No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Do Artificial Food Colors Promote Hyperactivity in Children with Hyperactive Syndromes? A Meta-Analysis of Double-Blind Placebo-Controlled Trials
Abstract
Burgeoning estimates of the prevalence of childhood attention-deficit/hyperactivity disorder (ADHD) raise the possibility of a widespread risk factor. We seek to assess whether artificial food colorings (AFCs) contribute to the behavioral symptomatology of hyperactive syndromes. We searched ten electronic databases for double-blind placebo-controlled trials evaluating the effects of AFCs. Fifteen trials met the primary inclusion criteria. Meta-analytic modeling determined the overall effect size of AFCs on hyperactivity to be 0.283 (95% CI, 0.079 to 0.488), falling to 0.210 (95% CI, 0.007 to 0.414) when the smallest and lowest quality trials were excluded. Trials screening for responsiveness before enrollment demonstrated the greatest effects. Despite indications of publication bias and other limitations, this study is consistent with accumulating evidence that neurobehavioral toxicity may characterize a variety of widely distributed chemicals. Improvement in the identification of responders is required before strong clinical recommendations can be made.
... Although BB is permitted to be used as a food colorant, its abuse can cause some food safety and health problems. Recent studies have shown that excessive use of BB can cause allergic reactions, asthma, cancer, insomnia, urticarial, and children's attention deficit hyperactivity disorder [4,5]. Accordingly, the use of BB ought to be completely controlled by the important regulatory authorities. ...
... The fluorescence spectra of ZL 1 can be analyzed at acidic to alkaline pH conditions (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). It is seen in Fig. 7, that ZL 1 exhibited very low fluorescence intensity at very strong acidic (<pH 5) conditions but showed very high fluorescence intensity at mild alkaline (>pH 8) conditions. ...
... It is noteworthy that the analyzed foods are often consumed by the population since childhood. In addition, artificial b Acronym for buthylated hydroxyanisole c Acronym for butylated hydroxytoluene d Acronym for tertiary butylhydroquinone colors, especially sunset yellow and tartrazine, are the target of toxicological studies that relate them to the development of allergy and hyperactivity symptoms in children [42][43][44] . ...
... Nine studies were found, of which six analyzed the health effects in adults 92,103-107 and three in children [42][43][44] . The results seem to point to the potential for the development of attention deficit hyperactivity disorder (ADHD), alterations in the intestinal microbiota, metabolic dysregulation, weight gain, cardiometabolic effects, development of cancer in the gastrointestinal tract, respiratory problems, rhinitis, urticaria, and angioedema. ...
Objective:
To discuss the context of scientific publications on the consumption of food additives by children and the possible health consequences in this age group.
Methods:
A literature review, with a search carried out between April 2020 and April 2021 in the Web of Science, Scopus, PubMed and Google Scholar databases, as well as in websites of Brazilian and foreign official bodies. Official documents and studies published since 2000 were selected. Keywords related to food additives, children, food consumption, and health were used for the search.
Results:
Food additives are substances intentionally added to foods for technological purposes. Processed foods are the main sources of additives in food and their consumption occurs since childhood. It is observed, however, that there are limitations inherent to the scientific method regarding the analysis of consumption and toxicity of food additives in humans, causing scarcity of data in the scientific literature. Additionally, existing data suggest that the additives have a higher toxic potential in children, considering that the body weight in this age group is lower than in adults. This context emphasizes the need to observe the precautionary principle, according to which risks of harm must be prevented.
Conclusions:
This is a scenario in which the literature points to a risk to people's health and, in particular, to children, about whom the duty of protection must be even greater, with absolute priority. Thus, the relevance of an expanded technical-scientific debate regarding the establishment of specific and stricter parameters for children is considered, regarding the consumption and toxicity of additives, as well as the different sources of exposure to these substances.
... Attention Deficit Hyperactivity Disorder (ADHD) melaporkan bahwa bahan-bahan makanan tertentu berpengaruh terhadap hiperaktivitas anak-anak mereka (Schab & Trinh, 2004). ...
... Pewarna makanan artifisial seperti sunset yellow, carmoisine, tartrazine, ponceau 4R, quinolone yellow dan allura red AC dapat meningkatkan hiperaktivitas pada anak-anak kelompok usia 3 tahun (kelompok pra sekolah) dan kelompok usia 8-9 tahun (kelompok Sekolah Dasar) di Inggris (McCann et al., 2007). Penelitian serupa juga menemukan bahwa menghilangkan pewarna makanan artifisial dari makanan anak dengan ADHD sebanding dengan sepertiga sampai setengah efek terapi methylphenidate (Ritalin) (Schab & Trinh, 2004 (Prinz & Riddle, 1986). Penelitian di Yale juga mengindikasikan bahwa diet tinggi gula bisa meningkatkan gangguan untuk memperhatikan pada anak dengan ADHD (Jones et al., 1995). ...
Banyak Anak Berkebutuhan Khusus (ABK) mempunyai gejala hiperaktif. Gejala ini sangat mengganggu proses belajar baik di sekolah maupun di rumah. Hiperaktifitas berkaitan dengan gangguan konsentrasi dan kemampuan untuk memahami materi pelajaran. Beberapa penelitian menyebutkan bahwa ada hubungan antara makanan yang dikonsumsi ABK dengan gejala hiperaktifitas. Bahan makanan dapat mempengaruhi fungsi otak yang berkaitan dengan hiperaktifitas, pola tidur, kemampuan kognitif dan suasana hati (mood) seseorang. Berdasarkan latar belakang di atas, maka penyuluhan tentang makanan yang seharusnya diberikan untuk orang tua atau pihak yang bertanggungjawab menyediakan makanan untuk Anak Berkebutuhan Khusus (ABK) dengan tipe hiperaktif. Berkaitan dengan kondisi Pandemi Covid 19, maka penyuluhan ini dilakukan secara daring pada 98 peserta webinar yang terdiri dari orang tua ABK, orang tua non ABK, pengasuh anak, guru ABK, guru non ABK, mahasiswa jurusan kesehatan dan lain-lain. Dari hasil pos tes yang dilakukan sekitar 68% peserta bisa menjawab dengan benar pertanyaan seputar makanan yang dianjurkan untuk ABK yang hiperaktif. Semua peserta menjawab penyuluhan daring tentang nutrisi pada ABK hiperaktif ini bermanfaat.
