Mediterranean diet habits and their effects 
on symptomatology among children and 
adolescents with attention deficit hyperactivity disorder

Besenek, Mert; yazıcı, merve

doi:10.5505/kpd.2022.66592

Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder

Mert BEŞENEK, (Üsküdar Üniversitesi, Tıp Fakültesi, Çocuk ve Ergen Psikiyatrisi Anabilim Dalı, İstanbul, Türkiye)

Merve YAZICI (Recep Tayyip Erdoğan Üniversitesi, Rize Eğitim Ve Araştırma Hastanesi, Çocuk ve Ergen Psikiyatrisi Kliniği, Rize, Türkiye)

Klinik Psikiyatri Dergisi

10 2

Yıl: 2022 Cilt: 25 Sayı: 2 Sayfa Aralığı: 193 - 201 Metin Dili: İngilizce DOI: 10.5505/kpd.2022.66592 İndeks Tarihi: 05-06-2022

Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder

Öz:

Objective: Attention deficit hyperactivity disorder (ADHD); is a common neurodevelopmental disorder with multifactorial etiology. Despite the dominant role of the genetic factors; environmental factors such as diet related features may have effect on ADHD diagnosis and symptomatology. In our study we aimed to compare Mediterranean diet (MD) habits of ADHD group with healthy controls and explore the effect of MD on ADHD symptom severity. Method: All participants were evaluated with semi-structured psychiatric interviews and total of 113 individuals with ADHD and 120 healthy controls were included. Socioeconomic and clinical features of both groups were examined. Adherence to MD was evaluated with Mediterranean Diet Quality Index (KIDMED) and ADHD symptomatology was evaluated with Turgay scale. Results: ADHD group had lower KIDMED scores and worse adherence to MD compared to healthy controls. “Medium adherence” to MD increased the risk of ADHD diagnosis two-folds and “low adherence” to MD increased the risk of ADHD diagnosis five-folds compared to “good adherence”. Total KIDMED scores and MD adherence levels were negatively correlated with inattention symptoms. Discussion: Adherence to a healthy diet (MD) seems to be related to lesser inattention problems in addition to lower rates of ADHD diagnosis and this indicates the importance of a “healthy diet” not only in the occurrence of ADHD, but also in the clinical symptomatology. certain dietary habits may play a role in both ADHD development and clinical appearance; but further evaluation is needed to shed light on causality and to determine if dietary manipulation could ameliorate ADHD symptoms.

Anahtar Kelime:

Dikkat eksikliği ve hiperaktivite bozukluğu tanılı çocuk ve ergenlerdeAkdeniz diyeti alışkanlıkları ve semptomlar üzerine etkileri

Öz:

