Environmental factors, such as sugar and sugar-sweetened beverage consumption may contribute to the development of Attention Deficit Hyperactivity Disorder (ADHD) in childhood and adolescence. The purpose of this meta-analysis and systematic review was to determine the effect of dietary sugars and sugar sweetened beverages on ADHD symptoms. Inclusion criteria were: 1) observational study design, 2) English language, 3) reported odds ratios, hazard ratios, relative risks with 95% confidence intervals for ADHD in relation to sugar and sugar-sweetened beverage consumption. Studies that were not observational were excluded. A total of seven studies with 25,945 children and adolescents (greater than or equal to seven years-old) were included for analysis. Odds ratios and standard errors were calculated to determine overall effect sizes, and the random effects model was used if there was significance of heterogeneity among studies. Results showed a positive association between consumption of sugar and sugar-sweetened beverages, and symptoms of ADHD (pooled effect size: 1.22, 95% CI: 1.04-1.42, p = 0.01) with significant heterogeneity (p<0.0001). More research controlling for confounding variables is needed to determine the cause-and-effect relationship between sugar intake and ADHD symptoms.

Study strengths: ADHD is a noteworthy concern among children since it can contribute to poor academic and social outcomes, and this study highlighted sugar intake as an important environmental variable to be considered.

Study limitations: Sugar was defined as “sugar, sweets, added sugar, sugary foods, sugary drinks, and sugar-sweetened beverages”, and was not limited to added sugar. Additionally, assessment of sugar intake varied between studies, which resulted in significant heterogeneity.  This study was unable to assess the relationship between other factors that may contribute to ADHD symptoms (i.e., caffeine, artificial colors and flavorings). Additionally, the studies analyzed were observational in nature and cannot determine causality.

What this means for your practice: More research is needed to understand the relationship between dietary sugar and ADHD symptoms.  However, most children consume too much sugar and sugar-sweetened beverages represent a significant source.  When counseling parents, including those of children with ADHD, encourage them to offer a well-balanced diet and to limit added sugars.  Replacing sugar-sweetened beverages with more healthful beverages such as water and fat-free/low-fat milk, is one way to accomplish this.

Original citation: Farsad-Naeimi, A., Asjodi, F., Omidian, M., Askari, M., Nouri, M., Pizarro, A. B., & Daneshzad, E. (2020). Sugar consumption, sugar sweetened beverages and Attention Deficit Hyperactivity Disorder: A systematic review and meta-analysis. Complementary Therapies in Medicine, 102512.

About the Author:  Chenin Treftz, Ph.D., R.D.N., is a member of the research faculty at the University of Nevada, Reno.  Dr. Treftz has expertise in research, community nutrition, and higher education. Dr. Treftz has been a member of the Rethink Your Drink team since 2012.

The goal of Rethink Your Drink Nevada is to promote healthy beverages and reduce sugary drinks. To support this goal, free educational resources are available to eligible medical and dental care practices in Nevada.  For more information, please visit www.rethinkyourdrinknevada.com/healthpros or e-mail rethinkyourdrinknevada@cabnr.unr.edu.

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