... Synthetic coloring agents have been demonstrated as causal agents of certain damages in different organs of the experimental animals, i.e in brain and testes resulting in imbalance in neurotransmitters and exploratory behavior [5][6]. In this respect, repeated ingestion of erythrosine B in rats has developed behavioral hyperactivity [7][8][9]. A single very high dosage (10, 100 or 200 mg/kg) of erythrosine administration to young adult male rats had reduced motor activity maximally at 2 h and brain regional (medulla-pons, hippocampus and hypothalamus) serotonergic activity [5]. ...
... Generally, the results obtained in the present study indicated that the overdose (5 times of the ADI) of the synthetic coloring agents for 60 days induced considerable changes in both horizontal and vertical activity of tested rats. Despite the differing conditions of the present experiment, the obtained findings are in agreement with those stated in other previous studies [5,[7][8][9]. Moreover, in experimental animal, it is well known that long-term administration of erythrosine and sunset yellow, like other synthetic food color [23,24] causes significantly increases the movement activity of exploratory behavior in a dosage dependent manner [11,13]. ...
The aim of the present work is to investigate the effect of beet (BE) and curcumin (CE) extracts as natural red and yellow color, edicol erythrosine and sunset yellow as recommended synthetic colors in addition to two unknown commercial coloring agents (red and yellow) on the balance of four hormones in the serum of male rats. Rats were divided into 11 groups and administrated daily for 60 days with 1 mL color solution contained the admissible daily intake (ADI) and overdose (5 times) of the synthetic recommended or commercial colors. BE (0.31 mg) and CE (7.87 mg) were also tested as natural colorants. No significant (p=0.05) changes were noticed in brain and testes weight due to treatment with the ADI dose of all studied colorants. Significant reduction in the testes weight was recorded when rats were treated with the overdose. The overdose applied in the present study led to elevation in the level of dopamine and noradrenaline and reduction in the concentration of testosterone and interstitial cell-stimulating hormone (ICSH) in blood serum compared with the control group. These changes were associated with alterations in the histological architecture of brain and disturbance in the exploratory behavior. Correlation coefficient matrix indicated strong relationship between changes in the balance of studied hormones and histopathological alterations in brain induced by consumption of the artificial food colorants. The obtained results emphasis that, there is a need to re-evaluate use of edicol erythrosine and sunset yellow as synthetic food colorants. Moreover, beet and curcumin extracts could be used as alternative natural red and yellow colorants, respectively.
... Orange B and Citrus Red No. 2, are only authorized for limited use as external colorants and will not be covered in this review. Of the colors utilized in the Southampton studies, toms thereof [4]. Observational studies regarding diet and ADHD symptoms in youth have appeared in the literature over the past forty-plus years. ...
... Pelsser, et al. [42] noted the inconsistency in the literature and conducted a review of two meta-analyses [4,43] of double-blind placebo-controlled trials evaluating the effect of the artificial food color elimination on children with ADHD. The authors found SMD effect sizes for FCA elimination were higher as measured by parents (effect size = 0.21), but lower when rated by teachers (effect size = 0.08) and observers (effect size = 0.11). ...
... The hypothesis that the consumption of artificial dyes promotes behavioral changes in hyperactivity-diagnosed children from the assessment of parents, but not teachers or observers, was confirmed in a 2004 meta-analysis that included a double-blind placebo-controlled trial (Schab & Trinh, 2004). However, the authors cautioned that a greater understanding of pharmacokinetics is required before imposing a restricted diet. ...
The food industry uses dyes mainly to overcome color loss during the processing and storage of products, with the azo dyes currently being the most employed. Studies on the safety of using these dyes in foods started in the 1950s and have indicated the potential for concern. This review discusses the risk assessment of food intake containing artificial azo dyes. There are case reports and, subsequently, double‐blind placebo‐controlled trials in some individuals who may experience adverse effects from the intake of azo dyes, but it is unclear whether these adverse effects are restricted to specific populations or more generalized. In view of this, different toxicological endpoints are evaluated to verify toxic effects in in vitro and in vivo models and to establish the no observed adverse effect level. Exposure estimation studies have shown that human exposure to azo dyes via oral intake is mainly below the acceptable daily intake established by advisory bodies. However, most countries do not have studies that estimate the oral intake of azo dyes. In this case, local food diversity and racial–ethnic specificities are not considered when stating the exposure estimate is below the acceptable daily intake for the human population and thus may not represent actual intake. Concerning the scenario established above, this review discusses the most critical gaps to be overcome to contribute to the direction of future studies and the development of more effective public policies concerning the safety of the intake of artificial azo dyes.
... falling to 0.210 (95% CI, 0.007-0.414) when the smallest and lowest quality trials were excluded [39]. ...
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood, affecting ~7% of children and adolescents. Given its adverse health outcomes and high healthcare and societal costs, other treatment options beyond pharmacotherapy have been explored. Case-control studies have shown that dietary patterns may influence the risk of ADHD, and specific dietary interventions have been proposed as coadjuvant treatments in this disorder. These include nutritional supplements, gut microbiome-targeted interventions with biotics, and elimination diets. The purpose of this review is to examine which dietary patterns are most associated with ADHD and to summarize the existing evidence for the clinical use of dietary interventions. The literature showed that non-healthy dietary patterns were positively associated with ADHD, whereas healthy patterns were negatively associated. As for nutritional supplements, only vitamin D and vitamin D + magnesium appeared to improve ADHD symptoms when baseline levels of vitamin D were insufficient/deficient. Regarding biotics, evidence was only found for Lactobacillus rhamnosus GG and for multi-species probiotic supplementation. Elimination diets have scarce evidence and lead to nutritional deficiencies, so caution is advised. Overall, more robust scientific evidence is required for these dietary interventions to be implemented as part of ADHD therapy.
... We used U.S. FDA-supervised laboratory measurements of over 600 foods as the basis of our assessment [14,25]. Examining food dye consumption over two days represents a short-term intake, which may have clinical relevance for neurobehavioral outcomes resulting from children's exposure to AFCs [9][10][11][39][40][41]. Lastly, we calculated maternal and early postnatal exposure estimates and structured the child age categories to allow for intake estimations through the developmentally distinct phases of childhood. ...
