The Mediterranean Diet and ADHD in Children and Adolescents
Abstract
OBJECTIVES: Although attention-deficit/hyperactivity disorder (ADHD) has been related to nutrient deficiencies and "unhealthy" diets, to date there are no studies that examined the relationship between the Mediterranean diet and ADHD. We hypothesized that a low adherence to a Mediterranean diet would be positively associated with an increase in ADHD diagnosis. METHODS: A total of 120 children and adolescents (60 with newly diagnosed ADHD and 60 controls) were studied in a sex- and age-matched case-control study. ADHD diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Energy, dietary intake, adherence to a Mediterranean diet, and familial background were measured. Logistic regression was used to determine associations between the adherence to a Mediterranean diet and ADHD. RESULTS: Lower adherence to a Mediterranean diet was associated with ADHD diagnosis (odds ratio: 7.07; 95% confidence interval: 2.65-18.84; relative risk: 2.80; 95% confidence interval: 1.54-5.25). Both remained significant after adjusting for potential confounders. Lower frequency of consuming fruit, vegetables, pasta, and rice and higher frequency of skipping breakfast and eating at fast-food restaurants were associated with ADHD diagnosis (P < .05). High consumption of sugar, candy, cola beverages, and noncola soft drinks (P < .01) and low consumption of fatty fish (P < .05) were also associated with a higher prevalence of ADHD diagnosis. CONCLUSIONS: Although these cross-sectional associations do not establish causality, they raise the question of whether low adherence to a Mediterranean diet might play a role in ADHD development. Our data support the notion that not only "specific nutrients" but also the "whole diet" should be considered in ADHD.
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In ADHD, high consumption of sugar and candy, cola beverages, and noncola soft drinks and low consumption of fatty fish were associated with higher prevalence of ADHD diagnosis.
“In addition, a high consumption of sugar and candy, cola beverages, and noncola soft drinks and a low consumption of fatty fish were also associated with a higher prevalence of ADHD diagnosis.”
From Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions (2019) · cites this paper as [123]
Low adherence to the Mediterranean diet is associated with odds of an ADHD diagnosis in children and adolescents.
“This was the first study showing that low adherence to the MD is associated with odds of an ADHD diagnosis in children and adolescents.”
From Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions (2019) · cites this paper as [123]
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“An increase in the prevalence of ADHD diagnosis was associated with low adherence to a Mediterranean diet (Rios-Hernandez et al., 2017).”
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Bridging ADHD and Metabolic Disorders: Insights into Shared Mechanisms and Clinical Implications
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“Previous research found a direct association between the Western/unhealthy diet (characterized by high consumption of refined sugar and saturated fat but low consumption of fruits and vegetables) [7,19,20] and a low adherence to a Mediterranean diet with elevated ADHD symptoms [21].”
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Is there a place for dietetic interventions in adult ADHD?
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Macronutrients and water – do they matter in the context of cognitive performance in athletes?
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Advertising Influences Food Choices of University Students With ADHD
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Lifestyle and attention deficit/hyperactivity disorder
Lange, K. W. (2017) · University of Regensburg Publication Server (University of Regensburg) · doi:10.5283/mnhd.10 · Cited by 11 · see citing works
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“15 Additionally, this diet has been shown to lower the risk of depression in adolescents, 16 has been associated with fewer ADHD diagnoses among children, 17 and decreased the cardiovascular risk of obese youth by lowering BMI, glucose, and lipid pro fi les.”
BackgroundAnnual Research Review: Micronutrients and their role in the treatment of paediatric mental illness
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“…ADHD in adults and children, as it is associated with improvements in cognitive function, working memory, executive function, lower impulsivity, and lower prevalence of ADHD overall (Hardman et al., 2016; Ríos-Hernández et al., 2017; San Mauro Martín et al., 2018; San Mauro Martín et al., 2019).”
Preserving Cardiovascular Health in Young Children: Beginning Healthier by Starting Earlier
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The influence of attractiveness and convenience cues on food appeal in adults with and without ADHD
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“Additionally, lower frequency of consuming fruits and vegetables was associated with higher prevalence of ADHD diagnosis and increased level of inattention in a previous cross-sectional analysis of this sample of children with ADHD [7, 10].”
