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1.
Adv Neurobiol ; 24: 481-504, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006369

RESUMO

Autism has been increasing dramatically since its description by Leo Kanner in 1943. The Centers for Disease Control and Prevention (CDC) in 2018 has identified 1 in 59 children (1 in 37 boys and 1 in 151 girls) has autism spectrum disorder (ASD). Autistic spectrum disorders and ADHD are complex conditions in which nutritional and environmental factors play major roles. It is important to understand how food can have an impact on their current and future health. Appealing food colors stimulate the consumption of different food products. Since 2011, it is evident that dyes are linked to harmful effects in children. Artificial dyes have neurotoxic chemicals that aggravate mental health problems. Many families with autistic children avoid food dyes in their diet in order to avoid behavioral issues. A study reported that there is a correlation between yellow dye and sleep disturbance. Food colors Blue 1 and 2, Green 3, Red 3, Yellow 5 and 6, Citrus Red 2, and Red 40 can trigger many behaviors in most kids. Artificial food color usually contains petroleum and is manufactured in a chemical process that includes formaldehyde, aniline, hydroxides, and sulfuric acids. Most impurities in the food color are in the form of salts or acids. Sometimes lead, arsenic, and mercury may be present as impurities. The U.S. FDA is yet to study the effects of synthetic dyes on behavior in children. A study conducted at Southampton University in England found a link between food dyes and hyperactive behavior in children. The research does not prove that food coloring actually causes autism spectrum disorder, but there seems to be a link. This chapter attempts to provide a broad review of the available literature on food color and the epidemiology, etiology, prevention, and treatment of autistic spectrum disorder.


Assuntos
Transtorno do Espectro Autista/induzido quimicamente , Transtorno do Espectro Autista/epidemiologia , Dieta/efeitos adversos , Corantes de Alimentos/efeitos adversos , Transtorno do Deficit de Atenção com Hiperatividade/induzido quimicamente , Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Espectro Autista/dietoterapia , Transtorno do Espectro Autista/psicologia , Criança , Dieta/estatística & dados numéricos , Feminino , Humanos , Masculino
2.
Mol Psychiatry ; 24(3): 390-408, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29955166

RESUMO

Attention-deficit/hyperactivity disorder (ADHD) is a common and impairing disorder affecting children, adolescents, and adults. Several treatment strategies are available that can successfully ameliorate symptoms, ranging from pharmacological to dietary interventions. Due to the increasing range of available options, an informed selection or prioritization of treatments is becoming harder for clinicians. This review aims to provide an evidence-based appraisal of the literature on ADHD treatment, supplemented by expert opinion on plausibility. We outline proposed mechanisms of action of established pharmacologic and non-pharmacologic treatments, and we review targets of novel treatments. The most relevant evidence supporting efficacy and safety of each treatment strategy is discussed. We review the individualized features of the patient that should guide the selection of treatments in a shared decision-making continuum. We provide guidance for optimizing initiation of treatment and follow-up of patients in clinical settings.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Protocolos Clínicos/normas , Humanos , Resultado do Tratamento
3.
Curr Pharm Biotechnol ; 20(2): 130-136, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30255748

RESUMO

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric diagnosis in childhood and adolescence, with an estimated worldwide-pooled prevalence of 5,29%. The type of treatment depends on several factors. Psychopharmacological treatment entails undesirable side effects, with unclear long-term benefits, which has led the scientific community to investigate other therapeutic approaches, such as dietary interventions. METHOD: The authors conducted a classical review on the current treatment recommended in individuals with ADHD diagnosis, their dietary patterns, as well as dietary factors possibly implicated in the etiology and treatment of this disorder. An extensive bibliographic research was carried out in the databases PubMed, The Cochrane Library and the National Guideline Clearinghouse. DISCUSSION: The most common dietary interventions in the case of ADHD are food supplementation diets (e.g. PUFAs, vitamins) and elimination diets. Supplementation with omega-3 PUFAs lacks further studies that can validate them as an effective therapeutic approach in this disorder. Also, regarding vitamin supplementation, studies are not consistent as to their role in the etiology of ADHD. Elimination diets are unclear as to the benefits provided in individuals with ADHD. Children with ADHD are less likely to engage in healthy lifestyle behaviors than non-ADHD youth. CONCLUSION: There is no clear evidence that supports dietary interventions for the treatment of ADHD. The effects of unhealthy diet patterns in ADHD individuals are not yet fully understood and, like the general population, children with ADHD may benefit from a healthy lifestyle.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Adolescente , Criança , Dieta , Suplementos Nutricionais , Humanos
4.
Epigenomics ; 10(9): 1201-1214, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30182732

