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Scientific Electronic Archives
Education and Teaching
DOI: 10.36560/14920211441
Submitted: 2021-07-26
Published: 2021-08-30

The association of diet quality and lifestyle factors in children and adults with ADHD: a systematic review and meta-analysis

Institute of Informatics and Telecommunications, NCSR Demokritos, Athens, Greece / Department of Information and Communication Systems Engineering, University of the Aegean, Greece
Institute of Informatics and Telecommunications, NCSR Demokritos, Athens, Greece
Institute of Informatics and Telecommunications, NCSR Demokritos, Athens, Greece
Diet quality, lifestyle factors, ADHD, attention-deficit/hyperactivity disorder

Abstract

Eating habits of individuals with learning and behavioral difficulties is an important and emerging area of ​​nutrition expertise. An unhealthy diet, combined with limited physical activity, is linked with an increased risk of chronic diseases and a lower quality of life. The study aims to review in a systematic way evidence on: (a) the relationship between diet quality and ADHD; and (b) the effect of three lifestyle factors, physical activity, quality of sleep, and stress on children and adults with ADHD. In December 2020, we searched for relevant articles in PubMed and Scopus. The studies included were those that assessed diet, physical activity, sleep, and stress, of children and adults with ADHD. We identified a total of eighteen studies with an invasive and observational approach that matched our research criteria. Fourteen of these studies were included in the meta-analysis. The pooled analysis showed that a high-diet quality decreases the prevalence of ADHD in children (OR: 0.43, 95% CI: 0.28-0.70), while a poor diet quality is associated with an increased risk of ADHD in both children and adults (OR: 2.24, 95% CI: 1.49-3.65). Also, a poor lifestyle indicates a higher prevalence of ADHD in both children and adults (OR: 1.90, 95% CI: 1.43-2.61). This study is limited to its ability to extract data from some of the included studies while sampling was limited due to the absence of studies in adults with ADHD. The present study suggests that a high-quality diet with increased consumption of fruits, vegetables, and fish, may be protective against ADHD in children. On top of that, a poor-quality diet with higher consumption of sugar, sweetened drinks, and junk food, as well as a lifestyle that is characterized by reduced sleep and physical activity can be associated with increased risk of ADHD, for both children and adults. The current domain needs more experimental data

References

  1. Abdullah, M., Jowett, B., Whittaker, P. J., & Patterson, L. (2019). The effectiveness of omega-3 supplementation in reducing ADHD associated symptoms in children as measured by the Conners' rating scales: A systematic review of randomized controlled trials. Journal of psychiatric research, 110, 64–73. https://doi.org/10.1016/j.jpsychires.2018.12.002
  2. Akhondzadeh, S., Mohammadi, M. R., & Khademi, M. (2004). Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial [ISRCTN64132371]. BMC psychiatry, 4, 9. https://doi.org/10.1186/1471-244X-4-9
  3. Becker, S. P., Epstein, J. N., Tamm, L., Tilford, A. A., Tischner, C. M., Isaacson, P. A., Simon, J. O., & Beebe, D. W. (2019). Shortened Sleep Duration Causes Sleepiness, Inattention, and Oppositionality in Adolescents With Attention-Deficit/Hyperactivity Disorder: Findings From a Crossover Sleep Restriction/Extension Study. Journal of the American Academy of Child and Adolescent Psychiatry, 58(4), 433–442. https://doi.org/10.1016/j.jaac.2018.09.439
  4. Bilici, M., Yildirim, F., Kandil, S., Bekaroğlu, M., Yildirmiş, S., Değer, O., Ulgen, M., Yildiran, A., & Aksu, H. (2004). Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Progress in neuro-psychopharmacology & biological psychiatry, 28(1), 181–190. https://doi.org/10.1016/j.pnpbp.2003.09.034
  5. Bloch, M. H., & Qawasmi, A. (2011). Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 50(10), 991–1000. https://doi.org/10.1016/j.jaac.2011.06.008
  6. Bobb, A. J., Castellanos, F. X., Addington, A. M., & Rapoport, J. L. (2005). Molecular genetic studies of ADHD: 1991 to 2004. American journal of medical genetics. Part B, Neuropsychiatric genetics: the official publication of the International Society of Psychiatric Genetics, 132B(1), 109–125.
