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Rucklidge JJ, Eggleston MJF, Boggis A, Darling K, Gorman B, Frampton CM. Do Changes in Blood Nutrient Levels Mediate Treatment Response in Children and Adults With ADHD Consuming a Vitamin-Mineral Supplement? J Atten Disord 2021; 25:1107-1119. [PMID: 31707909 DOI: 10.1177/1087054719886363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: We investigated whether changes in serum nutrient levels mediate clinical response to a micronutrient intervention for ADHD. Method: Data were compiled from two ADHD trials (8-10 weeks), one in adults (n = 53) and one in children (n = 38). Seven outcomes included change in ADHD symptoms, mood, overall functioning (all clinician-rated) as well as response status. Change in serum/plasma nutrient levels (vitamins B12 and D, folate, ferritin, iron, zinc, and copper) were considered putative mediators. Results: A decrease in ferritin and an increase in copper were weakly associated with greater likelihood of being identified as an ADHD responder; none of the other nutrient biomarkers served as mediators. Conclusion: Further research looking at nutrients more broadly from other tissues are required to confirm these initial observations of the limited value of nutrient levels in deciphering mechanism of action. Monitoring these biomarkers on their own is unlikely helpful in understanding clinical response to a broad-spectrum micronutrient approach.
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Affiliation(s)
| | | | - Anna Boggis
- Canterbury District Health Board, Christchurch, New Zealand
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2
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Abstract
Objective: The objective of the study is to examine whether children aged 7 to 11 years with very well-characterized ADHD, recruited from the community, have a similar number of healthy lifestyle behaviors as compared with typically developing children from the same community. Method: Parents of children with (n = 184) and without (n = 104) ADHD completed a lifestyle questionnaire asking about water intake, sweetened beverage consumption, multivitamin/supplement use, reading, screen time, physical activity, and sleep. A lifestyle index was formed from these seven domains (0-7), and multivariable ordered logistic regression was used to examine the association of ADHD status and total healthy lifestyle behaviors. Results: Children with ADHD were almost twice as likely to have fewer healthy behaviors, even after adjustment for age, sex, intelligence quotient (IQ), ADHD medication use, household income, and four comorbid psychiatric disorders (odds ratio [OR] [95% confidence interval] = 1.95 [1.16, 3.30], p = .01). Conclusion: Future research is needed to assess the effects of a combined lifestyle intervention in this group.
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Affiliation(s)
| | - Joel T. Nigg
- Oregon Health & Science University, Portland, OR, USA
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3
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Rosi E, Grazioli S, Villa FM, Mauri M, Gazzola E, Pozzi M, Molteni M, Nobile M. Use of Non-Pharmacological Supplementations in Children and Adolescents with Attention Deficit/Hyperactivity Disorder: A Critical Review. Nutrients 2020; 12:nu12061573. [PMID: 32481502 PMCID: PMC7352506 DOI: 10.3390/nu12061573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents, with environmental and biological causal influences. Pharmacological medication is the first choice in ADHD treatment; recently, many studies have concentrated on dietary supplementation approaches to address nutritional deficiencies, to which part of non-responses to medications have been imputed. This review aims to evaluate the efficacy of non-pharmacological supplementations in children or adolescents with ADHD. We reviewed 42 randomized controlled trials comprised of the following supplementation categories: polyunsaturated fatty acids (PUFAs), peptides and amino acids derivatives, single micronutrients, micronutrients mix, plant extracts and herbal supplementations, and probiotics. The reviewed studies applied heterogeneous methodologies, thus making it arduous to depict a systematic overview. No clear effect on single cognitive, affective, or behavioral domain was found for any supplementation category. Studies on PUFAs and micronutrients found symptomatology improvements. Peptides and amino acids derivatives, plant extracts, herbal supplementation, and probiotics represent innovative research fields and preliminary results may be promising. In conclusion, such findings, if confirmed through future research, should represent evidence for the efficacy of dietary supplementation as a support to standard pharmacological and psychological therapies in children and adolescents with ADHD.
