Research Review: The role of diet in the treatment of attention‐deficit/hyperactivity disorder – an appraisal of the evidence on efficacy and recommendations on the design of future studies

Stevenson, Jim; Buitelaar, Jan K.; Cortese, Samuele; Ferrín, Maite; Konofal, Éric; Lecendreux, Michel; Simonoff, Emily; Wong, Ian C. K.; Sonuga‐Barke, Edmund

doi:10.1111/jcpp.12215

Cited by 87 publications

(82 citation statements)

References 97 publications

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“…Evaluation of reviews and meta-analyses of 11 randomized controlled trials found evidence of a small effect of free fatty acid supplements in ADHD, and an uncertain benefit of artificial color elimination [3]. Similar conclusions are expressed by parents of patients in our neurology clinic for ADHD in children and adolescents at Ann & Robert H. Lurie Children's Hospital of Chicago.…”

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confidence: 60%

PUFA Supplement in ADHD: Meta Analysis

Millichap¹

2014

Pediatr Neurol Briefs

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conducted an updated meta-analysis of randomized controlled trials (RCTs) in ADHD, using data on PUFA content obtained from independent fatty acid methyl ester analyses of each study PUFA regimen. Standardized mean differences (SMD) in inattention, hyperactive-impulsive and combined symptoms were assessed as rated by parents, teachers or all raters. The pooled estimate from 18 studies showed that combined ADHD symptoms rated by all raters decreased with PUFA supplementation (P<0.001). When analyzed by rater, only parent-rated symptoms decreased significantly. Multivariable meta-regression showed that longer study duration, y-linolenic acid (GLA), and the interaction between GLA and eicosapentaenoic acid (EPA) were associated with significant decreases in inattention. PUFA regimen content was unrelated to changes in hyperactive-impulsive symptoms, but the potential psychoactivity of certain fatty acids in placebo preparations could not be excluded. The meta-analysis provides modest evidence of PUFA effectiveness in ADHD, especially a reduction of inattention symptoms by GLA and EPA. (Puri BK, Martins JG. Which polyunsaturated fatty acids are active in children with attention-deficit hyperactivity disorder receiving PUFA supplementation? A fatty acid validated meta-regression analysis of randomized controlled trials. Prostaglandins Leukot Essent Fatty Acids 2014 Feb 3. [Epub ahead of print]).

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supporting

confidence: 60%

PUFA Supplement in ADHD: Meta Analysis

Millichap¹

2014

Pediatr Neurol Briefs

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“…In several studies dietary interventions comprising elimination and restrictive diets have shown promise as effective treatments for ADHD (Nigg and Holton 2014;Stevenson et al 2014). Although it requires significant effort and is difficult to maintain long-term, positive effects have been found following the implementation of very restrictive diets, such as the "few foods" diet (Pelsser et al 2009).…”

Section: The Potential For Antioxidant-related Therapies In Adhdmentioning

confidence: 99%

Oxidative and nitrosative stress in ADHD: possible causes and the potential of antioxidant-targeted therapies

Lopresti

2015

ADHD Atten Def Hyp Disord

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Attention deficit hyperactivity disorder (ADHD) has a complex etiology although theories associated with disturbances in dopaminergic and noradrenergic activity are most commonly cited.The importance of these catecholamines in ADHD is supported by its effective treatment utilising stimulant and non-stimulant medications that modify their activity. Recently there has been interest in oxidative and nitrosative stress (O&NS) in ADHD and its potential to contribute to this condition. In this article, research investigating O&NS in ADHD is reviewed and its impact on catecholaminergic activity and neurological structure is discussed. Lifestyle, environmental, ADHD is most commonly treated with stimulant medications such as methylphenidate and amphetamines, non-stimulants such as atomoxetine, and alpha2-adrenergic agonists such as clonidine and guanfacine. Through their effects on dopamine and noradrenaline transporters, stimulants inhibit the reuptake of dopamine and noradrenaline, thereby increasing the extracellular levels of these neurotransmitters. These stimulants also inhibit monoamine oxidase, the enzyme that metabolises these catecholamines (Wilens et al. 2011). Atomoxetine works as a selective reuptake inhibitor of noradrenaline leading to its increased extracellular concentration (Garnock- Jones and Keating 2009).While effective, these medications are associated with several adverse effects. These include loss of appetite, growth delay and sleep disturbances (Cortese et al. 2013). It is important to note that despite their widely accepted short-term efficacy, the long-term effectiveness of pharmacological treatments on social, educational and occupational functioning in people with ADHD continues to be debated (Huang and Tsai 2011;Langberg and Becker 2012;Nijmeijer et al. 2008). On a positive note, recent analyses using the Swedish national registrar suggests that long-term stimulant use in people with ADHD is associated with reduced rates of substance use, criminality, and serious traffic accidents (Chang et al. 2014a;Chang et al. 2014b;Lichtenstein et al. 2012).Despite wide appreciation of catecholaminergic theories associated with ADHD, there has been increased research into other biological mechanisms associated with ADHD. For example, in psychiatry there has been interest in immune-inflammatory pathways and oxidative and nitrosative stress (O&NS). In particular, it has been confirmed through recent meta-analyses that depression is Increased O&NS has also been found in bipolar disorder (Andreazza et al. 2008;Brown et al. 2014),

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“…1,2 However, research on the relationship between ADHD and nutrients and food components thus far has yielded inconsistent results. 3,4 Therefore, a dietary approach to ADHD treatment is still regarded as controversial without a comprehensive evidence base.…”

mentioning

confidence: 99%

The Mediterranean Diet and ADHD in Children and Adolescents

et al. 2017

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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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Research Review: The role of diet in the treatment of attention‐deficit/hyperactivity disorder – an appraisal of the evidence on efficacy and recommendations on the design of future studies

Cited by 87 publications

References 97 publications

PUFA Supplement in ADHD: Meta Analysis

PUFA Supplement in ADHD: Meta Analysis

Oxidative and nitrosative stress in ADHD: possible causes and the potential of antioxidant-targeted therapies

The Mediterranean Diet and ADHD in Children and Adolescents

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