deficit hyperactivity disorder (ADHD) significantly affects the well-being of medical students in various aspects. Sugar-sweetened beverages (SSBs) pose a potential risk of ADHD. Our study aimed to determine the prevalence of ADHD symptoms and the association between consumption of added sugar in common beverages and ADHD symptoms in Thai medical students. An online cross-sectional survey was conducted among medical students at Chiang Mai University from May 2022 to April 2023. The consumption of added sugar from common beverages in Thailand was assessed using the Thai Adolescence Sugar Sweetened Beverage Intake (THASSI) questionnaire. An Adult ADHD Self-Report Scale (ASRS) score ≥ 3 identified the presence of ADHD symptoms. Multivariable logistic regression was used for the analysis. Of 441 participants, 29.9% had ADHD symptoms. Daily consumption of added sugar from beverages higher than 25 g/day showed an increased risk of ADHD symptoms (adjusted odds ratio (OR) 1.80, 95%CI 1.15 to 2.84, p = 0.011). The same trend was observed when using the sex-specific cutoff points (adjusted OR 1.73, 95%CI 1.10 to 2.73, p = 0.018). Higher consumption of added sugar from beverages may increase the risk of ADHD symptoms in Thai medical students. This finding supports the implementation of health policies that promote healthy consumption behaviors among medical students.

Development and initial evaluation of the COnfident Parent INternet Guide program for parents of 3-8 year olds

INTRODUCTION

Positive parenting promotes children's cognitive, social and emotional development and parenting programs based on social learning theory are effective in supporting parents to help reduce behavioral problems among high challenge children. However there is less evidence for programs with non-clinical populations. COPING (COnfident Parent INternet Guide) is a 10-week online universal program for parents of 3 - 8 year olds presenting evidence-informed principles based on social learning theory to support parents in addressing common challenges with their children. This study explored the development and feasibility of delivery of the program in terms of recruitment, retention and acceptability. It also reports on initial program effectiveness, evaluated via a pilot randomized controlled trial.

METHODS

Data on child behavior, parental skills and mental health were collected at baseline and three months later for all participants and six months post-baseline for the intervention group only.

RESULTS

Those parents who accessed the course provided very positive feedback however the trial experienced challenges with recruitment and initial engagement, particularly for parents referred by professionals. For parents who engaged with the program there were significant improvements in reported parenting skills with evidence of longer-term maintenance.

DISCUSSION

This paper provides limited evidence of effectiveness for the COPING program however further feasibility work, particularly around recruitment, is needed before conducting larger effectiveness trials.

Early life exposure to high fructose diet induces metabolic dysregulation associated with sex-specific cognitive impairment in adolescent rats

The incidence of adolescent mental health disorders is on the rise. Epidemiological studies suggest that poor nutrition is a significant contributor to this public health crisis, specifically through exposure to high level of dietary sugar, including fructose, during critical periods of development. Previous studies have shown that elevated fructose exposure during adolescence disrupts mental health. Despite these data, it is currently unknown how fructose exposure, specifically during infancy, may impact adolescent mental health. We developed a rat experimental protocol to investigate the effects of fructose exposure during infancy on behavioral, cognitive and metabolic endpoints in adolescence. We found that exposing rats to high fructose from birth to weaning resulted in higher circulating glucose, insulin and leptin levels in adolescence. High fructose during infancy also increased bodyweight, disrupted metabolic homeostasis in the basolateral amygdala (BLA) as indicated by decreased activity of the cellular energy sensor AMPK, and impaired attention and impulsivity in a male-specific manner. This impaired attention observed in adolescent male rats following neonatal fructose exposure was partially rescued by viral-mediated, in vivo expression of a constitutively active form of AMPK in principal neurons of the BLA. Our results suggest that exposure to high level of fructose during infancy may impact adolescent mental health in a male-specific manner and that manipulation of AMPK activity may mitigate this impact.

Sugar-sweetened beverage consumption retarded weight gain but not induced depression and anxiety-like behaviors in mice

AIMS

To assess the effects of sugar-sweetened beverage (SSB) consumption and exercise on behaviors.

METHODS

Twenty-four male mice were divided into four groups: the water + sedentary (WS), the SSB + sedentary (CS), the water + exercise (WE), and the SSB + exercise (CE). After three-month of interventions, forced swim test (FST), open field test (OFT), and morris water maze (MWM) were conducted. Then, mRNA levels of MAO-A, COMT, and 5-HT1A and protein levels of synapsin, STAT3, A2AR, CRTC1, CREB, and BDNF were measured.