The Food and Drug Administration (FDA) regulates artificial food colors (AFCs) in the United States. Exposure to AFCs has raised concerns about adverse behavioral effects in children. We quantified AFC exposure in women of childbearing age, pregnant women, and children and compared them to FDA and World Health Organization acceptable daily intakes (ADIs). We estimated the “typical” and “high” single-day and two-day average dietary exposure to each AFC (mg/kg/day) based on laboratory measurements and food consumption data from the 2015–2016 National Health and Nutrition Examination Survey (NHANES). We also examined whether AFC intake differed by income, education, and ethnicity. Exposure tended to be higher in children and the highest AFC exposure was found for Red No. 40. Children’s mean and 95th percentile FD&C Red No. 3 estimated intakes exceeded the ADIs in some instances. Juice drinks, soft drinks, icings, and ice cream cones were major foods contributing to children’s (<16 years old) AFC exposure. AFC intake was higher in participants with lower incomes and education and of African American ethnicity. The findings indicate widespread AFC exposure including in very young children. Research is needed on the sociodemographic determinants of exposure and AFC toxicokinetics to better describe the absorption and organ-specific exposure.
... [18] Parents who have negative reactions to children are one of the factors that cause children to become hyperactive, for example, parents who give negative responses when children tell parents about activities that make children proud of what they do. [19] Food is also a factor that can cause children to become hyperactive which can increase excessive motor activity such as foods that contain excessive dyes. ...
... A variety of environmental factors have been associated with ADHD. Among them are exposure to potentially toxic substances like lead [11,48,93], artificial food dyes [92,110], and organophosphate pesticides [10]; prenatal exposure to maternal smoking [41,57,93]; maternal use of acetaminophen [25,131] or the anti-epileptic drug valproate during pregnancy [32]; and nutrient deficiencies like iron [122,128], omega-3 polyunsaturated fatty acids [9,51], and maternal vitamin D [118]. Potentially harmful events during pregnancy are also associated with ADHD in the children, including hypertensive disorders [79] and preeclampsia [78], and exposure to trauma or stress [72]. ...
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent condition affecting both children and adults and is characterized by age-inappropriate impairing symptoms in inattentive and/or hyperactive/impulsive dimensions. Since symptoms might be associated with underactivation of distinct fronto-striatal and fronto-cortical circuits, there is a potential role for modulating the frontal cortical activity with transcranial direct current stimulation (tDCS) as part of the treatment. The current literature in the area is yet small and present significant methodological problems. Fourteen pilot studies have investigated the effects of tDCS or transcranial slow-oscillating direct current stimulation (toDCS) in ADHD patients with heterogeneous methodologies and outcomes. Most studies applied anodal tDCS over the dorsolateral prefrontal cortex (DLPFC). Primary outcomes include neurophysiological tests evaluating inhibitory control, attention, and working memory, as well as clinical outcomes measuring inattention and/or hyperactivity/impulsivity symptoms. Overall, anodal stimulation over the DLPFC has shown promising results in improving attention and behavioral inhibition in ADHD with small to medium effect sizes. Among the challenges for future research are better powered studies with proper sample size calculations, protocol publication before data acquisition with primary outcomes defined a priori, methodological adaptations according to the target population, assessment of ideal electrode montages, and optimization of tDCS dosage. Moreover, ADHD clinical heterogeneity and comorbidities should be taken into consideration for the design of future trials.
... Dit effect is klinisch niet relevant en werd alleen gemeten in de niet geblindeerde trials. De gepoolde effectgrootte van 8 RCT's met niet-hyperactieve kinderen (n = 132) was niet-significant [Schab 2004]. ...
... Food additives were first suggested as potential cause of hyperactive behavior in the 1970. Systematic reviews and the meta-analyses of randomized trials with methodological limitations suggest that some children with ADHD respond favorably to elimination diets [9,10]. However, this conclusion is not universally accepted, and the issue remains controversial. ...
... Research going back to the 1980s suggests a dietary component that may be a culprit in contributing to poor mental health: food preservatives and artificial colors can affect the behavior of some children (Jacobson & Schardt, 1999). In a meta-analysis of 15 RCTs examining the impact of artificial food coloring (AFCs) on hyperactivity in children with attention-deficit/hyperactivity disorder (ADHD (N = 219)), Schwab and Trihn reported ES between 0.21 and 0.28, demonstrating the small negative impact of AFCs on hyperactivity (Schab & Trinh, 2004). ...
Although current evidence confirms the importance of diet for mental health, many psychologists avoid discussing dietary intake with clients, questioning whether this information is within their scope of practice. This article provides psychologists with a review focused on the connection between what we eat and how we feel. Eating a healthy, whole-foods-based diet is an important tool to promote mental health recovery and maintenance. We begin by reviewing several mechanisms by which nutrients maximize brain health, including enabling metabolic reactions to occur, supporting mitochondrial function, reducing inflammation and assisting with detoxification. Understanding the vital role of nutrients for brain health will aid clients in understanding the importance of optimizing their intake of a range of nutrients in order to maximize their mental health: no single nutrient is sufficient. Next, we summarize evidence relating diet to mental health, followed by a consideration of circumstances that may contribute to a client requiring additional nutrients, such as chronic stress, medication use, individual biochemistry, and consuming nutrient-depleted food. The evidence base for treating psychological problems in children with supplementary nutrients is then reviewed, and a case study of a child whose self-regulatory skills improved with broad-spectrum multinutrients is used to illustrate this treatment. The breadth and consistency of the research highlights the importance of children receiving a good foundation of nutrients for optimizing brain health. Finally, we offer practical suggestions for psychologists to incorporate this information into their clinical practice and discuss these suggestions within the context of informed consent.
... 37. In a meta-analysis of 15 double-blind, placebo-controlled trials with 219 participants, artificial food dyes were associated with a small increase in hyperactivity in children (Schab and Trinh, 2004). Another meta-analysis, covering 20 studies with a combined total of 794 individuals, found a very small increase in ADHD symptoms, but only when rated by parents, not by teachers or other observers . ...
Background: Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base.
Methods: We reviewed studies with more than 2,000 participants or meta-analyses from five or more studies or 2,000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder.
Results: We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 79 authors from 27 countries and
6 continents. The contents of the manuscript are endorsed by 362 people who have read this document and agree with its contents.
Conclusions: Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.
... In this study, any food containing artificial colorings, additives, preservatives or gluten were excluded and eliminated from the diet modification program and that was associated with improvement in behavior as measured by CPR going with many studies evaluated the effect of food color restriction as Schab and Trinh (2004), Nigg et al. (2012), Sonuga-Barke et al. (2013) and Stevenson et al. (2014) who concluded that there was reliable effect when synthetic food colors were restricted. ...