Amaç: Dikkat eksikliği hiperaktivite bozukluğu (DEHB), multifaktöriyel etiyolojiye sahip sık görülen nörogelişimsel bir hastalıktır. Genetik etmenlerin baskın rolüne rağmen; diyetle ilişkili özellikler gibi bazı çevresel etmenler de DEHB tanısında ve semptomatolojisinde etkili olabilmektedir. Çalışmamızda Akdeniz diyeti (AD) alışkanlıklarının DEHB grubu ve sağlıklı kontroller arasında karşılaştırılması ve DEHB semptom şiddetine etkisinin incelenmesi amaçlanmıştır. Yöntem: Tüm katılımcılar yarı-yapılandırılmış psikiyatrik görüşmelerle incelenmiş ve toplam 113 DEHB olgusu ile 120 sağlıklı kontrol çalışmaya alınmıştır. İki grubun da sosyoekonomik ve klinik özellikleri araştırılmıştır. AD’ne uyumları Akdeniz Diyeti Kalite İndeksi (KIDMED) ve DEHB semptomatolojisi Turgay Ölçeği ile değerlendirilmiştir. Bulgular: DEHB gurubunun daha düşük KIDMED puanlarına ve daha kötü AD uyum düzeylerine sahip oldukları saptanmıştır. AD’ne “iyi düzeyde uyuma” göre “orta düzeyde uyum” DEHB tanı riskini iki kat, “düşük düzeyde uyum” ise beş kat arttırmaktadır. Ayrıca toplam KIDMED puanları ve AD’ne uyum düzeyleri ile dikkatsizlik semptomları arasında negatif korelasyon gözlenmiştir. Sonuç: Sağlıklı bir diyete (AD) uyumun daha düşük DEHB tanı oranları ve daha düşük şiddette dikkatsizlik problemleriyle ilişkili olduğu gözlenmiştir ve bu “sağlıklı bir diyetin” yalnızca DEHB’nin ortaya çıkmasında değil, kliniğinde de etkili olduğunu göstermektedir. Ancak nedensellik ilişkisini açığa çıkarmak ve diyetsel girişimlerin DEHB bulgularını düzeltip düzeltemeyeceklerini saptamak için ileri araştırmalara ihtiyaç vardır.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Scahill L, Schwab-Stone M. Epidemiology of ADHD in school-age children. Child Adolesc Psychiatr Clin N Am. 2000;9(3):541–55.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Editio. Washington, DC: American Psychiatric Association; 2000.
3. Huss M, Duhan P, Gandhi P, Chen CW, Spannhuth C, Kumar V. Methylphenidate dose optimization for ADHD treatment: Review of safety, efficacy, and clinical necessity. Neuropsychiatric Disease and Treatment. 2017;13:1741–51.
4. Schmidt S, Petermann F. Developmental psychopathology: Attention Deficit Hyperactivity Disorder (ADHD). BMC Psychiatry. 2009;9(1):58.
5. Núñez-Jaramillo L, Herrera-Solís A, Herrera-Morales WV. Adhd: Reviewing the causes and evaluating solutions. Journal of Personalized Medicine. 2021;11(3):166.
6. Polanczyk G V., Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry Allied Discip. 2015;56(3):345–65.
7. San Mauro Martín I, Blumenfeld Olivares JA, Garicano Vilar E, Echeverry López M, García Bernat M, Quevedo Santos Y, Blanco López M, Elortegui Pascual P, Borregon Rivilla E, Rincón Barrado M. Nutritional and environmental factors in attention-deficit hyperactivity disorder (ADHD): A cross-sectional study. Nutr Neurosci. 2018;21(9):641–7.
8. Millichap JG, Yee MM. The diet factor in attentiondeficit/hyperactivity disorder. Pediatrics. 2012;129(2):330–7.
9. 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):403–11.
10. Park S, Cho SC, Hong YC, Oh SY, Kim JW, Shin MS, Kim BN, Yoo HJ, Cho IH, Bhang SY. Association between dietary behaviors and attention-deficit/hyperactivity disorder and learning disabilities in school-aged children. Psychiatry Res. 2012;198(3):468–76.
11. Woo HD, Kim DW, Hong YS, Kim YM, Seo JH, Choe BM, Park JH, Kang JW, Yoo JH, Chueh HW, Lee JH, Kwak MJ, Kim J. Dietary patterns in children with attention deficit/hyperactivity disorder (ADHD). Nutrients. 2014;6(4):1539–53.
12. Donini LM, Serra-Majem L, Bulló M, Gil Á, Salas-Salvadó J. The Mediterranean diet: Culture, health and science. British Journal of Nutrition. 2015;113(Suupl 2):S1–3.
13. Faul F, Erdfelder E, Lang A, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175– 91.
14. Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F, Baş F. Weight, height, head circumference and body mass index references for Turkish children. Çocuk Sağlığı ve Hast Derg. 2008;51:1–14.
15. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36(7):980–8.
16. Gökler B, Ünal F, Pehlivantürk B, Kültür E, Akdemir D, Taner Y. Reliability and Validity of Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version-Turkish Version (K-SADS-PL-T). Turkish J Child Adolesc Ment Heal. 2004;11(3):109–16.
17. Turgay A. DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale. Integrative Therapy Institude, Toronto, Canada; 1995.
18. Ercan E, Amado S, Somer O, Çıkoğlu S. Dikkat eksikliği ve hiperaktivite bozukluğu ve yıkıcı davranım bozuklukları için bir test bataryası geliştirme çabası. Çocuk ve Ergen Ruh Sağlığı Derg. 2001;8(3):132–44.
19. Serra-Majem L, Ribas L, Ngo J, Ortega RM, García A, Pérez-Rodrigo C, Aranceta J. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr. 2004;7(7):931–5.
