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McWilliams S, Hill O, Ipsiroglu OS, Clemens S, Weber AM, Chen M, Connor J, Felt BT, Manconi M, Mattman A, Silvestri R, Simakajornboon N, Smith SM, Stockler S. Iron Deficiency and Sleep/Wake Behaviors: A Scoping Review of Clinical Practice Guidelines-How to Overcome the Current Conundrum? Nutrients 2024; 16:2559. [PMID: 39125438 PMCID: PMC11314179 DOI: 10.3390/nu16152559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Current evidence suggests that iron deficiency (ID) plays a key role in the pathogenesis of conditions presenting with restlessness such as attention deficit hyperactivity disorder (ADHD) and restless legs syndrome (RLS). In clinical practice, ID and iron supplementation are not routinely considered in the diagnostic work-up and/or as a treatment option in such conditions. Therefore, we conducted a scoping literature review of ID guidelines. Of the 58 guidelines included, only 9 included RLS, and 3 included ADHD. Ferritin was the most frequently cited biomarker, though cutoff values varied between guidelines and depending on additional factors such as age, sex, and comorbidities. Recommendations surrounding measurable iron biomarkers and cutoff values varied between guidelines; moreover, despite capturing the role of inflammation as a concept, most guidelines often did not include recommendations for how to assess this. This lack of harmonization on the interpretation of iron and inflammation biomarkers raises questions about the applicability of current guidelines in clinical practice. Further, the majority of ID guidelines in this review did not include the ID-associated disorders, ADHD and RLS. As ID can be associated with altered movement patterns, a novel consensus is needed for investigating and interpreting iron status in the context of different clinical phenotypes.
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Affiliation(s)
- Scout McWilliams
- H-Behaviours Research Lab (Previously Sleep/Wake-Behaviours Research Lab), BC Children’s Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada; (S.M.); (O.H.); (S.S.)
| | - Olivia Hill
- H-Behaviours Research Lab (Previously Sleep/Wake-Behaviours Research Lab), BC Children’s Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada; (S.M.); (O.H.); (S.S.)
| | - Osman S. Ipsiroglu
- H-Behaviours Research Lab (Previously Sleep/Wake-Behaviours Research Lab), BC Children’s Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada; (S.M.); (O.H.); (S.S.)
- Divisions of Developmental Pediatrics, Child and Adolescent Psychiatry and Respirology, BC Children’s Hospital, Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Stefan Clemens
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA;
| | - Alexander Mark Weber
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Michael Chen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (M.C.); (A.M.)
| | - James Connor
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA 17033, USA;
| | - Barbara T. Felt
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Department of Neurology, University of Bern, 3012 Bern, Switzerland
| | - Andre Mattman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (M.C.); (A.M.)
| | - Rosalia Silvestri
- Department of Clinical and Experimental Medicine, Sleep Medicine Center, University of Messina, Azienda Ospedaliera Universitaria “Gaetano Martino”, 98122 Messina, Italy;
| | - Narong Simakajornboon
- Sleep Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Susan M. Smith
- Department of Nutrition, UNC-Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA;
| | - Sylvia Stockler
- H-Behaviours Research Lab (Previously Sleep/Wake-Behaviours Research Lab), BC Children’s Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC V5Z 4H4, Canada; (S.M.); (O.H.); (S.S.)
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Division of Biochemical Diseases, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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Morandini HAE, Watson PA, Barbaro P, Rao P. Brain iron concentration in childhood ADHD: A systematic review of neuroimaging studies. J Psychiatr Res 2024; 173:200-209. [PMID: 38547742 DOI: 10.1016/j.jpsychires.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/23/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
Iron deficiency may play a role in the pathophysiology of Attention Deficit/Hyperactivity Disorder (ADHD). Due to its preponderant function in monoamine catecholamine and myelin synthesis, brain iron concentration may be of primary interest in the investigation of iron dysregulation in ADHD. This study reviewed current evidence of brain iron abnormalities in children and adolescents with ADHD using magnetic resonance imaging methods, such as relaxometry and quantitative susceptibility mapping, to assess brain iron estimates. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed for studies published between January 1, 2008 and July 7, 2023 in Medline, Scopus and Proquest. Regions of interest, brain iron index values and phenotypical information were extracted from the relevant studies. Risk of bias was assessed using a modified version of the National Heart, Lung, and Blood Institute quality assessment tool. Seven cross-sectional studies comparing brain iron estimates in children with ADHD with neurotypical children were included. Significantly reduced brain iron content in medication-naïve children with ADHD was a consistent finding. Two studies found psychostimulant use may increase and normalize brain iron concentration in children with ADHD. The findings were consistent across the studies despite differing methodologies and may lay the early foundation for the recognition of a potential biomarker in ADHD, although longitudinal prospective neuroimaging studies using larger sample sizes are required. Lastly, the effects of iron supplementation on brain iron concentration in children with ADHD need to be elucidated.