RESUMO

Exposure times and dosage required for dietary components to modify DNA methylation patterns are largely unknown. AIM: This exploratory research represents the first genome-wide analysis of DNA methylation changes during a randomized-controlled-trial (RCT) for dietary supplementation with broad spectrum vitamins, minerals and amino acids in humans. METHODS: Genome-wide changes in methylation from paired, peripheral blood samples were assessed using the Infinium Methylation EPIC 850 K array. RESULTS: Methylation increased at 84% of the most significant differentially methylated CpGs; however, none showed significance after adjustment for genome-wide testing. CONCLUSION: Micronutrient supplementation is unlikely to have a substantial biological effect on DNA methylation over 10 weeks; however, the trend toward hypermethylation that we observed is likely to become more marked with longer exposure periods.


Assuntos
Aminoácidos/farmacologia , Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Metilação de DNA/efeitos dos fármacos , Metilação de DNA/genética , Suplementos Nutricionais , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Minerais/farmacologia , Vitaminas/farmacologia , Aminoácidos/administração & dosagem , Criança , Ilhas de CpG , Epigênese Genética/efeitos dos fármacos , Feminino , Estudo de Associação Genômica Ampla , Genótipo , Humanos , Masculino , Minerais/administração & dosagem , Vitaminas/administração & dosagem
5.
Appetite ; 127: 274-279, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29758272

RESUMO

OBJECTIVE: The aim of the present study was to investigate the associations between dietary habits and attention deficit/hyperactivity disorder (ADHD) symptoms in elementary school children. METHODS: The parents of 16,831 participating children assessed the ADHD symptoms of their children by responding to the Korean version of the ADHD rating scale (K-ARS). Parents also responded to the food habit questionnaire, which consists of 8 items regarding the eating pace, the frequency of overeating, and patterns of eating six types of food: fast food, soft drinks, instant noodles, fruit and vegetables, and milk. RESULTS: K-ARS scores were positively associated with higher consumption of foods categorized as unhealthy, including fast food, soft drinks, and instant noodles, and negatively associated with higher consumption of fruit and vegetables categorized as healthy foods. K-ARS scores were also higher in the groups who overate more frequently and ate faster or slower compared to other family members. CONCLUSION: Our findings may provide useful clinical information for dietary interventions in children with ADHD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Comportamento Alimentar/fisiologia , Animais , Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Bebidas Gaseificadas , Criança , Fast Foods , Feminino , Frutas , Humanos , Hiperfagia/fisiopatologia , Masculino , Leite , Razão de Chances , República da Coreia , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários , Verduras
6.
Eur J Clin Nutr ; 72(11): 1517-1523, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29535404

RESUMO

BACKGROUND/OBJECTIVES: To identify the major dietary patterns among preschoolers and assess the relation of major dietary patterns to attention-deficit/hyperactivity disorder (ADHD). SUBJECTS/METHODS: A cross-sectional survey was conducted comprising a large sample of 14,912 children aged 3-6 years old in Ma'anshan city of Anhui Province in China. A semi-quantitative food frequency questionnaire and the 10-item Chinese version of the Conners' abbreviated symptom questionnaire were administered to assess usual dietary intakes and ADHD. Social-demographic information was also collected. Major dietary patterns were identified by principal components analysis. Logistic regression was employed to explore the association of dietary patterns with ADHD. RESULTS: Five dietary patterns were identified explaining 47.96% of the total diet variation. The "processed" dietary component was the principal pattern that explained the higher percentage of variability, 24.69%. After controlling for potential confounders, preschoolers in the top quintile of the "processed" (odds ratio (OR) = 1.56, 95% confidence interval (CI): 1.31-1.86) and "snack" (OR = 1.76, 95% CI = 1.49-2.07) dietary pattern score had greater odds for having ADHD symptoms compared with those in the lowest quintile. Lowest scores on the "vegetarian" were associated with significantly a higher likelihood of indications of ADHD symptoms (OR = 0.67, 95% CI = 0.56-0.79). CONCLUSIONS: This study showed that preschoolers tend to choose unhealthy dietary pattern in Ma'anshan, China. "Processed" and "snack" dietary patterns were significantly and positively correlated with ADHD symptoms, while "vegetarian" dietary patterns were negatively correlated with ADHD symptoms.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Dieta/efeitos adversos , Fast Foods/efeitos adversos , Comportamento Alimentar , Lanches , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Criança , Pré-Escolar , China , Estudos Transversais , Inquéritos sobre Dietas , Dieta Vegetariana , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Fatores de Risco , Inquéritos e Questionários
7.
Nutrients ; 10(4)2018 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-29587355

