Sugar consumption, sugar sweetened beverages and Attention Deficit Hyperactivity Disorder: A systematic review and meta-analysis

Alireza Farsad-Naeimi; Foad Asjodi; Mahsa Omidian; Mohammadreza Askari; Mehran Nouri; Ana Beatriz Pizarro; Elnaz Daneshzad

doi:10.1016/j.ctim.2020.102512

Sugar consumption, sugar sweetened beverages and Attention Deficit Hyperactivity Disorder: A systematic review and meta-analysis

Complement Ther Med. 2020 Sep:53:102512. doi: 10.1016/j.ctim.2020.102512. Epub 2020 Aug 16.

Authors

Alireza Farsad-Naeimi¹, Foad Asjodi², Mahsa Omidian³, Mohammadreza Askari⁴, Mehran Nouri⁵, Ana Beatriz Pizarro⁶, Elnaz Daneshzad⁷

Affiliations

¹ Department of Nutrition, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
² Sport Nutrition Board, Football Medical Assessment and Rehabilitation Center (IFMARC), Tehran, Iran.
³ Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
⁵ Students Research Committee, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran.
⁶ Department of clinical epidemiology and biostatistics, Pontificia Universidad Javeriana, Bogota Colombia.
⁷ Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran. Electronic address: daneshzad@gmail.com.

PMID: 33066852
DOI: 10.1016/j.ctim.2020.102512

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is a significant neurobehavioral disorder in children and adolescence which may be affected by diet.

Objective: To evaluate the possible relationship between sugar consumption and the development of symptoms of ADHD.

Methods: In March 2020, an exhaustive systematic literature search was conducted using Google Scholar, PubMed, and Scopus. In this meta-analysis of observational studies, odds ratios, relative risks, hazard ratios, and their 95% confidence intervals, which was reported for ADHD regarding SSBS, soft drink consumption, and dietary sugars, were used to calculate ORs and standard errors. At first, a fixed-effects model was used to drive the overall effect sizes using log ORs and SEs. If there was any significant between-studies heterogeneity, the random-effects model was conducted. Cochran's Q test and I² were used to measure potential sources of heterogeneity across studies. The Newcastle-Ottawa scale was used to assess the quality of the included articles.

Results: Seven studies, two cross-sectional, two case-control, and three prospective with a total of 25,945 individuals were eligible to include in the current meta-analysis. The association between sugar and soft drink consumption and the risk of ADHD symptoms were provided based on the random-effects model (pooled effect size: 1.22, 95%CI: 1.04-1.42, P = 0.01) (I² = 81.9%, P _{heterogeneity}< 0.0001).

Conclusion: This meta-analysis indicated a positive relationship between overall sugar and sugar-sweetened beverages consumption and symptoms of ADHD; however, there was heterogeneity among included studies. Future well-designed studies that can account for confounds are necessary to confirm the effect of sugar on ADHD.

Keywords: ADHD; hyperactivity; soft drink; sugar; sugar-sweetened beverages.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Attention Deficit Disorder with Hyperactivity / metabolism*
Dietary Sugars / adverse effects*
Humans
Sugar-Sweetened Beverages / adverse effects*

Substances

Dietary Sugars