الفهرس 
Attention Deficit Hyperactivity DisorderOnly 14 pages are availabe for public view
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Abstract
A ttention deficit hyperactivity disorder (ADHD) is a
neurodevelopmental disorder and is characterized by excessive and
impairing inattentive, hyperactive, and impulsive behavior. Follow-up studies have reported long-term side effects of pharmacological treatment and beneficial effects of complementary and alternative treatment.
One of the risk environmental factors for ADHD that could be targeted for intervention is food. Sphingosin-1-phosphate (S1P) is involved in the development of intestinal immune diseases including food allergies and intestinal inflammation and is highly abundant in nervous tissue, affects neuronal and glial proliferation, differentiation, apoptosis as well as membrane permeability to Ca2+ and K+, relevant
to the generation and propagation of the nervous impulse and neurotransmitter release
The study included 47 children newly diagnosed with attention deficit hyperactivity disorder aged from 6-9years and recruited from the behavioral and psychiatric assessment unit of the national research center and psychiatric clinics of faculty of postgraduate childhood studies. They were 34 boys and 13 girls. They didn’t receive medication or behavioral therapy. Parents were motivated and wanted to complete the study.
The aim of the study was to 1) assess the effect of diet modification on ADHD outcome. 2) assess effect of nutrients intake on ADHD symptoms. 3) measure serumS1P level and its relation to ADHD symptoms and different nutrient intakes.
The patients are subjected to the following:
1. Full history taking: lying stress on age, sex, academic achievement and other behavioral disturbances.
2. Psychiatric, mental health examination and clinical examination.
3. Anthropometric assessment: length, weight and BMI.
4. Diagnosis of ADHD using DSM 5 criteria.
5. Assessment of IQ was done to exclude IQ below 70: using Wechsler intelligence scale for children.
6. Dietary history: using previous 24 hour recall and food records before diet modification and during diet modification.
7. Dietary analysis: was done using food composition tables before and during diet modification.
8. Assessment of physical activity.
9. Conner’s rating scale- revised parent short form: was done before and after diet modification.
10. Serum sphingosin-1-phosphate: was assessed before and after diet modification.
11. Baseline period: Patients followed baseline period for 2 weeks during which the study was explained to them and to the parents to know the ability to complete the study, written informed consent was obtained from one of the parents while verbal approval was obtained from the children, serum samples withdrawn, dietary history and analysis and Conner’s test- revised parent short form were done.
12. Health education tips: were provided that the child should get enough sleep, do regular exercise, learn deep breathing
techniques, remove all chemicals from the diet, prohibit eating in front of television and limit the television and any electronic time
13. Diet modification program for 5 weeks
• The energy intake for each child was calculated according to USDA tables that takes age, sex, PAL and BMI into consideration.
• Macronutrient intake was distributed according to AMDR (CHO: 45-65%; proteins: 10-35%; fat 20-35%) and then to number of servings according to food exchange lists (starch- vegetables-fruits-meat-fat-milk) and subdivided into 3 main meals and 2 snacks (ADA, 2008).
• The diet consisted only of a limited number of hypoallergenic foods, like rice, potatoes, chicken, meat, a range of vegetables (lettuce, carrots, cabbage and cauliflower), a range of legumes (broad beans, kidney beans, lentils, peas and lupines), range of fruits (apples- pears- bananas- dates) or juices performed at home with no added sugars and honey. Soya milk or rice milk were used instead of cow’s milk.
• Foods containing gluten, egg, milk and dairy products, artificial food colors, preservatives were prohibited.
• Highly containing sulfite and salicylate foods were also avoided.
• Stressing on drinking water.
• Records of children behavior, symptoms and foods were filled by the parents or caregivers with weekly visits and daily calls for follow up.
• The foods were cooked and prepared according to foods allowed and the parents were provided with diet sheet to show them number of servings, how to prepare and introduce variability in the diet so children didn’t get bored.
• There was focusing on foods rich in calcium and vitamin D to compensate milk, dairy products and eggs as legumes, fish and dark green vegetables as they were not able to buy soya milk or rice milk.
• All other foods will be prohibited.
• Dietary history and analysis were done during modified diet.
• Another serum samples withdrawn after finishing and Conner’s test was redone after finishing diet modification program.
The present study revealed the following results:-
There were 40.5% of children with normal weight, 40.5% were overweight and 19% were obese. The increased percentage of overweight and obese patients shows an interrelation between them.
There was statistically significant difference in hyperactivity index scores between normal weight versus obese and overweight versus obese indicating relation between obesity and the disorder.
After diet modification program, 53% became normal weight, 32% over weight and 15% obese.
Assessment of physical activity revealed that 55.3% of cases were inactive, 38.3 % were moderate active and 6.4% were highly active.
The study showed decrease in energy intake after diet modification but with no significant difference from before diet modification that can be attributed to increase in quantity of servings not quality.
Energy intakes before and after diet modification were above the required energy intake according to their age, sex and physical activity.
Carbohydrates intake decreased significantly after diet modification program.
Protein intake decreased significantly after diet modification program.
There was statistically significant reduction in vitamin A, vitamin C, thiamin, riboflavin and iron intakes after diet modification program.
Calcium intake was not different before and after diet modification and both did not meet the RDA for calcium.
Conner’s test subscales scores decreased statistically significantly after diet modification.
Serum S1P levels decreased statistically significantly after diet modification with cutoff point at 47.5 ng /L with sensitivity 0.977 and specificity 0.727.
There was negative correlation between hyperactivity index scores of Conner’s test and vitamin A intake before diet modification.
There was positive correlation between carbohydrate intake and hyperactivity index and learning problems scores of Conner’s test during baseline.
Also positive correlation existed between serum S1P levels and protein intake during baseline.
The concomitant improvement of ADHD symptoms as documented by significant reduction of Conner’s test subscales scores after following diet modification and healthy tips indicate the precipitating role of food in exaggerating ADHD symptoms.
The decrease of serum S1P after diet modification (exclusion of artificial colorings, additives and allergenic food) and its correlation with protein intake with concomitant improvement in symptoms prove role of diet on ADHD disorder and S1P level.