RESUMO

Increasing understanding arises regarding disadvantages of stimulant medication in children with ADHD (Attention-Deficit Hyperactivity Disorder). This review presents scientific findings supporting dietary antioxidant treatment of ADHD and describes substantial alterations in the immune system, epigenetic regulation of gene expression, and oxidative stress regulation in ADHD. As a result, chronic inflammation and oxidative stress could develop, which can lead to ADHD symptoms, for example by chronic T-cell-mediated neuroinflammation, as well as by neuronal oxidative damage and loss of normal cerebral functions. Therefore, modulation of immune system activity and oxidant-antioxidant balance using nutritional approaches might have potential in ADHD treatment. The use of natural antioxidants against oxidative conditions is an emerging field in the management of neurodegenerative diseases. Dietary polyphenols, for example, have antioxidant capacities as well as immunoregulatory effects and, therefore, appear appropriate in ADHD therapy. This review can stimulate the development and investigation of dietary antioxidant treatment in ADHD, which is highly desired.


Assuntos
Antioxidantes/administração & dosagem , Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Suplementos Nutricionais , Estado Nutricional , Estresse Oxidativo , Antioxidantes/efeitos adversos , Transtorno do Deficit de Atenção com Hiperatividade/genética , Transtorno do Deficit de Atenção com Hiperatividade/imunologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Suplementos Nutricionais/efeitos adversos , Epigênese Genética , Predisposição Genética para Doença , Humanos , Sistema Imunitário/imunologia , Fenótipo , Resultado do Tratamento
8.
Atten Defic Hyperact Disord ; 10(2): 135-139, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28975530

RESUMO

Attention deficit disorder with and without hyperactivity (ADHD) in children is associated with decreased 24-h heart rate variability (HRV). Previous research has shown that supplementation of omega-3-fatty acid increases HRV. Here, we aimed to investigate whether the supplementation of omega-3-fatty acids would increase 24-h HRV in an uncontrolled case series of children with ADHD. HRV was recorded in 18 children and adolescents (age 13.35 ± 2.8 years) before and after omega-3 supplementation. Preliminary results indicate that omega-3 supplementation in children with AD(H)D may reduce mean heart rate and increase its variability. Future studies would do well to implement randomized, placebo-controlled designs with greater methodological rigor.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Ritmo Circadiano/efeitos dos fármacos , Suplementos Nutricionais , Ácidos Graxos Ômega-3/farmacologia , Ácidos Graxos Ômega-3/uso terapêutico , Frequência Cardíaca/efeitos dos fármacos , Adolescente , Eletrocardiografia Ambulatorial , Feminino , Humanos , Masculino
9.
Nutr Neurosci ; 21(3): 202-209, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27924679

RESUMO

OBJECTIVES: Previous studies have shown that serum levels of vitamin D were lower in attention deficit hyperactivity disorder (ADHD) children compared to healthy controls. The aim of the study was to determine the effect of vitamin D supplementation as adjunctive therapy to methylphenidate on symptoms of children with ADHD. METHODS: Sixty-two children aged 5-12 years with a diagnosis of ADHD based on DSM-IV criteria were randomly assigned into two groups to receive either 2000IU vitamin D or placebo in addition to methylphenidate for 8 weeks. Symptoms severity was assessed by Conner's Parent Rating Scale-Revised[S] (CPRS), ADHD rating scale-IV (ADHD-RS), and Weekly Parent Ratings of Evening and Morning Behavior (WPREMB) at weeks 0, 4, and 8. Serum levels of 25(OH)D were measured at baseline and after 8 weeks. Anthropometric variables, dietary intake, physical activity, sun exposure, and side effects were assessed. RESULTS: Fifty-four participants completed the trial. After 8 weeks of supplementation, serum levels of 25(OH)D significantly increased in the vitamin D group. ADHD symptoms decreased significantly in both groups (P < 0.05). Evening symptoms and total score of WPREMB scale were significantly different at weeks 4 and 8 between the two groups (P = 0.013, 0.016, respectively), but no differences were found in symptoms by CPRS and ADHD-RS scales. DISCUSSION: Vitamin D supplementation as adjunctive therapy to methylphenidate improved ADHD evening symptoms. Future research is needed to clarify vitamin D effects as monotherapy in ADHD and its mechanism. The trial was registered in www.irct.ir is (IRCT201404222394N10).


