Prevalence of obesity and overweight among Chinese children with attention deficit hyperactivity disorder: a survey in Zhejiang Province, China

BMC Psychiatry

Zhengyan Zhao²  Rong Li³  Suhan Zhang³  Shujiong Mao¹  Rongwang Yang³ 

[1] Department of Pediatrics, The First People’s Hospital of Hangzhou, Hangzhou, Zhejiang Province, China;Department of Child Health Care, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China;Department of Child Psychology, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China

关键词: Prevalence;    Children;    Comorbidity;    Obesity;    Attention deficit hyperactivity disorder;   

Others  :  1124060
DOI  :  10.1186/1471-244X-13-133

 received in 2012-11-29, accepted in 2013-05-07,  发布年份 2013

【 摘 要 】

Background

Attention Deficit Hyperactivity Disorder (ADHD) is often comorbid with psychiatric and developmental disorders. This study aimed to investigate the prevalence of obesity and overweight among Chinese children with ADHD, and to explore which subtypes of the disorder may specifically be associated with obesity/overweight.

Methods

Children meeting the DSM-IV criteria for ADHD were enrolled in the study. Weight, weight z-score, height, height z-score, BMI, and BMI z-score were used to evaluate growth status. Obesity and overweight were determined using the National Growth Reference for Chinese Children and Adolescents. Relations between the prevalence of obesity/overweight and different ADHD subtypes and pubertal development were analyzed.

Results

A total of 158 children with ADHD (mean age: 9.2 years) were recruited for the study. The prevalences of obesity, overweight, and combined obesity/overweight were 12.0%, 17.1%, and 29.1%, respectively, which were significantly higher than in the general Chinese population (2.1%, 4.5%, and 6.6%, respectively). Multivariable analysis showed that the children with the combined subtype of ADHD and the onset of puberty were at a higher risk of becoming obese or overweight.

Conclusions

The prevalence of obesity in Chinese children with ADHD is higher than that of the general population. Children with the ADHD combined subtype who were at the onset of puberty were more likely to be overweight or obese.