Background
Attention-deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, affects 5% of children worldwide and characterized by impaired inattention, hyperactivity and impulsivity. One of the risk factors that precipitate ADHD is food. Food affects behavior of children by different ways such as food allergy, food intolerance and gut–microbiota–brain axis. The study aimed to assess effect of diet modification on ADHD outcome and the role of food as a precipitating factor for ADHD symptomatology. The study included 47 children newly diagnosed with ADHD, not receiving medical or behavioral therapy, their ages ranged from 6 to 9 years and their intelligence quotient not below 70 with no associated comorbidities. All participants were subjected to Full history taking, clinical examination, anthropometric measurements, 24 h dietary recall. Dietary analysis and Conner’s parent rating scale-revised short form (CPR-RS) were done before and after diet modification program for 5 weeks.
Results
There was improvement in ADHD symptoms as measured by CPR-RS after 5-weeks of diet modification program. Carbohydrate and protein intake decreased significantly after diet modification program. Energy intake did not show statistical difference while fat intake increased significantly after the diet program. Vitamin A, C, riboflavin, thiamin and iron intakes decreased significantly after diet program but were within the recommended dietary allowance.
Conclusion
Following the Diet modification program, ADHD symptoms were improved as documented by decrease in CPR scores. Diminished carbohydrate and protein intake in diet were positively associated with improvement of ADHD symptoms. Diet modification program succeeded in reducing obesity and then ADHD symptoms.
... Food additives were first suggested as potential cause of hyperactive behavior in the 1970. Systematic reviews and the meta-analyses of randomized trials with methodological limitations suggest that some children with ADHD respond favorably to elimination diets [9,10]. However, this conclusion is not universally accepted, and the issue remains controversial. ...
... One type of color dyes known as Erythrosine (E 127/ Red No. 3) is a cherry-pink coal tar-based food dye; It has been found that it can cause allergic reactions and sensitivity as well as learning difficulties with increasing thyroid hormone levels and that lead to hyperthyroidism. It has been found that 'erythrosine' acts as a potent neurocompetitive dopamine inhibitor of the dopamine uptake via nerve endings when exposed in vitro on a rat brain [32]. Another study showed that 'erythrosine' can act as an inhibitor on many other neurotransmitters which results in an increased concentration of the neurotransmitters near the receptors, therefore functionally augmenting the synaptic neurotransmission. ...
... Artificial food coloring is used to brighten and improve the appearance of food. However, it may promote hyperactivity in sensitive children and can cause allergic reactions [27]. Frequently found in processed meats, sodium nitrite acts as a preservative to prevent the growth of bacteria while also adding a salty flavor and reddish-pink color. ...
In view of the critical role of food value chain stakeholders in the public effort to prevent unhealthy practices that give rise to high in- cidence of obesity and other health risks, this study examined im- ported chicken value chain practices, knowledge and perceptions of key actors. A combination of purposive and snowball sampling tech- niques was adopted to select candidates for personal interviews. The participants were twenty (20) wholesalers and thirty (30) food vendors who use imported frozen chicken for food preparation. The UNIDO framework was adopted to generate a comprehensive value chain map for imported frozen chicken. The study revealed that the imported chicken value chain is controlled by a few importers and large scale distributors with cold storage facilities and distribution lo- gistics. Wholesaler and retailer stakeholders have good knowledge about (un) healthy food cooking and handling practices. However, a dichotomy exists between knowledge level and actual cooking and handling practices, resulting in the high prevalence of unhealthy practices. General indifference exists among food vendors about the
contribution of their cooking and handling practices to the risk of obesity. The results have implications for education and training for food vendors and public health promotion to reduce the risk of obesity.
... Nonetheless, the California Office of Environmental Health Hazard Assessment (OEHHA) is currently itself reviewing the evidence on these colors (e.g., toxicology, epidemiology, exposure literature) to conduct their own risk assessment which would include neurobehavioral endpoints in children (OEHHA, 2018). The relationship between synthetic food color intake and neurobehavioral effects has been tested in both epidemiological studies and in animal models, all of which have been reviewed in recent EFSA and JECFA assessments with concluding, similar to US FDA, (2011), a causal relationship between exposure and response has not been demonstrated (Nigg et al., 2012;Schab and Trinh, 2004;US FDA, 2011). ...
Seven US FDA-batch certified synthetic food colors are approved for use as food additives in the United States. Perceived neurodevelopmental concerns for these colors persist. This study assessed the plausibility of such an association through the evaluation of mechanistic evidence collected from in vitro assays or other alternative models. Mechanisms and molecular targets underlying neurodevelopmental processes associated with Attention Deficit and Hyperactivity Disorder (ADHD) and other neurodevelopmental-related symptoms (e.g., cognitive function, learning and memory disorder, etc.) were identified. Publicly available data from the ToxCast/Tox21 high-throughput screening (HTS) program and peer-reviewed literature that measure activity of the colors for such molecular targets were analyzed and reviewed. Erythrosine (Red No. 3) was active in several assays mapped to neurodevelopmental processes — specifically, HTS assays that measure signals in neurotransmitter pathways. The remaining six colors do not appear to alter signaling pathways related to neurodevelopmental processes on the molecular or cellular level. This assessment provides an approach for systematically identifying and mapping mechanistic data to putative neurodevelopmental processes as a means to prioritize substances for possible further investigation. The assessment also provides insights into the lack of activity of synthetic food colors for key events in neurodevelopmental signaling pathways.
... Since then, the effects of AFC on children with ADHD has been heavily researched with reports of increased hyperactive behavior, impulsivity, motor responses, sleep disturbances, and negative mood after being exposed to varying doses (26-150 mg) of AFC [10]. In a meta-analysis of 15 double-blind placebo-controlled trials, parental reporting of hyperactive behaviors was significantly different during challenge with AFC as compared to placebo [11]. Another more recent metaanalysis concluded that approximately 8% of children with ADHD may benefit from removing AFC from their diet [12]. ...
Objectives: Removing artificial food coloring (AFC) is a common dietary intervention for children with Attention-Deficit/Hyperactivity Disorder (ADHD), but has not been tested in young adults. This pilot study examined the effects of AFC on ADHD symptoms and electroencephalography (EEG) in college students with and without ADHD.
