Minji An; Hyojin An; Hwang-Hyo Jeong; Ho-Jang Kwon; Mina Ha; Yun-Chul Hong; Soo-Jong Hong; Se-Young Oh

doi:10.5720/kjcn.2018.23.5.397

Articles

Page Path: HOME > Korean J Community Nutr > Volume 23(5); 2018 > Article

Research Article
Dietary Factors Associated with Attention Deficit Hyperactivity Disorder (ADHD) in School-aged Children: Minji An, Hyojin An, Hwang-Hyo Jeong, Ho-Jang Kwon, Mina Ha, Yun-Chul Hong, Soo-Jong Hong, Se-Young Oh; Korean Journal of Community Nutrition 2018;23(5):397-410.
DOI: https://doi.org/10.5720/kjcn.2018.23.5.397
Published online: October 31, 2018

¹Graduate School of Kyung Hee University, Seoul, Korea, Student.

²Department of Food and Nutrition, Kyung Hee University, Seoul, Korea, Researcher.

³Department of Food and Nutrition, Sahmyook University, Seoul, Korea, Professor.

⁴Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea, Professor.

⁵Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea, Professor.

⁶Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Professor.

⁷Department of Food and Nutrition, Kyung Hee University, Seoul, Korea, Professor.

Corresponding author: Se-Young Oh. Department of Food and Nutrition, College of Human Ecology, Kyunghee University, Seoul 02447, Dongdaemun-gu, Korea. Tel: (02) 961-0602, Fax: (02) 959-0649, seyoung@khu.ac.kr

• Received: July 31, 2018 • Revised: September 7, 2018 • Accepted: September 7, 2018

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

170 Views
3 Download
4 Crossref

prev next

Full Article

Download PDF

Abstract
Acknowledgments
Acknowledgments
REFERENCES

Abstract

Objectives
An association between dietary patterns and mental health in children has been suggested in a series of studies, yet detailed analyses of dietary patterns and their effects on ADHD (attention deficit hyperactivity disorder) are limited.
Methods
We included 4569 children who had dietary intake data as part of the CHEER (Children's Health and Environmental Research) study conducted nationwide from 2005 to 2010. We assessed ADHD (Attention Deficit Hyperactivity Disorder) by the DuPaul's ADHD Rating Scales and dietary intake by a semi-quantitative food frequency questionnaire. Using intake data, we constructed five dietary patterns: “Plant foods & fish,” “Sweets,” “Meat & fish,” “Fruits & dairy products,” and “Wheat based.”
Results
The overall proportion of ADHD was 12.3%. Boys (17.8%) showed a higher rate of ADHD than girls (6.5%). The total intake of calories (85 kcal) and plant fat (2g) in the ADHD group was significantly higher than that of the normal group. ADHD was significantly negatively associated with dietary habits such as having breakfast and meal frequency, and positively associated with eating speed, unbalanced diet, overeating, and rice consumption. Regarding dietary patterns, the “Sweets” category was relevant to high ADHD risk (OR 1.59, 95% CI: 1.18, 2.15 for Q5 vs. Q1) in a linear relationship. An inverse, non-linear association was found between “Fruits & dairy products” and ADHD (OR 0.55, 95% CI: 0.39, 0.76 for Q4 vs. Q1).
Conclusions
Our study confirms both positive and negative associations between diet and ADHD in elementary school age children. Moreover, linear or nonlinear associations between diet and ADHD draw attention to the possible threshold role of nutrients. Further studies may consider characteristics of diet in more detail to develop better intervention or management in terms of diet and health.
Keywords: ADHD (attention deficit hyperactivity disorder); dietary patterns; dietary habits; food frequency questionnaire; linear or nonlinear association

Acknowledgments

This research was supported by the Ministry of Environment, Korea.