【 授权许可】

   
2013 Yang et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]American Psychiatric Association: Diagnostic and statistical manual of mental disorders. 4th edition. Washington, DC: American Psychiatric Association; 1994.
• [2]Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder: Pediatrics. 2001, 108(4):1033-1044.
• [3]Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA: The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007, 164(6):942-948.
• [4]Biederman J, Kwon A, Aleardi M, Chouinard VA, Marino T, Cole H, Mick E, Faraone SV: Absence of gender effects on attention deficit hyperactivity disorder: findings in nonreferred subjects. Am J Psychiatry 2005, 162(6):1083-1089.
• [5]Smalley SL, McGough JJ, Moilanen IK, Loo SK, Taanila A, Ebeling H, Hurtig T, Kaakinen M, Humphrey LA, McCracken JT: Prevalence and psychiatric comorbidity of attention-deficit/hyperactivity disorder in an adolescent Finnish population. J Am Acad Child Adolesc Psychiatry 2007, 46(12):1575-1583.
• [6]Jensen PS, Martin D, Cantwell DP: Comorbidity in ADHD: implications for research, practice, and DSM-V. J Am Acad Child Adolesc Psychiatry 1997, 36(8):1065-1079.
• [7]Newcorn JH, Halperin JM, Jensen PS, Abikoff HB, Arnold LE, Cantwell DP, Conners CK, Elliott GR, Epstein JN, Greenhill LL: Symptom profiles in children with ADHD: effects of comorbidity and gender. J Am Acad Child Adolesc Psychiatry 2001, 40(2):137-146.
• [8]Spencer TJ: ADHD and comorbidity in childhood. J Clin Psychiatry 2006, 67(Suppl 8):27-31.
• [9]Dulcan M: Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 1997, 36(10 Suppl):85S-121S.
• [10]Purper-Ouakil D, Wohl M, Michel G, Mouren MC, Gorwood P: Symptom variations in ADHD: importance of context, development and comorbidity. Encéphale 2004, 30(6):533-539.
• [11]Rasmussen P, Gillberg C: Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study. J Am Acad Child Adolesc Psychiatry 2000, 39(11):1424-1431.
• [12]Cortese S, Angriman M, Maffeis C, Isnard P, Konofal E, Lecendreux M, Purper-Ouakil D, Vincenzi B, Bernardina BD, Mouren MC: Attention-deficit/hyperactivity disorder (ADHD) and obesity: a systematic review of the literature. Crit Rev Food Sci Nutr 2008, 48(6):524-537.
• [13]Levy LD, Fleming JP, Klar D: Treatment of refractory obesity in severely obese adults following management of newly diagnosed attention deficit hyperactivity disorder. Int J Obes (Lond) 2009, 33(3):326-334.
• [14]Erhart M, Herpertz-Dahlmann B, Wille N, Sawitzky-Rose B, Holling H, Ravens-Sieberer U: Examining the relationship between attention-deficit/hyperactivity disorder and overweight in children and adolescents. Eur Child Adolesc Psychiatry 2012, 21(1):39-49.
• [15]Cortese S, Morcillo Penalver C: Comorbidity between ADHD and obesity: exploring shared mechanisms and clinical implications. Postgrad Med 2010, 122(5):88-96.
• [16]Altfas JR: Prevalence of attention deficit/hyperactivity disorder among adults in obesity treatment. BMC Psychiatry 2002, 2:9. BioMed Central Full Text
• [17]Holtkamp K, Konrad K, Muller B, Heussen N, Herpertz S, Herpertz-Dahlmann B, Hebebrand J: Overweight and obesity in children with attention-deficit/hyperactivity disorder. Int J Obes Relat Metab Disord 2004, 28(5):685-689.
• [18]Lam LT, Yang L: Overweight/obesity and attention deficit and hyperactivity disorder tendency among adolescents in China. Int J Obes (Lond) 2007, 31(4):584-590.
• [19]Waring ME, Lapane KL: Overweight in children and adolescents in relation to attention-deficit/hyperactivity disorder: results from a national sample. Pediatrics 2008, 122(1):e1-e6.
• [20]Dubnov-Raz G, Perry A, Berger I: Body mass index of children with attention-deficit/hyperactivity disorder. J Child Neurol 2011, 26(3):302-308.
• [21]Curtin C, Bandini LG, Perrin EC, Tybor DJ, Must A: Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: a chart review. BMC Pediatr 2005, 5:48. BioMed Central Full Text
• [22]Erermis S, Cetin N, Tamar M, Bukusoglu N, Akdeniz F, Goksen D: Is obesity a risk factor for psychopathology among adolescents? Pediatr Int 2004, 46(3):296-301.
• [23]Fleming JP, Levy LD, Levitan RD: Symptoms of attention deficit hyperactivity disorder in severely obese women. Eat Weight Disord 2005, 10(1):e10-e13.
• [24]Agranat-Meged AN, Deitcher C, Goldzweig G, Leibenson L, Stein M, Galili-Weisstub E: Childhood obesity and attention deficit/hyperactivity disorder: a newly described comorbidity in obese hospitalized children. Int J Eat Disord 2005, 37(4):357-359.
• [25]Lin CD, Zhang HC: Manual of Chinese revised Wechsler intelligence scale for children (Chinese version). Beijing: Capital Normal University Press; 1986.
• [26]Li H: Growth chart for Chinese children and adolescents aged 0 to 18 years. Shanghai: Second military medical university press; 2010.
• [27]Li H, Ji CY, Zong XN, Zhang YQ: Body mass index growth curves for Chinese children and adolescents aged 0 to 18 years. Zhonghua Er Ke Za Zhi 2009, 47(7):493-498.
• [28]Wu Y: Overweight and obesity in China. BMJ 2006, 333(7564):362-363.
• [29]Yang Y: Prevalence of simple obesity among children aged 6–13 in Zhoushan. Zhongguo Xuexiao Weisheng 2006, 27(5):376-377.
• [30]Shan XY, Xi B, Cheng H, Hou DQ, Wang Y, Mi J: Prevalence and behavioral risk factors of overweight and obesity among children aged 2–18 in Beijing, China. Int J Pediatr Obes 2010, 5(5):383-389.
• [31]Ying-Xiu Z, Shu-Rong W: Secular trends in body mass index and the prevalence of overweight and obesity among children and adolescents in Shandong, China, from 1985 to 2010. J Public Health (Oxf) 2012, 34(1):131-137.
