飲食與注意力不足過動症的關係

有人懷疑注意力不足過動症與飲食存在關聯。關注的焦點主要為食品添加物、人工色素、含糖食物和衍生的食物過敏、食物不耐、和維他命、礦物質及Ω-3脂肪酸等營養素的缺乏。整體來說，飲食並不會影響一個人的言行舉止到需要就醫的情形，而且飲食也不是絕大多數注意力不足過動症的成因。 只有極少數人的言行舉止會受到食品添加物、人工色素、攝取過度的糖分、缺乏維生素礦物質與Ω-3脂肪酸的的影響。 迄今未有證據能證明「食品添加物與人工色素」會導致兒童出現食物不耐症和注意力不足過動症的症狀。 雖然有些人工色素可能真的會誘發些本來就帶有食物不耐症和注意力不足過動症基因或體質的人之症狀，但這個結論的證據力被認為是薄弱的，因為那些文獻似乎存在「不中立（bias）」、「統計數據的樣本數不足」的問題。 研究發現，讓ADHD患者改用無糖飲食，並不會顯著改善其ADHD的症狀；平常少吃含糖食物的人，改吃較多量的含醣食物後，也未出現ADHD的症狀。 然而不排除仍有極少數的人對於糖較為敏感，畢竟多數研究所使用的含糖食物，其所含的糖分，都不至於到非常高的地步。 有些人認為攝取糖分、甜食、人工香料（英语：artificial flavors）（包含：阿斯巴甜）等會導致過動，不過一旦回顧那些曾經比較學齡兒童（英语：school-aged children）和學齡前兒童（英语：preschooler）的對照實驗會發現，受試者即便將糖分攝取至遠高於正常範圍的程度，對受試者的「注意力」及「行為」並沒有產生影響，如果將實驗組成員（受試者）換成是「其父母對糖分敏感的兒童試驗者」，得到的結果也相同。 除此之外，美國小兒科醫學會舉出一個研究顯示，數名被其父母認為對糖分有反應的（reactive）的男孩子，當攝取較多量的糖分時，反而會變得較不活躍。 美國小兒科醫學會另表示，不同研究人員通過數項比對血糖的研究，都得到ADHD患者與非ADHD患者在生活中的糖分攝取量並無不同的結論。據此，「美國小兒科醫學會」決定不建議患者透過任何「特別飲食」來治療ADHD。 MedlinePlus則表示，精緻糖可能對孩子的活動量有些許 影響，MedlinePlus認為精緻糖（英语：refined sugar）和碳水化合物能快速進入血管中，使血糖迅速升高，這可能使得孩子變得較為活躍。雖然MedlinePlus不認為攝取精緻糖與ADHD有直接關係，仍建議不要過量甚至建議節制精緻糖的攝取，並且以更健康的飲食型態取而代之。 截至2019年7月，沒有任何科學證據顯示糖、或甜食（包括：糖分含量遠高於一般菜餚的食物）會影響人類的行為或導致ADHD 。 有些研究指出，Ω-3脂肪酸在ADHD患者的血液中，含量較低。 然而，「Ω-3脂肪酸在血液中的濃度是否會直接導致或改變ADHD的症狀」以及「ADHD患者中較低的Ω-3脂肪酸濃度之成因」，迄今仍不得而知。 而「攝取Ω-3脂肪酸是否能改善ADHD的核心症狀」，學術界的研究至今仍未有結論。 補充維生素和礦物質（例如：維他命B群、維他命C、鐵、鎂及碘等）對於改善ADHD病情的功效，尚有待更多的實驗證明。 （页面存档备份，存于互联网档案馆）</ref> 在美国，没有膳食补充剂被 FDA 批准用于治疗多动症。 一些用于管理多动症症状的流行补充剂： 咖啡因 — 多动症与咖啡因摄入量增加有关，咖啡因对认知的刺激作用可能对多动症有一些好处。 有限的证据表明，其治疗效果明显不如哌醋甲酯和右旋安非他命等标准治疗，但仍会产生类似或更大的副作用。 尼古丁 — 多动症和尼古丁摄入之间的关联是众所周知的，有限的证据表明尼古丁可能有助于改善多动症的某些症状，尽管效果通常很小。 Omega-3 脂肪酸 — 2012 年 Cochrane 综述发现，几乎没有证据表明补充 omega-3 或其他多不饱和脂肪酸可以改善儿童或青少年的 ADHD 症状。2011 年的一项荟萃​​分析发现了“小而显着的益处”，其益处“与目前可用的 ADHD 药物治疗的功效相比是适度的”。 该评论得出结论，由于其“相对良性的副作用”，补充剂可能值得考虑作为与药物组合的增强治疗，但不作为主要治疗。 大多数关于 Omega-3 脂肪酸的研究被认为质量很差，存在广泛的方法学缺陷。 锌 – 尽管锌在 ADHD 中的作用尚未阐明，但有少量有限证据表明较低的组织锌水平可能与 ADHD 相关。 在没有证明缺锌的情况下（在发展中国家以外很少见），不建议将补锌作为 ADHD 的治疗选择。 在 1980 年代，维生素 B6 被推广为对学习困难（包括多动症）的儿童有益的补救措施；然而，一项针对多动症儿童的大剂量维生素研究表明，它们对改变行为无效。 维生素D 注意力不足過動症的治療 § 飲食 攝取過多的維他命可能產生健康問題。 Center for Food Safety and Applied Nutrition. Background Document for the Food Advisory Committee: Certified Color Additives in Food and Possible Association with Attention Deficit Hyperactivity Disorder in Children (PDF) (报告). Food and Drug Administration. 30 March 2011 [2019-08-03]. （原始内容存档 (PDF)于2015-11-06）.  （页面存档备份，存于互联网档案馆） Author:Kevin R Krull, PhDSection Editor:Marilyn Augustyn, MDDeputy Editor:Mary M Torchia, MD. Attention deficit hyperactivity disorder in children and adolescents: Epidemiology and pathogenesis. UpToDate. [2019-08-03]. （原始内容存档于2019-08-03）.  （页面存档备份，存于互联网档案馆） Tomaska, LD; Brooke-Taylor, S. Food Additives - General. Motarjemi, Y; Moy, G; Todd, ECD (编). Hazards and Diseases. Encyclopedia of Food Safety 2 1st. Amsterdam: Elsevier. 2014: 449–454. ISBN 978-0-12-378613-5.  Millichap, JG; Yee, MM. The diet factor in attention-deficit/hyperactivity disorder. Pediatrics. February 2012, 129 (2): 330–337 [2019-08-03]. PMID 22232312. doi:10.1542/peds.2011-2199. （原始内容存档于2015-09-11）.  （页面存档备份，存于互联网档案馆） Nigg, Joel T.; Lewis, Kara; Edinger, Tracy; Falk, Michael. Meta-Analysis of Attention-Deficit/Hyperactivity Disorder or Attention-Deficit/Hyperactivity Disorder Symptoms, Restriction Diet, and Synthetic Food Color Additives. Journal of the American Academy of Child and Adolescent Psychiatry (Elsevier BV). 2012, 51 (1): 86–97.e8. ISSN 0890-8567. PMC 4321798 . PMID 22176942. doi:10.1016/j.jaac.2011.10.015.  pubmeddev; ML, Wolraich; Al., Et. The effect of sugar on behavior or cognition in children. A meta-analysis. - PubMed. NCBI. 1995-11-22 [2019-08-03]. （原始内容存档于2020-01-12）.  （页面存档备份，存于互联网档案馆） Rojas, Neal L.; Chan, Eugenia. Old and new controversies in the alternative treatment of attention-deficit hyperactivity disorder. Mental retardation and developmental disabilities research reviews (Wiley). 2005, 11 (2): 116–130. ISSN 1080-4013. PMID 15977318. doi:10.1002/mrdd.20064.  Hyperactivity and sugar: MedlinePlus Medical Encyclopedia. MedlinePlus. 2018-07-09 [2018-07-13]. （原始内容存档于2017-12-23）. In some cases, a special diet of foods without artificial flavors or colors works for a child, because the family and the child interact in a different way when the child eliminates these foods. These changes, not the diet itself, may improve the behavior and activity level. Refined (processed) sugars may have some effect on children's activity. Refined sugars and carbohydrates enter the bloodstream quickly. Therefore, they cause rapid changes in blood sugar levels. This may make a child become more active. Several studies have shown a link between artificial colorings and hyperactivity. On the other hand, other studies do not show any effect. This issue is yet to be decided.  （页面存档备份，存于互联网档案馆） Kanarek, RB. Does sucrose or aspartame cause hyperactivity in children?. Nutrition reviews. 1994, 52 (5): 173–5. ISSN 0029-6643. PMID 8052458.  Krummel, Debra A.; Seligson, Frances H.; Guthrie, Helen A.; Gans, Dian A. Hyperactivity: Is candy causal?. Critical Reviews in Food Science and Nutrition (Informa UK Limited). 1996, 36 (1-2): 31–47. ISSN 1040-8398. doi:10.1080/10408399609527717.  American Academy of Pediatrics. Allergies and Hyperactivity. HealthyChildren.org. 2018-07-13 [2018-07-13]. （原始内容存档于2017-12-21）.  （页面存档备份，存于互联网档案馆） Dietz, William. Nutrition : what every parent needs to know. Elk Grove Village, IL: American Academy of Pediatrics. 2012. ISBN 978-1-58110-631-2. OCLC 767736204.  Wolraich, Mark L. The Effect of Sugar on Behavior or Cognition in Children. JAMA (American Medical Association (AMA)). 1995-11-22, 274 (20): 1617. ISSN 0098-7484. doi:10.1001/jama.1995.03530200053037. The meta-analytic synthesis of the studies to date found that sugar does not affect the behavior or cognitive performance of children. The strong belief of parents may be due to expectancy and common association. However, a small effect of sugar or effects on subsets of children cannot be ruled out.