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Affiliation(s)
- Eleonora Rosi
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy; (E.R.); (F.M.V.); (M.M.); (M.M.); (M.N.)
| | - Silvia Grazioli
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy; (E.R.); (F.M.V.); (M.M.); (M.M.); (M.N.)
- Correspondence:
| | - Filippo Maria Villa
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy; (E.R.); (F.M.V.); (M.M.); (M.M.); (M.N.)
| | - Maddalena Mauri
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy; (E.R.); (F.M.V.); (M.M.); (M.M.); (M.N.)
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Erica Gazzola
- Department of Psychology, University of Milano Bicocca, 20126 Milan, Italy;
| | - Marco Pozzi
- Scientific Institute, IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy;
| | - Massimo Molteni
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy; (E.R.); (F.M.V.); (M.M.); (M.M.); (M.N.)
| | - Maria Nobile
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy; (E.R.); (F.M.V.); (M.M.); (M.M.); (M.N.)
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Abstract
The field of 'nutritional psychiatry' has evolved with rapidity over the past several years, with an increasing amount of dietary or nutrient-based (nutraceutical) intervention studies being initiated, and more preclinical and epidemiological data being available. This emergent paradigm involves the clinical consideration (where appropriate) of prescriptive dietary modification/improvement, and/or the select judicious use of nutrient-based supplementation to prevent or manage psychiatric disorders. In the last several years, significant links have increasingly been established between dietary quality and mental health (although not all data are supportive). Maternal and early-life nutrition may also affect the mental health outcomes in offspring. In respect to nutraceutical research, like with many recent conventional drug studies, results are fairly mixed across the board, and in many cases there is not emphatic evidence to support the use of nutraceuticals in various psychiatric disorders. This may in part be due to a preponderance of recent studies within the field revealing marked placebo effects. Due to current indicators pointing towards mental disorders having an increasing burden of disease, bold and innovative approaches on a societal level are now required. In light of the widespread use of nutrient supplements by those with and without mental disorders, it is also critical that scientifically rigorous methodologies be brought to bear on the assessment of the efficacy of these supplements, and to determine if, or what dose of, a nutrient supplement is required, for whom, and when, and under what circumstances. More simple studies of additional isolated nutrients are not of great benefit to the field (unless studied in supra-dosage in an individualised, biomarker-guided manner), nor, based on recent data, is the research of 'shotgun' formulations of nutraceuticals. The next critical step for the field is to design psychiatric interventional studies for both dietary modification and nutraceuticals, based on more of a personalised medicine approach, using biomarkers (e.g. nutrient deficiencies, inflammatory cytokine levels, genomic assessment, microbiome analysis) and a person's dietary patterns and individual macro/micronutrient requirements.
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Affiliation(s)
- Jerome Sarris
- NICM Health Research Institute, Western Sydney University, 158 Hawkesbury Rd, Westmead, NSW, 2145, Australia. .,Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Richmond, VIC, Australia.