RESULTS

Under a similar baseline body weight condition, SSB consumption reduced the weight gain from the 3rd week (p < 0.05, or p < 0.01). Exercise decreased the escape latency in the CE group when compared to the CS group on day5 (p < 0.01) and increased the time in the target quadrant in the WE group than the WS group on day4 (p < 0.05) and 5 (p < 0.01) during MWM. No significant differences were found during the FST and OFT. COMT mRNA level was increased after SSB consumption (p < 0.05), but no differences were found in the MAO-A and 5-HT1A mRNA levels and the concerned biomarkers, all of which were previously reported to be associated with depression and anxiety-like behaviors.

CONCLUSION

SSB consumption reduced weight gain but not result in depression and anxiety-like behaviors in mice. Therefore, the behavioral effects of exercise were not significant. This is not consistent with the results of previous epidemiological surveys of humans.

Association between Hyperactivity and SSB Consumption in Schoolchildren: A Cross-Sectional Study in China

Sugar-sweetened beverages (SSBs) consumption has risen significantly, which may lead to various health problems. Studies about the association between SSBs and attention-deficit/hyperactivity disorder (ADHD) in children are rare and inconsistent. We have used the two-stage cluster sampling method to select 6541 students aged 6-12. We further investigated their basic information and SSB intake. Teachers' questionnaires and parents' questionnaires were used to evaluating the hyperactive behaviors in children. We examined the associations between SSB consumption and hyperactivity index (HI) by adopting the censored least absolute deviation (CLAD) estimator. Then, we further evaluated the impacts of sex and age on the association between SSB intake and hyperactivity. Children who weekly drank SSB two or more times were associated with 0.05 (0.04, 0.07) and 0.04 (0.02, 0.06) higher scores of ln (HI+1) reported by teachers and parents, respectively, compared to non-consumers children (p for trend < 0.05). A stronger association between SSB intake and hyperactivity occurred in girls and old children. (p for interaction < 0.05). SSB intake has a positive correlation with the risk of hyperactivity in children, and the frequency of SSB consumption and hyperactivity have a dose-response relationship.

Association between free sugars intake and early psychopathological problems

Mental health problems are highly prevalent in childhood and adolescence and may be associated with nutritional intake. It has recently been shown that a high percentage of infants and children consume large amounts of free sugars. In this paper, we analyse the relationship between free sugar consumption at 12 and 30 months and the risk of developing psychological problems at 30 months in a community sample of 86 children evaluated longitudinally. Socio-family and anthropometric data, and the amount of free sugars consumed were collected at both ages. At 30 months, the Child Behavior Checklist 1.5-5 was administered to parents and an interview was conducted to identify psychological disorders in accordance with DC: 0-3's classification. We report a relationship between high free sugar consumption at 30 months and the concurrent presence of sleeping problems, ADHD and anxiety symptoms. However, no significant association was observed between free sugar consumption at 12 months and the subsequent development of psychological problems. Early detection of emotional and behavioural manifestations and high sugar consumption in children may help to prevent the persistence of psychological problems.

Eating Patterns and Dietary Interventions in ADHD: A Narrative Review

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood, affecting ~7% of children and adolescents. Given its adverse health outcomes and high healthcare and societal costs, other treatment options beyond pharmacotherapy have been explored. Case-control studies have shown that dietary patterns may influence the risk of ADHD, and specific dietary interventions have been proposed as coadjuvant treatments in this disorder. These include nutritional supplements, gut microbiome-targeted interventions with biotics, and elimination diets. The purpose of this review is to examine which dietary patterns are most associated with ADHD and to summarize the existing evidence for the clinical use of dietary interventions. The literature showed that non-healthy dietary patterns were positively associated with ADHD, whereas healthy patterns were negatively associated. As for nutritional supplements, only vitamin D and vitamin D + magnesium appeared to improve ADHD symptoms when baseline levels of vitamin D were insufficient/deficient. Regarding biotics, evidence was only found for Lactobacillus rhamnosus GG and for multi-species probiotic supplementation. Elimination diets have scarce evidence and lead to nutritional deficiencies, so caution is advised. Overall, more robust scientific evidence is required for these dietary interventions to be implemented as part of ADHD therapy.

