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Introduction: The influence of our diet on mental health is of increasing importance in current research. Study results on the gut-brain axis suggest that the gut microbiome can influence mental processes via neuronal, hormonal and immune signaling pathways [1]. The gut microbiome is largely influenced by our diet. Some studies provide evidence that a "Western diet" rich in saturated fat and sugar may promote mental disorders [2]. There is evidence, that dietary behaviour in individuals with Attention Deficit Hyperactivity Disorder (ADHD) is characterized by an increased intake of sugar and saturated fat [3]. So far, it is unclear whether this dietary pattern contributes to ADHD symptoms such as impulsivity. The aim of this study is to investigate the influence of certain macronutrients such as fats and mono/disaccharides on impulsivity in individuals with ADHD. Using our APPetite-mobile-app [4] enabled us to study dietary behaviour and momentary impulsiveness in everyday life of our participants.
Methods: 43 participants with ADHD (mean age 36.0 ± 12.3 years, 21 females) and 186 healthy controls (mean age 28.5 ± 7.7 years, 133 females) without any psychiatric condition were included into the study. Food intake was recorded over a period of three days using the APPetite-mobile-app via a 6 step process: (1) Selection of meal type, (2) Entry of time of meal, (3) Selection of consumed foods and drinks, (4) Specification of consumed amounts, (5) Presentation of reminder for commonly forgotten foods, and (6) Indication of predominant reason for eating. In addition to entering consumed foods in the APPetite-mobile-app, subjects completed an online food log for the last 24 hours (myfood 24) at the beginning of the study. After the data collection period, a detailed analysis of the ingested nutrients was performed for each subject. Trait impulsivity was assessed using the UPPS-P, a self-assessment questionnaire. Momentary impulsiveness was assessed via the mHealth APP by means of the Momentary Impulsiveness scale (MIS). The MIS consists of 4 questions capturing different aspects of impulsivity. The participants were prompted to answer these questions at 8 semi-random times per day between 8 AM and 10 PM. The minimum time between 2 prompts was 1 hour. Thereby participants could not predict the exact time of the next prompt and the assessed situations are a better reflection of the participant’s real life.
Results: ANOVA revealed higher levels of both, trait and momentary impulsivity in individuals with ADHD compared to controls (p < 0,01). After preprocessing of data that was sampled via the mHealth APP is completed, a regression analysis with different macronutrients as predictors and impulsivity as dependent variable will be computed. To assess the association between momentary impulsiveness and dietary intake, generalized linear multilevel modelling will be used. Results of these analyses will be presented.
Background: The risk for major depression and obesity is increased in adolescents and adults with attention-deficit / hyperactivity disorder (ADHD) and adolescent ADHD predicts adult depression and obesity. Non-pharmacological interventions to treat and prevent these co-morbidities are urgently needed. Bright light therapy (BLT) improves day–night rhythm and is an emerging therapy for major depression. Exercise intervention (EI) reduces obesity and improves depressive symptoms. To date, no randomized controlled trial (RCT) has been performed to establish feasibility and efficacy of these interventions targeting the prevention of co-morbid depression and obesity in ADHD. We hypothesize that the two manualized interventions in combination with mobile health-based monitoring and reinforcement will result in less depressive symptoms and obesity compared to treatment as usual in adolescents and young adults with ADHD.
Methods: This trial is a prospective, pilot phase-IIa, parallel-group RCT with three arms (two add-on treatment groups [BLT, EI] and one treatment as usual [TAU] control group). The primary outcome variable is change in the Inventory of Depressive Symptomatology total score (observer-blinded assessment) between baseline and ten weeks of intervention. This variable is analyzed with a mixed model for repeated measures approach investigating the treatment effect with respect to all three groups. A total of 330 participants with ADHD, aged 14 – < 30 years, will be screened at the four study centers. To establish effect sizes, the sample size was planned at the liberal significance level of α = 0.10 (two-sided) and the power of 1-β = 80% in order to find medium effects. Secondary outcomes measures including change in obesity, ADHD symptoms, general psychopathology, health-related quality of life, neurocognitive function, chronotype, and physical fitness are explored after the end of the intervention and at the 12-week follow-up.
Discussion: This is the first pilot RCT on the use of BLT and EI in combination with mobile health-based monitoring and reinforcement targeting the prevention of co-morbid depression and obesity in adolescents and young adults with ADHD. If at least medium effects can be established with regard to the prevention of depressive symptoms and obesity, a larger scale confirmatory phase-III trial may be warranted.
Trial registration: German Clinical Trials Register, DRKS00011666. Registered on 9 February 2017. ClinicalTrials.gov, NCT03371810. Registered on 13 December 2017.