• [32]Tang Q, Chen S: Comparison of incidences of obesity in children in urban area and rural area of Nanning. Guangxi. Zhongguo Fuyou Baojian 2011, 26(3):380-382.
• [33]Chen S, Sun Y, Lv J, Hua C, Yang L: Investigation of the physical health on 860 children and adolescents in Harbin. Journal of Harbin Medical University 2010, 44(3):233-236.
• [34]Wang H, Ran Y, Cao L, Li W, Zhang J, Chen J: Epidemiological investigation of obesity in children and adolescents aged 0–18 years in Chengdu. Xiandai Yufang Yixue 2008, 35(3):460-462.
• [35]Jiang R: The survey of the obesity and risk factors in 6098 school-aged children. Zhongguo Ertong Baojian Zazhi 2005, 13(3):256-257.
• [36]Sun G, Wu G, Gu Y, Qi X, Huang L, Zhao Y, Bi X, Yang B: Study on children adiposis in Tianjin area and its risk factors. Tianjin Yiyao 2004, 32(10):607-609.
• [37]Luo F, Shen S, Tu Y, Xia H, Zhi D, Yao J, Sun L, Hong Q, Ye J, Zhao Z: The prevalence of obesity in Shanghai children and adolescents aged 6–18 years. Chinese Journal of Diabetes 2004, 12(6):427-429.
• [38]Li M, Dibley MJ, Sibbritt DW, Yan H: Dietary habits and overweight/obesity in adolescents in Xi'an City, China. Asia Pac J Clin Nutr 2010, 19(1):76-82.
• [39]Safer D, Allen R, Barr E: Depression of growth in hyperactive children on stimulant drugs. N Engl J Med 1972, 287(5):217-220.
• [40]Mattes JA, Gittelman R: Growth of hyperactive children on maintenance regimen of methylphenidate. Arch Gen Psychiatry 1983, 40(3):317-321.
• [41]Biederman J, Faraone SV, Monuteaux MC, Plunkett EA, Gifford J, Spencer T: Growth deficits and attention-deficit/hyperactivity disorder revisited: impact of gender, development, and treatment. Pediatrics 2003, 111(5 Pt 1):1010-1016.
• [42]Odent M: Attention deficit hyperactivity disorder (ADHD) and obesity: two facets of the same disease? Med Hypotheses 2010, 74(1):139-141.
• [43]Liu LL, Li BM, Yang J, Wang YW: Does dopaminergic reward system contribute to explaining comorbidity obesity and ADHD? Med Hypotheses 2008, 70(6):1118-1120.
• [44]Cortese S, Konofal E, Dalla Bernardina B, Mouren MC, Lecendreux M: Does excessive daytime sleepiness contribute to explaining the association between obesity and ADHD symptoms? Med Hypotheses 2008, 70(1):12-16.
• [45]Stice E, Figlewicz DP, Gosnell BA, Levine AS, Pratt WE: The contribution of brain reward circuits to the obesity epidemic. Neurosci Biobehav Rev 2012. http://dx.doi.org/10.1016/j.neubiorev.2012.12.001 webcite
• [46]Bazar KA, Yun AJ, Lee PY, Daniel SM, Doux JD: Obesity and ADHD may represent different manifestations of a common environmental oversampling syndrome: a model for revealing mechanistic overlap among cognitive, metabolic, and inflammatory disorders. Med Hypotheses 2006, 66(2):263-269.
• [47]Tsai SJ, Hong CJ, Yu YW, Chen TJ: Association study of catechol-O-methyltransferase gene and dopamine D4 receptor gene polymorphisms and personality traits in healthy young chinese females. Neuropsychobiology 2004, 50(2):153-156.
• [48]Mitsuyasu H, Hirata N, Sakai Y, Shibata H, Takeda Y, Ninomiya H, Kawasaki H, Tashiro N, Fukumaki Y: Association analysis of polymorphisms in the upstream region of the human dopamine D4 receptor gene (DRD4) with schizophrenia and personality traits. J Hum Genet 2001, 46(1):26-31.
• [49]Noble EP: D2 dopamine receptor gene in psychiatric and neurologic disorders and its phenotypes. Am J Med Genet B Neuropsychiatr Genet 2003, 116B(1):103-125.
• [50]Poston WS 2nd, Ericsson M, Linder J, Haddock CK, Hanis CL, Nilsson T, Astrom M, Foreyt JP: D4 dopamine receptor gene exon III polymorphism and obesity risk. Eat Weight Disord 1998, 3(2):71-77.
• [51]Bobb AJ, Castellanos FX, Addington AM, Rapoport JL: Molecular genetic studies of ADHD: 1991 to 2004. Am J Med Genet B Neuropsychiatr Genet 2005, 132B(1):109-125.
• [52]Scheres A, Tontsch C, Lee Thoeny A: Steep temporal reward discounting in ADHD-combined type: acting upon feelings. Psychiatry Res 2013. http://dx.doi.org/10.1016/j.psychres.2012.12.007 webcite
• [53]Lecendreux M, Cortese S: Sleep problems associated with ADHD: a review of current therapeutic options and recommendations for the future. Expert Rev Neurother 2007, 7(12):1799-1806.
• [54]Vgontzas AN: Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance? Arch Physiol Biochem 2008, 114(4):211-223.
• [55]Cortese S, Konofal E, Yateman N, Mouren MC, Lecendreux M: Sleep and alertness in children with attention-deficit/hyperactivity disorder: a systematic review of the literature. Sleep 2006, 29(4):504-511.
• [56]Cortese S, Maffeis C, Konofal E, Lecendreux M, Comencini E, Angriman M, Vincenzi B, Pajno-Ferrara F, Mouren MC, Dalla Bernardina B: Parent reports of sleep/alertness problems and ADHD symptoms in a sample of obese adolescents. J Psychosom Res 2007, 63(6):587-590.
• [57]Fuemmeler BF, Ostbye T, Yang C, McClernon FJ, Kollins SH: Association between attention-deficit/hyperactivity disorder symptoms and obesity and hypertension in early adulthood: a population-based study. Int J Obes (Lond) 2011, 35(6):852-862.
• [58]Davis C, Levitan RD, Smith M, Tweed S, Curtis C: Associations among overeating, overweight, and attention deficit/hyperactivity disorder: a structural equation modelling approach. Eat Behav 2006, 7(3):266-274.
• [59]van Egmond-Frohlich AW, Widhalm K, de Zwaan M: Association of symptoms of attention-deficit/hyperactivity disorder with childhood overweight adjusted for confounding parental variables. Int J Obes (Lond) 2012, 36(7):963-968.
• [60]Marks S, Shaikh U, Hilty DM, Cole S: Weight status of children and adolescents in a telepsychiatry clinic. Telemed J E Health 2009, 15(10):970-974.