Diet cost plays a key role in determining the risk of pediatric attention deficit hyperactivity disorder: Findings from a case-control study

The aim of our study was to assess the association between diet cost and attention deficit hyperactivity disorder (ADHD) in children. This study was a case-control study conducted in Isfahan, Iran. Based on the Diagnostic and Statistical Manual of Mental Disorders-V criteria, a total of 200 children aged 4-12 years with ADHD and 300 age- and sex-matched children without ADHD, respectively, participated in case and control groups. A validated food frequency questionnaire that contained 168 food items was used to assess the dietary intake. The cost of food items was obtained from licensed markets. The food price was corrected for edible portion sizes as well as food weight changes due to cooking process. Our results indicated that diet cost per 1000 kcal was significantly lower in the case group compared with the control group (60,843.48 ± 6987.83 vs. 67,828.33 ± 8989.48 Rials, p < .01). In the crude model, a significantly lower risk of ADHD was observed in the higher quartiles of diet cost per 1000 kcal (odds ratio (OR) = 0.06; 95% confidence interval (CI) = 0.03, 0.13; p < .001). This finding remained significant, even after adjustment for potential confounders such as age, gender, body mass index (BMI), socioeconomic status (SES), and intakes of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and saturated fatty acids (SFA). Therefore, it seems that the risk of ADHD is inversely associated with diet cost in children. Further studies, particularly longitudinal ones, are warranted.

Sugar-Sweetened Beverages and Symptom Complaints among School-Aged Children: A National Longitudinal Study

The association between sugar-sweetened beverages (SSBs) and symptom complaints among school-aged children remains unclear. Children aged 6−17 years (n = 29,028) were recruited on the basis of a national school-based study. Data collection included two waves: the exposure was the amount and frequency of SSB consumption, collected in the 2013 autumn semester, and outcomes were defined as having clinical symptom complaints after two weeks of observation, collected in the 2014 spring semester. Symptom complaints were defined as fever, cough, headache, loose bowels, vomiting, sore throat, rash, conjunctival congestion, and stomachache. The associations between the amount/frequency of SSBs and symptoms complaints were explored by a general linear model, with adjustments made for socio-demographic and other lifestyle information. Among the 12,454 children (10.32 ± 3.15 years, 48.7% male) in the final analysis, the odds ratio for having symptom complaints (1.46, 95% CI: 1.10−1.95) among children whose SSB consumption was >75 mL/day was significantly higher than that among children who had no SSB consumption. Among children with a daily SSB intake of more than 75 mL, there was a higher risk for symptom complaints. We recommend more support for decreasing SSB consumption among children to minimize negative health outcomes.

Effects of chronic bubble tea administration on behavior and cognition in C57BL/6 mice

PURPOSE

There is a lack of rigorous experimental evidence to verify the effects of bubble tea on body weight and mental health, especially whether it is an addictive thing.

MATERIALS AND METHODS

Male adult C57BL/6 mice were randomly assigned to two groups, including the bubble-tea and the control group. The change in their body weight was calculated. Behavior tests include novel object recognition test (NORT), elevated plus maze test (EPMT), forced swim test (FST), tail suspension test (TST), conditioned place preference (CPP).

RESULTS

There was a significant time effect on weight change of the two groups (F = 36.83, P < 0.01). The bubble tea-treated mice spent significantly less time in the open arms, indicating an increase in anxiety (t = 2.39, P = 0.03). In FST, bubble tea treatment produced a significantly increased immobility time (186.58 ± 29.67 s) as compared to pure water treated group (112.50 ± 46.67 s) (t = -3.79, P < 0.01). Similarly, the immobility time in the TST was also significantly increased by bubble tea treatment (437.63 ± 27.72 s) compared to the treatment with pure water (340.24 ± 77.22 s) (t = -3.36, P < 0.01). We investigated the rewarding effects of bubble tea, using the CPP paradigm, which measures the rewarding properties of abused drugs. Independent-samples t-test revealed no significant difference between the two groups (t = -0.47, P = 0.65).

CONCLUSION

In conclusion, we showed that long-term administration of bubble tea could not induce addictive behavior in mice. Meanwhile, the long-term effects of bubble tea on weight were also very limited. However, long-term consumption of bubble tea can lead to anxiety and depression-like behaviors and impair cognitive function in mice.

Exposome of attention deficit hyperactivity disorder in Taiwanese children: exploring risks of endocrine-disrupting chemicals

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is diagnosed in ~7% of school-aged children. The role of endocrine-disrupting chemicals (EDC) and oxidative stress in ADHD etiology are not clear.

OBJECTIVE

Assessment of the associations between simultaneous exposure to multiple compounds and ADHD in children.

