Introduction
Methods
Results
First author (year) | Country | Design | Participants (N) | Mean age (SD)/age range (years) | Key results |
---|---|---|---|---|---|
Aguirre Castaneda et al. (2016) [10] | USA | Longitudinal | Participants with at least 2 measures of height/weight on or after 2 years of age: Total = 1001 ADHD = 336 Controls = 665 Subsample with BMI data after 20 years from baseline: Total = 735 ADHD = 285 Controls 450 | ADHD 26.4 (5.7) Controls 23.4 (7.1) | Participants with ADHD were 1.23 times more likely (95% CI = 1.00–1.50; p < 0.05) to be obese during the follow-up than controls, even after adjusting for birth weight and maternal age at birth. At 20-year follow-up, 34.4% of ADHD participants and 25.1% of controls, respectively, were obese (p = 0.01). Treatments with stimulants did not significantly impact the results. |
Byrd et al. (2013) [11] | USA | Cross-sectional | Total = 3050 ADHD = 412 Subsample of ADHD Medicated = 185 Not medicated = 227 Non-ADHD = 2638 | 8–15 | Males with ADHD who were medicated had lower odds of obesity compared to males without ADHD (aOR = 0.42, 95% CI = 0.23–0.78). Unmedicated males with ADHD were as likely as males without ADHD to be obese (aOR = 1.02, 95% CI = 0.43–2.42). The odds of obesity for females taking medication for ADHD did not differ statistically from those of females without ADHD (adjusted OR = 1.21, 95% CI = 0.52–2.81). Females with ADHD not taking medication had odds of obesity 1.54 times those of females without ADHD; however, the 95% CI (0.79–2.98) indicated that the finding was not significant. |
Cook et al. (2015) [12] | USA | Cross-sectional | Total sample = 45,897 ADHD = 506 | 10–17 | In both nonadjusted and adjusted models (controlling for social demographic factor), individuals with ADHD only were not significantly more likely to present with obesity compared to controls. |
Cortese et al. (2013a) [13•] | USA | Cross-sectional | Total = 34,653 Lifetime ADHD = 616 Persistent ADHD = 340 Remitted ADHD = 276 Non-ADHD = 34,037 | >20 years old | In the unadjusted model, obesity rates and BMI were significantly higher in adults with persistent ADHD than in those without ADHD (obesity: OR = 1.44, 95% CI = 1.06–1.95; BMI = p = 0.015). Obesity rates were not significantly higher in adults with lifetime ADHD vs. those without ADHD. In the model adjusted for sociodemographic factors and psychiatric comorbidities, persistent, lifetime, or remitted ADHD was not significantly associated with obesity. The number of ADHD symptoms in childhood was significantly associated with obesity in adulthood, even in the adjusted model, but in women only. |
Cortese et al. (2013b) [14] | USA | Longitudinal but only data at follow-up at age 41 where considered | 111 individuals with childhood ADHD 111 individuals without childhood ADHD Persistent ADHD = 24 Remitted ADHD = 87 | Men with childhood ADHD had significantly higher obesity rates (41.4 vs. 21.6%; p = 0.001) than men without childhood ADHD, even in the model adjusted for socioeconomic status and comorbid lifetime mental disorders. Participants with persistent ADHD were not significantly more obese than those without childhood ADHD. By contrast, participants with remitted ADHD were significantly more likely to be obese than those without childhood ADHD. The rates of obesity did not significantly differ between participants with persistent and remitted ADHD. | |
Fliers et al. (2013) [15] | Netherlands | Cross-sectional | Total = 372 children with ADHD | 5–17 | Boys with ADHD aged 10–17 and girls aged 10–12 were more likely to be overweight than children in the general Dutch population. Younger girls and female teenagers, however, were at lower risk for being overweight. |
Gungor et al. (2016) [16] | Turkey | Cross-sectional | Total = 752 ADHD = 362 Controls = 390 | 5–15 | Frequency of overweight/obesity according to Weigh For Height (WFH) criteria was significantly higher in the ADHD group compared with the control group (24.8 vs. 18.9%, p < 0.0001). |
