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Cited by 260Attention Deficit Hyperactivity DisorderDye analysis and toxicityBehavioral and Psychological Studies

Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives

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Nigg, Joel T., Lewis, Kara, Edinger, Tracy, Falk, Michael·2012·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2011.10.015PMC PMC4321798
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Abstract

Objective The role of diet and of food colors in attention-deficit/hyperactivity disorder (ADHD) or its symptoms warrants updated quantitative meta-analysis, in light of recent divergent policy in Europe and the United States.Method Studies were identified through a literature search using the PubMed, Cochrane Library, and PsycNET databases through February 2011. Twenty-four publications met inclusion criteria for synthetic food colors; 10 additional studies informed analysis of dietary restriction. A random-effects meta-analytic model generated summary effect sizes.Results Restriction diets reduced ADHD symptoms at an effect of g = 0.29 (95% CI, 0.07-0.53). For food colors, parent reports yielded an effect size of g = 0.18 (95% CI, 0.08-0.24; p = .0007), which decreased to 0.12 (95% CI, 0.01-0.23; p < .05) after adjustment for possible publication bias. The effect was reliable in studies restricted to food color additives (g = 0.21, 95% CI = 0.06-0.36) but did not survive correction for possible publication bias and was not reliable in studies confined to Food and Drug Administration-approved food colors. Teacher/observer reports yielded a nonsignificant effect of 0.07 (95% CI = -0.03 to 0.18; p = .14). However, high-quality studies confined to color additives yielded a reliable effect (g = 0.22, 95% CI = 0.10-0.41, p = .030) that survived correction. In psychometric tests of attention, the summary effect size was 0.27 (95% CI = 0.07-0.47; p = .007) and survived correction. An estimated 8% of children with ADHD may have symptoms related to synthetic food colors.Conclusions A restriction diet benefits some children with ADHD. Effects of food colors were notable were but susceptible to publication bias or were derived from small, nongeneralizable samples. Renewed investigation of diet and ADHD is warranted.

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  • Artificial food dyes show a very small increase in ADHD symptoms only in parent ratings, not teacher or observer ratings.

    “Another meta-analysis, covering 20 studies with a combined total of 794 individuals, found a very small increase in ADHD symptoms, but only when rated by parents, not by teachers or other observers”

    From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Nigg et al., 2012

    The Results (Synthetic Food Additives, Parent Reports) report 20 studies with 794 participants and a small parent-rated effect (g = 0.18). The Teacher/Observer Reports section finds no significant effect when those reports are pooled, but does find a reliable effect in studies confined to food colors. Thus, “only” parent ratings overstates the finding, and the 794 participants are the parent-report sample. (LLM, conf=0.88)

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  • Restricting synthetic food colors from children's diets was associated with a small reduction in ADHD symptoms.

    “A meta-analysis of five double-blind crossover studies with 164 participants found that restricting synthetic food colors from children’s diets was associated with a small reduction in ADHD symptoms (Nigg et al., 2012).”

    From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Nigg et al., 2012

    The Results > Dietary Restriction section reports a small reduction in ADHD symptoms (g = 0.29) across five studies after an outlier was removed, leaving 164 children. But those studies tested restriction diets that removed food colors alongside other foods or additives, not the restriction of synthetic colors alone. The paper also describes the original six studies as using either a placebo-controlled diet challenge or a crossover design, so it does not establish that all five were double-blind crossover studies. (LLM, conf=0.88)

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Authors
Nigg, J. T., Lewis, K., Edinger, T., & Falk, M.
Affiliations
Oregon Health & Science University (US)
Corresponding author
Nigg, Joel T.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2012-01
Volume
51
Issue
1
Pages
86-97.e8
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2011.10.015
PMC
PMC4321798
OpenAlex
W2141557060
Cited by
260
References
57
Citations by year
2026: 13 · 2025: 18 · 2024: 20 · 2023: 16 · 2022: 21 · 2021: 18 · 2020: 22 · 2019: 16 · 2018: 14 · 2017: 19 · 2016: 18 · 2015: 18 · 2014: 24 · 2013: 12 · 2012: 11
FWCI
1.97
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH059105)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Physical Sciences › Chemistry › Analytical Chemistry › Dye analysis and toxicity
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
Keywords
attention deficit hyperactivity disorder, dietary restriction, ADHD symptoms, children, publication bias, attention tests
MeSH terms
Attention, Attention Deficit Disorder with Hyperactivity, Food Coloring Agents, Humans, Neuropsychological Tests, United States

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