ADHD小孩有鋅銅不足的風險
【24drs.com】November 3, 2009 (檀香山) — 注意力不足過動障礙症(attention deficit hyperactivity disorder，ADHD)孩童的整體營養狀態顯示，這類病患處於微量元素偏低的風險，包括鋅與銅不足，此類礦物質在產生多巴胺、正腎上腺素、與調節睡眠有關的褪黑激素等有重要影響。
美國兒童與青少年精神疾病第56屆年會中，加拿大英屬哥倫比亞大學和兒童及婦女健康中心進行的研究顯示，在44名6-12歲的ADHD病童中，鋅和銅不足的比率分別為45%和35%。
主要研究者、Margaret Weiss博士向Medscape Psychiatry表示，有關ADHD孩童的研究大多聚焦於糖的攝取等等，但是未曾實際探討ADHD孩童飲食攝取和之後的營養狀態。
偕同第一作者Joy Kiddie醫師，該研究包括了未曾用藥與正使用藥物治療ADHD的44名6-12歲孩童。這些孩童之中，17人未曾用藥，18人服用興奮劑、9人服用atomoxetine。
使用3天飲食日記與24小時回憶評估這些小孩的飲食。飲食評估巨量營養素/微量營養素攝取與每日建議攝取量及食物團體建議的關聯。24小時回憶用來評估低營養素食物，即所謂的垃圾食物的百分比。
研究發現，血清鋅低於實驗室正常值的，6-9歲孩童有77%、10-12歲孩童有67%，共有25%的孩童為鋅不足。有23%的孩童為血清銅低於實驗室正常值。
【垃圾食物的攝取沒有差異】
研究者發現，研究樣本攝取的蛋白質、碳水化合物、脂肪量及建議量與群體常值一致，ADHD孩童攝取低營養素食物的情況與群體常值沒有差異。不過，40%孩童攝取的肉類和肉類替代物低於建議量，與身體製造多巴胺、正腎上腺素、與褪黑激素等必要輔因相關之微量營養素值也較低。
測量血中微量營養素值，重現了之前發現的鋅不足，而銅不足則是首次發現。此外，多數小孩的血清鐵蛋白值低於50 μg/mL，而這被視為進入中樞神經系統的必要值。
Weiss博士表示，一般相信，ADHD孩童比其他小孩吃更多垃圾食物，但是此研究發現並非如此。不過，我們的資料認為，ADHD孩童因為吃較少肉、魚和禽肉，所以他們的營養狀態和其他小孩不同，身體製造多巴胺、正腎上腺素、與褪黑激素等必要輔因相關之微量營養素值也較低。
【需聚焦在營養上】
同樣發表於美國兒童與青少年精神疾病第56屆年會中的另一篇有關鋅補充品的研究中，俄亥俄州立大學的Eugene Arnold醫師等人發現，對於診斷為ADHD的孩童，補充15或30mg的元素鋅，在13週治療之後，與安慰劑組相比，症狀上並無差異。
Weiss博士表示，此研究引發許多問題，因為之前的研究認為，鋅補充品會產生不一樣的結果。她表示，可能不只是孩子們吃什麼的問題，而是他們是否吸收或代謝鋅、或他們是否排泄它。換句話說，有一些鋅是浪費的了。
Weiss博士表示，根據此研究，還不足以做出臨床建議，必須注意的是，確保ADHD小孩有包括肉、魚和禽肉的適當飲食。不過，她也承認，這對於那些使用具有抑制食慾效果之興奮劑的孩童來說，是個挑戰。
她指出，重點在於由有經驗的醫師評估營養狀態，提供良好營養的資訊給家長。Weiss博士表示，傳統上，ADHD強調的是治療該異常的核心症狀，但是，評估與管理睡眠、營養和生長等基本健康議題也是重要的。良好的健康就會有不同的結果。
Weiss博士宣告她擔任Eli Lilly and Company、Janssen、Purdue University、Shire Pharmaceuticals Inc和Takeda Pharmaceuticals North America,Inc.等的諮詢委員和/或接受研究資助。
美國兒童與青少年精神疾病第56屆年會：摘要17.3。發表於2009年10月31日。
Children With ADHD at Risk for Zinc and Copper Deficiency
By Caroline Cassels
Medscape Medical News
November 3, 2009 (Honolulu, Hawaii) — Overall nutritional status in children with attention deficit hyperactivity disorder (ADHD) shows that this patient population is at risk for low trace mineral status, including deficiencies in zinc and copper — minerals that may play a crucial role in the production of dopamine, norepinephrine, and melatonin, which regulates sleep.