Hanc et al. (2015a) [17] | Poland | Cross-sectional | Total = 615 ADHD = 219 Controls = 396 | 6–18 | ADHD was significantly related to higher rate of overweight, both when ADHD was treated as a single factor (unadjusted OR = 2.31, 95% CI = 1.40–3.81, p = 0.001) and after controlling for birth weight, place of residence, parents’ education, and income level (unadjusted OR = 2.31, 95% CI 1.40–3.81, p = 0.001; aOR = 2.44, 95% CI 1.38–4.29, p = 0.002). |
Hanc et al. (2015b) [18] | Poland | This study reports a retrospective analysis on participants from Hanc et al. [17]. | Total = 420 ADHD = 112 308 controls | 6–18 | At age 2 (retrospective analysis), children with ADHD were overweight/obese less frequently than controls (ADHD 10.71%, control group 20.13%, p = 0.02). At age 6 (retrospective analysis), children with ADHD were significantly more often diagnosed with underweight than boys without ADHD (8.93 vs. 3.25%, p = 0.02). |
Kummer et al. (2016) [19] | Brazil | Cross-sectional | ADHD = 23 Controls = 19 | ADHD 8.5 (2.4) Controls 8.6 (2.9) | Children and adolescents with ADHD had significantly increased frequency of overweight and obesity (p = 0.04) compared to controls. |
Nigg et al. (2016) [20••] Note: this paper presents data from 2 empirical studies plus a meta-analysis. The first study is not pertinent for the present review since it presents data on BMI but not on rates of obesity (see Supplemental Table 1). Data here refer to the second study | USA | Cross-sectional | Total = 43,796 ADHD = 6209 Non-ADHD = 37,587 | 10–17 | In boys, ADHD was not significantly associated with obesity, even in unadjusted models. In girls, ADHD and obesity were significantly associated considering the age range 14–17 in the unadjusted model. |
Özcan et al. (2015) [21] | Turkey | Cross-sectional | Total = 76 ADHD = 36 Controls = 40 | 9.3 years (1.78) | In the ADHD and control group, 2.5 and 13.9%, respectively, were overweight/obese. |
Pauli-Pott et al. (2014) [22] | Germany | Cross-sectional | Total = 360 ADHD = 257 Controls (adjustment disorder) = 103 | 6–12 years | Rates of obesity in the pure ADHD and control groups were 5.7 and 3.9%, respectively. |
Phillips et al. (2014) [23] | USA | Cross-sectional | Total = 9619 ADHD = 845 Non-ADHD = 8774 | 12–17 years | The prevalence of obesity in individuals with ADHD and in those without developmental disorders was 17.6 and 13.1%, respectively. Compared to adolescents without developmental disorders, obesity was significantly increased in adolescents with ADHD not taking prescription medications [aPR = 1.6 (95% CI 1.2–2.1)]. |
Racicka et al. (2015) [24] | Poland | Cross-sectional | Total = 408 ADHD | 7 to 18 | The prevalence of overweight (14.71 vs. 12.83%, p < 0.001) and obesity (6.37 vs. 3.45%, p < 0.001) was significantly higher in children with ADHD compared with controls in the general population. |
Turkotlu et al. (2015) [25] | Turkey | Cross-sectional | Total = 375 ADHD = 300 Controls = 75 | 10.1 years (2.5), 7–17 years | The rate of overweight/obese children was higher in the ADHD group (p < 0.001) than controls. |
Yang et al. (2013) [26] | China | Cross-sectional | Total = 158 children with ADHD | 9.2 years (2.0), 6–16.6 years | Children with ADHD in the pubertal stage were more likely to be overweight/obese (OR = 3.162, p = 0.027) than children in the general population. Children with ADHD combined subtype had a greater chance of being overweight/obese (OR = 2.192, p = 0.048) than children in the general population. Gender was not a risk factor for obesity/overweight. Children in puberty who had ADHD had a 4-fold increase in the odds ratio of obesity/overweight than those in the prepubertal stage (95% CI = 1.337–12.191). Children with ADHD combined subtype were 2.8 times more likely to be obese/overweight than those with either of the other two ADHD subtypes (95% CI = 1.225–6.434). |
First author (year) | Country | Design | Participants (N) | Mean age (SD)/age range (years) | Key results |
---|---|---|---|---|---|
