**Dietary Patterns in Children with Attention Deficit/Hyperactivity Disorder (ADHD)**

**Hae Dong Woo <sup>1</sup> , Dong Woo Kim <sup>1</sup> , Young-Seoub Hong 2,3, Yu-Mi Kim 2,3, Ju-Hee Seo 3 , Byeong Moo Choe 4 , Jae Hong Park 4 , Je-Wook Kang 5 , Jae-Ho Yoo 6 , Hee Won Chueh <sup>6</sup> , Jung Hyun Lee <sup>7</sup> , Min Jung Kwak 8 and Jeongseon Kim 1,\*** 


*Received: 12 February 2014; in revised from: 17 March 2014 / Accepted: 28 March 2014 / Published: 14 April 2014* 

**Abstract:** The role of diet in the behavior of children has been controversial, but the association of several nutritional factors with childhood behavioral disorders has been continually suggested. We conducted a case-control study to identify dietary patterns associated with attention deficit hyperactivity disorder (ADHD). The study included 192 elementary school students aged seven to 12 years. Three non-consecutive 24-h recall (HR) interviews were employed to assess dietary intake, and 32 predefined food groups were considered in a principal components analysis (PCA). PCA identified four major dietary patterns: the "traditional" pattern, the "seaweed-egg" pattern, the "traditional-healthy" pattern, and the "snack" pattern. The traditional-healthy pattern is characterized by a diet low in fat and high in carbohydrates as well as high intakes of fatty acids and minerals. The multivariate-adjusted odds ratio (OR) of ADHD for the highest tertile of the traditional-healthy pattern in comparison with the lowest tertile was 0.31 (95% CI: 0.12–0.79). The score of the snack pattern was positively associated with the risk of ADHD, but a significant association was observed only in the second tertile. A significant association between ADHD and the dietary pattern score was not found for the other two dietary patterns. In conclusion, the traditional-healthy dietary pattern was associated with lower odds having ADHD.

**Keywords:** dietary pattern; attention deficit/hyperactivity disorder (ADHD); school-aged children; Korean

### **1. Introduction**

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed neurobehavioral disorders in childhood, and it often lasts into adulthood [1]. ADHD prevalence rates vary by age, gender, and ethnicity [2,3]. Boys are more likely to have ADHD than girls, and higher rates of ADHD in younger age groups have been observed in studies of children and adolescents [4]. Worldwide, the overall prevalence of ADHD/hyperkinetic disorder (HD) was found to be 5.29% in a pooled analysis [2]. The prevalence of ADHD is 8.7% in US children aged eight to 15 years [5] and 9.7% in Iranian school-aged children [6]. In Korea, the prevalence of ADHD is 7.6% in elementary school children with a mean age of 9.4 years [7] and upper-grade elementary school children with a mean age of 11.6 years [8]. The etiology of ADHD is multifactorial, and both genetic and environmental factors may be involved in ADHD [9]. Family and twin studies have shown that genes play an important role in the development of ADHD. Genome-wide association studies are inconclusive, but candidate gene studies suggest the involvement of genes related to the receptors and transporters of dopamine and serotonin [10,11]. Proposed ADHD environmental risk factors include heavy metal and chemical exposures such as lead, mercury, organochlorine, organophosphates, and phthalates, as well as nutritional and lifestyle/psychosocial factors [5].

The effect of diet and dietary supplements is unclear, but considerable evidence suggests that dietary factors are associated with childhood behavioral disorders such as ADHD [12,13]. Low levels of copper, iron, zinc, magnesium, and omega-3 fatty acids have been reported in children with ADHD, and sugar, artificial food colorings, and preservatives are associated with an increased risk of ADHD [12,13]. Recently, the association between dietary pattern and ADHD has been examined in several studies [6,20,21]. As nutrients are consumed in combination and because nutrients are highly interrelated, the study of dietary patterns is useful to further understand the overall role of diet in ADHD. Thus, the purpose of this study was to determine the association between various dietary patterns and ADHD among Korean school-aged children.
