Journal of the American Academy of Child & Adolescent Psychiatry
New researchMeta-Analysis of Attention-Deficit/Hyperactivity Disorder or Attention-Deficit/Hyperactivity Disorder Symptoms, Restriction Diet, and Synthetic Food Color Additives
Section snippets
Method
Studies were identified through a literature search using the PubMed, Cochrane Library, and PsycNET electronic databases. We initially used the following combination of terms: behavior or ADHD or hyperactivity or impulsivity and food coloring; behavior or ADHD or hyperactivity or impulsivity and diet; behavior or ADHD or hyperactivity or impulsivity; and the name of each individual food coloring by either its formal or generic name (listed in parenthetical statement earlier), as well as the
Open-Label Trials
Before evaluating the effects of food colors, we examined the evidence regarding dietary restriction, in which synthetic food colors and/or other additives were eliminated as a component of the restrictive diet and ADHD symptoms were evaluated. Our literature review identified 14 open-label trials of hyperactive children that offered an operational definition of a “responder” (e.g., 25% improvement in symptoms), with aggregated N = 2025.20, 24, 26, 27, 28, 29, 30, 31, 32, 33, 34 (Note that
Discussion
The relation of food color additives to ADHD has provoked periodic controversy for nearly 40 years, but has gained renewed currency with review by European and American authorities recently taking different policy actions. The present meta-analysis provides new clarification and nuance, and overturns some previous conclusions. It is important to note that we emphasized randomized controlled trials, because these provide prima facia evaluation of causality. We began by examining whether a
References (53)
- et al.
Measured gene-by-environment interaction in relation to attention-deficit/hyperactivity disorder
J Am Acad Child Adolesc Psychiatry
(2010) - et al.
Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial
Lancet
(2007) - et al.
Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study
J Pediatr
(1994) - et al.
Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial
Lancet
(2011) - et al.
Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome
Lancet
(1985) - et al.
Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder
Arch Gen Psychiatry
(2010) - et al.
Does attention-deficit/hyperactivity disorder have a dimensional latent structure?A taxometric analysis
J Abnorm Psychol
(2011) Variance components models for gene-environment interaction in twin analysis
Twin Res
(2002)- et al.
The role of histamine degradation gene polymorphisms in moderating the effects of food additives on children's ADHD symptoms
Am J Psychiatry
(2010) Temperament and developmental psychopathology
J Child Psychol Psychiatry
(2006)
Neuropathic manifestations in infants and children as a result of anaphylatic reactions to foods contained in their diet
Am J Dis Child
Hyperkinesis and learning disabilities linked to artificial food flavors and colors
Am J Nurs
Hyperactivity and diet treatment: a meta-analysis of the Feingold hypothesis
J Learn Disabil
Do artificial food colors promote hyperactivity in children with hyperactive syndromes?A meta-analysis of double-blind placebo-controlled trials
J Dev Behav Pediatr
US Food and Drug AdministrationSummary of color additives for use in United States in foods, drugs, cosmetics, and medical devices
Petition to ban the use of Yellow 5 and other food dyes, in the interim to docket require a warning on foods containing these dyes, to correct the information the Food and Drug Administration gives to consumers on the impact of these dyes on the behavior of some children, and to require neurotoxicity testing of new food additives and food colors
Dietary sensitivities and ADHD symptoms: thirty-five years of research
Clin Pediatr
Lack of behavioral effects from Feingold diet violations
Percept Mot Skills
Effects of a few food diet in attention deficit disorder
Arch Dis Child
Effects of artificial colors on hyperkinetic children: a double-blind challenge study [proceedings]
Psychopharmacol Bull
Food dyes impair performance of hyperactive children on a laboratory learning test
Science
Foods, food dyes, and allergies
Does diet affect hyperactivity?
J Learn Disabil
Physiological changes in hyperactive children following the ingestion of food additives
Int J Neurosci
Topographic mapping of brain electrical activity in children with food-induced attention deficit hyperkinetic disorder
Eur J Pediatr
The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children
Arch Dis Child
Cited by (170)
Reductive metabolism of azo dyes and drugs: Toxicological implications
2023, Food and Chemical ToxicologyHeavy metals in honey and poultry eggs as indicators of environmental pollution and potential risks to human health
2023, Journal of Food Composition and AnalysisComplementary and Integrative Treatments for Attention-Deficit/Hyperactivity Disorder in Youth
2023, Child and Adolescent Psychiatric Clinics of North AmericaHyperactivity: Nutritional aspects
2023, Encyclopedia of Human Nutrition: Volume 1-4, Fourth Edition
This study was supported by the North American Branch of the International Life Sciences Institute (ILSI) Technical Committee on Food and Chemical Safety. ILSI North America is a public, nonprofit foundation that provides a forum to advance understanding of scientific issues related to the nutritional quality and safety of the food supply by sponsoring research programs, educational seminars and workshops, and publications. ILSI North America receives support primarily from its industry membership. The Life Sciences Research Organization Inc and Dr. Nigg received a grant from the organization for their work reviewing, analyzing, and summarizing the information contained in this article. Partial funding for this project was also received from the National Confectioners Association.
The opinions and conclusions expressed herein are those of the authors and do not necessarily represent the views of either funding organization.
Disclosure: Drs. Falk and Lewis are employees of the Life Sciences Research Organization, Inc. (LSRO). LSRO has received research support from numerous federal government agencies (including the U.S. Food and Drug Administration), trade associations, and corporations (including food and dietary supplement manufacturers and distributers). Drs. Nigg, Lewis, Edinger, and Falk report no biomedical financial interests or potential conflicts of interest.
Supplemental material cited in this article is available online.