Methods: At baseline, control and ADHD participants completed the Adult ADHD Self-Report Scale (ASRS), simple and complex attention measures, and resting-state EEG recordings. ADHD participants (n = 18) and a subset of controls (extended control group or EC, n = 11) avoided AFC in their diet for 2 weeks and then were randomized to a double-blind, placebo-controlled crossover challenge. Subjects received either 225 mg AFC disguised in chocolate cookies or placebo chocolate cookies for 3 days each week, with testing on the third day each week. Baseline comparisons were made using Student’s t-test or Wilcoxon rank sum tests and challenge period analyses were run using General Linear Modeling.
Results: The ADHD group had significantly greater scores on the ASRS (p < 0.001), confirming a symptom differential between groups; however, there were no differences in attentional measures or EEG at baseline. The AFC challenge resulted in an increase in posterior mean gamma power (p = 0.05), a decrease in posterior relative alpha power (p = 0.04), and a marginal increase in inattentive symptoms (p = 0.08) in the ADHD group. There were no effects of AFC in the EC group.
Discussion: This study indicates that AFC exposure may affect brainwave activity and ADHD symptoms in college students with ADHD. Larger studies are needed to confirm these findings.
... A 2004 meta-analysis that involved placebo-controlled double-blind studies found a significant linkage between synthetic colors to ADHD symptoms by parent ratings, but the same was not found in teacher or observer ratings (76). Since that time, there have been more studies evaluating the effectiveness of synthetic color elimination on ADHD symptom improvement, although nearly all of them rely on parent ratings, or physician ratings which rely on parent reports, of children's symptoms (77). ...
Attention-deficit/hyperactivity disorder (ADHD) is a very common neurobehavioral disorder that affects children and adolescents with impact that persists beyond adolescence into adulthood. Medication and non-pharmacological treatments are evidence-based interventions for ADHD in various age groups, and this article will elaborate on the psychosocial, physical and integrative medicine interventions that have been studied in ADHD.
... 41 A meta-analysis reported that there was a reliable effect linking the Kaiser-Permanente diet (eliminating salicilates, artificial food colours and flavours, and the preservative butylatedhydroxytoulene) to ADHD symptoms. 42 These studies have led to popularity of multiple different diets among individuals with ADHD in the quest to find non-pharmacological methods to control symptoms. ...
Current research shows that the gastro-intestinal and central nervous systems are linked by multiple interconnecting layers and have been known to continually influence each other's actions. The enteric nervous system, vagus, hypothalamic pituitary axis, and the local endocrine system are few of the components of this complex system, forming neurological, immunological as well as endocrine bridges through which information relay occurs. In addition, the gut microbiota exerts overarching influence on all these components, directly and indirectly affecting the brain and impacting human behaviour. This, in effect, creates a gut-brain-microbiotal (GBM) axis, which has a potential role in various physiological functions. It is also implicated in pathological processes as well, and is found to have a role in many psychiatric conditions such as autism spectrum disorders, schizophrenia, mood disorders, substance use and neurodegenerative disorders. The mechanisms involved in each disorder, as well as psychological correlates of the GBM axis, along with potential treatment implications involving microbiota and possible strategies to modulate microbiota to affect changes in psychiatric symptoms are explored in this article.
... McCann et al. published a study in 2007 which brought about renewed interest in the hypothesis of AFCAs' adverse effect on neurobehavior [7]. Other studies have supported a link between long-term or repeated ingestion of AFCAs and childhood behavioral hyperactivity [8][9][10]. However, none of these studies have led to a consensus on a particular AFCA or any other food additives, which are periodically re-evaluated by a scientific committee of the European Food Safety Authority (EFSA) to determine their safety and acceptable daily intake (ADI) values. ...
Exposure to artificial food color additives (AFCAs) has been implicated in the etiology of certain childhood hyperactivity and learning disabilities. N-methyl-D-aspartate receptors and alpha-7 nicotinic acetylcholine receptor (α7 nAChR) are involved in learning and memory. We administered a mixture of AFCAs (erythrosine, ponceau 4R, allura red AC, sunset yellow FCF, tartrazine, amaranth, brilliant blue, azorubine, and indigotine) to female rats during gestation to investigate the effects of prenatal exposure to AFCAs on neurobehavior, spatial learning, and memory in their offspring. We also investigated whether AFCAs modulate NR2A, NR2B, and α7 nAChR protein levels in their offsprings’ hippocampi. Although spatial learning and memory were not altered, the offspring of rats exposed to AFCAs exhibited decreased motivation and increased despair-related behavior. NR2A and NR2B protein levels were significantly reduced in female offspring in the experimental group (p < 0.05), whereas α7 nAChR level was not significantly altered. Our results suggest that prenatal exposure to AFCAs may lead to sex-dependent alterations in glutamatergic signaling which may continue into adolescence.
... Since then, the effects of AFC on children with ADHD has been heavily researched with reports of increased hyperactive behavior, impulsivity, motor responses, sleep disturbances, and negative mood after being exposed to varying doses (26-150 mg) of AFC [10]. In a meta-analysis of 15 double-blind placebo-controlled trials, parental reporting of hyperactive behaviors was significantly different during challenge with AFC as compared to placebo [11]. Another more recent metaanalysis concluded that approximately 8% of children with ADHD may benefit from removing AFC from their diet [12]. ...
Attention-Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder in children, and over half of these individuals carry the diagnosis into adulthood. Dietary exposure to artificial food coloring (AFC) has been reported to worsen symptoms of ADHD in children, but the validity of these findings has been debated. Furthermore, no studies have been completed to date examining the potential effects of AFC on young adults with ADHD. The current study examined the effects of AFC on brainwave activity of college students with and without ADHD. Participants (mean (SD) age of 20 (1.3) yrs) with (n=18) and without (n=41) ADHD completed baseline testing, including the Adult ADHD Self-Report Scale (ASRS) and 4 minutes of eyes-closed resting-state EEG. After avoiding AFC in the diet for 2 weeks, the ADHD group and 11 controls (referred to as Extended Controls or EC) were randomized to a double-blind placebo-controlled crossover challenge lasting three days each over two consecutive weeks. The challenge materials consisted of either 225 mg of combined AFC disguised in chocolate cookies or placebo chocolate cookies. The ASRS and EEG measures were collected at the end of each 3-day exposure. ASRS scores significantly differed at baseline between the ADHD and control group (p<0.001), confirming significantly elevated symptoms in the ADHD group. There were no differences between the ADHD and control group in any EEG frequency band at baseline. The ADHD group experienced a significant decrease in relative
alpha power (p=0.04) and an increase in mean gamma power (p=0.05) in the posterior region (Pz, P3, P4, P7, P8, P9, P10, T7, T8, O1, O2) when challenged with AFC relative to placebo. There were no significant EEG changes in the EC group across challenge periods. Importantly, no changes were noted in ASRS scores across challenge periods in either group, but there was a marginally significant negative correlation between relative alpha power and the ASRS when exposed to AFC in the ADHD group (r= -0.49, p=0.06). These results indicate that AFC in the diet can change the brainwave activity of college students with ADHD, specifically in the mid and high frequency bands, but not in those without ADHD. More research is needed to better understand the underpinnings of how AFC changes brainwave activity, and if such changes are related to clinically meaningful symptom changes or more sensitive measures of attention not captured by the ASRS.