REFERENCES

1. Sarris J, Kean J, Schweitzer I, Lake J. Complementary medicines (herbal and nutritional products) in the treatment of Attention Deficit Hyperactivity Disorder (ADHD): A systematic review of the evidence. Complement Ther Med 2011; 19(4): 216-227.Article PubMed
2. Korean Academy of Child and Adolescent Psychiatry. The prevalence of ADHD in Korea [internet]. Korean Academy of Child and Adolescent Psychiatry; 2017; cited 2018 Jul 12]. Available from: http://adhd.or.kr/adhd/adhd02.php.
3. Heilskov Rytter MJ, Andersen LB, Houmann T, Bilenberg N, Hvolby A, Molgaard C. Diet in the treatment of ADHD in children: a systematic review of the literature. Nord J Psychiatry 2015; 69(1): 1-18.Article PubMed
4. Rowland AS, Lesesne CA, Abramowitz AJ. The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view. Ment Retard Dev Disabil Res Rev 2002; 8(3): 162-170.Article PubMed
5. Sung HS. Our elementary education. In; to understand children who have excessive distraction. Atten Defic Hyperact Disord 2005; 3: 38-39.
6. Song MR, Ha EH. The effects of children's executive function impairments and ADHD symptoms on self-directed learning capability. Korean J Play Ther 2014; 17(2): 193-207.
7. Kim SY. Attentional functions and dysfunctions in ADHD. Korean J Cogn Biol Psychol 2014; 26(2): 67-94.Article
8. Koo HJ, Choi JS. Language and cognitive development of preschool children from multicultural families and mono-Korean families in rural areas. Korean J Early Child Educ 2012; 32(4): 115-136.Article
9. Lee JR, Jae KS, Yoon CY. ADHD and substance abuse. Korean J East West Sci 2004; 7(1): 151-166.
10. Chen JR, Hsu SF, Hsu CD, Hwang LH, Yang SC. Dietary patterns and blood fatty acid composition in children with attention-deficit hyperactivity disorder in Taiwan. J Nutr Biochem 2004; 15(8): 467-472.Article PubMed
11. Kim HY, Choi EY, Kong MR. A study on the correlation between symptoms of ADHD, problem behaviors and emotional regulation ability of adolescents. J Spec Educ Rehabil Sci 2013; 52(4): 339-358.
12. Kwon HJ, Ha M, Kim BN, Lim MH. Harmful environmental factors leading to attention-deficit hyperactivity disorder. J Korean Acad Child Adolesc Psychiatry 2016; 27(4): 267-277.Article
13. Landrigan PJ, Schechter CB, Lipton JM, Fahs MC, Schwartz J. Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities. Environ Health Perspect 2002; 110(7): 721-728.Article PubMed PMC
14. Choi WY. A study on regulation of mobile phone radiation: Necessity and content. J Leg Stud 2013; 21(2): 499-527.
15. Choi JO. Influence of youth internet fame addiction on ADHD and academic achievement: Focusing on elementary school students in Seoul, Incheon, and Gyeonggi region. J Korea Inst Youth Facil Environ 2014; 12(2): 19-28.
16. Han JY, Kim HJ, Ha MN, Paik KC, Lim MH, Lee SG. The effects of prenatal exposure to alcohol and environmental tobacco smoke on risk for ADHD: A large population-based study. Psychiatry Res 2015; 225(1-2): 164-168.Article PubMed
17. Mattes JA. The Feingold diet: a current reappraisal. J Learn Disabil 1983; 16(6): 319-323.Article PubMed PDF
18. Kim WK, Cho SS. Sugar and cognitive performance. J Nutr Health 2007; 40(sup): 50-65.
19. Chung SH. Sugar and children's behavior. J Nonviol 2010; 4: 121-132.
20. Millichap JG, Yee MM. The diet factor in attention-deficit/hyperactivity disorder. Pediatrics 2012; 129(2): 330-337.Article PubMed PDF
21. Kim KM, Lim MH, Kwon HJ, Yoo SJ, Kim EJ, Kim JW. Associations between attention-deficit/hyperactivity disorder symptoms and dietary habits in elementary school children. Appetite 2018; 127(1): 274-279.Article PubMed
22. Howard AL, Robinson M, Smith GJ, Ambrosini GL, Piek JP, Oddy WH. ADHD is associated with a "Western" dietary pattern in adolescents. J Atten Disord 2011; 15(5): 403-411.Article PubMed PDF
23. Woo HD, Kim DW, Hong YS, Kim YM, Seo JH, Choe BM. Dietary patterns in children with Attention Deficit/Hyperactivity Disorder (ADHD). Nutrients 2014; 6(4): 1539-1553.Article PubMed PMC