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Affiliation(s)
- Hugo A E Morandini
- Complex Attention and Hyperactivity Disorders Service, Child and Adolescent Health Services, Perth, WA, Australia; Division of Psychiatry, UWA Medical School, Faculty of Health & Medical Sciences, The University of Western Australia, Australia.
| | - Prue A Watson
- Complex Attention and Hyperactivity Disorders Service, Child and Adolescent Health Services, Perth, WA, Australia
| | - Parma Barbaro
- Complex Attention and Hyperactivity Disorders Service, Child and Adolescent Health Services, Perth, WA, Australia
| | - Pradeep Rao
- Complex Attention and Hyperactivity Disorders Service, Child and Adolescent Health Services, Perth, WA, Australia; Division of Psychiatry, UWA Medical School, Faculty of Health & Medical Sciences, The University of Western Australia, Australia; Telethon Kids Institute, Perth, Australia
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Elliott SD, Vickers ML, McKeon G, Eriksson L, Malacova E, Scott JG. Iron Supplementation in Management of Neurodevelopmental Disorders: Systematic Review, Meta-Analysis, and Qualitative Synthesis. J Neuropsychiatry Clin Neurosci 2024; 36:178-186. [PMID: 38343311 DOI: 10.1176/appi.neuropsych.20230081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVE The authors sought to explore the role of iron supplementation in the management of neurodevelopmental disorders among children and youths. METHODS A systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. A subset of results was suitable for meta-analysis. The quality of the evidence and strength of the clinical recommendations were assessed by using the Grading of Recommendations, Assessment, Development, and Evaluation method, and critical appraisal was conducted with the Joanna Briggs Institute critical appraisal tools. RESULTS Nine articles met inclusion criteria. These articles included studies of attention-deficit hyperactivity disorder (ADHD) (N=7), autism spectrum disorder (N=1), and Tourette's syndrome (N=1). Three randomized controlled trials evaluating iron supplementation for ADHD hyperactivity symptom severity (124 participants: placebo, N=56; supplement, N=68) met inclusion criteria for a meta-analysis. Effect sizes for the placebo and supplement groups were moderate (Cohen's d=0.76) and large (Cohen's d=1.70), respectively, although these differences were not significant. The impact of iron supplementation on inattentive ADHD symptom severity was examined in two trials (75 participants: placebo, N=31; supplement, N=44). Large, nonsignificant effect sizes were demonstrated for the placebo (Cohen's d=1.66) and supplementation (Cohen's d=3.19) groups. The quality of the evidence and strength of the clinical recommendations were considered very low. CONCLUSIONS Further research is needed to examine the role of iron supplementation in the management of ADHD and neurodevelopmental disorders more generally. Additionally, iron supplementation comes with risks, including death in the case of overdose.
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Affiliation(s)
- Stephen D Elliott
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
| | - Mark L Vickers
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
| | - Gemma McKeon
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
| | - Lars Eriksson
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
| | - Eva Malacova
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
| | - James G Scott
- Metro North Mental Health Service, Herston, Australia (Elliott, Vickers); Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom (Elliott); Faculty of Medicine (Vickers), Child Health Research Center (McKeon, Scott), and Herston Health Sciences Library (Eriksson), University of Queensland, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia (Vickers); West Moreton Health Psychology, Park Center for Mental Health, Brisbane, Australia (McKeon); Child and Youth Mental Health Group, Queensland Center for Mental Health Research, Brisbane, Australia (McKeon, Scott); Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Australia (Malacova, Scott); Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia (Scott)
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Pinto S, Correia-de-Sá T, Sampaio-Maia B, Vasconcelos C, Moreira P, Ferreira-Gomes J. Eating Patterns and Dietary Interventions in ADHD: A Narrative Review. Nutrients 2022; 14:nu14204332. [PMID: 36297016 PMCID: PMC9608000 DOI: 10.3390/nu14204332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Sofia Pinto
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal
| | - Teresa Correia-de-Sá
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- INEB—Institute of Biomedical Engineering, University of Porto, 4200-135 Porto, Portugal
- i3S—Institute for Research & Innovation in Health, University of Porto, 4200-135 Porto, Portugal
| | - Benedita Sampaio-Maia
- INEB—Institute of Biomedical Engineering, University of Porto, 4200-135 Porto, Portugal
- i3S—Institute for Research & Innovation in Health, University of Porto, 4200-135 Porto, Portugal
- Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
| | - Carla Vasconcelos
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal
- Nutrition Service, University Hospital Center of São João, 4200-319 Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, 4200-450 Porto, Portugal
- Correspondence: ; Tel.: +351-225-074-320
| | - Joana Ferreira-Gomes
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- i3S—Institute for Research & Innovation in Health, University of Porto, 4200-135 Porto, Portugal