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Fenômenos Fisiológicos da Nutrição Infantil , Suplementos Nutricionais , Inibidores da Captação de Dopamina/uso terapêutico , Metilfenidato/uso terapêutico , Vitamina D/uso terapêutico , Atividades Cotidianas , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Calcifediol/sangue , Criança , Fenômenos Fisiológicos da Nutrição Infantil/efeitos dos fármacos , Pré-Escolar , Terapia Combinada/efeitos adversos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Suplementos Nutricionais/efeitos adversos , Inibidores da Captação de Dopamina/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Irã (Geográfico) , Masculino , Metilfenidato/efeitos adversos , Pais , Índice de Gravidade de Doença , Avaliação de Sintomas , Vitamina D/efeitos adversos , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/dietoterapia , Deficiência de Vitamina D/fisiopatologia
10.
Neuropsychopharmacology ; 43(3): 534-545, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28741625

RESUMO

The role of omega-3 polyunsaturated fatty acids (omega-3 or n-3 PUFAs) in the pathogenesis and treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD) is unclear. A systematic review followed by meta-analysis was conducted on: (1) randomized controlled trials (RCTs) assessing the effects of n-3 PUFAs on clinical symptoms and cognition in children and adolescent with ADHD; and (2) case-control studies assessing the levels of n-3 PUFAs in blood and buccal tissues of children and adolescents with ADHD. In seven RCTs, totalling n=534 randomized youth with ADHD, n-3 PUFAs supplementation improves ADHD clinical symptom scores (g=0.38, p<0.0001); and in three RCTs, totalling n=214 randomized youth with ADHD, n-3 PUFAs supplementation improves cognitive measures associated with attention (g=1.09, p=0.001). Moreover, children and adolescents with ADHD have lower levels of DHA (seven studies, n=412, g=-0.76, p=0.0002), EPA (seven studies, n=468, g=-0.38, p=0.0008), and total n-3 PUFAs (six studies, n=396, g=-0.58, p=0.0001). In summary, there is evidence that n-3 PUFAs supplementation monotherapy improves clinical symptoms and cognitive performances in children and adolescents with ADHD, and that these youth have a deficiency in n-3 PUFAs levels. Our findings provide further support to the rationale for using n-3 PUFAs as a treatment option for ADHD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Transtorno do Deficit de Atenção com Hiperatividade/metabolismo , Ácidos Graxos Ômega-3/administração & dosagem , Ácidos Graxos Ômega-3/metabolismo , Adolescente , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Actas Esp Psiquiatr ; 45(Supplement): 48-64, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29171641

RESUMO

Complementary and alternative treatments, including dietary supplements, are very popular and increasingly used in developed countries. Some features such as accessibility, ease of use, the possibility of self-administration and the belief they are safe without side effects, have led to an increase in their consumption. However, there is limited evidence of the effectiveness and safety of these treatments because of methodological issues. The level of scientific evidence is particularly low and weak in the field of child and adolescent Psychiatry. The purpose of this article is to give an updated overview of dietary treatments in this area. We make a brief introduction about general questions, including legal aspects, and propose general practical recommendations for a proper management by the families that choose these treatments. We focus on reviewing the current state of research into dietary treatments in some childhood and juvenile psychiatric disorders, highlighting current evidence of specific treatments. The final purpose of this article is to describe the level of current evidence on dietary treatments and to provide professionals involved in the care of children and adolescents with a useful tool to help, guide and educate families about their use in order to achieve the greatest benefit to patients.