METHODS

The case-control study included 76 clinically diagnosed ADHD cases and 98 controls, aged 4-15 years old. Concentrations quartiles of urinary metabolites of acrylamide, acrolein, nonylphenol, phthalates, and organophosphate pesticides and biomarkers of oxidative stress were used to fit logistic regressions for each compound and weighted quantiles sum (WQS) regression for the mixture.

RESULTS

Positive dose-response relationships with ADHD were observed for 4-hydroxy-2-nonenal-mercapturic acid (HNE-MA) (odds ratio(OR)_Q4 = 3.73, 95%CI [1.32, 11.04], p_trend = 0.003), dimethyl phosphate (DMP) (OR_Q4 = 4.04, 95%CI [1.34, 12.94], p_trend = 0.014) and diethyl phosphate (OR_Q4 = 2.61, 95%CI = [0.93, 7.66], p_trend = 0.030), and for the mixture of compounds (OR_WQS = 3.82, 95%CI = [1.78, 8.19]) with the main contributions from HNE-MA (28.9%) and DMP (18.4%).

CONCLUSIONS

The dose-response relationship suggests enhanced susceptibility to EDC burden in children even at lower levels, whereas the main risk is likely from organophosphate pesticides. HNE-MA is recommended as a sensitive biomarker of lipid peroxidation in the further elucidation of the oxidative stress role in ADHD etiology.

Students' perceptions of school sugar-free, food and exercise environments enhance healthy eating and physical activity

OBJECTIVE

The objective of this study was to examine the relationships between students' perceptions of their school policies and environments (i.e. sugar-sweetened beverages (SSB) free policy, plain water drinking, vegetables and fruit eating campaign, outdoor physical activity initiative, and the SH150 programme (exercise 150 min/week at school)) and their dietary behaviours and physical activity.

DESIGN

Cross-sectional study.

SETTING

Primary, middle and high schools in Taiwan.

PARTICIPANTS

A nationally representative sample of 2433 primary school (5th-6th grade) students, 3212 middle school students and 2829 high school students completed the online survey in 2018.

RESULTS

Multivariate analysis results showed that after controlling for school level, gender and age, the students' perceptions of school sugar-free policies were negatively associated with the consumption of SSB and positively associated with consumption of plain water. Schools' campaigns promoting the eating of vegetables and fruit were positively associated with students' consumption of vegetables. In addition, schools' initiatives promoting outdoor physical activity and the SH150 programme were positively associated with students' engagement in outdoor physical activities and daily moderate-to-vigorous physical activity.

CONCLUSIONS

Students' perceptions of healthy school policies and environments promote healthy eating and an increase in physical activity for students.

Long-Term Overconsumption of Sugar Starting at Adolescence Produces Persistent Hyperactivity and Neurocognitive Deficits in Adulthood

Sugar has become embedded in modern food and beverages. This has led to overconsumption of sugar in children, adolescents, and adults, with more than 60 countries consuming more than four times (>100 g/person/day) the WHO recommendations (25 g/person/day). Recent evidence suggests that obesity and impulsivity from poor dietary habits leads to further overconsumption of processed food and beverages. The long-term effects on cognitive processes and hyperactivity from sugar overconsumption, beginning at adolescence are not known. Using a well-validated mouse model of sugar consumption, we found that long-term sugar consumption, at a level that significantly augments weight gain, elicits an abnormal hyperlocomotor response to novelty and alters both episodic and spatial memory. Our results are similar to those reported in attention deficit and hyperactivity disorders. The deficits in hippocampal-dependent learning and memory were accompanied by altered hippocampal neurogenesis, with an overall decrease in the proliferation and differentiation of newborn neurons within the dentate gyrus. This suggests that long-term overconsumption of sugar, as that which occurs in the Western Diet might contribute to an increased risk of developing persistent hyperactivity and neurocognitive deficits in adulthood.

Association of beverage consumption types with weight, height, and body mass index in grade 3 children in northern Taiwan: A cross-sectional study

OBJECTIVES

The prevalence of convenience and beverage stores in Taiwan provides an environment for children to access different beverages. To our knowledge, the relationship between beverage consumption types and anthropometrics in children has not been reported in Taiwan. The aim of this study was to examine the association between the consumption frequency of beverage type and anthropometrics in third-grade children.

METHODS

This was a cross-sectional study conducted in 10 elementary schools in 12 administrative regions distributed evenly throughout Taipei City from June 2017 to December 2018. Parents of 515 children completed a questionnaire with written instructions, which was designed to collect demographic characteristics, frequency of consumed beverage types, and anthropometrics. This study was novel because beverage types were categorized based on sugar and protein contents, namely nutritious, sugar, nutritious and sugar, and non-nutritious and sugar-free. The differences in height and body weight between intake frequencies within each beverage type were determined using analysis of variance test or nonparametric statistics, depending on the confirmation of normal data distribution.