  7. Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 1143–1211. https://doi.org/10.1002/cphy.c110025
  8. Cerrillo-Urbina, A. J., García-Hermoso, A., Sánchez-López, M., Pardo-Guijarro, M. J., Santos Gómez, J. L., & Martínez-Vizcaíno, V. (2015). The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials. Child: care, health and development, 41(6), 779–788. https://doi.org/10.1111/cch.12255
  9. Chang, J. P., Su, K. P., Mondelli, V., & Pariante, C. M. (2018). Omega-3 Polyunsaturated Fatty Acids in Youths with Attention Deficit Hyperactivity Disorder: a Systematic Review and Meta-Analysis of Clinical Trials and Biological Studies. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 43(3), 534–545. https://doi.org/10.1038/npp.2017.160
  10. Chang, J. P., Su, K. P., Mondelli, V., & Pariante, C. M. (2018). Omega-3 Polyunsaturated Fatty Acids in Youths with Attention Deficit Hyperactivity Disorder: a Systematic Review and Meta-Analysis of Clinical Trials and Biological Studies. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 43(3), 534–545. https://doi.org/10.1038/npp.2017.160
  11. Chou, W. J., Lee, M. F., Hou, M. L., Hsiao, L. S., Lee, M. J., Chou, M. C., & Wang, L. J. (2018). Dietary and nutrient status of children with attention-deficit/ hyperactivity disorder: a case-control study. Asia Pacific journal of clinical nutrition, 27(6), 1325–1331. https://doi.org/10.6133/apjcn.201811_27(6).0020
  12. Combs, M. A., Canu, W. H., Broman-Fulks, J. J., Rocheleau, C. A., & Nieman, D. C. (2015). Perceived stress and ADHD symptoms in adults. Journal of attention disorders, 19(5), 425–434. https://doi.org/10.1177/1087054712459558
  13. Cortese, S., Moreira-Maia, C. R., St Fleur, D., Morcillo-Peñalver, C., Rohde, L. A., & Faraone, S. V. (2016). Association Between ADHD and Obesity: A Systematic Review and Meta-Analysis. The American journal of psychiatry, 173(1), 34–43. https://doi.org/10.1176/appi.ajp.2015.15020266
  14. Cortese, S., Ramos Olazagasti, M. A., Klein, R. G., Castellanos, F. X., Proal, E., & Mannuzza, S. (2013). Obesity in men with childhood ADHD: a 33-year controlled, prospective, follow-up study. Pediatrics, 131(6), e1731–e1738. https://doi.org/10.1542/peds.2012-0540
  15. Del-Ponte, B., Anselmi, L., Assunção, M., Tovo-Rodrigues, L., Munhoz, T. N., Matijasevich, A., Rohde, L. A., & Santos, I. S. (2019). Sugar consumption and attention-deficit/hyperactivity disorder (ADHD): A birth cohort study. Journal of affective disorders, 243, 290–296. https://doi.org/10.1016/j.jad.2018.09.051
  16. Farsad-Naeimi, A., Asjodi, F., Omidian, M., Askari, M., Nouri, M., Pizarro, A. B., & Daneshzad, E. (2020). Sugar consumption, sugar sweetened beverages and Attention Deficit Hyperactivity Disorder: A systematic review and meta-analysis. Complementary therapies in medicine, 53, 102512. https://doi.org/10.1016/j.ctim.2020.102512
  17. Fuentes-Albero, M., Martínez-Martínez, M. I., & Cauli, O. (2019). Omega-3 Long-Chain Polyunsaturated Fatty Acids Intake in Children with Attention Deficit and Hyperactivity Disorder. Brain sciences, 9(5), 120. https://doi.org/10.3390/brainsci9050120
  18. Ghanizadeh, A., & Haddad, B. (2015). The effect of dietary education on ADHD, a randomized controlled clinical trial. Annals of general psychiatry, 14, 12. https://doi.org/10.1186/s12991-015-0050-6
