注意缺陷多动障碍儿童的体格生长和膳食特征：一项横断面研究

林霜; 吴丹丹; 陈书进; 燕武; 窦丽华; 李晓南

doi:10.7499/j.issn.1008-8830.2301052

PDF(661 KB)

HTML

中国当代儿科杂志 ›› 2023, Vol. 25 ›› Issue (7) : 711-717. DOI: 10.7499/j.issn.1008-8830.2301052

论著·临床研究

注意缺陷多动障碍儿童的体格生长和膳食特征：一项横断面研究

林霜, 吴丹丹, 陈书进, 燕武, 窦丽华, 李晓南

作者信息 +

Physical growth and dietary characteristics of children with attention deficit hyperactivity disorder: a cross-sectional study

LIN Shuang, WU Dan-Dan, CHEN Shu-Jin, YAN Wu, DOU Li-Hua, LI Xiao-Nan

Author information +

文章历史 +

摘要

目的调查注意缺陷多动障碍（attention deficit hyperactivity disorder，ADHD）儿童的体格生长及膳食特征，并分析其与ADHD核心症状的关系。方法纳入2020年6—12月在南京医科大学附属儿童医院初诊为ADHD的患儿268例（ADHD组），另选取同期健康体检的非ADHD儿童102例作为对照组。对两组儿童进行体格测评、膳食调查，并依据美国精神障碍诊断与统计手册第5版进行ADHD诊断及评分，采用因子分析、Spearman秩相关分析及中介效应分析评估ADHD核心症状、膳食模式及体格生长之间的关系。结果 ADHD组超重/肥胖检出比例显著高于对照组（35.8% vs 21.6%，P<0.05）。依据食物频率问卷共提取3种膳食模式：素食膳食模式、传统膳食模式及零食快餐模式。其中ADHD组儿童零食快餐模式因子得分高于对照组（P<0.05）。ADHD症状评分、零食快餐模式因子得分及体脂百分比两两之间呈显著正相关（P<0.05）。中介效应分析显示，零食快餐模式因子得分在ADHD症状评分与体脂百分比的关系中起到了部分中介作用，中介占比为26.66%。结论 ADHD儿童超重/肥胖率高于非ADHD儿童；ADHD儿童核心症状与膳食模式、体格生长状况相关，其中零食快餐模式在ADHD核心症状与体格生长状况之间发挥了部分中介作用。

Abstract

Objective To investigate the physical growth and dietary characteristics of children with attention deficit hyperactivity disorder (ADHD), and to analyze their relationship with core symptoms of ADHD. Methods A total of 268 children who were newly diagnosed with ADHD in Children's Hospital of Nanjing Medical University from June to December 2020 were included in the ADHD group, and 102 healthy children who underwent physical examination during the same period were selected as the control group. Physical evaluations and dietary surveys were conducted for both groups. ADHD diagnosis and scoring were performed according to the Diagnostic and Statistical Manual of Mental Disorders (5th edition). Factor analysis, Spearman correlation analysis, and mediation analysis were used to study the relationship between core symptoms of ADHD, dietary patterns, and physical growth. Results The rate of overweight/obesity in the ADHD group was significantly higher than that in the control group (35.8% vs 21.6%, P<0.05). Three dietary patterns were extracted from the food frequency questionnaire: vegetarian dietary pattern, traditional dietary pattern, and snack/fast food pattern. The factor score for the snack/fast food pattern in the ADHD group was higher than that in the control group (P<0.05). There was a significant positive correlation between ADHD symptom scores, snack/fast food pattern factor scores, and body fat percentage (P<0.05). The mediation analysis showed that the snack/fast food pattern played a partial mediating role in the relationship between ADHD symptom scores and body fat percentage, with a mediation proportion of 26.66%. Conclusions The rate of overweight/obesity in children with ADHD is higher than that in non-ADHD children. Core symptoms of ADHD are related to dietary patterns and physical growth, with the snack/fast food pattern playing a partial mediating role in the relationship between core symptoms of ADHD and physical growth.