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5
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Darling KA, Eggleston MJF, Retallick-Brown H, Rucklidge JJ. Mineral-Vitamin Treatment Associated with Remission in Attention-Deficit/Hyperactivity Disorder Symptoms and Related Problems: 1-Year Naturalistic Outcomes of a 10-Week Randomized Placebo-Controlled Trial. J Child Adolesc Psychopharmacol 2019; 29:688-704. [PMID: 31343273 DOI: 10.1089/cap.2019.0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: This article presents 1-year follow-up of a randomized placebo-controlled trial with open-label extension evaluating the efficacy of a broad-spectrum micronutrient (vitamins and minerals) intervention. The object was to determine if dominant treatment at follow-up was associated with differential psychological outcomes. Methods: Ninety percent of the original sample of 93 children with attention-deficit/hyperactivity disorder (ADHD) were followed 52 weeks postbaseline. Assessments included measures of ADHD, mood, anxiety, and general function based on parent/clinician report. Outcome was considered based on dominant therapy at 52 weeks (trial micronutrients [n = 19], medications [n = 21], and no treatment [n = 35]). Nine children were not categorized due to inconsistent therapies. Results: Based on dominant treatment, more of those who stayed on trial micronutrients (84%) were identified as "Much" or "Very Much" improved overall relative to baseline functioning, compared to 50% of those who switched to psychiatric medications and only 21% of those who discontinued treatment [χ2(2) = 19.476, p < 0.001]. Fifteen (79%) of those still taking micronutrients, 8 (42%) of those using medications, and 7 (23%) of those who discontinued treatment were considered remitters based on parent-reported ADHD [χ2(2) = 15.3, p < 0.001]. Those who stayed on micronutrients were more likely to have failed medication treatment in the past. The micronutrient group also displayed better outcomes on measures of parent-rated hyperactivity and anxiety, and clinician-rated general function and mood, with moderate to large between-group effect sizes (micronutrients vs. medication: ES = 0.73-1.01; micronutrients vs. no treatment: ES = 0.54-1.01). Most common reasons for stopping trial micronutrients were cost and number of pills to swallow. No continued side effects were associated with micronutrients. Conclusions: Children who benefitted from micronutrients in the short term maintained changes at follow-up, without side effects. While both those who continued micronutrients and those who switched to medication showed improved ADHD symptoms, psychiatric medication use was associated with deterioration in mood and anxiety. Inherent selection bias limits generalizability.
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Affiliation(s)
- Kathryn A Darling
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | | | | | - Julia J Rucklidge
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
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6
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Firth J, Teasdale SB, Allott K, Siskind D, Marx W, Cotter J, Veronese N, Schuch F, Smith L, Solmi M, Carvalho AF, Vancampfort D, Berk M, Stubbs B, Sarris J. The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry 2019; 18:308-324. [PMID: 31496103 PMCID: PMC6732706 DOI: 10.1002/wps.20672] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The role of nutrition in mental health is becoming increasingly acknowledged. Along with dietary intake, nutrition can also be obtained from "nutrient supplements", such as polyunsaturated fatty acids (PUFAs), vitamins, minerals, antioxidants, amino acids and pre/probiotic supplements. Recently, a large number of meta-analyses have emerged examining nutrient supplements in the treatment of mental disorders. To produce a meta-review of this top-tier evidence, we identified, synthesized and appraised all meta-analyses of randomized controlled trials (RCTs) reporting on the efficacy and safety of nutrient supplements in common and severe mental disorders. Our systematic search identified 33 meta-analyses of placebo-controlled RCTs, with primary analyses including outcome data from 10,951 individuals. The strongest evidence was found for PUFAs (particularly as eicosapentaenoic acid) as an adjunctive treatment for depression. More nascent evidence suggested that PUFAs may also be beneficial for attention-deficit/hyperactivity disorder, whereas there was no evidence for schizophrenia. Folate-based supplements were widely researched as adjunctive treatments for depression and schizophrenia, with positive effects from RCTs of high-dose methylfolate in major depressive disorder. There was emergent evidence for N-acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia. All nutrient supplements had good safety profiles, with no evidence of serious adverse effects or contraindications with psychiatric medications. In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentaenoic acid in depression), but also made aware of those currently lacking evidentiary support. Future research should aim to determine which individuals may benefit most from evidence-based supplements, to further elucidate the underlying mechanisms.