  19. Gillies, D., Sinn, J., Lad, S. S., Leach, M. J., & Ross, M. J. (2012). Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. The Cochrane database of systematic reviews, 2012(7), CD007986. https://doi.org/10.1002/14651858.CD007986.pub2
  20. Gruber, R., Wiebe, S., Montecalvo, L., Brunetti, B., Amsel, R., & Carrier, J. (2011). Impact of sleep restriction on neurobehavioral functioning of children with attention deficit hyperactivity disorder. Sleep, 34(3), 315–323. https://doi.org/10.1093/sleep/34.3.315
  21. Hardman, R. J., Kennedy, G., Macpherson, H., Scholey, A. B., & Pipingas, A. (2016). Adherence to a Mediterranean-Style Diet and Effects on Cognition in Adults: A Qualitative Evaluation and Systematic Review of Longitudinal and Prospective Trials. Frontiers in nutrition, 3, 22. https://doi.org/10.3389/fnut.2016.00022
  22. Holton, K. F., & Nigg, J. T. (2020). The Association of Lifestyle Factors and ADHD in Children. Journal of attention disorders, 24(11), 1511–1520. https://doi.org/10.1177/1087054716646452
  23. Hong, G., Conduit, R., Wong, J., Di Benedetto, M., & Lee, E. (2020). Diet, Physical Activity, and Screen Time to Sleep Better: Multiple Mediation Analysis of Lifestyle Factors in School-Aged Children with and without Attention Deficit Hyperactivity Disorder. Journal of attention disorders, 1087054720940417. Advance online publication. https://doi.org/10.1177/1087054720940417
  24. Johnson, R. J., Gold, M. S., Johnson, D. R., Ishimoto, T., Lanaspa, M. A., Zahniser, N. R., & Avena, N. M. (2011). Attention-deficit/hyperactivity disorder: is it time to reappraise the role of sugar consumption?. Postgraduate medicine, 123(5), 39–49. https://doi.org/10.3810/pgm.2011.09.2458
  25. Khalife, N., Kantomaa, M., Glover, V., Tammelin, T., Laitinen, J., Ebeling, H., Hurtig, T., Jarvelin, M. R., & Rodriguez, A. (2014). Childhood attention-deficit/hyperactivity disorder symptoms are risk factors for obesity and physical inactivity in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 53(4), 425–436. https://doi.org/10.1016/j.jaac.2014.01.009
  26. Kohlboeck, G., Heitmueller, D., Neumann, C., Tiesler, C., Heinrich, J., Heinrich-Weltzien, R., ... & Kühnisch, J. (2013). Is there a relationship between hyperactivity/inattention symptoms and poor oral health? Results from the GINIplus and LISAplus study. Clinical oral investigations, 17(5), 1329-1338.
  27. Kohlboeck, G., Sausenthaler, S., Standl, M., Koletzko, S., Bauer, C. P., von Berg, A., Berdel, D., Krämer, U., Schaaf, B., Lehmann, I., Herbarth, O., Heinrich, J., & GINI-plus and LISA-plus Study Groups (2012). Food intake, diet quality and behavioral problems in children: results from the GINI-plus/LISA-plus studies. Annals of nutrition & metabolism, 60(4), 247–256. https://doi.org/10.1159/000337552
  28. Lingineni, R. K., Biswas, S., Ahmad, N., Jackson, B. E., Bae, S., & Singh, K. P. (2012). Factors associated with attention deficit/hyperactivity disorder among US children: results from a national survey. BMC pediatrics, 12, 50. https://doi.org/10.1186/1471-2431-12-50
  29. Marmorstein, N. R. (2016). Energy drink and coffee consumption and psychopathology symptoms among early adolescents: cross-sectional and longitudinal associations. Journal of caffeine research, 6(2), 64-72.