导出引用

林霜, 吴丹丹, 陈书进, 燕武, 窦丽华, 李晓南. 注意缺陷多动障碍儿童的体格生长和膳食特征：一项横断面研究[J]. 中国当代儿科杂志. 2023, 25(7): 711-717 https://doi.org/10.7499/j.issn.1008-8830.2301052

LIN Shuang, WU Dan-Dan, CHEN Shu-Jin, YAN Wu, DOU Li-Hua, LI Xiao-Nan. Physical growth and dietary characteristics of children with attention deficit hyperactivity disorder: a cross-sectional study[J]. Chinese Journal of Contemporary Pediatrics. 2023, 25(7): 711-717 https://doi.org/10.7499/j.issn.1008-8830.2301052

参考文献

1 Drechsler R, Brem S, Brandeis D, et al. ADHD: current concepts and treatments in children and adolescents[J]. Neuropediatrics, 2020, 51(5): 315-335. PMID: 32559806. PMCID: PMC7508636. DOI: 10.1055/s-0040-1701658.
2 Perry C, Guillory TS, Dilks SS. Obesity and psychiatric disorders[J]. Nurs Clin North Am, 2021, 56(4): 553-563. PMID: 34749894. DOI: 10.1016/j.cnur.2021.07.010.
3 Porfirio MC, Campanile R, Masi G, et al. Exploring the link between ADHD and obesity: a focus on temperament[J]. Brain Sci, 2022, 12(12): 1631. PMID: 36552091. PMCID: PMC9775563. DOI: 10.3390/brainsci12121631.
4 Davallow Ghajar L, DeBoer MD. Children with attention-deficit/hyperactivity disorder are at increased risk for slowed growth and short stature in early childhood[J]. Clin Pediatr (Phila), 2020, 59(4/5): 401-410. PMID: 32009447. DOI: 10.1177/0009922820902437.
5 Del-Ponte B, Quinte GC, Cruz S, et al. Dietary patterns and attention deficit/hyperactivity disorder (ADHD): a systematic review and meta-analysis[J]. J Affect Disord, 2019, 252: 160-173. PMID: 30986731. DOI: 10.1016/j.jad.2019.04.061.
6 Kaisari P, Dourish CT, Higgs S. Attention deficit hyperactivity disorder (ADHD) and disordered eating behaviour: a systematic review and a framework for future research[J]. Clin Psychol Rev, 2017, 53: 109-121. PMID: 28334570. DOI: 10.1016/j.cpr.2017.03.002.
7 Li YJ, Xie XN, Lei X, et al. Global prevalence of obesity, overweight and underweight in children, adolescents and adults with autism spectrum disorder, attention-deficit hyperactivity disorder: a systematic review and meta-analysis[J]. Obes Rev, 2020, 21(12): e13123. PMID: 32783349. DOI: 10.1111/obr.13123.
8 Biedermann F, Fleischhacker WW. Psychotic disorders in DSM-5 and ICD-11[J]. CNS Spectr, 2016, 21(4): 349-354. PMID: 27418328. DOI: 10.1017/S1092852916000316.
9 甄诗翰, 刘洋, 丁宁, 等. 国内外儿童肥胖相关膳食调查方法及评价[J]. 中华健康管理学杂志, 2017, 11(2): 193-197. DOI: 10.3760/cma.j.issn.1674-0815.2017.02.018.
10 Zhao J, Li Z, Gao Q, et al. A review of statistical methods for dietary pattern analysis[J]. Nutr J, 2021, 20(1): 37. PMID: 33874970. PMCID: PMC8056502. DOI: 10.1186/s12937-021-00692-7.
11 李辉, 季成叶, 宗心南, 等. 中国0～18岁儿童、青少年身高、体重的标准化生长曲线[J]. 中华儿科杂志, 2009, 47(7): 487-492. PMID: 19951507. DOI: 10.3760/cma.j.issn.0578-1310.2009.07.003.
12 Posner J, Polanczyk GV, Sonuga-Barke E. Attention-deficit hyperactivity disorder[J]. Lancet, 2020, 395(10222): 450-462. PMID: 31982036. PMCID: PMC7880081. DOI: 10.1016/S0140-6736(19)33004-1.
13 许明慧, 韩梦蝶, 赵雪, 等. 注意力缺陷多动障碍评估工具的研究进展[J]. 护理研究, 2023, 37(2): 289-292. DOI: 10.12102/j.issn.1009-6493.2023.02.020.