24. Azadbakht L, Esmaillzadeh A. Dietary patterns and attention deficit hyperactivity disorder among Iranian children. Nutrition 2012; 28(3): 242-249.Article PubMed
25. Kwon HJ. Korean environmental health survey for children. Ministry of Environment. National Institute of Environmental Research; 2010 Report No. VI.
26. Shin MS, Cho SJ, Chun SY, Hong KE. A study of the development and standardization of ADHD diagnostic system. J Child Adolesc Psychiatry 2000; 11(1): 91-99.
27. Lim Y, Oh SY. Development of a semi-quantitative food questionnaire for pre-school children in Korea. Korean J Community Nutr 2002; 7(1): 58-66.
28. Connolly A, Vance A. Psychosocial factors associated with parent and teacher reports of aggression in children and adolescents with attention deficit hyperactivity disorder. Aust New Zealand J Psychiatry 2010; 44(7): 667-675.Article PDF
29. Gungor S, Celiloglu OS, Raif SG, Ozcan OO, Selimoglu MA. Malnutrition and obesity in children with ADHD. J Atten Disord 2016; 20(8): 647-652.Article PubMed PDF
30. Ptacek R, Kuzelova H, Stefano GB, Raboch J, Sadkova T, Goetz M. Disruptive patterns of eating behaviors and associated lifestyles in males with ADHD. Med Sci Monit 2014; 20: 608-613.Article PubMed PMC
31. Durá-Travé T, Gallinas-Victoriano F. Caloric and nutrient intake in children with attention deficit hyperactivity disorder treated with extended-release methylphenidate: analysis of a cross-sectional nutrition survey. JRSM Open 2014; 5(2): 2042533313517690.PubMed PMC
32. Cho SC, Kim BN, Kim JW, Rohde LA, Hwang JW, Chung DS. Full syndrome and subthreshold attention-deficit/ hyperactivity disorder in a Korean community sample: comorbidity and temperament findings. Eur Child Adolesc Psychiatry 2009; 18(7): 447-457.Article PubMed PDF
33. Kim DW, Lee JE, Jung WC, Nam KC, Bang YW, Kim SJ. Cross sectional study on the prevalence of attention deficit hyperactivity disorder and associated factors among elementary school students living nearby Shihwa-Banwol industrial complex. Korean J Occup Environ Med 2012; 24(3): 252-262.Article PDF
34. Pastor P, Reuben C, Duran C, Hawkins L. Association between diagnosed ADHD and selected characteristics among children aged 4-17 years: United States, 2011-2013. NCHS Data Brief 2015; 4(5): 4-17.
35. Han JY, Kim HJ, Ha MN, Paik KC, Lim MH, Lee SG. The effects of prenatal exposure to alcohol and environmental tobacco smoke on risk for ADHD: A large population-based study. Psychiatry Res 2015; 225(1-2): 164-168.Article PubMed
36. Choi JY, Lee SS. Relation between dietary habit and nutrition knowledge, and Attention Deficit Hyperactivity Disorder (ADHD) in the middle school students in Seoul. Korean J Nutr 2009; 42(8): 682-690.Article
37. Jang CB, Kim HY. The relationship between attention deficit hyperactivity disorder, dietary habit and caffeine intake in uppergrade elementary school children. Korean J Nutr 2012; 45(6): 522-530.Article
38. Reinblatt SP, Mahone EM, Tanofsky Kraff M, Lee Winn AE, Yenokyan G, Leoutsakos JMS. Pediatric loss of control eating syndrome: Association with attention deficit/hyperactivity disorder and impulsivity. Int J Eat Disord 2015; 48(6): 580-588.Article PubMed PMC
39. Merkt J, Gawrilow C. Health, dietary habits, and achievement motivation in college students with self-reported ADHD diagnosis. J Atten Disord 2016; 20(9): 727-740.Article PubMed PDF
40. Ríos-Hernández A, Alda JA, Farran-Codina A, Ferreira-García E, Izquierdo-Pulido M. The Mediterranean diet and ADHD in children and adolescents. Pediatrics 2017; 139(2): pii: e20162027.
41. Yan S, Cao H, Gu C, Ni L, Tao H, Shao T. Dietary patterns are associated with attention-deficit/hyperactivity disorder (ADHD) symptoms among preschoolers in mainland China. Eur J Clin Nutr 2018; Published online: 13 March.Article PDF

