Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

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

International Journal of Obesity volume 46, pages 1204–1211 (2022)Cite this article

Subjects

Abstract

Background/Objectives

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.

Subjects/Methods

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.

Results

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]).

Conclusion

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

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.

Similar content being viewed by others

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th rev ed. Washington, DC: APA; 2013.

  2. WHO. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a World Health Organization Consultation. ObesityTechnical Report Series. 2000;284:256.

    Google Scholar 

  3. 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;7:266–74.

    Article  Google Scholar 

  4. Van der Oord S, Braet C, Cortese S, Claes L. Testing the dual pathway model of ADHD in obesity: a pilot study. Eat Weight Disord. 2018;23:507–12.

    Article  Google Scholar 

  5. Cortese S, Castellanos FX. The relationship between ADHD and obesity: implications for therapy. Expert Rev Neurother. 2014;14:473–9.

    Article  CAS  Google Scholar 

  6. Cortese S, Holtmann M, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, et al. Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents. J Child Psychol Psychiatry. 2013;54:227–46.

    Article  Google Scholar 

  7. Sahin S, Yuce M, Alacam H, Karabekiroglu K, Say GN, Salıs O. Effect of methylphenidate treatment on appetite and levels of leptin, ghrelin, adiponectin, and brain-derived neurotrophic factor in children and adolescents with attention deficit and hyperactivity disorder. Int J Psychiatry Clin Pract. 2014;18:280–7.

    Article  CAS  Google Scholar 

  8. Link JC, Reue K. Genetic basis for sex differences in obesity and lipid metabolism. Annu Rev Nutr. 2017;37:225–45.

    Article  CAS  Google Scholar 

  9. Bowling AB, Tiemeier HW, Jaddoe VWV, Barker ED, Jansen PW. ADHD symptoms and body composition changes in childhood: a longitudinal study evaluating directionality of associations. Pediatr Obes. 2018;13:567–75.

    Article  CAS  Google Scholar 

  10. Ebenegger V, Marques-Vidal P-M, Munsch S, Quartier V, Nydegger A, Barral J, et al. Relationship of hyperactivity/inattention with adiposity and lifestyle characteristics in preschool children. J Child Neurol. 2012;27:852–8.

    Article  Google Scholar 

  11. Khalife N, Kantomaa M, Glover V, Tammelin T, Laitinen J, Ebeling H, et al. Childhood attention-deficit/hyperactivity disorder symptoms are risk factors for obesity and physical inactivity in adolescence. J Am Acad Child Adolesc Psychiatry. 2014;53:425–36.

    Article  Google Scholar 

  12. Schwartz BS, Bailey-Davis L, Bandeen-Roche K, Pollak J, Hirsch AG, Nau C, et al. Attention deficit disorder, stimulant use, and childhood body mass index trajectory. Pediatrics. 2014;133:668–76.

    Article  Google Scholar 

  13. Cortese S, Ramos Olazagasti MA, Klein RG, Castellanos FX, Proal E, Mannuzza S. Obesity in men with childhood ADHD: a 33-year controlled, prospective, follow-up study. Pediatrics. 2013;131:e1731–8.

    Article  Google Scholar 

  14. White B, Nicholls D, Christie D, Cole TJ, Viner RM. Childhood psychological function and obesity risk across the lifecourse: findings from the 1970 British Cohort Study. Int J Obes (Lond). 2012;36:511–6.

    Article  CAS  Google Scholar 

  15. Cortese S, Tessari L. Attention-deficit/hyperactivity disorder (ADHD) and obesity: update 2016. Curr Psychiatry Rep. 2017;19:4. https://doi.org/10.1007/s11920-017-0754-1

  16. De Cock N, Van Lippevelde W, Vervoort L, Vangeel J, Maes L, Eggermont S, et al. Sensitivity to reward is associated with snack and sugar-sweetened beverage consumption in adolescents. Eur J Nutr. 2016;55:1623–32.