(JAMA. 1995;274:1617-1621)  Busting the Sugar-Hyperactivity Myth. WebMD. 2018-04-05 [2018-07-13]. （原始内容存档于2018-02-22）.  （页面存档备份，存于互联网档案馆） Hyperactivity and sugar: MedlinePlus Medical Encyclopedia. MedlinePlus. 2018-07-09 [2018-07-13]. （原始内容存档于2017-12-23）. Recommendations. There are many reasons to limit the sugar a child has other than the effect on activity level. A diet high in sugar is a major cause of tooth decay. High-sugar foods tend to have fewer vitamins and minerals. These foods may replace foods with more nutrition. High-sugar foods also have extra calories that can lead to obesity. Some people have allergies to dyes and flavors. If a child has a diagnosed allergy, talk to a dietitian. Add fiber to your child's diet to keep blood sugar levels more even. For breakfast, fiber is found in oatmeal, shredded wheat, berries, bananas, whole-grain pancakes. For lunch, fiber is found in whole-grain breads, peaches, grapes, and other fresh fruits. Provide "quiet time" so that children can learn to calm themselves at home. Talk to your health care provider if your child cannot sit still when other children of his or her age can, or cannot control impulses.  （页面存档备份，存于互联网档案馆） Young, G; Conquer, J. Omega-3 fatty acids and neuropsychiatric disorders. Reproduction, Nutrition, Development. January 2005, 45 (1): 1–28. PMID 15865053. doi:10.1051/rnd:2005001.  Haag, M. Essential fatty acids and the brain. Canadian Journal of Psychiatry. April 2003, 48 (3): 195–203. PMID 12728744. doi:10.1177/070674370304800308.  Author:Kevin R Krull, PhDSection Editor:Marilyn Augustyn, MDDeputy Editor:Mary M Torchia, MD. Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis. UpToDate. [2019-08-03]. （原始内容存档于2018-02-24）.  （页面存档备份，存于互联网档案馆） Rucklidge, Julia J.; Johnstone, Jeanette; Gorman, Brigette; Boggis, Anna; Frampton, Christopher M. Moderators of treatment response in adults with ADHD treated with a vitamin–mineral supplement. Progress in neuro-psychopharmacology & biological psychiatry (Elsevier BV). 2014-04-03, 50: 163–171. ISSN 0278-5846. PMID 24374068. doi:10.1016/j.pnpbp.2013.12.014.  Helen Briggs. Vitamins ‘effective in treating ADHD symptoms’. BBC News. 2014-01-30 [2017-04-13]. （原始内容存档于2017-04-14）. After eight weeks of treatment those on supplements reported greater improvements in both their inattention and hyperactivity/impulsivity compared with those taking the placebo. "Our study provides preliminary evidence of the effectiveness for micronutrients in the treatment of ADHD symptoms in adults," said Prof Julia Rucklidge, who led the study.  （页面存档备份，存于互联网档案馆） Rucklidge, Julia J.; Eggleston, Matthew J.F.; Johnstone, Jeanette M.; Darling, Kathryn; Frampton, Chris M. Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo-controlled trial. Journal of child psychology and psychiatry, and allied disciplines (Wiley). 2018, 59 (3): 232–246. ISSN 0021-9630. PMID 28967099. doi:10.1111/jcpp.12817.  Vitamins: MedlinePlus. MedlinePlus. 