Halfon et al. (2013) [27] | USA | Cross-sectional | Total = 43,297 43,106 population with available records ADHD = 3879 (9%) Non-ADHD = 39,418 (91%) | 10–17 | Children with obesity not taking stimulant medication were significantly more likely to present with ADHD compared to nonoverweight children (OR = 1.93, 95% CI 1.26–2.94; aOR 1.85, 95% CI 1.18–2.92). This finding was not significant when considering obese children taking stimulant medication. |
Perez-Bonaventura et al. (2015) [28] | Spain | Longitudinal | Participants available at age of 3 years = 611 ADHD nonoverweight (558, 3.3%) = 20 ADHD overweight (53, 8.3%) = 4 Total ADHD = 24 Participants available at age of 4 years = 596 ADHD nonoverweight (541, 4.4%) = 24 ADHD overweight (55, 13.6%) = 7 Total ADHD = 31 | All patients tested at 3, 4, and 5 years | At age 4 years, being overweight was associated with higher percentages of ADHD. A higher BMI z-score at age 3 years was related to higher mean scores in hyperactivity problems, peer relationship problems, and total difficulties and to higher percentages for ADHD at age 4 years. |
First author (year) | Country | Design | Participants | Mean age (SD)/age range (years) | Key results |
---|---|---|---|---|---|
Albayrak et al. (2013) [29] a
| Germany | Cross-sectional | ADHD = 495 Controls = 1300 | 6–18 | rs206936 NUDT3 gene (nudix; nucleoside diphosphate linked moiety X-type motif 3) was significantly associated with ADHD risk (OR 1.39; p 3.4104; Pcorr 0.01) |
Choudhry et al. (2013a) [30] | Canada | Cross-sectional | Total = 451 children ADHD | 9.05 (1.86), 6–12 | FTO SNP rs8050136 gene was marginally associated with ADHD (p = 0.05). Exploratory analysis based on ADHD subtype and medication status did not show any significant association between FTO SNP rs8050136 and ADHD. |
Choudhry et al. (2013b) [31] | Canada | Cross-sectional | Total = 284 ADHD children | 9.15 (1.86), 6–12 | Obese ADHD children were significantly less likely to be previously on medication (20.3%) compared to subjects in the overweight (25.0%) and normal weight (36.1%) groups (p = 0.04). There were no significant differences between normal overweight and obese subjects in their neurocognitive, emotional, and motor profile. |
Cook et al. (2015) [12] | USA | Cross-sectional | Total sample = 45,897 ADHD = 506 | 10–17 | After controlling for demographic variables, participants with ADHD only were 57% less likely to meet recommended levels of physical activity than controls but not significantly more likely to exceed recommended level of sedentarial behavior. |
Docet et al. (2012) [32] | Spain | Case-control | Total = 51 ADHD = 45 Non-ADHD = 6 Total = 179 ADHD = 52 Non-ADHD = 127 | 42.3 (15.5), 18–76 50.9 (2.4 years), 19–79 | 88.2% of obese patients with symptoms of ADHD above the threshold of the ASRS-V1.1 scale vs. 70.9% of those without significant symptoms with ADHD presented with abnormal eating behaviors (including eating between-meal snacks and binge eating). |
Ebenegger et al. (2012) [33] | Switzerland | Cross-sectional | Total = 450 | 4–6 | Scores of hyperactivity and less inattention were significantly associated with a higher level of physical activity (p < 0.01) and more television viewing (p < 0.04). |
Graziano et al. (2012) [34] | USA | Cross-sectional | Total = 80 ADHD | 4.5–18 | Children with ADHD who performed poorly on the neuropsychological battery were more likely to be classified as overweight/obese compared with children with ADHD who performed better on the neuropsychological battery (2.31 (1.01–5.26), p < 0.05). Participants in the stimulant group had significantly lower BMI z-scores than children in the nonstimulant. |
Khalife et al. (2014) [35•] | Finland | Longitudinal | Total (at age 8) = 8106 | Significant association between probable ADHD at 8 years and obesity at 16 years (OR ¼ 2.01, 95% CI ¼ 1.37–3.00) but nonsignificance in the opposite direction, that is, from obesity at 8 years to probable ADHD at 16 years (OR 0.90, 95% CI 0.69–1.18). There were significant associations between probable ADHD at 8 years and physical inactivity at 16 years (OR 1.30, 95% CI 1.01–1.67), and reduced physically active play at 8 years and inattention at 16 years (OR 1.53, 95% CI 1.15–2.05). The adjusted analyses revealed similar results. | |