    Article  Google Scholar 

  17. Nguyen-Michel ST, Unger JB, Spruijt-Metz D. Dietary correlates of emotional eating in adolescence. Appetite. 2007;49:494–9.

    Article  Google Scholar 

  18. Perez-Bonaventura I, Granero R, Ezpeleta L. The relationship between weight status and emotional and behavioral problems in Spanish preschool children. J Pediatr Psychol. 2015;40:455–63.

    Article  Google Scholar 

  19. Martins-Silva T, Vaz JDS, Hutz MH, Salatino-Oliveira A, Genro JP, Hartwig FP, et al. Assessing causality in the association between attention-deficit/hyperactivity disorder and obesity: a Mendelian randomization study. Int J Obes (Lond). 2019;43:2500–8.

    Article  Google Scholar 

  20. Cortese S, Konofal E, Lecendreux M. Alertness and feeding behaviors in ADHD: Does the hypocretin/orexin system play a role? Med Hypotheses. 2008;71:770–5. https://www.sciencedirect.com/science/article/pii/S0306987708002867.

    Article  CAS  Google Scholar 

  21. Inoue Y, Howard AG, Stickley A, Yazawa A, Gordon-Larsen P. Sex and racial/ethnic differences in the association between childhood attention-deficit/hyperactivity disorder symptom subtypes and body mass index in the transition from adolescence to adulthood in the United States. Pediatr Obes. 2019;14:e12498.

    Article  CAS  Google Scholar 

  22. Murphy KR, Barkley RA, Bush T. Young adults with attention deficit hyperactivity disorder: subtype differences in comorbidity, educational, and clinical history. J Nerv Ment Dis. 2002;190:147–57.

    Article  Google Scholar 

  23. Goncalves H, Wehrmeister FC, Assuncao MCF, Tovo-Rodrigues L, Oliveira IO, de, Murray J, et al. Cohort profile update: the 1993 Pelotas (Brazil) Birth Cohort follow-up at 22 years. Int J Epidemiol. 2018;47:1389–1390.

    Article  Google Scholar 

  24. Victora CG, Hallal PC, Araujo CL, Menezes AM, Wells JC, Barros FC. Cohort profile: the 1993 Pelotas (Brazil) birth cohort study. Int J Epidemiol. 2008;37:704–9.

    Article  Google Scholar 

  25. Fleitlich-Bilyk B, Goodman R. Prevalence of child and adolescent psychiatric disorders in southeast Brazil. J Am Acad Child Adolesc Psychiatry. 2004;43:727–34.

    Article  Google Scholar 

  26. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22–57.

    PubMed  Google Scholar 

  27. Amorim P. Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais. Brazilian J Psychiatry. 2000;22:106–15.

    Article  Google Scholar 

  28. de Azevedo Marques JM, Zuardi AW. Validity and applicability of the Mini International Neuropsychiatric Interview administered by family medicine residents in primary health care in Brazil. Gen Hosp Psychiatry. 2008;30:303–10.

    Article  Google Scholar 

  29. Pagoto SL, Curtin C, Lemon SC, Bandini LG, Schneider KL, Bodenlos JS, et al. Association between adult attention deficit/hyperactivity disorder and obesity in the US population. Obesity (Silver Spring). 2009;17:539–44.

    Article  Google Scholar 

  30. Hanć T, Słopień A, Wolańczyk T, Dmitrzak-Węglarz M, Szwed A, Czapla Z, et al. ADHD and overweight in boys: cross-sectional study with birth weight as a controlled factor. Eur Child Adolesc Psychiatry. 2015;24:41–53.

    Article  Google Scholar 

  31. Pauli-Pott U, Reinhardt A, Bagus E, Wollenberg B, Schroer A, Heinzel-Gutenbrunner M, et al. Psychosocial risk factors underlie the link between attention deficit hyperactivity symptoms and overweight at school entry. Eur Child Adolesc Psychiatry. 2017;26:67–73.

    Article  Google Scholar 

  32. van Egmond-Fröhlich AWA, 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;36:963–8. https://doi.org/10.1038/ijo.2012.78.