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Affiliation(s)
- Joseph Firth
- NICM Health Research InstituteWestern Sydney UniversityWestmeadAustralia,Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK,Centre for Youth Mental HealthUniversity of MelbourneMelbourneAustralia
| | - Scott B. Teasdale
- School of Psychiatry, Faculty of MedicineUniversity of New South WalesSydneyAustralia,Keeping the Body in Mind ProgramSouth Eastern Sydney Local Health DistrictSydneyAustralia
| | - Kelly Allott
- Centre for Youth Mental HealthUniversity of MelbourneMelbourneAustralia,Orygen, The National Centre of Excellence in Youth Mental HealthParkvilleAustralia
| | - Dan Siskind
- Metro South Addiction and Mental Health ServiceBrisbaneAustralia,School of MedicineUniversity of QueenslandBrisbaneAustralia
| | - Wolfgang Marx
- IMPACT Strategic Research Centre, School of MedicineDeakin University, Barwon HealthAustralia
| | | | - Nicola Veronese
- Neuroscience InstituteNational Research CouncilPaduaItaly,Research Hospital, National Institute of GastroenterologyIRCCS De Bellis, Castellana GrotteBariItaly
| | - Felipe Schuch
- Department of Sports Methods and TechniquesFederal University of Santa MariaSanta MariaBrazil
| | - Lee Smith
- Cambridge Centre for Sport and Exercise SciencesAnglia Ruskin UniversityCambridgeUK
| | - Marco Solmi
- Department of NeurosciencesUniversity of PaduaPaduaItaly,Padua Neuroscience CenterUniversity of PaduaPaduaItaly
| | - André F. Carvalho
- Centre for Addiction and Mental HealthTorontoONCanada,Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation SciencesLeuvenBelgium,University Psychiatric Centre KU LeuvenKortenbergBelgium
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental HealthParkvilleAustralia,IMPACT Strategic Research Centre, School of MedicineDeakin University, Barwon HealthAustralia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation TrustLondonUK,Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Jerome Sarris
- NICM Health Research InstituteWestern Sydney UniversityWestmeadAustralia,Professional Unit, The Melbourne Clinic, Department of PsychiatryUniversity of MelbourneMelbourneAustralia
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7
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Lu S, Perez L, Leslein A, Hatsu I. The Relationship between Food Insecurity and Symptoms of Attention-Deficit Hyperactivity Disorder in Children: A Summary of the Literature. Nutrients 2019; 11:nu11030659. [PMID: 30893802 PMCID: PMC6470829 DOI: 10.3390/nu11030659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 12/21/2022] Open
Abstract
Food insecurity is a major public health concern characterized by an individual or household lacking access to adequate food to support a healthy lifestyle. Food insecurity has been associated with predisposing or exacerbating mental health symptoms in children. However, the evidence is scarce with regards to Attention-Deficit Hyperactivity Disorder (ADHD) symptoms in children. The purpose of this review is to summarize and identify gaps in the existing literature, as well as to explore associations between food insecurity and symptoms of childhood ADHD. Literature for this review was pulled from Ovid MEDLINE and PubMed library databases, with a focus on food insecurity, food insufficiency, hunger, and ADHD symptoms such as inattention, hyperactivity, and impulsivity in children. The limited evidence to date shows a predictive and inverse relationship between childhood experience of food insecurity and symptoms of ADHD, with lasting impacts into adulthood. Evidence exists to hypothesize that childhood food insecurity is associated with predisposing or exacerbating ADHD symptoms in children, yet the literature needed to confirm this relationship is scarce and utilizes inconsistent methodology. Future research is needed to further characterize this complex relationship and inspire community or public health interventions addressing food insecurity in children with ADHD. Additionally, it may be clinically useful to routinely screen for food insecurity when assessing pediatric ADHD symptoms.
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Affiliation(s)
- Stacy Lu
- Department of Human Sciences, Ohio State University, Columbus, OH 43210, USA.
| | - Leanna Perez
- Department of Human Sciences, Ohio State University, Columbus, OH 43210, USA.
| | - Abby Leslein
- Department of Neuroscience, Ohio State University, Columbus, OH 43210, USA.
| | - Irene Hatsu
- Department of Human Sciences, Ohio State University, Columbus, OH 43210, USA.
- OSU Extension, Ohio State University, Columbus, OH 43210, USA.
