ADHD symptoms and body composition changes in childhood

Background: Attention-deficit/hyperactivity disorder (ADHD) is linked toincreased risk of overweight/obesity among children and adults. Studies have alsoimplicated obesity as a risk factor for ADHD. However, no studies have evaluatedbidirectional, longitudinal associations between childhood fat mass and ADHDsymptom severity.

Objectives: We investigate bidirectional associations between ADHD symptomsand measures of body composition between ages 1.5 and 9. We further examineeffects of specific eating patterns linked to ADHD on associations betweensymptom severity and body composition.

Methods: The study utilized data from children (N= 3903) participating in theGeneration R cohort (Netherlands). Children were enrolled at birth and retainedregardless of ADHD symptoms over time. Cross-lagged and change models exam-ined bidirectional associations between body composition (body mass index/dual-energy X-ray absorptiometry) and ADHD symptoms at four time points in childhood.

Results: A child with a clinically concerning ADHD symptom z-score twostandard deviations above the mean at age 6 would be expected to experienceabout 0.22 kg greater fat mass gain measured via dual-energy x-ray absorptiom-etry between ages 6 and 9, even if they displayed healthy eating patterns (95%CI: 0.11 - 0.28,p<0.001). Conversely, fat mass at any age did not predictworse ADHD symptoms later.

Conclusions: Beginning in early childhood, more ADHD symptoms predicthigher fat mass at later ages. We did notfind evidence of a reverse association.Based on these and priorfindings, lifestyle counselling during treatment for childrenwith a diagnosis of ADHD should be considered, even if they are diagnosed in earlychildhood and do not yet have a body mass index of clinical concern.