- IBMC—Institute for Molecular and Cell Biology, University of Porto, 4200-135 Porto, Portugal
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McWilliams S, Singh I, Leung W, Stockler S, Ipsiroglu OS. Iron deficiency and common neurodevelopmental disorders—A scoping review. PLoS One 2022; 17:e0273819. [PMID: 36173945 PMCID: PMC9522276 DOI: 10.1371/journal.pone.0273819] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background A wealth of human and experimental studies document a causal and aggravating role of iron deficiency in neurodevelopmental disorders. While pre-, peri-, and early postnatal iron deficiency sets the stage for the risk of developing neurodevelopmental disorders, iron deficiency acquired at later ages aggravates pre-existing neurodevelopmental disorders. Yet, the association of iron deficiency and neurodevelopmental disorders in childhood and adolescence has not yet been explored comprehensively. In this scoping review, we investigate 1) the association of iron deficiency in children and adolescents with the most frequent neurodevelopmental disorders, ADHD, ASD, and FASD, and 2) whether iron supplementation improves outcomes in these disorders. Method Scoping review of studies published between 1994 and 2021 using “iron deficiency / iron deficiency anemia” AND “ADHD” OR “autism” OR “FASD” in four biomedical databases. The main inclusion criterion was that articles needed to have quantitative determination of iron status at any postnatal age with primary iron markers such as serum ferritin being reported in association with ADHD, ASD, or FASD. Results For ADHD, 22/30 studies and 4/4 systematic reviews showed an association of ADHD occurrence or severity with iron deficiency; 6/6 treatment studies including 2 randomized controlled trials demonstrated positive effects of iron supplementation. For ASD, 3/6 studies showed an association with iron deficiency, while 3/6 and 1/1 systematic literature review did not; 4 studies showed a variety of prevalence rates of iron deficiency in ASD populations; 1 randomized controlled trial found no positive effect of iron supplementation on behavioural symptoms of ASD. For FASD, 2/2 studies showed an association of iron deficiency with growth retardation in infants and children with prenatal alcohol exposure. Conclusion Evidence in favor of screening for iron deficiency and using iron supplementation for pediatric neurodevelopmental disorders comes primarily from ADHD studies and needs to be further investigated for ASD and FASD. Further analysis of study methodologies employed and populations investigated is needed to compare studies against each other and further substantiate the evidence created.
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Affiliation(s)
- Scout McWilliams
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Ishmeet Singh
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Wayne Leung
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Sylvia Stockler
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Division of Biochemical Diseases, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Osman S. Ipsiroglu
- H-Behaviours Research Lab (previously Sleep/Wake-Behaviour Research Lab), BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Divisions of Child & Adolescent Psychiatry, Developmental Pediatrics and Respirology, Department of Pediatrics, Sleep/Wake-Behaviour Clinic at Sleep Program, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
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Rosenau PT, van den Hoofdakker BJ, Matthijssen AFM, van de Loo-Neus GHH, Buitelaar JK, Hoekstra PJ, Dietrich A. Withdrawing methylphenidate in relation to serum levels of ferritin and zinc in children and adolescents with attention-deficit/hyperactivity disorder. J Psychiatr Res 2022; 152:31-37. [PMID: 35714551 DOI: 10.1016/j.jpsychires.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/26/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
Iron and zinc have been associated with attention-deficit/hyperactivity disorder (ADHD), executive functioning, and response to methylphenidate, given their link with the dopaminergic system. This study aimed to investigate the effect of withdrawing methylphenidate after long-term treatment on serum levels of ferritin and zinc; and if baseline (pre-discontinuation) serum levels of these nutritional markers moderated the effects of withdrawing methylphenidate on ADHD and oppositional defiant disorder (ODD) symptoms, and working memory. Blood samples were collected from 63 children and adolescents who participated in a randomized, placebo-controlled methylphenidate discontinuation study. They were assigned to either seven weeks of continued treatment with methylphenidate or to gradual withdrawal to placebo. With mixed models for repeated measures we (i) compared changes in ferritin and zinc serum levels between both groups, and (ii) investigated moderating effects of ferritin and zinc on the effects of discontinuation on ADHD and ODD symptoms, and working memory. We additionally explored correlations of baseline and change serum levels with respective symptom scores. Withdrawing methylphenidate led to a decrease in ferritin levels. Higher baseline ferritin was associated with a larger increase (i.e., worsening) of teacher-rated hyperactivity-impulsivity and ODD symptoms after withdrawal; and higher baseline zinc with a larger increase in number of errors on the working memory task after withdrawal. Serum levels did not correlate with ADHD and ODD symptoms. Our preliminary results suggest that ferritin and zinc may be potential biomarkers for the effectiveness of long-term treatment with methylphenidate.