  30. Millichap, J. G., & Yee, M. M. (2012). The diet factor in attention-deficit/hyperactivity disorder. Pediatrics, 129(2), 330–337. https://doi.org/10.1542/peds.2011-2199
  31. Pelsser, L. M., Frankena, K., Toorman, J., Savelkoul, H. F., Pereira, R. R., & Buitelaar, J. K. (2009). A randomised controlled trial into the effects of food on ADHD. European child & adolescent psychiatry, 18(1), 12–19. https://doi.org/10.1007/s00787-008-0695-7
  32. Peralta, G. P., Forns, J., García de la Hera, M., González, L., Guxens, M., López-Vicente, M., Sunyer, J., & Garcia-Aymerich, J. (2018). Sleeping, TV, Cognitively Stimulating Activities, Physical Activity, and Attention-Deficit Hyperactivity Disorder Symptom Incidence in Children: A Prospective Study. Journal of developmental and behavioral pediatrics : JDBP, 39(3), 192–199. https://doi.org/10.1097/DBP.0000000000000539
  33. Pingault, J. B., Viding, E., Galéra, C., Greven, C. U., Zheng, Y., Plomin, R., & Rijsdijk, F. (2015). Genetic and Environmental Influences on the Developmental Course of Attention-Deficit/Hyperactivity Disorder Symptoms From Childhood to Adolescence. JAMA psychiatry, 72(7), 651–658. https://doi.org/10.1001/jamapsychiatry.2015.0469
  34. Ptacek, R., Kuzelova, H., Stefano, G. B., Raboch, J., Sadkova, T., Goetz, M., & Kream, R. M. (2014). Disruptive patterns of eating behaviors and associated lifestyles in males with ADHD. Medical science monitor : international medical journal of experimental and clinical research, 20, 608–613. https://doi.org/10.12659/MSM.890495
  35. Ríos-Hernández, A., Alda, J. A., Farran-Codina, A., Ferreira-García, E., & Izquierdo-Pulido, M. (2017). The Mediterranean Diet and ADHD in Children and Adolescents. Pediatrics, 139(2), e20162027. https://doi.org/10.1542/peds.2016-2027
  36. Rucklidge, J., Johnstone, J., Harrison, R., & Boggis, A. (2011). Micronutrients reduce stress and anxiety in adults with Attention-Deficit/Hyperactivity Disorder following a 7.1 earthquake. Psychiatry research, 189(2), 281–287. https://doi.org/10.1016/j.psychres.2011.06.016
  37. San Mauro Martín, I., Blumenfeld Olivares, J. A., Garicano Vilar, E., Echeverry López, M., García Bernat, M., Quevedo Santos, Y., Blanco López, M., Elortegui Pascual, P., Borregon Rivilla, E., & Rincón Barrado, M. (2018). Nutritional and environmental factors in attention-deficit hyperactivity disorder (ADHD): A cross-sectional study. Nutritional neuroscience, 21(9), 641–647. https://doi.org/10.1080/1028415X.2017.1331952
  38. San Mauro Martin, I., Sanz Rojo, S., González Cosano, L., Conty de la Campa, R., Garicano Vilar, E., & Blumenfeld Olivares, J. A. (2019). Impulsiveness in children with attention-deficit/hyperactivity disorder after an 8-week intervention with the Mediterranean diet and/or omega-3 fatty acids: A randomised clinical trial. Impulsividad en el trastorno por déficit de atención e hiperactividad en niños después de una intervención de 8 semanas con dieta mediterránea y/o ácidos grasos omega-3: ensayo clínico aleatorizado. Neurologia (Barcelona, Spain), S0213-4853(19)30132-X. Advance online publication. https://doi.org/10.1016/j.nrl.2019.09.007
  39. Simon, V., Czobor, P., Bálint, S., Mészáros, A., & Bitter, I. (2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. The British journal of psychiatry: the journal of mental science, 194(3), 204–211. https://doi.org/10.1192/bjp.bp.107.048827
  40. Sivertsen, B., Harvey, A. G., Reichborn-Kjennerud, T., Torgersen, L., Ystrom, E., & Hysing, M. (2015). Later emotional and behavioral problems associated with sleep problems in toddlers: a longitudinal study. JAMA pediatrics, 169(6), 575–582. https://doi.org/10.1001/jamapediatrics.2015.0187
  41. Sonuga-Barke, E.J.S., Brandeis, D., Cortese, S., Daley, D., Ferrin, M., Holtmann, M., … & Wong, I.A.C., Sergeant, J. & European ADHD Guidelines Group (2013). Nonpharmacological interventions for Attention-Deficit/ Hyperactivity Disorder: Systematic review and meta-analyses of randomised controlled trials of dietary and psychological treatments. American Journal of Psychiatry, 170, 275–289.