... Such studies provide an impression of the potential danger for psychological health of humans during prolonged consumption of food additives. The works by Schab & Trinh (2004) and McCann et al. (2007) describe hyperactivity of children, which was related to consumption of tartrazine. Rus et al. (2010) studied the toxicity of tartrazine for guinea pigs in 1, 2 and 3% doses during 3 weeks. ...
Substances for protecting plants often contain colourings, the impact of which on invertebrates has been studied insufficiently. The addition of food colourings in different concentrations to the diet of saprophage beetles can affect their metabolism, causing loss of body weight. In the experiment, we determined the impact of tartrazine, allura red and indigo carmine on the body weight of Tenebrio molitor Linnaeus, 1758 larvae. The substances were added to their fodder at five concentrations (1, 0.1, 0.01, 0.001 and 0.0001 g/kg of dry fodder) during a 21-day experiment. Statistically significant data on changes in the body weight of T. molitor larvae were received after adding 1 g/kg concentration of indigo carmine and 0.1 and 1 g/kg concentrations of tartrazine. In the other variants of the experiment, no statistically significant differences were determined. Tartrazine, allura red and indigo carmine cause decrease in the body weight of T. molitor larvae, depending on the concentration of the colouring. The toxic effect of synthetic food colourings on living organisms and the low number of studies devoted to such impact on insects indicate the relevance and necessity for further research in this sphere.
... Some reports confirmed that TAZ exerts no danger-ous effect in both human and experimental models (5)(6)(7)(8). However, other studies reported that TAZ induces neurotoxic (9,10), immunotoxic (11), reprotoxic (12,13), genotoxic, and mutagenic effects (4), as well as irritability, restlessness, and sleep disturbance (14)(15)(16). Recently, researchers' attention has focused on the potential teratogenic effects of some food additives in pregnant women. ...
Tartrazine (TAZ) is one of the most commonly used artificial dyes for foods and drugs. We determined the effect of TAZ on fetal development by examining morphological, visceral, and skeletal malformations in rat fetuses following daily oral administration of TAZ to pregnant Wistar rats at the 6th-15th day of gestation. TAZ at 0.45 and 4.5 mg/kg induced 6.0 and 7.1% fetal resorptions, as well as 10.0 and 10.5% fetal mortality, respectively. Fetal body weight and length were significantly lower in the groups treated with TAZ at 0.45 (3.97 ± 0.21 g and 27.3 ± 0.54 mm, respectively) and 4.5 mg/kg (3.48 ± 0.15 g and 23.22 ± 1.02 mm, respectively) than in the control group (4.0 ± 0.15 g and 30.01 ± 0.42 mm, respectively). TAZ at 0.45 and 4.5 mg/kg induced hepatic damage (20 and 33.3%, respectively), dark brown pigmentation due to hemosiderin in the splenic parenchyma (16.7 and 21.7%, respectively), as well as destructed and necrotic renal tubules (16.7 and 26.7%, respectively) in the fetuses. Moreover, TAZ at 0.45 and 4.5 mg/kg caused one or more missing coccygeal vertebrae (20 and 40%, respectively), missing sternebrae (6 and 10%, respectively), missing hind limbs (24 and 4%, respectively), and irregular ribs (16 and 20, respectively) in the fetuses. We concluded that TAZ has embryotoxic and teratogenic potentials in rats.
... Dietary factors were thought to plays a role in the pathogenesis of ADHD. It was found that, high consumption of artificial food colors and additives from fruit drinks were associated with increase in the hyperactive behavior (Schab D.W., 2004;McCann D., 2007). ...
Objective: Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder
of childhood. In this study we have evaluated the antioxidant activity in ADHD. Methods: Thirty ADHD
patients from the outpatient clinic at the institute of postgraduate childhood studies, Ain Shams University,
were diagnosed according to the DSM based diagnostic screening scale with thirty normal age and sex matched
controls. Blood samples were collected: superoxide dismutase (SOD), glutathione peroxidase (GPX), glutathione
s-transferase (GST), catalase (CAT), Ferritin and hemoglobin (Hb) were measured. Results: The mean level
of SOD, GST, GPX, CAT were significantly lower in cases than controls indicating low antioxidant activity
in children with ADHD. Conclusion: Remarkable low antioxidant activity in ADHD suggested that, oxidative
imbalance plays a role in the pathogenesis and prognosis of ADHD and should be taken in consideration in
the therapeutic plans.
... Many of the studies concluded that they causeand-effect relationship between food dyes and hyperactivity. The authors stated that dyes "promote hyperactivity in hyperactive children, as measured on behavioral rating scales" and that "society should engage in a broader discussion about whether the aesthetic and commercial rationale for the use of [artificial food colorings] is justified" [8] several cases of Tartrazine -sensitivity were reported, most frequently in the form of urticaria (hives) and asthma [9] genotoxicity studies performed on Allura Red 40 was positive in in vivo comet assay in the glandular stomach, lungs, and colon of mice [10] which indicates that Allura Red can cause DNA damage in vivo. ...
... After nutrient-adjusting for sugar and hydrogenated vegetable oil, the risk of the Western dietary pattern decreased but remained significant. This issue may be due to other confounders, such as food colors, food additives (33,34), fatty acids compounds (8,35), and oxidative stress (24). The effect of these confounders was not considered in the present study. ...