Presented here at the American Academy of Child Adolescent Psychiatry 56th Annual Meeting, a study conducted by investigators at the University of British Columbia and the Children's and Women's Health Centre in Vancouver, Canada, showed among 44 children aged 6 to 12 years with ADHD, rates of zinc and copper deficiency were 45% and 35%, respectively.
"There are a lot of studies in ADHD children looking at sugar intake, etcetera, but no one has ever actually looked at the dietary intake and subsequent nutrients of children with ADHD, " principal investigator Margaret Weiss, MD, PhD, told Medscape Psychiatry.
With first author Joy Kiddie, RD, the study included 44 drug-naive and drug-treated ADHD children aged 6 to 12 years. Of these children, 17 were medication-naive, 18 were taking stimulant medications, and 9 were taking atomoxetine.
The children's dietary intake was assessed using a 3-day food record and 24-hour recall. The food record assessed macronutrient/micronutrient intake relative to the recommended dietary allowances and food group recommendations.
The 24-hour recall was used to assess the percentage of low–nutrient density foods, or so-called "junk food" intake.
The study revealed that serum zinc below laboratory norms was present in 77% of children aged 6 to 9 years and 67% of children aged 10 to 12 years, and 25% of the children were below the cutoffs for zinc deficiency. Serum copper below laboratory norms was present in 23% of children.
No Difference in Junk Food Consumption
The investigators found that the study sample consumed comparable levels of protein, carbohydrate, and fat compared with recommendations and population norms, and ADHD children were no different than population norms in intake of low–nutrient density foods. However, 40% of the children consumed less than the recommended levels of meat and meat alternatives and had low levels of related micronutrients that are essential cofactors for the body's manufacture of dopamine, norepinephrine, and melatonin.
Measurement of blood levels of micronutrients replicated previous findings of zinc deficiency and demonstrated copper deficiency for the first time. In addition, a majority of children had serum ferritin levels lower than 50 μg/mL, a level considered necessary for entry into the central nervous system.
"There is a commonly held belief that children with ADHD eat more junk food than other children, but the study did not confirm this view," said Dr. Weiss. "However, our data suggest children with ADHD are nutritionally different from the rest of the population in that they eat less meat, fish, and poultry and have low levels of related micronutrients that are essential cofactors for the body's manufacture of dopamine norephinephrine, and melatonin."
Need to Focus on Nutrition
In a separate study of zinc supplementation also presented here at the American Academy of Child & Adolescent Psychiatry 56th Annual Meeting, Eugene Arnold, MD, and colleagues from The Ohio State University, Columbus, found that supplementation with 15 or 30 mg of elemental zinc made no difference to symptoms compared with placebo in a group of children diagnosed with ADHD after 13 weeks of treatment.
This study, said Dr. Weiss, raises many questions because previous research has suggested that zinc supplementation does make a difference. "It may not just be a question of what children eat but also whether they can absorb or metabolize zinc, or whether they are excreting it. In other words, is there some kind of phenomenon of zinc wasting?" she said.
Dr. Weiss said that, based on this study, it is too early to make any clinical recommendations beyond ensuring that children with ADHD have an adequate diet that includes appropriate levels of fish, meat, and poultry. However, she acknowledged, this can be a challenge in children on stimulant medications because of the drugs' appetite-suppressing effect.
She added that it is important that clinicians with expertise in the assessment of nutritional status provide parents with information about good nutrition. "Traditionally, the emphasis on ADHD has been on treating the core symptoms of the disorder, but it is also important to assess and manage basic issues of health such as sleep, nutrition, and growth. Good health makes a difference," said Dr. Weiss.
Dr. Weiss has disclosed that she is on the advisory board of and/or has received research or grant support from Eli Lilly and Company, Janssen, Purdue University, Shire Pharmaceuticals Inc, and Takeda Pharmaceuticals North America, Inc.
American Academy of Child & Adolescent Psychiatry 56th Annual Meeting: Abstract 17.3. Presented October 31, 2009.
