目的 评估注意缺陷多动障碍(ADHD)儿童的营养素水平及体脂代谢情况,分析营养代谢水平与大脑皮质功能的相关性,为ADHD的临床诊疗提供参考依据。方法 选取2020年1-12月就诊于上海市儿童医院儿童保健科,初诊确诊为ADHD的患儿,招募同期体检的正常儿童,由家长提供人口学资料,临床医师对所有研究对象进行访谈评估。借助人体成份分析仪及脑功能定量成像装置分别检测体脂及脑功能,对所有研究对象行静脉血检测以获取维生素、微量元素、25(OH)D等营养素水平。结果 选取筛选后的有效样本共60名,其中ADHD组和对照组各30名,维生素B12水平分别为(375.45±69.25)pm/ml、(421.68±103.72)pm/ml,差异有统计学意义(t=2.031,P<0.05)。与正常儿童相比,ADHD儿童的体重指数(BMI)及体脂率明显增加(t=2.026、2.106,P<0.05)。ADHD的脑皮质功能受损以右前额叶背外侧区域最为显著,25(OH)D、维生素E水平与大脑皮质激活程度相关(r=0.695、-0.571,P<0.05)。结论 ADHD儿童存在更高的肥胖风险,25(OH)D与大脑皮质激活程度呈正相关,可为临床辅助诊疗提供参考。
Abstract
Objective To assess nutrient level and body fat metabolism of children with attention deficit hyperactivity disorder (ADHD), and to analyze the correlation between nutrient metabolism and cerebral cortex function, thus to provide reference for clinical diagnosis and treatment of ADHD. Methods Children diagnosed with ADHD in theDepartment ofChild Health Care in Shanghai Children's Hospital were enrolled in this study from January to December 2020. Children who had regular physical examinations during the same period were recruited. Demographic data were collected from parents, then clinicians conducted interviews and assessments with children using body composition analyzers and brain function quantitative imaging devices to test body fat metabolism and brain function indicators. Venous blood tests were performed on all participants to obtain vitamins, trace elements, 25-hydroxyl vitamin D [25(OH)D] and other nutrients levels. Results Totally 60 effective samples were selected after screening, including 30 children in ADHD group and 30 children in control group. Vitamin B12 levelsof children in ADHD group and control group were (375.45±69.25) pm/ml and (421.68±103.72) pm/ml, respectively,and the difference was significant(t=2.031,P<0.05).Compared with children in control group, the body mass index (BMI) and body fat rate of ADHD children increased significantly (t=2.026, 2.106, P<0.05). The impairment of cerebral cortex function of ADHD was most prominent in the dorsolateral right prefrontal lobe. The levels of 25(OH)D and vitamin E were related to the degree of cerebral cortex activation (r=0.695, -0.571, P<0.05). Conclusions ADHD children have a higher risk of obesity. 25(OH)D is positively correlated with the degree of cerebral cortex activation,which may provide reference for auxiliary treatment of ADHD.
关键词
注意缺陷多动障碍 /
营养素 /
体脂代谢 /
脑功能
Key words
attention deficit hyperactivity disorder /
nutrients /
body fat metabolism /
brain function
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 童连,史慧静.中国儿童ADHD流行状况Meta分析[J].中国公共卫生,2013,29(9):1279-1283.
[2] Bull-Larsen S, Mohajeri MH. The potential influence of the bacterial microbiome on the development and progression of ADHD[J]. Nutrients, 2019,11(11):2805.
[3] 杨玉凤.重视早期营养对婴幼儿认知发展及行为疾病的重要性[J].中国儿童保健杂志,2021,29(2):117-119.
[4] Mohammadpour N, Jazayeri S. Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms:A randomized, double blind, placebo-controlled trial[J]. Nutr Neurosci,2018,21(3):202-209.
[5] Patrick RP, Ames BN. Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2:Relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior[J]. Faseb J,2015,29(6):2207-2222.
[6] Cortese S, Moreira-Maia CR. Association between ADHD and obesity:A systematic review and Meta-analysis[J]. Am J Psychiatry,2016,173(1):34-43.
[7] Friedman LA, Rapoport JL. Brain development in ADHD[J]. Curr Opin Neurobiol, 2015,30:106-111.
[8] American AP. Diagnostic and statistical manual of mental disorders (DSM-IV) [M].4th ed.Washington DC:American Psychiatric Association,2013.
[9] Cortese S, Tessari L. Attention-deficit/hyperactivity disorder (ADHD) and obesity:Update 2016[J]. Curr Psychiatry Rep,2017,19(1):4.
[10] Scholle O,Jilani H.Use of nutritional supplements in youth with medicated and unmedicated attention-deficit/hyperactivity disorder[J].J Child Adolesc Psychopharmacol,2019,29(1):58-65.
[11] Verlaet AAJ,Maasakkers CM.Rationale for dietary antioxidant treatment of ADHD[J].Nutrients,2018,10(4):40.
[12] 王俊丽,盛晓阳.学龄期注意缺陷多动障碍儿童的健康状况[J].教育生物学杂志,2020,8(4):250-256.
[13] 陈书进,吴丹丹.注意缺陷多动障碍和肥胖共病机制的研究进展[J/OL].中国儿童保健杂志.[2021-05-03].https://kns.cnki.net/kcms/detail/61.1346.R.20210330.1019.008.html.
[14] Mauri M, Nobile M. Light up ADHD:I. Cortical hemodynamic responses measured by functional near infrared spectroscopy (fNIRS):Special section on "translational and neuroscience studies in affective disorders"[J].J Affect Disord,2018,234:358-364.
[15] Arai S, Okamoto Y. Altered frontal pole development affects self-generated spatial working memory in ADHD[J]. Brain Dev,2016,38(5):471-480.
[16] Ichikawa H, Nakato E. Hemodynamic response of children with attention-deficit and hyperactive disorder (ADHD) to emotional facial expressions[J]. Neuropsychologia,2014,63:51-58.
[17] Yasumura A, Kokubo N. Neurobehavioral and hemodynamic evaluation of stroop and reverse stroop interference in children with attention-deficit/hyperactivity disorder[J]. Brain Dev,2014,36(2):97-106.
[18] Friedman LA, Rapoport JL. Brain development in ADHD[J]. Curr Opin Neurobiol, 2015,30:106-111.
[19] Bruchhage MMK, Bucci MP. Cerebellar involvement in autism and ADHD[J]. Handb Clin Neurol,2018,155:61-72.
[20] Grazioli S, Mauri M. Light up ADHD:II. Neuropharmacological effects measured by near infrared spectroscopy:is there a biomarker?[J]. J Affect Disord,2019,244:100-106.
[21] Araki A, Ikegami M, Okayama A, et al. Improved prefrontal activity in AD/HD children treated with atomoxetine:a NIRS study[J]. Brain Dev,2015,37(1):76-87.
基金
国家自然科学基金面上项目(81670810);上海市科委医学引导类(中、西医)科技支撑项目(18411967700);上海市卫健委老龄化和妇幼健康专项(2020YJZX0207);上海交通大学“交大之星”计划医工交叉研究基金(YG2019ZDB01);上海市儿童健康服务能力建设专项规划(GDEK201710);上海市临床重点专科项(shslczdzk05705);上海市科委医学引导类科技支撑项目(19411969000);上海市自然科学基金项目(19ZR1477700)
PDF(531 KB)