Kim et al. (2014) [36] | South Korea | Cross-sectional | Total = 12,350 children Non-ADHD = 11,418 With above threshold symptoms ADHD = 932 | 9.4 years (1.7), 5–13 years | The association between ADHD symptoms and BMI was mediated by unhealthy food and dietary behaviors (β = 0.086, p < 0.001). |
Korczak et al. (2014) [37] | Canada | Longitudinal | Total = 1992 aged 4 to 11 years With above threshold symptoms of ADHD = 105 Total = 1302 aged 12 to 16 years With above threshold symptoms of ADHD = 61 | 4–11 | In children, the association between above threshold symptoms of childhood ADHD and adult overweight was accounted for by the effect of comorbid conduct disturbance (p < 0.001). In adolescents, ADHD symptoms were not associated with BMI in adulthood, for either boys and girls. |
Kummer et al. (2016) [19] | Brazil | Cross-sectional | ADHD = 23 Controls = 19 | ADHD 8.5 (2.4) Controls 8.6 (2.9) | BMI was significantly and negatively correlated with the severity of opposition and defiance symptoms; no correlation with inattention or hyperactivity/impulsivity symptoms was found. |
Lindblad et al. (2015) [38] | Sweden | Cross-sectional | Total = 32 ADHD = 10 Controls = 22 | 10–15 | Fasting blood glucose was similar in ADHD and controls. HbA1c values were significantly higher in ADHD than in controls (p = 0.039). BMI and BMI-SDS were higher in the ADHD group but were not significantly associated with HbA1c values. |
Lingineni et al. (2012) [39] | USA | Cross-sectional | Total = 68,634 children ADHD = 7137 Non-ADHD = 61,378 | 5–17 | Significant association between ADHD and watching TV for ≥1 h (OR 1.32, 95% CI 1.03–1.70). Inverse association between ADHD and practicing sport (OR 0.80, 95% CI 0.65–0.98) |
McWilliams et al. (2013) [40] | UK | Cross-sectional | Total = 424 overweight or obese children | 9–11 | Children with obesity and teacher-rated abnormal hyperactivity/inattention scores reported higher levels of sedentary activity (OR 1.13, 95% CI 1.02–1.17) than those with subthreshold scores. |
Müller et al. (2014) [41] | Germany | Cross-sectional | Total = 156 obese individuals | 39.91 (11.42), 18–65 | Patients in the “emotionally dysregulated/undercontroled” cluster reported significantly more childhood (p = 0.035) and adult (p = 0.004) ADHD symptoms than those in the “resilient/high functioning” cluster. |
Nazar et al. (2014) [42] | Brazil | Cross-sectional | Total = 132 ADHD = 40 | 18–59 | Compared to those without ADHD, obese ADHD patients had a higher number of psychiatric comorbidities (p < 0.001), especially substance abuse disorders, and higher scores on psychopathology rating scales (p < 0.05). In regression models, ADHD symptoms predicted binge eating. |
Nazar et al. (2016) [43] | Brazil | Cross-sectional | Total = 106 adult women with obesity ADHD = 30 Controls = 76 | 38.9 (10.7) | The relationship between ADHD and increased BMI was not statistically significant (χ
2 = 0.591, p > 0.05) After controlling for depressive and anxiety symptoms, neither the number of current inattention symptoms nor the hyperactivity/impulsivity (r = −0.031; p = 0.350 and r = −0.05; p = 0.307, respectively) showed a significant correlation with BMI. Compared to participants without ADHD, those with ADHD had significantly higher scores of binge eating. |
Nigg et al. (2016) [20••] Note: this paper presents data from 2 empirical studies plus a meta-analysis. The first study is not pertinent for the present review since it presents data on BMI but not on rates of obesity (see Supplemental Table 1). Data here refer to the second study | USA | Cross-sectional | Total = 43,796 ADHD = 6209 Non-ADHD = 37,587 | 10–17 | In the unadjusted model and controlling for depression, but not in the model adjusting simultaneously for depression and conduct disorder, ADHD and obesity were significantly associated in girls aged 14–17. |