14 温忠麟, 方杰, 谢晋艳, 等. 国内中介效应的方法学研究[J]. 心理科学进展, 2022, 30(8): 1692-1702. DOI: 10.3724/SP.J.1042.2022.01692.
15 Racicka E, Han? T, Giertuga K, et al. Prevalence of overweight and obesity in children and adolescents with ADHD: the significance of comorbidities and pharmacotherapy[J]. J Atten Disord, 2018, 22(12): 1095-1108. PMID: 25895508. DOI: 10.1177/1087054715578272.
16 Cortese S, Moreira-Maia CR, St Fleur D, et al. Association between ADHD and obesity: a systematic review and meta-analysis[J]. Am J Psychiatry, 2016, 173(1): 34-43. PMID: 26315982. DOI: 10.1176/appi.ajp.2015.15020266.
17 Weiss F, Barbuti M, Carignani G, et al. Psychiatric aspects of obesity: a narrative review of pathophysiology and psychopathology[J]. J Clin Med, 2020, 9(8): 2344. PMID: 32717793. PMCID: PMC7463475. DOI: 10.3390/jcm9082344.
18 Harris HA, Bowling A, Santos S, et al. Child ADHD and autistic traits, eating behaviours and weight: a population-based study[J]. Pediatr Obes, 2022, 17(11): e12951. PMID: 35751176. PMCID: PMC9786764. DOI: 10.1111/ijpo.12951.
19 Mota NR, Poelmans G, Klein M, et al. Cross-disorder genetic analyses implicate dopaminergic signaling as a biological link between attention-deficit/hyperactivity disorder and obesity measures[J]. Neuropsychopharmacology, 2020, 45(7): 1188-1195. PMID: 31896117. PMCID: PMC7234984. DOI: 10.1038/s41386-019-0592-4.
20 Zerón-Rugerio MF, Carpio-Arias TV, Ferreira-García E, et al. ADHD subtypes are associated differently with circadian rhythms of motor activity, sleep disturbances, and body mass index in children and adolescents: a case-control study[J]. Eur Child Adolesc Psychiatry, 2021, 30(12): 1917-1927. PMID: 33063173. DOI: 10.1007/s00787-020-01659-5.
21 Landau Z, Pinhas-Hamiel O. Attention deficit/hyperactivity, the metabolic syndrome, and type 2 diabetes[J]. Curr Diab Rep, 2019, 19(8): 46. PMID: 31250219. DOI: 10.1007/s11892-019-1174-x.
22 Spencer T, Biederman J, Wilens T. Growth deficits in children with attention deficit hyperactivity disorder[J]. Pediatrics, 1998, 102(2 Pt 3): 501-506. PMID: 9685453.
23 Groom MJ, Cortese S. Current pharmacological treatments for ADHD[J]. Curr Top Behav Neurosci, 2022, 57: 19-50. PMID: 35507282. DOI: 10.1007/7854_2022_330.
24 Granato MF, Ferraro AA, Lellis DM, et al. Associations between attention-deficit hyperactivity disorder (ADHD) treatment and patient nutritional status and height[J]. Behav Neurol, 2018, 2018: 7341529. PMID: 30386441. PMCID: PMC6189682. DOI: 10.1155/2018/7341529.
25 Cena H, Calder PC. Defining a healthy diet: evidence for the role of contemporary dietary patterns in health and disease[J]. Nutrients, 2020, 12(2): 334. PMID: 32012681. PMCID: PMC7071223. DOI: 10.3390/nu12020334.
26 Rojo-Marticella M, Arija V, Alda Já, et al. Do children with attention-deficit/hyperactivity disorder follow a different dietary pattern than that of their control peers?[J]. Nutrients, 2022, 14(6): 1131. PMID: 35334788. PMCID: PMC8949924. DOI: 10.3390/nu14061131.
