Nutrients patterns and attention deficit hyperactivity disorder among Egyptian children: a sibling and community matched case-control study

Eur J Clin Nutr. 2024 Jan;78(1):64-71. doi: 10.1038/s41430-023-01345-0. Epub 2023 Sep 26.


Background: Attention Deficit Hyperactive Disorder (ADHD) diagnosis has been growing among children, with great public health concern. The relationship between nutrient intake pattern and ADHD remains unclear.

Aim: To identify the nutrient intake patterns and its association with ADHD in children.

Subjects and methods: The study involved 146 children with ADHD, 141 control sibling, and 146 community controls. ADHD diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) criteria following the assessment by the long-form Conner's Scale. Dietary intakes were assessed using a semi-quantitative food frequency questionnaire. Nutrients patterns were identified using the principal component analysis (PCA).

Results: ADHD children have significantly higher mean total energy intake than community controls and siblings (8867.9, 4481.9 and 7308.2 KJ, respectively, p < 0.001). Four nutrient patterns extracted by the PCA explained 75.9% of the total variance. Lower tertiles of "predominantly calcium-phosphorus; pattern 1" and "predominantly-vitamins; pattern 3" were significantly associated with increasing odds of ADHD, compared to community controls (p for trend: 0.002 and 0.005, respectively), while the same associations were noted in "predominantly-vitamins" and "predominantly Zinc-Iron; pattern 2" when compared to siblings (p for trend: <0.001 and <0.001, respectively). However, Higher tertiles of macronutrients; pattern 4" were associated with increased ADHD odds, compared to either community controls or siblings (p for trend: 0.017 and <0.001, respectively).

Conclusion: Lower intakes of nutrients patterns of minerals and vitamins, and higher intakes of macronutrients were associated with increased likelihood of ADHD in children.

MeSH terms

  • Attention Deficit Disorder with Hyperactivity* / epidemiology
  • Case-Control Studies
  • Child
  • Egypt / epidemiology
  • Humans
  • Nutrients
  • Siblings
  • Vitamins


  • Vitamins