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Huberts-Bosch A, Bierens M, Ly V, van der Velde J, de Boer H, van Beek G, Appelman D, Visser S, Bos LHP, Reijmers L, van der Meer J, Kamphuis N, Draaisma JMT, Donders R, van de Loo-Neus GHH, Hoekstra PJ, Bottelier M, Arias-Vasquez A, Klip H, Buitelaar JK, van den Berg SW, Rommelse NN. Short-term effects of an elimination diet and healthy diet in children with attention-deficit/hyperactivity disorder: a randomized-controlled trial. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02256-y. [PMID: 37430148 DOI: 10.1007/s00787-023-02256-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5-12 years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED-but not HD-participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably 'easier to treat' than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, number NL5324 ( https://www.onderzoekmetmensen.nl/en/trial/25997 ).
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Affiliation(s)
- Annick Huberts-Bosch
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.
| | - Margreet Bierens
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Verena Ly
- Institute of Psychology, Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Jessica van der Velde
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Heleen de Boer
- Accare, Child and Adolescent Psychiatry, Groningen, The Netherlands
| | - Gerry van Beek
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Danielle Appelman
- Triversum-GGZ-NHN, Child and Adolescent Psychiatry, Alkmaar, The Netherlands
| | | | - Lisa H P Bos
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Lisa Reijmers
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | | | - Niki Kamphuis
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud Institute for Health Sciences, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gigi H H van de Loo-Neus
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry and Accare Child Study Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco Bottelier
- Accare, Child and Adolescent Psychiatry, Groningen, The Netherlands
| | - Alejandro Arias-Vasquez
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helen Klip
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia W van den Berg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Utrecht, The Netherlands
| | - Nanda N Rommelse
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
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