Artificial food dyes and attention deficit hyperactivity disorder (original) (raw)
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A Research Model for Investigating the Effects of Artificial Food Colorings on Children With ADHD
PEDIATRICS, 2011
The United Kingdom and European Union recently restricted the use of artificial food colorings (AFCs) to improve the health of children. These decisions provide an interesting case study of the role of scientific evidence in the assessment of food additives and risk to children's health and formulation of food policy. Although there continues to be uncertainty concerning the link between AFCs and attention-deficit/hyperactivity disorder (ADHD), policy decisions have been made that have far-reaching implications. In addition, publicity surrounding the policy changes may shape public perceptions concerning effective management of ADHD. We believe that the balance of existing evidence neither refutes nor supports the link between AFCs and ADHD, which highlights the need for carefully designed studies to further investigate the link between AFCs and ADHD. In this article we describe a model for such studies. In developing our model, we drew from current investigative standards in AD...
Journal of the American Academy of Child & Adolescent Psychiatry, 2012
Objective-The role of diet and of food colors in attention-deficit/hyperactivity disorder (ADHD) or its symptoms warrants updated quantitative meta-analysis, in light of recent divergent policy in Europe and the United States. Method-Studies were identified through a literature search using the PubMed, Cochrane Library, and PsycNET databases through February 2011. Twenty-four publications met inclusion criteria for synthetic food colors; 10 additional studies informed analysis of dietary restriction. A random-effects meta-analytic model generated summary effect sizes. Results-Restriction diets reduced ADHD symptoms at an effect of g = 0.29 (95% CI, 0.07-0.53). For food colors, parent reports yielded an effect size of g = 0.18 (95% CI, 0.08-0.24; p =. 0007), which decreased to 0.12 (95% CI, 0.01-0.23; p < .05) after adjustment for possible publication bias. The effect was reliable in studies restricted to food color additives (g = 0.21, 95% CI = 0.06-0.36) but did not survive correction for possible publication bias and was not reliable in studies confined to Food and Drug Administration-approved food colors. Teacher/observer reports yielded a nonsignificant effect of 0.07 (95% CI = −0.03 to 0.18; p = .14). However, highquality studies confined to color additives yielded a reliable effect (g = 0.22, 95% CI = 0.10-0.41, p = .030) that survived correction. In psychometric tests of attention, the summary effect size was 0.27 (95% CI = 0.07-0.47; p = .007) and survived correction. An estimated 8% of children with ADHD may have symptoms related to synthetic food colors. Conclusions-A restriction diet benefits some children with ADHD. Effects of food colors were notable were but susceptible to publication bias or were derived from small, nongeneralizable samples. Renewed investigation of diet and ADHD is warranted.
Journal of Developmental & Behavioral …, 2004
Burgeoning estimates of the prevalence of childhood attention-deficit/hyperactivity disorder (ADHD) raise the possibility of a widespread risk factor. We seek to assess whether artificial food colorings (AFCs) contribute to the behavioral symptomatology of hyperactive syndromes. We searched ten electronic databases for double-blind placebo-controlled trials evaluating the effects of AFCs. Fifteen trials met the primary inclusion criteria. Meta-analytic modeling determined the overall effect size of AFCs on hyperactivity to be 0.283 (95% CI, 0.079 to 0.488), falling to 0.210 (95% CI, 0.007 to 0.414) when the smallest and lowest quality trials were excluded. Trials screening for responsiveness before enrollment demonstrated the greatest effects. Despite indications of publication bias and other limitations, this study is consistent with accumulating evidence that neurobehavioral toxicity may characterize a variety of widely distributed chemicals. Improvement in the identification of responders is required before strong clinical recommendations can be made.
