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ADHD in childhood predicts BMI and body composition measurements over time in a population-based birth cohort



Obesity has been reported as an attention-deficit hyperactivity disorder (ADHD) comorbidity. So far, few studies have aimed to explore the potential causal relationship between ADHD and obesity, as well as used other measures of body composition like fat-free mass (FFM) and fat mass (FM) as measures of obesity. This study aimed to test the association between ADHD and body composition (body mass index [BMI] and others) and to evaluate the potential causal relationship with obesity.


Data from the 1993 Pelotas (Brazil) birth cohort at age 11-, 15-, 18-, and 22-year follow-up was used. We performed a cross-lagged panel model (CLPM) analysis between ADHD symptoms and BMI to explore the causal relationship between both traits. Finally, we tested whether ADHD, inattention, and hyperactivity symptom scales were associated with BMI, FM, and FFM at 22 years.


In the CLPM, higher ADHD scores at age 11 predicted higher BMI at age 15 (β = 0.055, 95% CI [0.037; 0.073]). ADHD symptoms at age 11 was also associated with a decrease in the FFM (β = −0.16, 95% CI [−0.28; −0.05]), and an increase in the BMI (β = 0.17, 95% CI [0.10; 0.23]) and FM (β = 0.17, 95% CI [0.06; 0.29]) at 22 years. At 22 years of age, ADHD was associated with FFM and FM. Moreover, an increase in BMI was observed with an increase in several symptoms of ADHD in general (β = 0.06, 95% CI [0.004; 0.12]), and hyperactivity symptoms (β = 0.15, 95% CI [0.05; 0.25]).


ADHD at 11 years predicted a higher BMI at 15 years, and body fat composition in adulthood, suggesting higher scores on ADHD symptoms in early life may be a critical point for body composition in early adulthood. The hyperactivity symptoms may play an important role in the BMI increase.

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Fig. 1: Effect size (beta coefficient) of the bidirectional association tests between ADHD symptoms and body mass index estimated by cross-lagged panel models among participants in the 1993 Pelotas (Brazil) Birth Cohort.


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This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) – Finance Code 001.

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Authors and Affiliations



TM-S, JSV, JLS, and LT-R conceived the work. TM-S, JSV, and LT-R conducted the analyses. TM-S and LT-R drafted the first version of the manuscript. GAS, MXC, ESV, VB, EHG, CLdM, FB, AMBM, HG, FCW, and LAR revised the manuscript critically and contributed with interpretation of the findings. All authors gave final approval of the version to be published.

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Correspondence to Thais Martins-Silva.

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Competing interests

LAR has received grant or research support from, served as a consultant to, and served on the speakers’ bureau of Aché, Bial, Medice, Novartis/Sandoz, Pfizer/Upjohn, and Shire/Takeda in the last 3 years. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by LAR have received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Novartis/Sandoz and Shire/Takeda. LAR has received authorship royalties from Oxford Press and ArtMed. All other authors declare that they have no conflicts of interest.

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Martins-Silva, T., dos Santos Vaz, J., Schäfer, J.L. et al. ADHD in childhood predicts BMI and body composition measurements over time in a population-based birth cohort. Int J Obes 46, 1204–1211 (2022).

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