Objective: Associations between nutritional/dietary factors and mental disorders have been suggested. This study was conducted to assess the relation of major dietary patterns determined by factor analysis with attention-deficit/hyperactivity disorder (ADHD) in a group of Iranian preschool- and school-aged children.
Methods: This case-control study was conducted with 500 preschool- and school-aged children (4–12 years old) matched by age and sex, in Isfahan, Iran. Dietary intake was identified by a 168-item questionnaire, and major dietary patterns were identified by factor analysis. The multivariable logistic regression is used for the association of dietary patterns with the diagnosis of ADHD. ADHD diagnosis was carried out with the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Results: Two major dietary patterns were identified: healthy and Western. The healthy dietary pattern was rich in fruits, vegetables, vegetable oils, whole grains, legumes, and dairy products. The Western pattern was rich in processed meat, red meat, pizza, eggs, snacks, animal fat, hydrogenated fat, and salt. After controlling for potential confounders, children in the top quintile of the Western dietary pattern score had greater odds having ADHD, compared with those in the lowest quintile (odds ratio [OR] = 3.45; 95% confidence interval [CI], 1.17–18.3; ptrend = 0.03). The healthy pattern was inversely associated with ADHD (OR = 0.46; 95% CI, 0.38–0.91; ptrend = 0.01).
Conclusions: A significant independent association was found between the Western dietary pattern and the odds of ADHD. The healthy dietary pattern was associated with lower odds of having ADHD. Prospective studies are needed to confirm these findings.
Silver-doped zirconium ferrite (AxZ1-xFO, x = 0, 0.2, 0.4, 0.5, 0.6, 0.8, and 1) nanoparticles (NPs) have been successfully synthesised by utilising the facile auto-combustion approach. The synthesis of NPs has been confirmed by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscope with energy-dispersive spectrometer (SEM-EDS), high-resolution transmission electron microscope (HR-TEM) and Brunauer–Emmett–Teller (BET) analytical techniques. The magnetic and optical properties of synthesised AxZ1-xFO NPs have been investigated using a vibrating sample magnetometer (VSM) and UV-Visible spectroscopy, respectively. Additionally, herein the prepared magnetic NPs have been utilised for the photodegradation of hazardous colouring agents, namely, Chromotrope-FB (Chr-FB) and Ponceau-BS (PBS). The prepared NPs, particularly AxZ1-xFO, (x = 0.8), showed excellent photoresponse for photodegradation of Chr-FB and PBS having a % degradation of 99.77% for Chr-FB and 99.21% for PBS in just 40 and 45 min, respectively, under solar irradiation. The photocatalytic degradation has been determined by the electron-hole mechanism in which the electrons are transferred from the valence band to the conduction band of the photocatalyst’s surface and combined with oxygen or water to form radicals. It has been found that the OH radical played a significant role in the photodegradation of Chr-FB and PBSs in the presence of AxZ1-xFO, (x = 0.8). In addition, UV-Visible spectroscopy and mass spectrometry were used to analyse the degradation process. Moreover, the photocatalyst AxZ1-xFO (x = 0.8) achieved notable stability and reusability, thus making it an effective catalyst for environmental pollutant degradation.
The period from birth to 12 years is crucial in a child's development and can significantly impact future educational success, resilience and participation in society. Health and Wellbeing in Childhood provides readers with a comprehensive introduction to a wide range of topics and issues in health and wellbeing education, including child safety, bullying and social emotional wellbeing, resilience, physical education, communication development and friendships. It explores relevant policies, standards and frameworks, including the Early Years Learning Framework and the Australian Curriculum. The third edition provides a cohesive and accessible reading experience and includes updated and expanded coverage of nutrition, body image and community partnerships. Each chapter has been revised to include the latest research and developments in childhood health and wellbeing, and features definitions of key terms, case studies, pause and reflect activities and end-of-chapter questions. Supplementary materials, including video and audio links, are available on the companion website.
To date, there has been relatively little research into how the neurobiological mechanisms of sleep regulation may be affected in attention deficit hyperactivity disorder (ADHD). This chapter gives a broad overview of the neurobiology of sleep and explores possible neurobiological processes that may explain the association between sleep problems and ADHD. The chapter discusses the reciprocal inhibition between a system that promotes wakefulness, attention, and alertness, and a system that induces sleep. It highlights the nuclei and neurotransmitters of the ascending arousal system and the sleep-inducing system, and the mechanisms that drive the transition between the two systems. It also covers the homeostatic and circadian regulation that drives sleep to occur. This summary of the growing literature reveals that anomalies in particular neural circuitry or neurotransmitter systems may contribute to both difficulties in the regulation of sleep and the behavioral and cognitive deficits that characterize ADHD, however, the relationship may not be straightforward.
Studies support a relationship between food dye exposure and adverse behavioral outcomes in children. The amount of Food, Drug, & Cosmetic (FD&C) dyes used in commercial food products is proprietary information and can only be determined through the direct analysis of foods. Herein FD&C dyes were quantified in ten categories of foods previously identified as commonly consumed by children. Dyes were isolated using solid phase extraction (SPE) and quantified by high performance liquid chromatography (HPLC). Significant in-lot and between-lot variability was observed in some brands. FD&C Red No. 40 was the most prevalent dye identified in all food categories. The maximum exposure levels of FD&C dyes for an average-weight six-year-old to ten-year-old are all below 10% of the US ADI for each food category based upon one serving per day. Red No. 40 accounted for 7-9% of the maximum value of the US ADI in the drink categories for one serving. When the azo dyes are considered together, they contribute 10-22% of the ADI in the drink categories and 8% in the fruit snack/candy category based upon one serving. For an average weight six-year to ten-year old child, Red No. 40 is the most significant source of food dye in their diet.
Deficiencies of nutrients, including vitamins, minerals and polyunsaturated fatty acids, and surpluses of food items, such as sucrose and artificial food additives, have not convincingly been shown to be involved in the etiology of ADHD. At group level, there is no conclusive evidence supporting dietary interventions for the treatment of ADHD. The identification of a role of food compounds in ADHD is hindered by the complex and ill-defined nature of ADHD. In view of the heterogeneity of the disorder, potential therapeutic benefits of nutritional interventions could be confined to subpopulations of children with ADHD as yet unidentified. The cumulative benefits of the range of ingredients comprising healthy diets may result in better outcomes compared to a supplementation of individual nutrients. Diet and nutrition interact with other lifestyle factors, such as physical activity, and the interrelationship between nutrition and lifestyle should play a more prominent role in research on treatment approaches to ADHD. The few-foods or oligoallergenic diet allows the design of individually tailored diets and may offer treatment opportunities in subgroups of children diagnosed with ADHD. Further research is required to demonstrate the utility of nutrition-related interventions alone or in combination with other treatment approaches in ADHD.