Özcan et al. (2015) [21] | Turkey | Cross-sectional | Total = 76 ADHD = 36 Controls = 40 | 9.3 years (1.78) | Adiponectin plasma levels were significantly lower (p = 0.03) and leptin/adiponectin (L/A) ratio was significantly higher (p = 0.09) in the ADHD group compared to the non-ADHD group. |
Patte et al. (2016) [44] | Canada | Cross-sectional | Total = 421 | 33.56 (6.66), 24–50 | Structural equation model showed that ADHD symptoms, predicted by hypodopaminergic functioning in the prefrontal cortex, in combination with an enhanced appetitive drive, predicted hedonic eating and, in turn, higher BMI. |
Pauli-Pott et al. (2013) [45] | Germany | Cross-sectional | Total = 128 overweight obese ADHD = 17 Subclinical ADHD = 71 Non-ADHD = 40 | 8–15 years | ADHD symptoms were not significantly associated with disordered eating behaviors. |
Pauli-Pott et al. (2014) [22] | Germany | Cross-sectional | Total = 360 ADHD = 257 Controls (adjustment disorder) = 103 | 6–12 | The association between ADHD and obesity, after controlling for age, gender, and ODD/CD, was no more significant. |
Ptacek et al. (2014) [46] | Czech Republic | Cross-sectional | Total = 200 ADHD = 100 Controls = 100 | 6–10 | Subjects with ADHD skipped meals—breakfast (p < 0.004), lunch (p < 0.007), and dinner (p < 0.001)—significantly more often than controls. ADHD children eat more than 5 times a day (p < 0.001). Compared to controls, children with ADHD drank significantly more sweetened beverages (p < 0.003). |
Turkotlu et al. (2015) [25] | Turkey | Cross-sectional | Total = 375 ADHD = 300 treatment-naive children Controls = 75 | 1 0.1 (2.5), 7–17 | Breast-feeding duration in the ADHD group was significantly shorter than in the controls (p < 0.001). BMI percentile scores were significantly correlated with the oppositional, cognitive problems/inattentive, social problems, and psychosomatic subscores of the Conners Parents Rating Scales. |
Van Egmond-Frohlich et al. (2012) [47] | Germany | Cross-sectional | Total = 11,676 | 6–17 | Adjusting for sex and age only, ADHD symptoms score severity was significantly and positively associated with television exposure, medium- to high-intensity physical activity, and total energy intake, while they were negatively associated with the HuSKY diet quality index (all p < 0.001). |
Vogel et al. (2015) [48] | Netherlands | Cross-sectional | Total = 470 ADHD = 202 Obese = 114 Controls = 154 | 18–65 | Decreased sleep duration CI = 0.003–0.028 and an unstable eating pattern (CI = 0.003–0.031) mediated the association between ADHD symptoms and BMI. |
White et al. (2012) [49] | UK | Longitudinal | Total = 12,432 | For these analyses, data on BMI were available in 9661 at 10 years (67% of the sample at 10 years) 5732 (66%) at 26 years 8466 (78%) at 30 years 7356 (79%) at 34 years | Inattention/hyperactivity at 10 years increased risk of obesity at 30 years (aOR 1.3, 95% CI 1.0–1.6). After adjustment, conduct problems and hyperactivity were predictive at 30 years. |
Wynchank et al. (2015) [50] | Netherlands | Longitudinal | Total = 2303 Depressive/anxiety disorders with ADHD = 183 Depressive/anxiety disorders No ADHD = 1566 Controls = 554 | 18–65 | The presence of ADHD symptoms in individuals with depressive/anxiety disorders did not significantly increase risk for metabolic syndrome. |
First author (year) | Reason for exclusion |
---|---|
Erhart et al. (2012) [51] | No formal ADHD diagnosis |
Goulardins et al. (2016) [52] | No formal ADHD diagnosis |
Hanc et al. (2012) [53] | No data on overweight/obesity |
Ja (2014) [54] | No formal ADHD diagnosis |
Kerekes et al. (2015) [55] | No formal ADHD diagnosis |
McClure et al. (2012) [56] | No formal ADHD diagnosis |
Nigg et al. (2016) [20••]a
| The first study of this paper is not pertinent to the present review since it presents data on BMI but not on rates of obesity |
Pagoto et al. (2012) [57] | Review (treatment) without empirical data |