Assuntos
Suplementos Nutricionais , Transtornos Mentais/dietoterapia , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Transtorno do Espectro Autista/dietoterapia , Criança , Terapias Complementares , Transtorno Depressivo/dietoterapia , Humanos
13.
JBI Database System Rev Implement Rep ; 15(9): 2265-2269, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28902693

RESUMO

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to examine and map reported nutritional interventions and their outcomes in relieving symptoms of attention deficit hyperactivity disorder (ADHD) in the daily lives of children and adults. A further objective is to determine if experiences of people diagnosed with ADHD, their relatives or staff in being on a diet or having to eat or avoid eating specific food items have been reported in the existing literature.Specifically the scoping review questions are.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Terapias Complementares , Comportamento Alimentar , Adulto , Criança , Família/psicologia , Humanos
14.
Curr Opin Clin Nutr Metab Care ; 20(6): 464-469, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28832371

RESUMO

PURPOSE OF REVIEW: The purpose of this study is to discuss the role of dietary factors in the etiology and therapy of attention deficit/hyperactivity disorder (ADHD). Relevant literature published from January 2016 to January 2017 was included in this review. RECENT FINDINGS: Unhealthy prenatal diet may be associated with ADHD in the offspring through an increase in epigenetic changes. The few-foods diet may have some efficacy, but requires further investigation before firm conclusions can be drawn. The efficacy of the supplementation of polyunsaturated fatty acids in the therapy of ADHD is probably small and may be confined to patient subgroups. It is unclear whether vitamin deficiency plays a role in the etiology of ADHD. SUMMARY: There is no clear evidence supporting a role of food or nutrient-based intervention strategies in the etiology and therapy of ADHD. The investigation of the inter-relationship between diet and other lifestyle interventions may be a promising approach.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Dieta , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Deficiência de Vitaminas/complicações , Deficiência de Vitaminas/dietoterapia , Suplementos Nutricionais , Epigênese Genética , Ácidos Graxos Insaturados/administração & dosagem , Feminino , Microbioma Gastrointestinal , Humanos , Estilo de Vida , Fenômenos Fisiológicos da Nutrição Materna , Gravidez , Cuidado Pré-Natal , Ensaios Clínicos Controlados Aleatórios como Assunto , Oligoelementos/administração & dosagem , Vitaminas/administração & dosagem
16.
PLoS One ; 12(7): e0180355, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28700715

RESUMO

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorders in childhood. A wide variety of treatments have been used for the management of ADHD. We aimed to compare the efficacy and safety of pharmacological, psychological and complementary and alternative medicine interventions for the treatment of ADHD in children and adolescents. METHODS AND FINDINGS: We performed a systematic review with network meta-analyses. Randomised controlled trials (≥ 3 weeks follow-up) were identified from published and unpublished sources through searches in PubMed and the Cochrane Library (up to April 7, 2016). Interventions of interest were pharmacological (stimulants, non-stimulants, antidepressants, antipsychotics, and other unlicensed drugs), psychological (behavioural, cognitive training and neurofeedback) and complementary and alternative medicine (dietary therapy, fatty acids, amino acids, minerals, herbal therapy, homeopathy, and physical activity). The primary outcomes were efficacy (treatment response) and acceptability (all-cause discontinuation). Secondary outcomes included discontinuation due to adverse events (tolerability), as well as serious adverse events and specific adverse events. Random-effects Bayesian network meta-analyses were conducted to obtain estimates as odds ratios (ORs) with 95% credibility intervals. We analysed interventions by class and individually. 190 randomised trials (52 different interventions grouped in 32 therapeutic classes) that enrolled 26114 participants with ADHD were included in complex networks. At the class level, behavioural therapy (alone or in combination with stimulants), stimulants, and non-stimulant seemed significantly more efficacious than placebo. Behavioural therapy in combination with stimulants seemed superior to stimulants or non-stimulants. Stimulants seemed superior to behavioural therapy, cognitive training and non-stimulants. Behavioural therapy, stimulants and their combination showed the best profile of acceptability. Stimulants and non-stimulants seemed well tolerated. Among medications, methylphenidate, amphetamine, atomoxetine, guanfacine and clonidine seemed significantly more efficacious than placebo. Methylphenidate and amphetamine seemed more efficacious than atomoxetine and guanfacine. Methylphenidate and clonidine seemed better accepted than placebo and atomoxetine. Most of the efficacious pharmacological treatments were associated with harms (anorexia, weight loss and insomnia), but an increased risk of serious adverse events was not observed. There is lack of evidence for cognitive training, neurofeedback, antidepressants, antipsychotics, dietary therapy, fatty acids, and other complementary and alternative medicine. Overall findings were limited by the clinical and methodological heterogeneity, small sample sizes of trials, short-term follow-up, and the absence of high-quality evidence; consequently, results should be interpreted with caution. CONCLUSIONS: Clinical differences may exist between the pharmacological and non-pharmacological treatment used for the management of ADHD. Uncertainties about therapies and the balance between benefits, costs and potential harms should be considered before starting treatment. There is an urgent need for high-quality randomised trials of the multiple treatments for ADHD in children and adolescents. PROSPERO, number CRD42014015008.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Terapia Comportamental , Depressores do Sistema Nervoso Central/efeitos adversos , Depressores do Sistema Nervoso Central/uso terapêutico , Estimulantes do Sistema Nervoso Central/efeitos adversos , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Terapias Complementares/efeitos adversos , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
EBioMedicine ; 17: 24-29, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28242200