Fig. 1

Flow diagram of the study

Table 1

Food grouping used in the dietary pattern analysis

Table 2

Percentage of children who diagnosed with attention deficit hyperactivity disorder (ADHD) and the subtypes of ADHD

1) Abbrebiations: AD + HD = Attention deficit + Hyperactivity disorder, AD = Attention deficit, HD = Hyperactivity disorder

Table 3

General characteristics of the study participants by group (N=4,569)

Table 4

Nutrients intakes assessed by semi-food frequency questionnaire (SFFQ) by group

1) Analysis by T-test

2) Significantly different by student's t-test between ADHD and normal group (p<0.05)

3) Values are means ± SD

Table 5

Distribution of eating behaviors by group (N=4,569)

1) chi-square test

Table 6

Factor loadings1) for the five dietary patterns derived from semi-food frequency questionnaire (SFFQ)

1) Factor loadings ≥0.3 or ≤−0.3 are shown in bold and shaded

Table 7

Correlation coefficients of daily nutrient intakes and five dietary pattern (N=4,926)1)

1) Adjusted for age as continuous variables and gender as categorical variables. Significantly different at ^*: P<0.05 and ^**: P<0.01

2) Values were shaded, if not significant (p<0.05)

Table 8

Daily nutrient intakes¹⁾ of Q1 and Q5²⁾ by the quintile of dietary pattern scores(N=4,926)

1) Adjusted for age, gender, energy intake

2) Q1–Q5 : The values which estimated nutrient intakes from SFFQ divided into quintile categories. Q1 : the lowset, O5 : the highest

3) In each cell, value were shaded when Q1 is higher than Q5, if significant (p<0.001)

Table 9

Odds ratio of Dietary patterns¹⁾ on ADHD and subtypes of ADHD

1) Adjusted for area, age, gender, married status, father education and passive smoking

2) Abbrebiations: AD + HD=Attention deficit + Hyperactivity disorder

AD = Attention deficit

HD = Hyperactivity disorder

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

Correlation of attention deficit hyperactivity disorder with gut microbiota according to the dietary intake of Korean elementary school students
Tae-Hwan Jung, Hyo-Jeong Hwang, Kyoung-Sik Han, Regis Moreau
PLOS ONE.2022; 17(9): e0275520. CrossRef
Awareness and Practice of Sugar Reduction in School Foodservice and the Practice of Nutrition Education in Daegu
Suhyang Jang, Kilye Kim, Yeon-Kyung Lee
Korean Journal of Community Nutrition.2021; 26(3): 167. CrossRef
Effect of Nutrition Education on Reduced Sugar Intake in Elementary School Students
Young-Mi Seo, Ok-Jin Park, Min-June Lee
Journal of the East Asian Society of Dietary Life.2021; 31(1): 14. CrossRef
Analysis of the consumer perception and related education effect on the reduction of sugar for elementary school students in Seoul and Gyeonggi-do
Ki Nam Kim, Jung Sug Lee, Jee-Seon Shim, Hae Kyung Chung, Hae Rang Chung, Moon-Jeong Chang
Journal of Nutrition and Health.2020; 53(3): 303. CrossRef

PubReader

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Dietary Factors Associated with Attention Deficit Hyperactivity Disorder (ADHD) in School-aged Children