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Affiliation(s)
- Paul T Rosenau
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands.
| | - Barbara J van den Hoofdakker
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands
| | - Anne-Flore M Matthijssen
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
| | | | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry Center Nijmegen, Nijmegen, the Netherlands; Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, Nijmegen, the Netherlands
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands
| | - Andrea Dietrich
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands
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Tohidi S, Bidabadi E, Khosousi MJ, Amoukhteh M, Kousha M, Mashouf P, Shahraki T. Effects of Iron Supplementation on Attention Deficit Hyperactivity Disorder in Children Treated with Methylphenidate. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:712-720. [PMID: 34690126 PMCID: PMC8553525 DOI: 10.9758/cpn.2021.19.4.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/07/2021] [Accepted: 06/27/2021] [Indexed: 11/18/2022]
Abstract
Objective To evaluate the effect of iron on the attention deficit hyperactivity disorder, treated with methylphenidate. Methods This double-blind, randomized placebo-controlled clinical trial was performed on 50 children with attention deficit hyperactivity disorder under the treatment of methylphenidate, with ferritin levels below 30 ng/ml and absence of anemia. They were randomly assigned into two groups of ferrous sulfate and placebo, for 12 weeks. Conners' Parent Rating Scale (CPRS) was used to assess the outcome in the first, sixth, and twelfth weeks. Results Almost all CPRS subscales improved in the ferrous sulfate group from the baseline to the endpoint, although only the changes in conduct subscale scores were significant (p = 0.003). There was no significant difference in score changes between two groups in intergroup comparison. Also, the score of learning problems (p = 0.007) in the first six weeks, and conduct (p = 0.023) and psychosomatic (p = 0.018) subscales in the second six weeks were improved in the ferrous sulfate group compared with the placebo group. Conclusion Our study showed promising effects of iron supplementation in the improvement of subscales of the CPRS.
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Affiliation(s)
- Sepehr Tohidi
- Student Research Committee, School of Medicine, Guilan Universtiy of Medical Sciences, Rasht, Iran
| | - Elham Bidabadi
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad-Javad Khosousi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Melika Amoukhteh
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Kousha
- Department of Psychiatry, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Tamkin Shahraki
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
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The Role of Iron and Zinc in the Treatment of ADHD among Children and Adolescents: A Systematic Review of Randomized Clinical Trials. Nutrients 2021; 13:nu13114059. [PMID: 34836314 PMCID: PMC8618748 DOI: 10.3390/nu13114059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 12/18/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder common from childhood to adulthood, affecting 5% to 12% among the general population in developed countries. Potential etiological factors have been identified, including genetic causes, environmental elements and epigenetic components. Nutrition is currently considered an influencing factor, and several studies have explored the contribution of restriction and dietary supplements in ADHD treatments. Iron is an essential cofactor required for a number of functions, such as transport of oxygen, immune function, cellular respiration, neurotransmitter metabolism (dopamine production), and DNA synthesis. Zinc is also an essential trace element, required for cellular functions related to the metabolism of neurotransmitters, melatonin, and prostaglandins. Epidemiological studies have found that iron and zinc deficiencies are common nutritional deficits worldwide, with important roles on neurologic functions (poor memory, inattentiveness, and impulsiveness), finicky appetite, and mood changes (sadness and irritability). Altered levels of iron and zinc have been related with the aggravation and progression of ADHD. Objective: This is a systematic review focused on the contribution of iron and zinc in the progression of ADHD among children and adolescents, and how therapies including these elements are tolerated along with its effectiveness (according to PRISMA guidelines). Method: The scientific literature was screened for randomized controlled trials published between January 2000 to July 2021. The databases consulted were Medline, PsycINFO, Web of Science, and Google Scholar. Two independent reviewers screened studies, extracted data, and assessed quality and risk of bias (CONSORT, NICE, and Cochrane checklists used). Conclusion: Nine studies met the eligibility criteria and were selected. Evidence was obtained regarding the contribution of iron-zinc supplementation in the treatment of ADHD among young individuals. The discussion was focused on how the deficits of these elements contribute to affectation on multiple ADHD correlates, and potential mechanisms explaining the mediational pathways. Evidence also suggested that treating ADHD with diet interventions might be particularly useful for specific subgroups of children and adolescents, but further investigations of the effects of these diet interventions are needed.
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