Association of symptoms of attention-deficit/hyperactivity disorder with childhood overweight adjusted for confounding parental variables

Abstract

OBJECTIVE: There have been numerous reports on association between attention-deficit/hyperactivity disorder (ADHD) and overweight/obesity in children and adolescents; however, most studies adjusted only for a limited number of possible confounders. METHODS: We analyzed the data of 11 159 six through seventeen-year-old participants in the German Health Interview and Examination Survey for Children and Adolescents. We determined weight status based on measured anthropometry and national reference data by International Obesity Task Force criteria. The parent-rated hyperactivity/inattention subscale of the Strengths and Difficulties Questionnaire (SDQ-HI) was used as a continuous measure of ADHD symptoms. We examined whether the putative confounders socioeconomic status, migrant status, parental body mass index (BMI) and parental smoking were associated with both SDQ-HI and overweight/obesity. Associations between SDQ-HI and overweight/obesity vs normal weight were analyzed by binary logistic regression analyses. In the first model, we adjusted for age and sex only and in the second model also for the parental confounders. RESULTS: SDQ-HI was associated with an increased risk for overweight/obesity in both sexes adjusting for age and sex. However, after adjusting for all confounders SDQ-HI was associated with an increased risk for overweight/obesity only in adolescent females. Socioeconomic status, parental BMI and parental smoking each were relevant confounders. Migrant status was also significantly associated with both SDQ-HI and overweight/obesity, thus qualifying as a confounder but contributed only weakly to the association. CONCLUSIONS: The association between ADHD symptoms and overweight/obesity is due to confounding by family background variables in all but adolescent girls. Possible reasons for the increased risk for overweight/obesity in this subgroup are discussed. We also propose possible mechanisms for confounding by parental socioeconomic status, BMI and smoking.

Inattention and hyperactivity in children at risk of obesity: a community cross-sectional study

“…13 14 However, the findings are inconsistent possibly because of cross-sectional designs, methodological and sample characteristic differences. [15][16][17] Some children with ADHD may have low self-esteem and social functioning problems as well as possible coordination difficulties. 18 19 These problems may influence self-confidence and participation in physical activity, referred to as exercise selfefficacy and could therefore become risk factors for the development of later obesity.…”

Clarifying the nuances in ADHD and health outcomes: a case of overweight and obesity

“…The finding of effects in children was not echoed in the few studies confined only to preadolescent children in the literature,4 5 although with more data it may shade toward reliable. It remains possible, if not likely, that the effect reported by the present authors in children is primarily explained by effects of puberty.…”

The Hyperactivity/Inattention Subscale of the Strengths and Difficulties Questionnaire Predicts Short- and Long-Term Weight Loss in Overweight Children and Adolescents Treated as Outpatients

“…In a recent representative German community survey of 2,863 11- 17-year-old children and adolescents, overweight/obese minors were twice as likely to have an ADHD diagnosis, and youth with ADHD were twice as likely to be overweight or obese [15]. However, Egmond-Fröhlich et al [18] reported that in a German population sample of 11,159 8- to 17-year-old children and adolescents the association between obesity and ADHD symptoms as measured with the hyperactivity/inattention (HI) subscale of the SDQ was no longer significant after adjusting for family background variables.…”

“…Among the few epidemiological studies, three found an association between a diagnosis of ADHD or high rates of ADHD symptoms and obesity [13,14,15] while three did not find any association between ADHD symptoms measured by the Strengths and Difficulties Questionnaire (SDQ) and obesity [16,17,18]. In a recent representative German community survey of 2,863 11- 17-year-old children and adolescents, overweight/obese minors were twice as likely to have an ADHD diagnosis, and youth with ADHD were twice as likely to be overweight or obese [15].…”