Archives of Disease in Childhood, 2004
Aims: To determine whether artificial food colourings and a preservative in the diet of 3 year old children in the general population influence hyperactive behaviour. Methods: A sample of 1873 children were screened in their fourth year for the presence of hyperactivity at baseline (HA), of whom 1246 had skin prick tests to identify atopy (AT). Children were selected to form the following groups: HA/AT, not-HA/AT, HA/not-AT, and not-HA/not-AT (n = 277). After baseline assessment, children were subjected to a diet eliminating artificial colourings and benzoate preservatives for one week; in the subsequent three week within subject double blind crossover study they received, in random order, periods of dietary challenge with a drink containing artificial colourings (20 mg daily) and sodium benzoate (45 mg daily) (active period), or a placebo mixture, supplementary to their diet. Behaviour was assessed by a tester blind to dietary status and by parents' ratings. Results: There were significant reductions in hyperactive behaviour during the withdrawal phase. Furthermore, there were significantly greater increases in hyperactive behaviour during the active than the placebo period based on parental reports. These effects were not influenced by the presence or absence of hyperactivity, nor by the presence or absence of atopy. There were no significant differences detected based on objective testing in the clinic. Conclusions: There is a general adverse effect of artificial food colouring and benzoate preservatives on the behaviour of 3 year old children which is detectable by parents but not by a simple clinic assessment. Subgroups are not made more vulnerable to this effect by their prior levels of hyperactivity or by atopy.
Mechanisms of behavioral, atopic, and other reactions to artificial food colors in children
Nutrition Reviews, 2013
Artificial food colors (AFCs) have not been established as the main cause of attention-deficit hyperactivity disorder (ADHD), but accumulated evidence suggests that a subgroup shows significant symptom improvement when consuming an AFC-free diet and reacts with ADHD-type symptoms on challenge with AFCs. Of children with suspected sensitivities, 65% to 89% reacted when challenged with at least 100 mg of AFC. Oligoantigenic diet studies suggested that some children in addition to being sensitive to AFCs are also sensitive to common nonsalicylate foods (milk, chocolate, soy, eggs, wheat, corn, legumes) as well as salicylate-containing grapes, tomatoes, and orange. Some studies found "cosensitivity" to be more the rule than the exception. Recently, 2 large studies demonstrated behavioral sensitivity to AFCs and benzoate in children both with and without ADHD. A trial elimination diet is appropriate for children who have not responded satisfactorily to conventional treatment or whose parents wish to pursue a dietary investigation.
Effect of artificial food colours on childhood behaviour
Archives of Disease in Childhood, 1990
We performed an objective evaluation of 39 children whose behaviour was observed by their parents to improve on an artificial food additive free diet and to deteriorate with dietary lapses. Only 19 children completed a double blind placebo controlled challenge study with artificial food colours. In these children food colours were shown to have an adverse effect on a daily Conners' rating of behaviour, but most parents could not detect these changes. A pharmacological mechanism of food additive intolerance is proposed to explain these effects.
American Journal of Psychiatry, 2010
identify other major genes of signifi cant effect (3). The full effects of these genes may only become apparent when their association with environmental and experiential infl uences is taken into account. Variations in ADHD symptoms have also been attributed to environmental effects (4-6) and a wide range of adverse experiential factors that involve CNS damage (7). Artifi cial food additives are among putative environmental toxins adversely affecting the CNS that are postulated to place children at risk for ADHD (8-10). A meta-analysis of double-blind, placebo-controlled studies has indicated that for children with ADHD, artifi cial food colors have a signifi cantly adverse impact (11). There is less clear evidence for the adverse effect of such additives on behavior in children in the general population, and no studies have specifi cally attempted to identify whether there is a subgroup of children in the population vulnerable to their effects. An adverse effect of food additives in 3-year-old children in the general population has been shown in double-blind At tention defi cit hyperactivity disorder (ADHD) in children is characterized by symptoms of inattention, impulsivity, and overactivity. There are marked individual differences in these behaviors in the general population. A diagnosis of ADHD is usually reserved for those children with severe symptoms and a pervasive pattern of behavior from a young age that impairs other aspects of functioning, such as educational attainment (1). Genetic factors are a major contributor to these individual differences in ADHD symptoms (2). A number of genes contributing to this effect have been identifi ed, especially those infl uencing the dopamine system (e.g., dopamine D4 receptor [DRD4] and dopamine transporter [DAT1] genes). Other genes in the serotonin and noradrenergic neurotransmitter systems have also been implicated (2). However, the size of the effects identifi ed are such that they account for only a small portion of the genetic risk suggested by quantitative genetic analyses. To date, fi ve genome-wide association studies on ADHD have failed to