RESULTS

Height and weight of children consuming the most nutritious beverages fell in the highest respective percentile compared with those who did not consume them (P = 0.001 and 0.035, respectively). Consumption of nutritious and sugar and sugar beverages were not associated with height, body weight, or body mass index. Children who consumed more non-nutritious and sugar-free beverages were significantly heavier (P = 0.016) and had a higher body mass index (P = 0.001).

CONCLUSION

This was the first study conducted on third-grade children in Taiwan showing the beverage consumption type was associated with anthropometrics. Nutritious beverages appear to be a better choice for growth in children. Nevertheless, additional related studies, including an overall assessment of children's calorie and nutrient intakes and related dietary behaviors, are warranted to provide more helpful information for policymakers.

The Relationship Between Sugar-Sweetened Beverages, Takeaway Dietary Pattern, and Psychological and Behavioral Problems Among Children and Adolescents in China

Background and Aim: The association of sugar-sweetened beverage (SSB) consumption and takeaway dietary pattern with psychological problems in Chinese children and adolescents has not been concretely reported. Our study aimed to investigate the association between SSB consumption, takeaway dietary pattern, and psychological and behavioral problems (PBPs). Methods: Cluster sampling method has been adopted from April to May 2019 to conduct a questionnaire survey among 30,188 children and adolescents in grades 1 to 12 from 14 schools in six streets in Bao'an District of Shenzhen. This cross-sectional study investigated the association of consumption of SSBs and takeaway patterns with PBPs, and PBPs were measured by the Strengths and Difficulties Questionnaire (SDQ) in primary, junior, and senior high school students. Results: A total of 33,801 primary, junior, and senior high school students (mean age = 12.44, SD = 3.47) ranging from 6 to 18 years old were recruited in this study using a health survey of children and adolescents in junior and senior high schools (grades 1-12), and 30,188 students with no missing data were finally analyzed (questionnaires with missing value >5% were excluded). The top three SSBs in the intake frequency were milk beverage drinks (not milk), vegetable protein drinks, and fruit and vegetable juice drinks. Adjusted for demographic factors, the higher the frequency of students consuming SSBs who have significantly higher PBPs, the higher the frequency of students with takeaway dietary patterns who also have significantly higher PBPs. More frequent intake of SSBs [odds ratio (OR) = 2.23, 95%CI = 2.0-2.47, p < 0.01] and higher takeaway dietary patterns (OR = 2.34, 95%CI = 1.81-3.03, p < 0.01) were associated with higher SDQ total difficulties scores. When low and medium consumption of SSB was compared, children and adolescents who have high SSB intake were more associated with total difficulties score (OR = 3.10, 95%CI = 2.67-3.59, p < 0.01), and when low and medium takeaway dietary patterns were compared, children and adolescents who have high takeaway dietary patterns were more associated with total difficulties score. The joint associations of SSBs and takeaway pattern with SDQ were stronger than the associations individually. Conclusions: Students consuming higher SSBs and having takeaway dietary pattern are associated with increased levels of PBPs individually and interactively. These results may have implications for mental health prevention in adolescents.

The use of diet interventions to treat symptoms of ADHD in children and adolescents - a systematic review of randomized controlled trials

Background: For over forty years diet interventions have been investigated as a treatment of ADHD in children and adolescents and, with the new discoveries of the microbiota-gut-brain axis, this research becomes more relevant than ever. The aim of this systematic review was therefore to investigate the current knowledge of diet interventions as a treatment of ADHD in children and adolescentsMethods: A systematic literature search in PubMed was conducted, identifying randomized controlled trials investigating diet interventions to treat ADHD in children and adolescents.Results: The study populations were generally small and the studies varied in duration and nature of the exposure. Overall 10 out of 12 studies spoke in favour of an elimination diet, 2 out of 6 of eliminating artificial food colourings from the diet and none in favour of eliminating sucrose or aspartame from the diet to treat ADHD.Conclusion: The current evidence is not enough to recommend treating ADHD with diet interventions, but a subgroup of children and adolescents might warrant from elimination of certain food-items. Further investigations of the mechanism and effect of diet interventions to treat ADHD is needed.

Sugar consumption, sugar sweetened beverages and Attention Deficit Hyperactivity Disorder: A systematic review and meta-analysis

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a significant neurobehavioral disorder in children and adolescence which may be affected by diet.