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8
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Yektaş Ç, Alpay M, Tufan AE. Comparison of serum B12, folate and homocysteine concentrations in children with autism spectrum disorder or attention deficit hyperactivity disorder and healthy controls. Neuropsychiatr Dis Treat 2019; 15:2213-2219. [PMID: 31496704 PMCID: PMC6689552 DOI: 10.2147/ndt.s212361] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We aimed to investigate the serum concentrations of vitamin B12, folate and homocysteine in children diagnosed with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) and healthy controls. MATERIALS AND METHODS Serum vitamin B12, folate and homocysteine concentrations were measured in 118 children (48 children diagnosed with ADHD, 35 children diagnosed with ASD and 35 healthy controls). Symptom severity in the ADHD and ASD groups was evaluated by the Childhood Autism Rating Scale and Turgay-DSM-IV-Based Screening and Assessment Scale for Disruptive Behavior Disorders. Multivariate analysis of covariance was used to evaluate the effects of diagnosis and gender on biochemical parameters. RESULTS The ADHD and ASD groups and the healthy controls differed significantly regarding vitamin B12 and homocysteine concentrations, but not folate levels. Patients with ASD had the lowest vitamin B12 and the highest homocysteine levels. Vitamin B12 levels correlated negatively with hyperactivity and/orimpulsivity and oppositionality symptoms in children with ADHD. There were no relationships between psychometric evaluations and laboratory measurements in children with ASD. Gender did not affect vitamin concentrations. CONCLUSION Previous studies found that vitamin B12 was reduced while homocysteine was elevated among patients with ADHD and ASDs. Our results also support those reported previously. Oppositionality and hyperactivity and/orimpulsivity may be related to vitamin B12 and homocysteine levels in children with ADHD. Further studies are required to define the role of these parameters and effects on the etiology and clinical manifestations of ASD and ADHD.
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Affiliation(s)
- Çiğdem Yektaş
- Department of Child and Adolescent Psychiatry, Düzce Üniversitesi, Düzce, Turkey
| | - Merve Alpay
- Department of Medical Biochemistry, Faculty of Medicine, Düzce Üniversitesi, Düzce, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Acıbadem Üniversitesi Tıp Fakültesi, Istanbul, Turkey
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9
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Sandgren AM, Brummer RJ. ADHD-originating in the gut? The emergence of a new explanatory model. Med Hypotheses 2018; 120:135-145. [DOI: 10.1016/j.mehy.2018.08.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 08/25/2018] [Indexed: 12/12/2022]
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10
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Virk J, Liew Z, Olsen J, Nohr EA, Catov JM, Ritz B. Pre-conceptual and prenatal supplementary folic acid and multivitamin intake, behavioral problems, and hyperkinetic disorders: A study based on the Danish National Birth Cohort (DNBC). Nutr Neurosci 2018; 21:352-360. [PMID: 28276257 PMCID: PMC6082975 DOI: 10.1080/1028415x.2017.1290932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate whether early folic acid or multivitamin supplementation during pregnancy prevents diagnosis of hyperkinetic disorders (HKD), treatment for attention deficit hyperactivity disorder (ADHD), and ADHD-like behaviors reported by parents participating in the DNBC for children at age 7. METHODS HKD diagnosis and ADHD medication use data were obtained from the Danish National Hospital, Central Psychiatric and Pharmaceutical registers. We estimated hazard ratios (HRs) for HKD diagnosis and ADHD medication use and risk ratios (RRs) for parent-reported ADHD behavior collected with the Strength and Difficulties Questionnaire (SDQ), comparing children whose mothers took folic acid or multivitamin supplements early in pregnancy defined as starting periconceptionally (4 weeks prior to their last menstrual period (LMP)) through 8 weeks after their LMP (4-8 weeks), to children whose mothers indicated no supplement use for the same entire period. RESULTS We identified 384 children (1.1%) with a hospital diagnosis for HKD and 642 children (1.8%) treated with ADHD medication. We found no association between risk of HKD diagnosis or intake of ADHD medication and early maternal folic acid use. However, early multivitamin use was associated with an approximately 30% reduction in risk for HKD diagnosis (aHR: 0.70, 95% CI: 0.52-0.96) and 21% reduction in treatment with ADHD medication (aHR: 0.79, 95% CI: 0.62-0.98). We observed a reduced risk in parent-reported ADHD behaviors, but these results were attenuated after adjustment. CONCLUSION Our data suggest that multivitamin use in early pregnancy may reduce risk for HKD diagnosis and treatment for ADHD in the offspring.
