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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 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]
In the citing paper
“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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The influence of attractiveness and convenience cues on food appeal in adults with and without ADHD
Hershko, S., Cortese, S., Ert, E., Aronis, A., Maeir, A., & Pollak, Y. (2020) · Appetite · doi:10.1016/j.appet.2020.104679 · Cited by 10
Robinette, L. M., Hatsu, I. E., Johnstone, J. M., Bruton, A. M., Leung, B. M. Y., & Arnold, L. E. (2023) · Nutritional Neuroscience · doi:10.1080/1028415x.2023.2191415 · Cited by 9
“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].”
BackgroundKhazdouz, M., Safarzadeh, R., Hejrani, B., Hasani, M., Mahdavi, F. S., Ejtahed, H., & Qorbani, M. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02521-8 · Cited by 9
“…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.”
InfluentialZhang, Y., Wu, X., Wang, Q., Zong, Q., Wang, R., Li, T., Tao, S., & Tao, F. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.573168 · Cited by 13
Darzi, M., Abbasi, K., Ghiasvand, R., Tabib, M. A., & Rouhani, M. H. (2022) · BMC Pediatrics · doi:10.1186/s12887-022-03768-3 · Cited by 9
Kim, S.-J., Shin, J., Cha, H. R., Ha, E. K., Kim, J. H., & Han, M. Y. (2024) · Annals of Nutrition and Metabolism · doi:10.1159/000539458 · Cited by 8
“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].”
InfluentialDalnoki, L., Hurks, P. P. M., Gubbels, J. S., Eussen, S. J. P. M., Mommers, M., & Thijs, C. T. (2024) · Journal of Attention Disorders · doi:10.1177/10870547241293946 · Cited by 8
Bayranj, Z., Fotros, D., Sohouli, M. H., Rohani, P., Eslahi, M., Ferdosi, S., Khodadadi, N., & Hosseinzadeh, M. (2024) · Child Neuropsychology · doi:10.1080/09297049.2024.2375493 · Cited by 8
“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
Lange, K. W. (2020) · University of Regensburg Publication Server (University of Regensburg) · doi:10.5283/mnhd.22 · Cited by 11
Zhang, Y., Gui, Z., Jiang, N., Pu, X.-Y., Liu, M., Pu, Y., Huang, S., Huang, S.-Y., & Chen, Y. (2023) · Nutrients · doi:10.3390/nu15041034 · Cited by 7
Pediatric Anti-Inflammatory Diet
Mascarenhas, M. R. (2019) · Pediatric Annals · doi:10.3928/19382359-20190515-02 · Cited by 7
Attention Deficit Hyperactivity Disorder
Katzinger, J. J., Murray, M. T., & Lyon, M. R. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-43044-9.00151-5 · Cited by 7
Namimi‐Halevi, C., Dor, C., Shriqui, V. K., Dichtiar, R., Bromberg, M., & Sinai, T. (2026) · Pediatric Research · doi:10.1038/s41390-026-04844-5 · Cited by 8
Leon, L., Tran, T., Navadia, M., Patel, J., Vanderveen, A., Cruz, M. I., Le, T.-M., Assuah, F. B., Prager, V. R., Patel, D., et al. (2024) · Cureus · doi:10.7759/cureus.55792 · Cited by 6
Long, L., Peng, H., Chen, X., Wang, F. “., Long, W., Cheng, M. H., & Ma, J. (2024) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s449186 · Cited by 6
Contrasting presentations of children with ADHD and subthreshold ADHD
He, L., Zhao, Y., Gong, J.-X., Zhao, L., Ma, Z.-R., Xiong, Q., Cai, S., & Yan, X. (2024) · Pediatric Research · doi:10.1038/s41390-024-03502-y · Cited by 6
“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.”
Wolff, N., Reimelt, C., Ehrlich, S., Hölling, H., Mogwitz, S., & Roessner, V. (2018) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000609 · Cited by 6
Kwon, Y., Park, Y. H., Lee, Y., Lim, L. K. Y., & Lee, J. (2024) · Nutrients · doi:10.3390/nu16162754 · Cited by 5
“Additionally, the MD contributes to better cognitive and mental health outcomes [8,9].”
Darand, M., Hassanizadeh, S., Martami, F., Shareghfarid, E., Hosseinpour‐Niazi, S., & Hosseinzadeh, M. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.06.006 · Cited by 6
Diet Untuk Anak Attention Deficit Hyperactivity Disorder (ADHD): Tantangan Orang Tua
Siron, Y., Muslihah, L., Sari, N., & Dina, A. E. S. (2021) · Jurnal Pendidikan Anak Usia Dini Undiksha · doi:10.23887/paud.v8i3.25701 · Cited by 6
Gumma, S. D., Elotla, S. F., Ibrahim, O., & Rizkalla, N. H. (2023) · European Journal of Clinical Nutrition · doi:10.1038/s41430-023-01345-0 · Cited by 7
“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
Villagomez, A., Cross, M., & Ranjbar, N. E. (2023) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2023.1295635 · Cited by 5
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 5
“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
“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
Metadata
- 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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