ADHD Is a Risk Factor for Overweight and Obesity in Children : Journal of Developmental & Behavioral Pediatrics (original) (raw)

Original Articles

Fliers, Ellen A. MD, PhD*,†; Buitelaar, Jan K. MD, PhD*; Maras, Athanasios MD, PhD†; Bul, Kim MSc†; Höhle, Esther MSc†; Faraone, Stephen V. PhD‡; Franke, Barbara PhD*,§; Rommelse, Nanda N. J. PhD‖,¶

*Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands;

†Yulius Academy, Rotterdam, the Netherlands;

‡Departments of Neuroscience and Psychiatry, SUNY Upstate Medical University, Syracuse, NY;

§Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands;

‖Karakter, Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands;

¶Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.

Address for reprints: Ellen A. Fliers, MD, PhD, Yulius Academy, Havendijk 40, Gorinchem 4201 XA, the Netherlands; e-mail: [email protected].

This study was partly funded by NIH grants R01MH081803 and R01MH62873 to S. V. Faraone.

E. A. Fliers, B. Franke, K. Bul, E. Höhle, and N. N. J. Rommelse report no biomedical financial interests or potential conflicts of interest. A. Maras has been a consultant to/member of advisory board of/and/or speaker for Janssen Cilag BV, Eli Lilly, Shire, in the past 2 years and is not an employee or a stock shareholder of any of these companies. A. Maras has no other financial or material support, including expert testimony, patents, and royalties. S. V. Faraone receives research support from the following sources: McNeil Pediatrics, Eli Lilly & Company, the National Institute of Mental Health, the National Institute of Child Health and Development, and the National Institute of Neurological Diseases and Stroke. S. V. Faraone is a speaker for the following speaker's bureaus: Eli Lilly & Company, McNeil Pediatrics, Cephalon, Novartis, and Shire Laboratories. S. V. Faraone has had an advisory or consulting relationship with the following pharmaceutical companies: McNeil Pediatrics, Noven Pharmaceuticals, Shire Laboratories, Cephalon, Novartis, and Eli Lilly & Company. J. K. Buitelaar has been a consultant to/member of advisory board of/and/or speaker for Janssen Cilag BV, Eli Lilly, Bristol-Myer Squibb, Organon/Shering Plough, UCB, Shire, Medice, and Servier in the past 3 years. J. K. Buitelaar is not an employee of any of these companies and is not a stock shareholder of any of these companies. J. K. Buitelaar has no other financial or material support, including expert testimony, patents, and royalties.

Received November , 2012

Accepted April , 2013

Abstract

Objective:

Although hyperactivity would seem to increase energy expenditure, attention-deficit hyperactivity disorder (ADHD) appears to increase the risk for being overweight. This study examined the body mass index (BMI) in children with ADHD and its relationship with age, gender, ADHD and comorbid symptom severity, inhibitory control, developmental coordination disorder, sleep duration, and methylphenidate use.

Method:

Participants were 372 Dutch children with ADHD combined type aged 5 to 17 years participating in the International Multicenter ADHD Genetics (IMAGE) study. We categorized BMI according to international age- and gender-specific reference values and calculated BMI-standard deviation scores (BMI-SDS). The control population was matched for age, gender, and ethnicity and originated from the same birth cohort as the ADHD group. Inhibitory control was measured by the computerized Stop-signal task. Prevalence differences of underweight, overweight, and obesity between groups were expressed in odds ratios. We used linear regression analyses with gender, age, parent- and teacher-rated ADHD and comorbid scores, inhibitory control, sleep duration, motor coordination, and methylphenidate use to predict BMI-SDS.

Results:

Boys with ADHD aged 10 to 17 years and girls aged 10 to 12 years were more likely to be overweight than children in the general Dutch population. Younger girls and female teenagers, however, seemed to be at lower risk for being overweight. Higher oppositional behavior and social communication problems related to higher BMI-SDS scores, whereas more stereotyped behaviors related to lower BMI-SDS scores. We found no effects of the other examined associated risk factors on BMI-SDS.

Conclusions:

Attention-deficit hyperactivity disorder in boys is a risk factor for overweight. In girls with ADHD, the prevalence of overweight is age dependent and most pronounced in girls aged 10 to 12 years. They have a 4-fold risk of being obese. Higher oppositional and social communication problems pose an increased risk for overweight, whereas sleep duration, motor coordination problems, and methylphenidate use do not.