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Affiliation(s)
- Jasveer Virk
- a Department of Epidemiology, UCLA Fielding School of Public Health , University of California , Los Angeles , CA , USA
| | - Zeyan Liew
- a Department of Epidemiology, UCLA Fielding School of Public Health , University of California , Los Angeles , CA , USA
| | - Jørn Olsen
- b Department of Public Health, Institute of Epidemiology and Social Medicine , Aarhus University , Denmark
| | - Ellen A Nohr
- c Department of Obstetrics and Gynecology , Odense University Hospital , Denmark
| | - Janet M Catov
- d Department of Obstetrics & Gynecology , University of Pittsburgh , PA , USA
| | - Beate Ritz
- a Department of Epidemiology, UCLA Fielding School of Public Health , University of California , Los Angeles , CA , USA
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An obesogenic refined low-fat diet disrupts attentional and behavioral control processes in a vigilance task in rats. Behav Processes 2017; 138:142-151. [DOI: 10.1016/j.beproc.2017.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/02/2017] [Accepted: 03/10/2017] [Indexed: 01/07/2023]
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Ríos-Hernández A, Alda JA, Farran-Codina A, Ferreira-García E, Izquierdo-Pulido M. The Mediterranean Diet and ADHD in Children and Adolescents. Pediatrics 2017; 139:peds.2016-2027. [PMID: 28138007 DOI: 10.1542/peds.2016-2027] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Although attention-deficit/hyperactivity disorder (ADHD) has been related to nutrient deficiencies and "unhealthy" diets, to date there are no studies that examined the relationship between the Mediterranean diet and ADHD. We hypothesized that a low adherence to a Mediterranean diet would be positively associated with an increase in ADHD diagnosis. METHODS A total of 120 children and adolescents (60 with newly diagnosed ADHD and 60 controls) were studied in a sex- and age-matched case-control study. ADHD diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Energy, dietary intake, adherence to a Mediterranean diet, and familial background were measured. Logistic regression was used to determine associations between the adherence to a Mediterranean diet and ADHD. RESULTS Lower adherence to a Mediterranean diet was associated with ADHD diagnosis (odds ratio: 7.07; 95% confidence interval: 2.65-18.84; relative risk: 2.80; 95% confidence interval: 1.54-5.25). Both remained significant after adjusting for potential confounders. Lower frequency of consuming fruit, vegetables, pasta, and rice and higher frequency of skipping breakfast and eating at fast-food restaurants were associated with ADHD diagnosis (P < .05). High consumption of sugar, candy, cola beverages, and noncola soft drinks (P < .01) and low consumption of fatty fish (P < .05) were also associated with a higher prevalence of ADHD diagnosis. CONCLUSIONS Although these cross-sectional associations do not establish causality, they raise the question of whether low adherence to a Mediterranean diet might play a role in ADHD development. Our data support the notion that not only "specific nutrients" but also the "whole diet" should be considered in ADHD.
