Annick Huberts-Bosch, Margreet Bierens, Verena Ly, Jessica van der Velde, Heleen de Boer, Gerry van Beek, Danielle Appelman, Sacha Visser, Lisa H P Bos, Lisa Reijmers, Jolanda van der Meer, Niki Kamphuis, Jos M T Draaisma, Rogier Donders, Gigi H H van de Loo-Neus, Pieter J Hoekstra, Marco Bottelier, Alejandro Arias-Vasquez, Helen Klip, Jan K Buitelaar, Saskia W van den Berg, Nanda N Rommelse
Journal: European child & adolescent psychiatry 2024;33(5):1503-1516
PMID: 37430148
A dietary approach frequently studied as potential intervention for Attention-Deficit/Hyperactivity Disorder (ADHD) is an elimination diet (ED) in which a limited number of foods are allowed to be consumed. This study aimed to investigate the short-term (5-week) effects of two dietary interventions - a restricted ED and a healthy diet (HD) based on Dutch dietary guidelines - on ADHD symptoms and emotion regulation (ER) in children. A non-randomised Care As Usual (CAU) group was also included for comparison. The results showed that ED was not significantly more effective than the HD in improving ADHD and ER symptoms. Both dietary groups (ED and HD) outperformed the CAU group on physical health measures after 5 weeks. Parents in the dietary treatment groups were more likely to believe there was a connection between food and their child’s behaviour than those in the CAU group. Children in both dietary groups consumed higher levels of beneficial macro- and micronutrients compared to the CAU group. Authors concluded that while short-term improvements were noted, longer follow-up studies are required to assess whether the short-term results change over time; the feasibility of adhering to a diet over a longer period of time and the high burden this may place on families; and the potential risks of nutritional deficiencies in the long term. These findings are clinically relevant for healthcare practitioners as HD might be considered in ADHD care as a starter or co-treatment especially for parents who are interested in dietary treatments and have the capacity to manage dietary changes.
An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5-12 years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED-but not HD-participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably 'easier to treat' than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, number NL5324 ( https://www.onderzoekmetmensen.nl/en/trial/25997 ).
© 2023. The Author(s).
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