    Article  Google Scholar 

  33. Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2010. Rio de Janeiro: IBGE; 2010. http://www.censo2010.ibge.gov.br/. Accessed 20 May 2017.

  34. Mari JJ, Williams P. A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo. Br J Psychiatry. 1986;148:23–6.

    Article  CAS  Google Scholar 

  35. Strimas R, Davis C, Patte K, Curtis C, Reid C, McCool C. Symptoms of attention-deficit/hyperactivity disorder, overeating, and body mass index in men. Eat Behav. 2008;9:516–8.

    Article  Google Scholar 

  36. de Zwaan M, Gruss B, Muller A, Philipsen A, Graap H, Martin A, et al. Association between obesity and adult attention-deficit/hyperactivity disorder in a German community-based sample. Obes Facts. 2011;4:204–11.

    Article  Google Scholar 

  37. 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;35:852–62.

    Article  CAS  Google Scholar 

  38. Kase BE, Rommelse N, Chen Q, Li L, Andersson A, Du Rietz E, et al. Longitudinal associations between symptoms of ADHD and BMI from late childhood to early adulthood. Pediatrics. 2021;147:e2020036657.

  39. Cortese S, Vincenzi B. Obesity and ADHD: clinical and neurobiological implications. Curr Top Behav Neurosci. 2012;9:199–218.

    Article  Google Scholar 

  40. Blum K, Sheridan PJ, Wood RC, Braverman ER, Chen TJ, Comings DE. Dopamine D2 receptor gene variants: association and linkage studies in impulsive-addictive-compulsive behaviour. Pharmacogenetics. 1995;5:121–41.

    Article  CAS  Google Scholar 

  41. Demontis D, Walters RK, Martin J, Mattheisen M, Als TD, Agerbo E, et al. Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nat Genet. 2019;51:63–75. 2018/11/28

    Article  CAS  Google Scholar 

  42. Özcan Ö, Arslan M, Güngör S, Yüksel T, Selimoğlu MA. Plasma leptin, adiponectin, neuropeptide Y levels in drug naive children with ADHD. J Atten Disord. 2018;22:896–900.

    Article  Google Scholar 

  43. 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;66:263–9.

    Article  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

  1. Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil

    Thais Martins-Silva, Juliana dos Santos Vaz, Marina Xavier Carpena, Christian Loret de Mola, Fernando Barros, Ana Maria Baptista Menezes, Helen Gonçalves, Fernando C. Wehrmeister & Luciana Tovo-Rodrigues

  2. Faculty of Nutrition, Universidade Federal de Pelotas, Pelotas, Brazil

    Juliana dos Santos Vaz

  3. National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil

    Julia Luiza Schäfer, Giovanni Abrahão Salum & Luis Augusto Rohde

  4. ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Julia Luiza Schäfer, Giovanni Abrahão Salum, Eduardo Schneider Vitola, Vitor Breda, Eugênio Horacio Grevet & Luis Augusto Rohde

  5. Postgraduate Program in Public Health, Universidade Federal de Rio Grande, Rio Grande, Brazil

    Christian Loret de Mola

  6. Universidad Cientifica del Sur, Lima, Peru

    Christian Loret de Mola

  7. Grupo de Pesquisa e Inovação em Saúde (GPIS), Universidade Federal do Rio Grande, Rio Grande, Brazil

    Christian Loret de Mola

  8. Post-graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil

    Fernando Barros

Authors
  1. Thais Martins-Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juliana dos Santos Vaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julia Luiza Schäfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanni Abrahão Salum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marina Xavier Carpena
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eduardo Schneider Vitola
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vitor Breda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eugênio Horacio Grevet
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christian Loret de Mola
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Fernando Barros
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ana Maria Baptista Menezes
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Helen Gonçalves
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Fernando C. Wehrmeister
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Luis Augusto Rohde
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Luciana Tovo-Rodrigues
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Thais Martins-Silva.

Ethics declarations

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.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1038/s41366-022-01098-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-022-01098-z

This article is cited by

Search

Advanced search

Quick links