Korean J Community Nutr. 2018;23(5):397-410. Published online October 31, 2018

DOI: https://doi.org/10.5720/kjcn.2018.23.5.397

XML Download

Figure

We recommend

Dietary Factors Associated with Attention Deficit Hyperactivity Disorder (ADHD) in School-aged Children

Fig. 1 Flow diagram of the study

Fig. 1

Dietary Factors Associated with Attention Deficit Hyperactivity Disorder (ADHD) in School-aged Children

Table 1

Food grouping used in the dietary pattern analysis

Table 2

Percentage of children who diagnosed with attention deficit hyperactivity disorder (ADHD) and the subtypes of ADHD

1) Abbrebiations: AD + HD = Attention deficit + Hyperactivity disorder, AD = Attention deficit, HD = Hyperactivity disorder

Table 3

General characteristics of the study participants by group (N=4,569)

Table 4

Nutrients intakes assessed by semi-food frequency questionnaire (SFFQ) by group

1) Analysis by T-test

2) Significantly different by student's t-test between ADHD and normal group (p<0.05)

3) Values are means ± SD

Table 5

Distribution of eating behaviors by group (N=4,569)

1) chi-square test

Table 6

Factor loadings1) for the five dietary patterns derived from semi-food frequency questionnaire (SFFQ)

1) Factor loadings ≥0.3 or ≤−0.3 are shown in bold and shaded

Table 7

Correlation coefficients of daily nutrient intakes and five dietary pattern (N=4,926)1)

1) Adjusted for age as continuous variables and gender as categorical variables. Significantly different at ^*: P<0.05 and ^**: P<0.01

2) Values were shaded, if not significant (p<0.05)

Table 8

Daily nutrient intakes¹⁾ of Q1 and Q5²⁾ by the quintile of dietary pattern scores(N=4,926)

1) Adjusted for age, gender, energy intake

2) Q1–Q5 : The values which estimated nutrient intakes from SFFQ divided into quintile categories. Q1 : the lowset, O5 : the highest

3) In each cell, value were shaded when Q1 is higher than Q5, if significant (p<0.001)

Table 9

Odds ratio of Dietary patterns¹⁾ on ADHD and subtypes of ADHD

1) Adjusted for area, age, gender, married status, father education and passive smoking

2) Abbrebiations: AD + HD=Attention deficit + Hyperactivity disorder

AD = Attention deficit

HD = Hyperactivity disorder

Table 1 Food grouping used in the dietary pattern analysis

Table 2 Percentage of children who diagnosed with attention deficit hyperactivity disorder (ADHD) and the subtypes of ADHD

1) Abbrebiations: AD + HD = Attention deficit + Hyperactivity disorder, AD = Attention deficit, HD = Hyperactivity disorder

Table 3 General characteristics of the study participants by group (N=4,569)

Table 4 Nutrients intakes assessed by semi-food frequency questionnaire (SFFQ) by group

1) Analysis by T-test

2) Significantly different by student's t-test between ADHD and normal group (p<0.05)

3) Values are means ± SD

Table 5 Distribution of eating behaviors by group (N=4,569)

1) chi-square test

Table 6 Factor loadings1) for the five dietary patterns derived from semi-food frequency questionnaire (SFFQ)

1) Factor loadings ≥0.3 or ≤−0.3 are shown in bold and shaded

Table 7 Correlation coefficients of daily nutrient intakes and five dietary pattern (N=4,926)1)

1) Adjusted for age as continuous variables and gender as categorical variables. Significantly different at ^*: P<0.05 and ^**: P<0.01

2) Values were shaded, if not significant (p<0.05)

Table 8 Daily nutrient intakes1) of Q1 and Q52) by the quintile of dietary pattern scores(N=4,926)

1) Adjusted for age, gender, energy intake

2) Q1–Q5 : The values which estimated nutrient intakes from SFFQ divided into quintile categories. Q1 : the lowset, O5 : the highest

3) In each cell, value were shaded when Q1 is higher than Q5, if significant (p<0.001)

Table 9 Odds ratio of Dietary patterns1) on ADHD and subtypes of ADHD

1) Adjusted for area, age, gender, married status, father education and passive smoking