20. Kabaran S, Gezer C. Determination of the Mediterranean Diet and obesity status of children and adolescents in Turkish Republic of Northern Cyprus. Turkish J Pediatr Dis. 2013;1:11– 20.
21. IBM SPSS statistics for Windows. IBM Corporation; 2018.
22. Rios-Hernandez A, Alda JA, Farran-Codina A, FerreiraGarcia E, Izquierdo-Pulido M. The mediterranean diet and ADHD in children and adolescents. Pediatrics. 2017;139(2).
23. Ghanizadeh A, Haddad B. The effect of dietary education on ADHD, a randomized controlled clinical trial. Ann Gen Psychiatry. 2015;14(1):12.
24. Hughes TF, Andel R, Small BJ, Borenstein AR, Mortimer JA, Wolk A, Johansson B, Fratiglioni L, Pedersen NL, Gatz M. Midlife fruit and vegetable consumption and risk of dementia in later life in swedish twins. Am J Geriatr Psychiatry. 2010;18(5):413–20.
25. Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A. Dietary pattern and depressive symptoms in middle age. Br J Psychiatry. 2009;195(5):408–13.
26. Dai Q, Borenstein AR, Wu Y, Jackson JC, Larson EB. Fruit and Vegetable Juices and Alzheimer’s Disease: The Kame Project. Am J Med. 2006;119(9):751–9.
27. Azadbakht L, Kimiagar M, Mehrabi Y, Esmaillzadeh A, Padyab M, Hu FB, Willett WC. Soy inclusion in the diet improves features of the metabolic syndrome: A randomized crossover study in postmenopausal women. Am J Clin Nutr. 2007;85(3):735–41.
28. Hunt JR. Moving toward a plant-based diet: Are iron and zinc at risk? Nutr Rev. 2002;60(5 pt 1):127–34.
29. Li Y, Dai Q, Tedders SH, Arroyo C, Zhang J. Legume consumption and severe depressed mood, the modifying roles of gender and menopausal status. Public Health Nutr. 2010;13(8):1198–206.
30. Roberts BA, Martel MM. Prenatal testosterone an preschool disruptive behavior disorders. Pers Individ Dif. 2013;55(8):962–6.
31. Cheema M, Mahmood K, Haleem D. Nootropic and Antianxiety Effects of Olive Oil: Relationship with Dopamine and Serotonin Metabolism. J Nutraceuticals Food Sci. 2018;3(1):4.
32. Pitozzi V, Jacomelli M, Catelan D, Servili M, Taticchi A, Biggeri A, Dolara P, Giovannelli L. Long-term dietary extra-virgin olive oil rich in polyphenols reverses age-related dysfunctions in motor coordination and contextual memory in mice: Role of oxidative stress. Rejuvenation Res. 2012;15(6):601–12.
33. Farr SA, Price TO, Dominguez LJ, Motisi A, Saiano F, Niehoff ML, Morley JE, Banks WA, Ercal N, Barbagallo M. Extra virgin olive oil improves learning and memory in SAMP8 mice. J Alzheimer’s Dis. 2012;28(1):81–92.
34. Perveen T, Hashmi BM, Haider S, Tabassum S, Saleem S, Siddiqui MA. Role of Monoaminergic System in the Etiology of Olive Oil Induced Antidepressant and Anxiolytic Effects in Rats. ISRN Pharmacol. 2013;2013:615685.
35. Cormier E, Harrison Elder J. Diet and child behavior problems: fact or fiction? Pediatr Nurs. 2007;33(2):138–43.
36. Azadbakht L, Esmaillzadeh A. Dietary patterns and attention deficit hyperactivity disorder among Iranian children. Nutrition. 2012;28(3):242–9.
37. Wiles NJ, Northstone K, Emmett P, Lewis G. “Junk food” diet and childhood behavioural problems: Results from the ALSPAC cohort. Eur J Clin Nutr. 2009;63(4):491–8.
38. Lien L, Lien N, Heyerdahl S, Thoresen M, Bjertness E. Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among adolescents in Oslo, Norway. Am J Public Health. 2006;96(10):1815–20.
39. Wesnes KA, Pincock C, Richardson D, Helm G, Hails S. Breakfast reduces declines in attention and memory over the morning in schoolchildren. Appetite. 2003;41(3):329–31.
40. Tucker KL. Dietary patterns, approaches, and multicultural perspective. Appl Physiol Nutr Metab. 2010;35(2):211–8.
41. Wyon DP, Abrahamsson L, Järtelius M, Fletcher RJ. An experimental study of the effects of energy intake at breakfast on the test performance of 10-year-old children in school. Int J Food Sci Nutr. 1997;48(1):5–12.
42. Ptacek R, Stefano GB, Weissenberger S, Akotia D, Raboch J, Papezova H, Domkarova L, Stepankova T, Goetz M. Attention deficit hyperactivity disorder and disordered eating behaviors: Links, risks, and challenges faced. Neuropsychiatric Disease and Treatment. 2016;12:571–9.
43. Izquierdo-Pulido M, Rios-Hernandez A, Farran A, Alda J. The role of diet and physical activity in children and adolescents with ADHD, in Recent Advances in Pharmaceutical Sciences V. Editör Munoz-Torrero D, Vinardell M, Palazon J. Kerala, India: Research Signpost; 2015. p. 51–64.
44. O’Neil A, Quirk SE, Housden S, Brennan SL, Williams LJ, Pasco JA, Berk M, Jacka FN. Relationship between diet and mental health in children and adolescents: A systematic review. American Journal of Public Health. 2014;104(10):e31–42.
45. Barkley RA. ADHD, obesity, and eating pathology. ADHD Rep. 2014;22(5):1–6.