OBJECTIVE

To evaluate the possible relationship between sugar consumption and the development of symptoms of ADHD.

METHODS

In March 2020, an exhaustive systematic literature search was conducted using Google Scholar, PubMed, and Scopus. In this meta-analysis of observational studies, odds ratios, relative risks, hazard ratios, and their 95% confidence intervals, which was reported for ADHD regarding SSBS, soft drink consumption, and dietary sugars, were used to calculate ORs and standard errors. At first, a fixed-effects model was used to drive the overall effect sizes using log ORs and SEs. If there was any significant between-studies heterogeneity, the random-effects model was conducted. Cochran's Q test and I² were used to measure potential sources of heterogeneity across studies. The Newcastle-Ottawa scale was used to assess the quality of the included articles.

RESULTS

Seven studies, two cross-sectional, two case-control, and three prospective with a total of 25,945 individuals were eligible to include in the current meta-analysis. The association between sugar and soft drink consumption and the risk of ADHD symptoms were provided based on the random-effects model (pooled effect size: 1.22, 95%CI: 1.04-1.42, P = 0.01) (I² = 81.9%, P _{heterogeneity}< 0.0001).

CONCLUSION

This meta-analysis indicated a positive relationship between overall sugar and sugar-sweetened beverages consumption and symptoms of ADHD; however, there was heterogeneity among included studies. Future well-designed studies that can account for confounds are necessary to confirm the effect of sugar on ADHD.

Sugar-sweetened beverages consumption are associated with behavioral problems among preschoolers: A population based cross-sectional study in China

BACKGROUND

Previous researches showed a positive association between sugar-sweetened beverages (SSB) and behavioral problems, but there is a little known in Chinese preschoolers.

METHODS

A population based survey was conducted in 109 kindergartens, in 11 cities across China. Children's SSB consumption was assessed by questionnaires completed by caregivers. The Strengths and Difficulties Questionnaire (SDQ) and the Clancy Autism Behavior Scale (CABS) were used to assessing the children's behavioral problems.

RESULT

The prevalence of SSB consumption ≥ 1 time/day was 24.9%. The adjusted odds ratios (95% confidence interval) of having elevated total difficulties by increasing levels of SSB consumption were 1.00, 1.13 (1.05, 1.22) and 1.24 (1.10, 1.41) (P for trend < 0.001), respectivly. Similar results were found in emotional symptoms, conduct problems, peer problems, and CABS. No significantly increased the risk of hyperactivity and prosocial were observed for higher SSB consumption. No gender differences were found in these associations.

LIMITATIONS

This is a cross-sectional survey and the causal relationship is unclear.

CONCLUSIONS

Higher SSB consumption is positively associated with behavioral problems among preschoolers in China.

High Levels of Glycosaminoglycans in the Urines of Children with Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral/neurodevelopmental disorder. Some early studies indicated that increased intake of added sugars might have a role in ADHD. In the present study, we tested this possibility by evaluating the urinary excretion of oligosaccharides and glycosaminoglycans (GAGs) in ADHD and control subjects. Forty ADHD subjects matched with 34 controls were enrolled in the study. The subjects underwent a standardized dietary regimen. The urine levels of oligosaccharides and GAGs were quantified biochemically, and their covariance and association were evaluated statistically. Fructose (21/40, 52.5%), maltose (26/40, 65%), galactose (30/40, 75%), and lactose (38/40, 95%) excretions were frequently found in the urine of ADHD subjects (p < 0.05), an excretion which does not occur normally. Furthermore, these subjects showed a pathologic tGAG (glycosaminoglycan) excretion (40/40, 100%). The present study supports the thesis that carbohydrate metabolism differs in ADHD subjects compared with control subjects.

The myth of knowledge within a robust nutrition online training course

Purpose

The purpose of this paper was to develop a predictor model for an online nutrition course on sugar reduction. The proposed model is based on health knowledge, healthy behavior, social support, self-efficacy, attitude and the health belief model in relation to people’s behavior within a Facebook group. Subsequently, the model can be used to design a robust online training course for human resources, thereby reducing the training costs which managers have experienced as being expensive.

Design/methodology/approach

A single pre-post experimental group design was used. Pre and post data were collected from 100 Facebook users using an online questionnaire, within a three-week intervention.

Findings

The results show a significant difference between pre- and post-test scores of health knowledge and healthy behavior, indicating an effective intervention. In addition, perceived barriers, attitude, self-efficacy and emotional support were significant predictors of the healthy behavior model, predicting 70 percent of healthy behavior. However, knowledge had no significant relationship with any of the three dependent variables (self-efficacy, attitude and healthy behavior) proposed.

