The effect of dietary education on ADHD, a randomized controlled clinical trial

Annals of General Psychiatry, Mar 2015

Background The purpose of this research was to study the effectiveness of the overall dietary intervention rather than a single nutrient on children with attention deficit hyperactivity disorder (ADHD). Methods This is a randomized controlled trial conducted at a child psychiatry clinic in Iran. Participants were 106 children and adolescents with ADHD. One group received methylphenidate plus dietary recommendations, while the other group only received methylphenidate. ADHD DSM-IV checklist was used to assess inattentiveness and hyperactivity/impulsivity scores at baseline and at the end of the trial. Results The results revealed no significant difference between the two groups regarding mean age, gender ratio, body mass index, baseline inattentiveness score, and baseline hyperactivity score. Linear regression analysis considering the covariant variables showed that the inattentive score at the end of the trial was significantly associated with the mean change of favorite diet scores. Conclusion This is the first clinical trial examining the effect of overall dietary characteristics rather than a single nutrient on the children formally diagnosed with ADHD. According to the results, un-favorite diet had no effects on inattentive or hyperactivity/impulsivity score. Encouraging the children with ADHD to increase their intake of recommended diet markedly improves their attention. Trial registration The trial was registered at the Iranian Clinical Trials Registry (Irct ID: IRCT201311303930N29).

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The effect of dietary education on ADHD, a randomized controlled clinical trial

Ghanizadeh and Haddad Annals of General Psychiatry The effect of dietary education on ADHD, a randomized controlled clinical trial Ahmad Ghanizadeh 0 1 2 Behzad Haddad 1 0 Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences , Shiraz , Iran 1 Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences , Shiraz , Iran 2 Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences , Shiraz , Iran Background: The purpose of this research was to study the effectiveness of the overall dietary intervention rather than a single nutrient on children with attention deficit hyperactivity disorder (ADHD). Methods: This is a randomized controlled trial conducted at a child psychiatry clinic in Iran. Participants were 106 children and adolescents with ADHD. One group received methylphenidate plus dietary recommendations, while the other group only received methylphenidate. ADHD DSM-IV checklist was used to assess inattentiveness and hyperactivity/impulsivity scores at baseline and at the end of the trial. Results: The results revealed no significant difference between the two groups regarding mean age, gender ratio, body mass index, baseline inattentiveness score, and baseline hyperactivity score. Linear regression analysis considering the covariant variables showed that the inattentive score at the end of the trial was significantly associated with the mean change of favorite diet scores. Conclusion: This is the first clinical trial examining the effect of overall dietary characteristics rather than a single nutrient on the children formally diagnosed with ADHD. According to the results, un-favorite diet had no effects on inattentive or hyperactivity/impulsivity score. Encouraging the children with ADHD to increase their intake of recommended diet markedly improves their attention. Trial registration: The trial was registered at the Iranian Clinical Trials Registry (Irct ID: IRCT201311303930N29). ADHD; Attention; Diet; Clinical trial; Sugar; Cacao; Artificial food color - Introduction Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children and adolescents. The neurobiology of ADHD is not clearly known. However, claims have been made that diet is associated with ADHD and infantile malnutrition causes longlasting attention problems [1]. However, there is no scientific evidence showing that diet causes ADHD. There are also some reports about the association of junk food [2], Western dietary pattern [3], and fast food [4] with ADHD symptoms. Sweets and sugar are also believed to be associated with ADHD symptoms [4,5]. However, this assumption needs to be examined since some studies have not shown any association between sugar and behavioral problems [6,7]. On the contrary, another study reported that less consumption of sugar from fruit snacks increased the risk of ADHD [8]. Moreover, none of the studies has examined the effect of sugar on ADHD, but they have assessed its association with behavioral problems and cognition [6,7]. A 21-day, double-blind, placebo-controlled, repeatedmeasure study showed that ingestion of a synthetic food coloring was associated with irritability, restlessness, and sleep disturbance [9]. Toxicological, anti-nutritional, and hypersensitivity are the three supposed possible mechanisms for the effect of artificial food colors on the childrens behaviors [10]. However, evidence-based information is needed to support the potential efficacy of restricted diet on ADHD symptoms [11,12]. In a randomized controlled clinical trial, artificial food colorings and a preservative did not show any effects on the childrens behavior [13]. On the other hand, a systematic review showed that free fatty acid supplementation slightly reduced the ADHD symptoms and that exclusion of artificial food colors might reduce the symptoms in those with food sensitivities [14]. One other study reported that food supplements might be as effective as methylphenidate in improvement of some ADHD symptoms [15]. Nonetheless, more evidence regarding the efficacy of restricted diets is needed [14]. Although omitting some items is supposed to be helpful, their efficacy has not been assessed in controlled clinical trials [16]. In fact, it is a neglected research area [17]. Moreover, current literature suffers from publication bias and small nongeneralizable samples [18]. Thus, further investigations are recommended to be conducted on the effect of diet on ADHD [18]. One study showed that intake of sweetened desserts, fried food, and salt are associated with more attention and behavioral problems while a balanced diet, regular meals, and a high intake of dairy products and vegetables are associated with less attention and behavioral problems [19]. However, the cross-sectional design of that study did not allow the authors t (...truncated)


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Ahmad Ghanizadeh, Behzad Haddad. The effect of dietary education on ADHD, a randomized controlled clinical trial, Annals of General Psychiatry, 2015, pp. 12, 14, DOI: 10.1186/s12991-015-0050-6