27 Liberali R, Kupek E, Assis MAA. Dietary patterns and childhood obesity risk: a systematic review[J]. Child Obes, 2020, 16(2): 70-85. PMID: 31742427. DOI: 10.1089/chi.2019.0059.
28 Darabi Z, Vasmehjani AA, Darand M, et al. Adherence to Mediterranean diet and attention-deficit/hyperactivity disorder in children: a case control study[J]. Clin Nutr ESPEN, 2022, 47: 346-350. PMID: 35063225. DOI: 10.1016/j.clnesp.2021.11.014.
29 Mian A, Jansen PW, Nguyen AN, et al. Children's attention-deficit/hyperactivity disorder symptoms predict lower diet quality but not vice versa: results from bidirectional analyses in a population-based cohort[J]. J Nutr, 2019, 149(4): 642-648. PMID: 30915449. DOI: 10.1093/jn/nxy273.
30 Abbasi K, Beigrezai S, Ghiasvand R, et al. Dietary patterns and attention deficit hyperactivity disorder among Iranian children: a case-control study[J]. J Am Coll Nutr, 2019, 38(1): 76-83. PMID: 30307794. DOI: 10.1080/07315724.2018.1473819.
31 Shareghfarid E, Sangsefidi ZS, Salehi-Abargouei A, et al. Empirically derived dietary patterns and food groups intake in relation with attention deficit/hyperactivity disorder (ADHD): a systematic review and meta-analysis[J]. Clin Nutr ESPEN, 2020, 36: 28-35. PMID: 32220366. DOI: 10.1016/j.clnesp.2019.10.013.
32 Zhu Z, Tang Y, Zhuang J, et al. Physical activity, screen viewing time, and overweight/obesity among Chinese children and adolescents: an update from the 2017 physical activity and fitness in China—the youth study[J]. BMC Public Health, 2019, 19(1): 197. PMID: 30767780. PMCID: PMC6376726. DOI: 10.1186/s12889-019-6515-9.
33 Seymour KE, Reinblatt SP, Benson L, et al. Overlapping neurobehavioral circuits in ADHD, obesity, and binge eating: evidence from neuroimaging research[J]. CNS Spectr, 2015, 20(4): 401-411. PMID: 26098969. PMCID: PMC4560968. DOI: 10.1017/S1092852915000383.
34 Klein MO, Battagello DS, Cardoso AR, et al. Dopamine: functions, signaling, and association with neurological diseases[J]. Cell Mol Neurobiol, 2019, 39(1): 31-59. PMID: 30446950. DOI: 10.1007/s10571-018-0632-3.
35 Grimm O, van Rooij D, Hoogman M, et al. Transdiagnostic neuroimaging of reward system phenotypes in ADHD and comorbid disorders[J]. Neurosci Biobehav Rev, 2021, 128: 165-181. PMID: 34144113. DOI: 10.1016/j.neubiorev.2021.06.025.
36 Cannon Homaei S, Barone H, Kleppe R, et al. ADHD symptoms in neurometabolic diseases: underlying mechanisms and clinical implications[J]. Neurosci Biobehav Rev, 2022, 132: 838-856. PMID: 34774900. DOI: 10.1016/j.neubiorev.2021.11.012.
37 Leigh SJ, Morris MJ. The role of reward circuitry and food addiction in the obesity epidemic: an update[J]. Biol Psychol, 2018, 131: 31-42. PMID: 28011401. DOI: 10.1016/j.biopsycho.2016.12.013.
38 Fuemmeler BF, Sheng Y, Schechter JC, et al. Associations between attention deficit hyperactivity disorder symptoms and eating behaviors in early childhood[J]. Pediatr Obes, 2020, 15(7): e12631. PMID: 32119190. PMCID: PMC7391797. DOI: 10.1111/ijpo.12631.