Practical implications

This model has proved to be an effective intervention which can be used in online training of human resources, because the content of the training is known from the predictor model, thereby greatly reducing the training cost, since everything is done online. Moreover, the provided model and predictors show that the content to be delivered in the training program is not knowledge but perceived barriers, attitude, self-efficacy and emotional support.

Originality/value

This study is one of the first to propose an integrative model that suggests attitude and self-efficacy as key predictors of healthy behavior whereas knowledge is not.

Association between sleep duration and attention-deficit hyperactivity disorder: A systematic review and meta-analysis of observational studies✰

BACKGROUND

Several previous meta-analyses have investigated the association between sleep quality and attention-deficit/hyperactivity disorder (ADHD). To examine the relationship between short or long sleep duration and ADHD, a meta-analysis of observational studies was conducted.

METHODS

The PubMed, EMBASE, and Cochrane Library databases were systematically searched in March 2019 to retrieve observational studies. A random-effects model was used to analyze meta-estimates of sleep duration. Three evaluators independently reviewed and selected the articles based on pre-determined selection criteria.

RESULTS

Of 1466 articles retrieved, 10 observational epidemiological studies, comprising six case-control studies and four prospective cohort studies, were included in the final analysis. Short sleep duration was significantly linked to ADHD compared with average sleep duration (odds ratio [OR] or relative risk [RR] 1.28 [95% confidence interval (CI) 1.16-1.41]), and especially with hyperactivity (OR/RR 1.60 [95% CI 1.18-2.17]). Subgroup meta-analyses according to various factors, such as study design, number of participants, methodological quality, and adjustment for smoking status and education, yielded consistent results. A significant association between long sleep duration and ADHD was not observed.

LIMITATIONS

Publication bias and substantial heterogeneity due to the diverse measurement tools used to determine ADHD were observed. Lack of prospective cohort studies was another limitation.

CONCLUSION

Short sleep duration was associated with ADHD in the current meta-analysis. Clinicians may need to be more aware of this association.

Sugar rush or sugar crash? A meta-analysis of carbohydrate effects on mood

The effect of carbohydrate (CHO) consumption on mood is much debated, with researchers reporting both mood improvements and decrements following CHO ingestion. As global consumption of sugar-sweetened products has sharply increased in recent years, examining the validity of claims of an association between CHOs and mood is of high importance. We conducted a systematic review and meta-analysis to evaluate the relationship between acute CHO ingestion and mood. We examined the time-course of CHO-mood interactions and considered the role of moderator variables potentially affecting the CHO-mood relationship. Analysis of 176 effect sizes (31 studies, 1259 participants) revealed no positive effect of CHOs on any aspect of mood at any time-point following their consumption. However, CHO administration was associated with higher levels of fatigue and less alertness compared with placebo within the first hour post-ingestion. These findings challenge the idea that CHOs can improve mood, and might be used to increase the public's awareness that the 'sugar rush' is a myth, inform health policies to decrease sugar consumption, and promote healthier alternatives.

The Association between Lead and Attention-Deficit/Hyperactivity Disorder: A Systematic Review

The etiology of Attention-Deficit/Hyperactivity Disorder (ADHD) is complex and multifactorial. Although the development of ADHD symptoms remains to be elucidated, in recent years, epigenetic processes have emerged as candidate mechanisms. Lead is one of the most dangerous environmental pollutants, and it is suspected to be associated with ADHD. The aim of the present study was to review the epidemiological literature currently available on the relation between lead exposure and the diagnosis of ADHD. The PubMed and EMBASE databases were searched from 1 July 2018 up to 31 July 2018. The authors included observational studies (cohort, case⁻control and cross-sectional studies) published in English carried out on children within the last 5 years, measuring lead exposure and health outcomes related to ADHD. Seventeen studies met the inclusion criteria: 5 of these studies found no association between lead exposure and ADHD whereas the remaining 12 studies showed positive associations, even though not all of them were homogeneous in terms of exposure periods considered or ADHD diagnosis. To conclude, the evidence from the studies allowed us to establish that there is an association between lead and ADHD and that even low levels of lead raise the risk. However, there is still a lack of longitudinal studies about the relationship between lead exposure and the development of ADHD. Given the potential importance for public health, further research that includes the entire potential risk factors for ADHD in children must be encouraged.

