ESPE Yearbook of Paediatric Endocrinology

J Clin Psychiatry 2018;79.

DOI: 10.4088/JCP.17m11607

Summary: In a population-based prospective cohort study, based on the Taiwan National Health Insurance Research Database, 35,949 adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD) had a higher risk of developing T2DM and had a shorter duration between enrollment and onset of T2DM than did 71,898 age- and sex-matched controls. Long-term use of atypical antipsychotics was associated with a higher likelihood of subsequent T2DM.

Comment: ADHD is the most common neurodevelopmental disorder in childhood. The estimated prevalence of diagnosed ADHD in US children & adolescents increased from 6.1% in 1997–1998 to 10.2% in 2015–2016.¹ In parallel, the prevalence of childhood obesity rose by alarming rates. Meta-analysis evidence shows a significant association between ADHD and obesity, regardless of possible confounding factors such as psychiatric comorbidities. Several possibilities may explain this observation. Firstly, ADHD increases the risk of obesity. Both the deficient inhibitory control, as well as the inattention and poor planning that characterize ADHD might cause difficulties in adhering to regular eating patterns and healthy food intake. In addition, children with ADHD have been shown to watch more television and engage less in physical activity than those without ADHD. Secondly, factors associated with obesity such as sleep-disordered breathing, and shorter or later sleep may manifest with ADHD-like symptoms. Thirdly, ADHD and obesity share common biological risk factors, for example, severely obese mothers and mothers with diabetes have increased risks of having a child with ADHD, as well as an obese child. In the current study, adolescents with ADHD had a 2.83 (95% CI, 1.96–4.09) fold risk and young adults a 3.28 (95% CI, 1.41–7.63) fold risk of developing T2DM compared to the controls. Of note, long-term use of atypical antipsychotics was associated with a higher likelihood of subsequent T2DM. Young adults with ADHD and comorbid hypertension, dyslipidemia, and obesity were more susceptible to T2DM.

References: 1. Xu G, Strathearn L, Liu B, Yang B, Bao W (2018) Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997–2016. JAMA Netw Open 1:e181471.

2. Cortese S, Tessari L (2017) Attention-Deficit/Hyperactivity Disorder (ADHD) and Obesity: Update 2016. Curr Psychiatry Rep 19:4.

3. Xiang AH, Wang X, Martinez MP, Getahun D, Page KA, Buchanan TA, Feldman K (2018) Maternal Gestational Diabetes Mellitus, Type 1 Diabetes, and Type 2 Diabetes During Pregnancy and Risk of ADHD in Offspring. Diabetes Care 41:2502–2508.