Treatment response to supplemental nutrients for ADHD is independent of diet quality: the MADDY Study RCT.

Lisa M Robinette, Irene E Hatsu, Jeanette M Johnstone, Alisha M Bruton, Brenda M Y Leung, L Eugene Arnold

Journal: Nutritional neuroscience 2024;27(4):319-328

PMID: 36989335

Plain Language Summary

Attention-Deficit/Hyperactivity Disorder (ADHD) includes symptoms of inattention and/or hyperactivity/impulsivity that interfere with functioning in two or more settings for at least 6 months. This study aimed to investigate whether overall diet quality affects treatment response. This research was based on data from the Micronutrients for ADHD in Youth (MADDY) study — an 8-week, randomised, double-blind, placebo-controlled trial involving 124 children aged 6–12 years. Participants were randomly assigned to receive either broad-spectrum micronutrient supplements (n=69) or a placebo (n=55). Diet quality was assessed using the Healthy Eating Index (HEI-2015). The results showed that children in the multi-nutrient group had three times the number of treatment responders compared to the placebo group. However, baseline diet quality did not moderate treatment response. Children with both low- and high-quality diets responded similarly to the micronutrient intervention. Improvements were noted particularly in irritability, inattention, and emotional regulation, regardless of the participants’ initial diet quality. Authors concluded that multi-nutrient supplementation is effective in reducing ADHD-related symptoms and emotional dysregulation in children, and this benefit is independent of their baseline diet quality. These findings are clinically significant for healthcare practitioners because they suggest that multi-nutrient supplementation may benefit children with ADHD and irritability independent of overall diet quality.

Abstract

OBJECTIVES

The 8-week Micronutrients for ADHD in Youth (MADDY) randomized controlled trial ( = 126, age 6-12) of broad-spectrum multinutrients for ADHD with emotional dysregulation found 3 times as many responders with multinutrients (54%) compared to placebo (18%) by Clinical Global Impression-Improvement (CGI-I). Our primary aim for this analysis tests the hypothesis that those with poor overall diet quality at baseline benefit more. The second aim is to explore whether specific components of diet quality moderate treatment response.

METHODS

124 children (69 multinutrients, 55 placebo) had diet quality assessed using the Healthy Eating Index-2015 (HEI-2015). For each potential moderator, the outcome CGI-I at week 8 (RCT-end), was modeled two ways: (1) as a dichotomous variable: responder/non-responder, with responders defined by a rating of 1 or 2 'very much' or 'much improved,' all else equals non-responder using logistic regression, and (2) as a dimensional improvement outcome from 1 = very much improved to 7 = very much worse, using linear regression.

RESULTS

HEI-2015 total score did not moderate treatment response [odds ratio = 1.00 (95% CI: 0.90,1.10), = 0.984] or improvement [β = -0.01 (95% CI: -0.06,0.04), = 0.648]. However, total vegetable intake moderated level of improvement in exploratory analysis [β = -0.48 (95% CI: -0.82, -0.13), = 0.007]: those with higher baseline vegetable intake showed greater benefit from multinutrients compared to placebo.

CONCLUSIONS

Multinutrients may benefit children with ADHD and irritability regardless of overall diet quality. The finding that higher baseline vegetable intake may improve response to multinutrients deserves further exploration, including dietary effect on gut microbiota and absorption of multinutrients and parental factors.

Address: Department of Human Sciences, The Ohio State University (OSU), Columbus, OH, USA.; OSU Extension, The Ohio State University, Columbus, OH, USA.; Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA.; Helfgott Research Institute, National University of Natural Medicine.; Faculty of Health Sciences, University of Lethbridge, Lethbridge, CA, USA.; Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH, USA.; Nisonger Center, The Ohio State University, Columbus, OH, USA.

DOI: 10.1080/1028415X.2023.2191415