2017-10-06 [2017-11-02]. （原始内容存档于2017-11-07）.  （页面存档备份，存于互联网档案馆） FDA Asks Attention-Deficit Hyperactivity Disorder (ADHD) Drug Manufacturers to Develop Patient Medication Guides. Food and Drug Administration. 21 September 2007 [13 April 2009]. （原始内容存档于21 February 2008）.  （页面存档备份，存于互联网档案馆） Ioannidis, K; Chamberlain, SR; Müller, U. Ostracising caffeine from the pharmacological arsenal for attention-deficit hyperactivity disorder—was this a correct decision? A literature review. Journal of Psychopharmacology (Oxford, England). September 2014, 28 (9): 830–6. PMID 24989644. doi:10.1177/0269881114541014.  Schechter, MD; Timmons, GD. Objectively measured hyperactivity—II. Caffeine and amphetamine effects. Journal of Clinical Pharmacology. 1985, 25 (4): 276–80. Bibcode:1991JClP...31..928S. PMID 4008672. doi:10.1002/j.1552-4604.1985.tb02838.x.  Toledano A, Alvarez MI, Toledano-Díaz A. Diversity and variability of the effects of nicotine on different cortical regions of the brain – therapeutic and toxicological implications. Cent Nerv Syst Agents Med Chem. September 2010, 10 (3): 180–206. PMID 20528766. doi:10.2174/1871524911006030180. hdl:10261/61750.  McClernon, FJ; Kollins, SH. ADHD and smoking: from genes to brain to behavior. Annals of the New York Academy of Sciences. October 2008, 1141 (1): 131–47. Bibcode:2008NYASA1141..131M. PMC 2758663 . PMID 18991955. doi:10.1196/annals.1441.016.  Potter, AS; Schaubhut, G; Shipman, M. Targeting the nicotinic cholinergic system to treat attention-deficit/hyperactivity disorder: rationale and progress to date.. CNS Drugs. December 2014, 28 (12): 1103–13. PMC 4487649 . PMID 25349138. doi:10.1007/s40263-014-0208-9.  Gillies D, Sinn JK, Lad SS, Leach MJ, Ross MJ. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2012, 7 (7): CD007986. PMC 6599878 . PMID 22786509. doi:10.1002/14651858.CD007986.pub2.  Bloch MH, Qawasmi A. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. October 2011, 50 (10): 991–1000. PMC 3625948 . PMID 21961774. doi:10.1016/j.jaac.2011.06.008.  Arnold LE, DiSilvestro RA. Zinc in attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology. 2005, 15 (4): 619–27. PMID 16190793. doi:10.1089/cap.2005.15.619. hdl:1811/51593.  Bloch, MH; Mulqueen, J. Nutritional supplements for the treatment of ADHD. Child and Adolescent Psychiatric Clinics of North America. October 2014, 23 (4): 883–97. PMC 4170184 . PMID 25220092. doi:10.1016/j.chc.2014.05.002.  Haslam RH, Dalby JT, Rademaker AW. Effects of megavitamin therapy on children with attention deficit disorders. Pediatrics. 1984, 74 (1): 103–111. PMID 6234505.  Mohammadpour, Nakisa; Jazayeri, Shima; Tehrani-Doost, Mehdi; Djalali, Mahmoud; Hosseini, Mostafa; Effatpanah, Mohammad; Davari-Ashtiani, Rozita; Karami, Elham. Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial. Nutritional neuroscience (Informa UK Limited). 2018, 21 (3): 202–209. ISSN 1028-415X. PMID 27924679. doi:10.1080/1028415x.2016.1262097.