Short-term effects of an elimination diet and healthy diet in children with attention-deficit/hyperactivity disorder: a randomized-controlled trial

Annick Huberts-Bosch*, Margreet Bierens, Verena Ly, Jessica van der Velde, Heleen de Boer, Gerry van Beek, Danielle Appelman, Sacha Visser, Lisa H.P. Bos, Lisa Reijmers, Jolanda van der Meer, Niki Kamphuis, Jos M.T. Draaisma, Rogier Donders, Gigi H.H. van de Loo-Neus, Pieter J. Hoekstra, Marco Bottelier, Alejandro Arias-Vasquez, Helen Klip, Jan K. BuitelaarSaskia W. van den Berg, Nanda N. Rommelse

*Corresponding author voor dit werk

OnderzoeksoutputAcademicpeer review

4 Citaten (Scopus)
38 Downloads (Pure)

Samenvatting

An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5–12 years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED—but not HD—participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably ‘easier to treat’ than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, number NL5324 (https://www.onderzoekmetmensen.nl/en/trial/25997).

Originele taal-2English
Pagina's (van-tot)1503–1516
Aantal pagina's14
TijdschriftEuropean Child and Adolescent Psychiatry
Volume33
Nummer van het tijdschrift8
Vroegere onlinedatum11-jul.-2023
DOI's
StatusPublished - aug.-2024

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