The interactions among organophosphate pesticide exposure, oxidative stress, and genetic polymorphisms of dopamine receptor D4 increase the risk of attention deficit/hyperactivity disorder in children

OBJECTIVE

The aim of this study was to clarify the association between organophosphate pesticides (OPs) and attention-deficit/hyperactivity disorder (ADHD) related to oxidative stress and genetic polymorphisms.

METHODS

This case-control study enrolled 93 children with ADHD and 112 control children in north Taiwan. Six dialkyl phosphate (DAP) metabolites of OPs and oxidative stress biomarkers were analyzed. Polymorphisms of the dopamine receptor D4 gene (DRD4) were identified.

RESULTS

Children with ADHD had significantly higher dimethylphosphate (DMP, 236.69nmol/g cre. vs. 186.84nmol/g cre., p value = 0.01) and 4-hydroxy-2-nonenal-mercapturic acid (HNE-MA, 28.95µg/g cre. vs. 16.55µg/g cre., p value<0.01) concentrations than control children. Children who carried DRD4 GA/AA genotypes (rs752306) were less likely than those who carried the DRD4 GG genotype to have ADHD (odds ratio [OR]: 0.45, 95% CI: 0.24-0.84). The estimated value of the AP (attributable proportion due to interaction) was 0.59 (95% CI: 0.13-1.05), indicating that 59% of ADHD cases in DMP-exposed children with the DRD4 GG genotype were due to the gene-environment interaction. After adjustment for other covariates, children who carried the DRD4 GG genotype, had been exposed to high DMP levels (more than the median), and had high HNE-MA levels had a significantly increased risk for developing ADHD (OR = 11.74, 95% CI: 2.12-65.04).

CONCLUSION

This study indicated a gene-environment interaction in the risk of ADHD in children. The association between DMP and ADHD in children might relate to the mechanism of lipid peroxidation. Dose-response relationships and the combined effects of OPs, oxidative stress, and genetic polymorphism on ADHD should not be neglected.

ADHD Medication, Dietary Patterns, Physical Activity, and BMI in Children: A Longitudinal Analysis of the ECLS-K Study

OBJECTIVE

This study examined relationships between attention-deficit/hyperactivity disorder (ADHD), stimulant use, and BMI change in a nationally representative cohort of children as well as differences in diet and physical activity that may mediate associations between stimulant use and BMI change.

METHODS

By using the Early Childhood Longitudinal Study-Kindergarten Cohort 1998-1999 (N = 8,250), we modeled BMI and z score change by ADHD and stimulant start time, examined the odds of unhealthy diet and physical activity predicted by ADHD and stimulant use, and performed mediation analysis assessing indirect effects of health behaviors.

RESULTS

Early stimulant use predicted short-term BMI reductions, but any stimulant use predicted increased BMI growth between fifth grade (mean age = 11.2 years) and eighth grade (mean age = 14.3 years). Children with ADHD had higher odds of poor diet regardless of medication. Health behaviors were not associated with BMI change after controlling for medication use.

CONCLUSIONS

Stimulant use predicted higher BMI trajectory between fifth and eighth grade but did not affect dietary or physical activity patterns. Future research should explore potential mechanisms by which early and long-term stimulant use may affect metabolism, while clinicians should initiate nutrition counseling with families of children with ADHD, regardless of medication prescription, at or shortly after diagnosis.

Nutritional Status of Korean Children and Adolescents with Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) has been associated with an elevated risk for obesity but this seems to be paradoxical to the fact that many youths with ADHD have symptoms of hyperactivity. People diagnosed with ADHD tend to have a high risk of developing undesirable diet habits and consequently have health related problems. However, less attention has been paid to obesity in ADHD while many efforts have been devoted to the prevention of childhood obesity in mentally normal people. Hence the purpose of this study was to explore the nutritional status and life habits of children and adolescents with ADHD (n = 76) based on degree of obesity by utilizing the Korean National Health and Nutrition Examination Survey (KNHANES) data from 2005–2013. As results the levels of blood pressure, total triglycerides and the fat intake relative to total energy intake in overweight ADHD group were higher than those in normal weight group. Interestingly, overweight ADHD subjects consumed significantly less amount of iron compared to normal weight ADHD subjects and the level of serum ferritin was lower in the overweight ADHD group (59.0 ng/mL) than in the normal weight ADHD group (47.9 ng/mL). After adjusting total energy intake, total vegetable consumption was 14.3% lower in overweight group compared to the consumption in normal weight group. These results indicate a plausible relationship of iron status and obesity in ADHD subjects but this relationship may not be specific to ADHD. A future study with case-control design is necessary to investigate the association of obesity, nutrient intake, and cognitive/mental status of ADHD.