  42. Stevenson, J., Buitelaar, J., Cortese, S., Ferrin, M., Konofal, E., Lecendreux, M., Simonoff, E., Wong, I. C., & Sonuga-Barke, E. (2014). 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. Journal of child psychology and psychiatry, and allied disciplines, 55(5), 416–427. https://doi.org/10.1111/jcpp.12215
  43. Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics, 135(4), e994–e1001. https://doi.org/10.1542/peds.2014-3482
  44. Touchette, E., Côté, S. M., Petit, D., Liu, X., Boivin, M., Falissard, B., Tremblay, R. E., & Montplaisir, J. Y. (2009). Short nighttime sleep-duration and hyperactivity trajectories in early childhood. Pediatrics, 124(5), e985–e993. https://doi.org/10.1542/peds.2008-2005
  45. van Egmond-Fröhlich, A. W., Weghuber, D., & de Zwaan, M. (2012). Association of symptoms of attention-deficit/hyperactivity disorder with physical activity, media time, and food intake in children and adolescents. PloS one, 7(11), e49781. https://doi.org/10.1371/journal.pone.0049781
  46. Wang, L. J., Yu, Y. H., Fu, M. L., Yeh, W. T., Hsu, J. L., Yang, Y. H., Yang, H. T., Huang, S. Y., Wei, I. L., Chen, W. J., Chiang, B. L., & Pan, W. H. (2019). Dietary Profiles, Nutritional Biochemistry Status, and Attention-Deficit/Hyperactivity Disorder: Path Analysis for a Case-Control Study. Journal of clinical medicine, 8(5), 709. https://doi.org/10.3390/jcm8050709
  47. Weissenberger, S., Ptacek, R., Klicperova-Baker, M., Erman, A., Schonova, K., Raboch, J., & Goetz, M. (2017). ADHD, Lifestyles and Comorbidities: A Call for an Holistic Perspective - from Medical to Societal Intervening Factors. Frontiers in psychology, 8, 454. https://doi.org/10.3389/fpsyg.2017.00454
  48. Weissenberger, S., Ptacek, R., Vnukova, M., Raboch, J., Klicperova-Baker, M., Domkarova, L., & Goetz, M. (2018). ADHD and lifestyle habits in Czech adults, a national sample. Neuropsychiatric disease and treatment, 14, 293–299. https://doi.org/10.2147/NDT.S148921
  49. Wilens, T. E., & Spencer, T. J. (2010). Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgraduate medicine, 122(5), 97–109. https://doi.org/10.3810/pgm.2010.09.2206
  50. Wiles, N. J., Northstone, K., Emmett, P., & Lewis, G. (2009). 'Junk food' diet and childhood behavioural problems: results from the ALSPAC cohort. European journal of clinical nutrition, 63(4), 491–498. https://doi.org/10.1038/sj.ejcn.1602967
  51. Wolraich, M. L., Wilson, D. B., & White, J. W. (1995). The effect of sugar on behavior or cognition in children. A meta-analysis. JAMA, 274(20), 1617–1621. https://doi.org/10.1001/jama.1995.03530200053037
  52. Woo, H. D., Kim, D. W., Hong, Y. S., Kim, Y. M., Seo, J. H., Choe, B. M., Park, J. H., Kang, J. W., Yoo, J. H., Chueh, H. W., Lee, J. H., Kwak, M. J., & Kim, J. (2014). Dietary patterns in children with attention deficit/hyperactivity disorder (ADHD). Nutrients, 6(4), 1539–1553. https://doi.org/10.3390/nu6041539
  53. World Health Organization & United Nations Children's Fund (‎‎UNICEF)‎‎. (‎2020)‎. Landscape assessment on global monitoring of diet quality: conducted on behalf of the diet quality working group of the WHO/UNICEF technical expert advisory group on nutrition monitoring (‎TEAM)‎. World Health Organization. https://apps.who.int/iris/handle/10665/330765. License: CC BY-NC-SA 3.0 IGO
  54. Wu, X., Ohinmaa, A., & Veugelers, P. J. (2016). The Influence of Health Behaviours in Childhood on Attention Deficit and Hyperactivity Disorder in Adolescence. Nutrients, 8(12), 788. https://doi.org/10.3390/nu8120788
  55. Yu, C. J., Du, J. C., Chiou, H. C., Feng, C. C., Chung, M. Y., Yang, W., Chen, Y. S., Chien, L. C., Hwang, B., & Chen, M. L. (2016). Sugar-Sweetened Beverage Consumption Is Adversely Associated with Childhood Attention Deficit/Hyperactivity Disorder. International journal of environmental research and public health, 13(7), 678. https://doi.org/10.3390/ijerph13070678
  56. Zhou, F., Wu, F., Zou, S., Chen, Y., Feng, C., & Fan, G. (2016). Dietary, Nutrient Patterns and Blood Essential Elements in Chinese Children with ADHD. Nutrients, 8(6), 352. https://doi.org/10.3390/nu8060352

How to Cite

Papanastasiou, G., Drigas, A. ., & Papanastasiou, P. . (2021). The association of diet quality and lifestyle factors in children and adults with ADHD: a systematic review and meta-analysis. Scientific Electronic Archives, 14(9). https://doi.org/10.36560/14920211441