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Affiliation(s)
| | - José A Alda
- ADHD Unit, Child and Adolescent Psychiatry Department, Hospital Sant Joan de Deu, Barcelona, Spain; and
| | | | - Estrella Ferreira-García
- ADHD Unit, Child and Adolescent Psychiatry Department, Hospital Sant Joan de Deu, Barcelona, Spain; and.,Personality, Evaluation, and Psychological Treatment, University of Barcelona, Barcelona, Spain
| | - Maria Izquierdo-Pulido
- Departments of Nutrition, Food Science, and Gastronomy, and .,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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13
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Pelsser LM, Frankena K, Toorman J, Rodrigues Pereira R. Diet and ADHD, Reviewing the Evidence: A Systematic Review of Meta-Analyses of Double-Blind Placebo-Controlled Trials Evaluating the Efficacy of Diet Interventions on the Behavior of Children with ADHD. PLoS One 2017; 12:e0169277. [PMID: 28121994 PMCID: PMC5266211 DOI: 10.1371/journal.pone.0169277] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 12/14/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is a debilitating mental health problem hampering the child's development. The underlying causes include both genetic and environmental factors and may differ between individuals. The efficacy of diet treatments in ADHD was recently evaluated in three reviews, reporting divergent and confusing conclusions based on heterogeneous studies and subjects. To address this inconsistency we conducted a systematic review of meta-analyses of double-blind placebo-controlled trials evaluating the effect of diet interventions (elimination and supplementation) on ADHD. METHODS Our literature search resulted in 14 meta-analyses, six of which confined to double-blind placebo-controlled trials applying homogeneous diet interventions, i.e. artificial food color (AFC) elimination, a few-foods diet (FFD) and poly-unsaturated fatty acid (PUFA) supplementation. Effect sizes (ES) and Confidence intervals (CI) of study outcomes were depicted in a forest plot. I2 was calculated to assess heterogeneity if necessary and additional random effects subgroup meta-regression was conducted if substantial heterogeneity was present. RESULTS The AFC ESs were 0.44 (95% CI: 0.16-0.72, I2 = 11%) and 0.21 (95% CI: -0.02-0.43, I2 = 68%) [parent ratings], 0.08 (95% CI: -0.07-0.24, I2 = 0%) [teacher ratings] and 0.11 (95% CI: -0.13-0.34, I2 = 12%) [observer ratings]. The FFD ESs were 0.80 (95% CI: 0.41-1.19, I2 = 61%) [parent ratings] and 0.51 (95% CI: -0.02-1.04, I2 = 72%) [other ratings], while the PUFA ESs were 0.17 (95% CI: -0.03-0.38, I2 = 38%) [parent ratings], -0.05 (95% CI: -0.27-0.18, I2 = 0%) [teacher ratings] and 0.16 (95% CI: 0.01-0.31, I2 = 0%) [parent and teacher ratings]. Three meta-analyses (two FFD and one AFC) resulted in high I2 without presenting subgroup results. The FFD meta-analyses provided sufficient data to perform subgroup analyses on intervention type, resulting in a decrease of heterogeneity to 0% (diet design) and 37.8% (challenge design). CONCLUSION Considering the small average ESs PUFA supplementation is unlikely to provide a tangible contribution to ADHD treatment, while further research is required for AFC elimination before advising this intervention as ADHD treatment. The average FFD ES is substantial, offering treatment opportunities in subgroups of children with ADHD not responding to or too young for medication. Further FFD research should focus on establishing the underlying mechanisms of food (e.g. incrimination of gut microbiota) to simplify the FFD approach in children with ADHD.