RESUMO

The nascent field of 'Nutritional Psychiatry' offers much promise for addressing the large disease burden associated with mental disorders. A consistent evidence base from the observational literature confirms that the quality of individuals' diets is related to their risk for common mental disorders, such as depression. This is the case across countries and age groups. Moreover, new intervention studies implementing dietary changes suggest promise for the prevention and treatment of depression. Concurrently, data point to the utility of selected nutraceuticals as adjunctive treatments for mental disorders and as monotherapies for conditions such as ADHD. Finally, new studies focused on understanding the biological pathways that mediate the observed relationships between diet, nutrition and mental health are pointing to the immune system, oxidative biology, brain plasticity and the microbiome-gut-brain axis as key targets for nutritional interventions. On the other hand, the field is currently limited by a lack of data and methodological issues such as heterogeneity, residual confounding, measurement error, and challenges in measuring and ensuring dietary adherence in intervention studies. Key challenges for the field are to now: replicate, refine and scale up promising clinical and population level dietary strategies; identify a clear set of biological pathways and targets that mediate the identified associations; conduct scientifically rigorous nutraceutical and 'psychobiotic' interventions that also examine predictors of treatment response; conduct observational and experimental studies in psychosis focused on dietary and related risk factors and treatments; and continue to advocate for policy change to improve the food environment at the population level.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/prevenção & controle , Depressão/prevenção & controle , Dietoterapia/métodos , Dieta , Animais , Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Depressão/dietoterapia , Depressão/epidemiologia , Dietoterapia/tendências , Suplementos Nutricionais , Humanos
18.
Pediatrics ; 139(2)2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28138007

RESUMO

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.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Dieta Mediterrânea , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Estudos Transversais , Exercício , Comportamento Alimentar , Feminino , Humanos , Masculino , Razão de Chances , Cooperação do Paciente , Espanha , Inquéritos e Questionários
19.
PLoS One ; 12(1): e0169277, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28121994