APA	Besenek M, yazıcı m (2022). Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder. , 193 - 201. 10.5505/kpd.2022.66592
Chicago	Besenek Mert,yazıcı merve Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder. (2022): 193 - 201. 10.5505/kpd.2022.66592
MLA	Besenek Mert,yazıcı merve Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder. , 2022, ss.193 - 201. 10.5505/kpd.2022.66592
AMA	Besenek M,yazıcı m Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder. . 2022; 193 - 201. 10.5505/kpd.2022.66592
Vancouver	Besenek M,yazıcı m Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder. . 2022; 193 - 201. 10.5505/kpd.2022.66592
IEEE	Besenek M,yazıcı m "Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder." , ss.193 - 201, 2022. 10.5505/kpd.2022.66592
ISNAD	Besenek, Mert - yazıcı, merve. "Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder". (2022), 193-201. https://doi.org/10.5505/kpd.2022.66592

APA	Besenek M, yazıcı m (2022). Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder. Klinik Psikiyatri Dergisi, 25(2), 193 - 201. 10.5505/kpd.2022.66592
Chicago	Besenek Mert,yazıcı merve Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder. Klinik Psikiyatri Dergisi 25, no.2 (2022): 193 - 201. 10.5505/kpd.2022.66592
MLA	Besenek Mert,yazıcı merve Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder. Klinik Psikiyatri Dergisi, vol.25, no.2, 2022, ss.193 - 201. 10.5505/kpd.2022.66592
AMA	Besenek M,yazıcı m Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder. Klinik Psikiyatri Dergisi. 2022; 25(2): 193 - 201. 10.5505/kpd.2022.66592
Vancouver	Besenek M,yazıcı m Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder. Klinik Psikiyatri Dergisi. 2022; 25(2): 193 - 201. 10.5505/kpd.2022.66592
IEEE	Besenek M,yazıcı m "Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder." Klinik Psikiyatri Dergisi, 25, ss.193 - 201, 2022. 10.5505/kpd.2022.66592
ISNAD	Besenek, Mert - yazıcı, merve. "Mediterranean diet habits and their effects on symptomatology among children and adolescents with attention deficit hyperactivity disorder". Klinik Psikiyatri Dergisi 25/2 (2022), 193-201. https://doi.org/10.5505/kpd.2022.66592