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Affiliation(s)
| | - Klaas Frankena
- Quantitative Veterinary Epidemiology group, Wageningen University & Research, Wageningen, the Netherlands
| | - Jan Toorman
- Retired paediatrician, previously Catharina Hospital, Eindhoven, the Netherlands
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Natural Product-Derived Treatments for Attention-Deficit/Hyperactivity Disorder: Safety, Efficacy, and Therapeutic Potential of Combination Therapy. Neural Plast 2016; 2016:1320423. [PMID: 26966583 PMCID: PMC4757677 DOI: 10.1155/2016/1320423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/30/2015] [Accepted: 01/10/2016] [Indexed: 01/27/2023] Open
Abstract
Typical treatment plans for attention-deficit/hyperactivity disorder (ADHD) utilize nonpharmacological (behavioral/psychosocial) and/or pharmacological interventions. Limited accessibility to behavioral therapies and concerns over adverse effects of pharmacological treatments prompted research for alternative ADHD therapies such as natural product-derived treatments and nutritional supplements. In this study, we reviewed the herbal preparations and nutritional supplements evaluated in clinical studies as potential ADHD treatments and discussed their performance with regard to safety and efficacy in clinical trials. We also discussed some evidence suggesting that adjunct treatment of these agents (with another botanical agent or pharmacological ADHD treatments) may be a promising approach to treat ADHD. The analysis indicated mixed findings with regard to efficacy of natural product-derived ADHD interventions. Nevertheless, these treatments were considered as a “safer” approach than conventional ADHD medications. More comprehensive and appropriately controlled clinical studies are required to fully ascertain efficacy and safety of natural product-derived ADHD treatments. Studies that replicate encouraging findings on the efficacy of combining botanical agents and nutritional supplements with other natural product-derived therapies and widely used ADHD medications are also warranted. In conclusion, the risk-benefit balance of natural product-derived ADHD treatments should be carefully monitored when used as standalone treatment or when combined with other conventional ADHD treatments.
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Gordon HA, Rucklidge JJ, Blampied NM, Johnstone JM. Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study. J Child Adolesc Psychopharmacol 2015; 25:783-98. [PMID: 26682999 PMCID: PMC4702182 DOI: 10.1089/cap.2015.0105] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the clinical effect and safety of a broad spectrum, 36 ingredient micronutrient (vitamins and minerals) in treating children with attention-deficit/hyperactivity disorder (ADHD). METHODS This open-label, on-off-on-off (reversal design) study followed 14 participants (8-12 years of age) with ADHD, diagnosed using standardized instruments, for 6 months with no dropouts. Following baseline assessment, including hematology and biochemistry screening, participants began an 8 week treatment phase with micronutrients titrated up to maximum dose (15 capsules/day). Treatment was withdrawn for 4 weeks, reinstated for a further 8 weeks, and then withdrawn for 4 weeks. Primary outcomes included the Conners' Parent Rating Scale, the Clinical Global Impressions Scale (CGI), and the Strengths and Difficulties Questionnaire - Parent version (SDQ). Secondary outcomes were mood and global functioning. RESULTS Modified Brinley plots revealed a reduction in ADHD symptoms, improved mood, and improved overall functioning during intervention phases, and deterioration in ADHD symptoms, mood, and overall functioning during the withdrawal phases. Reliable change analyses, Cohen's d and percent superiority effect sizes, 95% confidence intervals and t tests confirmed clinically and statistically significant change between the intervention and withdrawal phases, with large effect sizes observed pre- to post-exposure of micronutrients (d = 1.2-2.2) on ADHD symptoms during intervention phases. Seventy-one percent of participants showed at least a 30% decrease in ADHD symptoms by the end of the second treatment phase, and 79% were identified as "much improved" or "very much improved" at the end of the second phase (5 months) based on the clinician-rated CGI when considering functioning generally. The SDQ showed that these benefits occurred across other areas of functioning including emotional symptoms, conduct problems, and prosocial behaviours. The children's self-reports confirmed the improvements. Excellent adherence to treatment occurred throughout, side effects were mild and transitory, and no safety issues were identified through blood analyses. CONCLUSIONS This study demonstrates the clinical benefit, feasibility, and safety of broad-spectrum micronutrients in the treatment of childhood ADHD. Replications utilizing double-blind placebo-controlled studies are warranted. Trial is registered with the Australia and New Zealand Clinical Trial Registry: ACTRN12612000645853.
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Affiliation(s)
- Heather A Gordon
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Julia J Rucklidge
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Neville M Blampied
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Jeanette M Johnstone
- Departments of Neurology and Psychiatry, Oregon Health & Science University, Portland, Oregon
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