RESUMO

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a debilitating mental health problem hampering the child's development. The underlying causes include both genetic and environmental factors and may differ between individuals. The efficacy of diet treatments in ADHD was recently evaluated in three reviews, reporting divergent and confusing conclusions based on heterogeneous studies and subjects. To address this inconsistency we conducted a systematic review of meta-analyses of double-blind placebo-controlled trials evaluating the effect of diet interventions (elimination and supplementation) on ADHD. METHODS: Our literature search resulted in 14 meta-analyses, six of which confined to double-blind placebo-controlled trials applying homogeneous diet interventions, i.e. artificial food color (AFC) elimination, a few-foods diet (FFD) and poly-unsaturated fatty acid (PUFA) supplementation. Effect sizes (ES) and Confidence intervals (CI) of study outcomes were depicted in a forest plot. I2 was calculated to assess heterogeneity if necessary and additional random effects subgroup meta-regression was conducted if substantial heterogeneity was present. RESULTS: The AFC ESs were 0.44 (95% CI: 0.16-0.72, I2 = 11%) and 0.21 (95% CI: -0.02-0.43, I2 = 68%) [parent ratings], 0.08 (95% CI: -0.07-0.24, I2 = 0%) [teacher ratings] and 0.11 (95% CI: -0.13-0.34, I2 = 12%) [observer ratings]. The FFD ESs were 0.80 (95% CI: 0.41-1.19, I2 = 61%) [parent ratings] and 0.51 (95% CI: -0.02-1.04, I2 = 72%) [other ratings], while the PUFA ESs were 0.17 (95% CI: -0.03-0.38, I2 = 38%) [parent ratings], -0.05 (95% CI: -0.27-0.18, I2 = 0%) [teacher ratings] and 0.16 (95% CI: 0.01-0.31, I2 = 0%) [parent and teacher ratings]. Three meta-analyses (two FFD and one AFC) resulted in high I2 without presenting subgroup results. The FFD meta-analyses provided sufficient data to perform subgroup analyses on intervention type, resulting in a decrease of heterogeneity to 0% (diet design) and 37.8% (challenge design). CONCLUSION: Considering the small average ESs PUFA supplementation is unlikely to provide a tangible contribution to ADHD treatment, while further research is required for AFC elimination before advising this intervention as ADHD treatment. The average FFD ES is substantial, offering treatment opportunities in subgroups of children with ADHD not responding to or too young for medication. Further FFD research should focus on establishing the underlying mechanisms of food (e.g. incrimination of gut microbiota) to simplify the FFD approach in children with ADHD.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Comportamento Infantil/psicologia , Comportamento Problema/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Método Duplo-Cego , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
20.
Actas esp. psiquiatr ; 45(supl.1): 48-63, 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-172029

RESUMO

Los tratamientos de la medicina complementaria y alternativa, incluyendo los tratamientos con suplementos nutricionales, son muy populares en los países desarrollados y su uso continúa creciendo. La facilidad de uso, su accesibilidad y posibilidad de autoadministración y la percepción como seguros y carentes de efectos secundarios han conducido a un incremento de su consumo. Sin embargo, la evidencia de la efectividad y seguridad de estos tratamientos es limitada a causa de los problemas metodológicos. En el caso de la psiquiatría del niño y del adolescente, el nivel de evidencia científica es particularmente escaso y débil. El propósito de este artículo es dar una visión general actualizada de los tratamientos nutricionales en psiquiatría del niño y del adolescente. Realizamos una breve introducción que expone cuestiones generales sobre este tema, incluyendo aspectos legales. Proponemos recomendaciones generales prácticas para un manejo adecuado de las familias que escogen estos tratamientos. Nos centramos en la revisión del estado actual de la investigación de los tratamientos nutricionales en varios trastornos psiquiátricos infanto-juveniles, y describimos la evidencia actual de tratamientos específicos. El objetivo último de este artículo es proporcionar a los profesionales implicados en la atención de niños y adolescentes la información sobre el nivel de la evidencia actual de los tratamientos nutricionales para que puedan orientar, ayudar y educar a las familias sobre su uso y procurar de esta manera el mayor beneficio de los pacientes (AU)


Complementary and alternative treatments, including dietary supplements, are very popular and increasingly used in developed countries. Some features such as accessibility, ease of use, the possibility of self-administration and the belief they are safe without side effects, have led to an increase in their consumption. However, there is limited evidence of the effectiveness and safety of these treatments because of methodological issues. The level of scientific evidence is particularly low and weak in the field of child and adolescent Psychiatry. The purpose of this article is to give an updated overview of dietary treatments in this area. We make a brief introduction about general questions, including legal aspects, and propose general practical recommendations for a proper management by the families that choose these treatments. We focus on reviewing the current state of research into dietary treatments in some childhood and juvenile psychiatric disorders, highlighting current evidence of specific treatments. The final purpose of this article is to describe the level of current evidence on dietary treatments and to provide professionals involved in the care of children and adolescents with a useful tool to help, guide and educate families about their use in order to achieve the greatest benefit to patients (AU)


Assuntos
Humanos , Criança , Adolescente , Transtornos do Neurodesenvolvimento/dietoterapia , Transtornos Mentais/dietoterapia , Suplementos Nutricionais , Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Transtorno do Espectro Autista/dietoterapia , Alimentação Alternativa , Micronutrientes/uso terapêutico , Ácidos Graxos Essenciais/uso terapêutico , Corantes de Alimentos , Conservantes de Alimentos
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