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“…Pelham, 4th revision (SNAP-IV) [31], the Korean ADHD rating scale (K-ARS) [4, 23], Conner abbreviated teacher rating scale (CATRS-10) [33], Hopkins Symptom Checklist (HSCL-10) [27], and the ADHD rating scale-IV (ADHD RS-IV) [19, 38] for the assessment of ADHD symptoms in children or adolescents.”
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“Similarly, a case-control study in Spain indicated that high consumption of sugar-sweetened beverages, such as colas or soft drinks, elevated the risk of ADHD by 3.5 – 3.9 times in children and adolescents aged 6 – 16 years [19].”
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“Based on a study conducted by Rosas-Hernández et al. indicated that a lower adherence to a Mediterranean diet (As one of the components of MIND’s diet) was also associated with higher odds of ADHD, even after adjustment for potential confounding factors (Rios-Hernandez et al., 2017).”
The need for alternative treatments for attention-deficit/hyperactivity disorder
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Pediatric Anti-Inflammatory Diet
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Attention Deficit Hyperactivity Disorder
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“Hernandez et al. 24 reported that ADHD children tend to consume more desserts, candy, and drinks, while lacking a suf fi cient intake of nutritious fi sh. Lewinsohn et al. 25 reported a high prevalence of comorbid eating disorders and substance abuse in children with subthreshold ADHD.”
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“Additionally, the MD contributes to better cognitive and mental health outcomes [8,9].”
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Diet Untuk Anak Attention Deficit Hyperactivity Disorder (ADHD): Tantangan Orang Tua
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“Higher intake of high-fat, high-sugar, and high-additives diets have been signi fi cantly associated with ADHD [22].”
BackgroundBroad spectrum micronutrients: a potential key player to address emotional dysregulation
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Alsoqih, N. S., Elmorsy, E. A., Abu‐Khudir, R., Saber, S., Keshk, N., Elnaghy, F., Hamad, R. S., El-kott, A. F., Negm, S., AlShehri, M. A., et al. (2025) · The FASEB Journal · doi:10.1096/fj.202501829rr · Cited by 4 · see citing works
“Research indicates that children with ADHD are less likely to follow healthy dietary habits compared to their non-ADHD peers [60, 61].”
Beyond the Brain: Attention Deficit/Hyperactivity Disorder and the Gut-Brain Axis
Gandhi, D. N., Pande, D., Harikrishna, A., Advilkar, A., Basavan, I., & Ansari, R. (2024) · Cureus · doi:10.7759/cureus.76291 · Cited by 7 · see citing works
“Concurrently, Ríos-Hernández et al. [100] found that children with ADHD show less adherence to healthy eating patterns than children without this disorder.”
Phatak, M., Nair, B., Soni, U., & Pujari, R. (2025) · Current Drug Metabolism · doi:10.2174/0113892002361676250325082424 · Cited by 3 · see citing works
- Authors
- Ríos-Hernández, A., Alda, J. A., Farran-Codina, A., Ferreira-García, E., & Izquierdo-Pulido, M.
- Affiliations
- Departments of Nutrition, Food Science, and Gastronomy, and
- Hospital Sant Joan de Déu Barcelona (ES)
- ADHD Unit, Child and Adolescent Psychiatry Department, Hospital Sant Joan de Deu, Barcelona, Spain; and
- ORCID
- Alda, José A.
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2017-02-01
- Volume
- 139
- Issue
- 2
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2581960492
- Cited by
- 160
- References
- 50
- Citations by year
- 2026: 20 · 2025: 19 · 2024: 18 · 2023: 13 · 2022: 18 · 2021: 19 · 2020: 20 · 2019: 13 · 2018: 13 · 2017: 7
- FWCI
- 13.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Keywords
- Mediterranean diet, attention deficit hyperactivity disorder, dietary adherence, children, adolescents, dietary intake, fruit and vegetable intake, breakfast skipping, fast food consumption, fatty fish consumption, dietary risk factors
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Cross-Sectional Studies, Feeding Behavior, Female, Humans, Male, Patient Compliance, Surveys and Questionnaires, Spain, Exercise, Body Mass Index, Odds Ratio, Case-Control Studies, Diet, Mediterranean
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