النسخة العربية المترجمة (إشراق) من: البيان الدولي الصادر بالإجماع عن الاتحاد الدولي لفرط الحركة وتشتت الانتباه نسخة الموقع الرسمي
I'm extremely proud and honoured to have been part of this amazing international team. A
The ARABIC Version of the International Consensus Statement on ADHD is here:
https://www.adhd-federation.org/publications/international-consensus-statement.html
نسخة الوثيقة العلمية المنشورة
The main article link:
https://lnkd.in/dMQNrqx
شكرا جزيلا جمعية إشراق بهذا لهذا الوقف العلمي المميز
Thank you Saudi ADHD Society | جمعية إشراق:
الجمعية السعودية لاضطراب فرط الحركة
https://adhd.org.sa/en/
The concept of ADHD arose from neurological formulations, but does not entail them, and the modern definition simply describes a set of behavioural traits. The historical evolution of the concept was described by Schachar. It began with the idea that some behavioural problems in children arose, not from social and familial adversity, but from subtle changes in brain development. The term ‘minimal brain dysfunction (MBD)’ was often applied, and covered not only disorganized and disruptive behaviour but other developmental problems (such as dyspraxias and language delays) presumed to have an unknown physical cause. MBD, however, stopped being a useful description when studies of children with definite and more-than-minimal brain damage made it plain that they showed a very wide range of psychological impairment, not a characteristic pattern (see Harris, this volume); and therefore it was invalid to infer the presence of brain disorder from the nature of the psychological presentation. The successor to the concept of MBD was attention deficit and hyperactivity: defined, observable behaviour traits without assumption of cause. ‘Attention Deficit/Hyperactivity Disorder’ (ADHD) in DSM-IV, and ‘Hyperkinetic Disorder’ in ICD-10, describe a constellation of overactivity, impulsivity and inattentiveness . These core problems often coexist with other difficulties of learning, behaviour or mental life, and the coexistent problems may dominate the presentation. This coexistence, to the psychopathologist, emphasizes the multifaceted nature of the disorder; to the sociologist, a doubt about whether it should be seen as a disorder at all; to the developmentalist, the shifting and context-dependent nature of childhood traits. For clinicians, ADHD symptoms usually need to be disentangled from a complex web of problems. It is worthwhile to do so because of the strong developmental impact of ADHD and the existence of effective treatments. Public controversy continues, but professional practice in most countries makes ADHD one of the most commonly diagnosed problems of child mental health.
Microbiological studies have proposed that bacteria are associated with all diseases; hence, the notion of microorganisms facilitating cancer. Cancer cells have become more resistant to chemotherapy treatments. The aim of this review was to advance the association of microbes to cancer development among basic science researchers and clinical scientists in order to direct the processes to minimize the cancer epidemic. Furthermore, a view on a large number of microbes being observed in the areas of tumor than that of normal tissue is presented. Microbes can be identified in precancerous tissues, suggesting their presence before the induction of cancer; therefore they should be referred to as hidden killers. Overall, cancer development is caused by infected injuries by most fungi (Aspergillus species), viruses (human papillomaviruses), bacteria (Helicobacter pylori), and parasites (Schistosoma haematobium). There is minimal awareness on the relationship between cancer and microbes including their metabolites, especially in the developing world, which further increases the risk of cancer development by microbes that can be easily eradicated using basic drugs.
In the field of athletics, running is one of the most popular activities having beneficial health effects as well as negative effects during sports injury. Not only elite marathoners, but recreational marathoners have various lower limb musculoskeletal injuries that occur quite frequently which produces an adverse effect over the performance of the marathoners. Studies have suggested that the most common muscles that were affected were quadriceps group of muscles as well as the hamstrings muscles. The main mechanism behind the injury to the quadriceps muscles is the strong contraction of the muscle against the forced flexion action of the knee joint which is commonly seen in runners in a downhill marathon. Some of the risk factors that are responsible for the quadriceps muscle strains are inadequate stretching, muscle imbalance of the lower extremity and inadequate warm-up before vigorous exercise. Objective of this study was to find out the effect of eccentric training and whether isolytic contraction helps to improve the flexibility of the quadriceps muscle and joint range of motion of knee as well as hip joint. A total of 30 subjects were selected for the study from Krishna College of Physiotherapy. The subjects were divided into two groups namely, group A and group B consisting of 15 subjects each. Demographic data, assent and consent was taken from the marathoners that were selected according to the inclusion criteria. Pre and post assessment was taken on the basis of both active range of motion of the hip joint, active range of motion of knee joint, Manual Muscle Test of the quadriceps and Ely’s test for quadriceps before and after 6 weeks (total 16 sessions) of the treatment respectively. The session lasted for a time period of 45 mins. After the data was collected, evaluation and interpretation of collected data was done thoroughly. The subjects under the eccentric training protocol were found to have more effect compared to the ones in the group consisting of isolytic contraction protocol. The conclusion of this study was that significant effect of eccentric training and isolytic contraction helps to improve the flexibility of the quadriceps muscle and joint range of motion.
Food, Drug, & Cosmetic (FD&C) dyes are synthetic color additives used in food, prescription drugs and over-the-counter medicines (OTCs). Consumption of FD&C dyes is associated with hyperactive behavior in some children. The amount of dye used in commercial products is proprietary, making it difficult to assess dietary intake and determine exposure in children. To date, no studies have examined FD&C dyes in OTCs or vitamins in the United States. To address this, FD&C Red No. 40, Yellow No. 5, Yellow No. 6, Blue No. 1, and Blue No. 2 levels were measured in prenatal vitamin tablets, children’s chewable and gummy vitamins, pain reliever tablets and syrups, and cough/cold/allergy tablets and syrups. Dyes were isolated using solid phase extraction (SPE) and quantified by high performance liquid chromatography (HPLC). Dye levels varied between products with highest levels in pain reliever and cough/cold/allergy syrups. Significant variability was observed within some brands. Degradation of Red No. 40, Blue No. 1, and Yellow No. 6 was observed in the vitamin gummies. Intake of FD&C Red No. 40 is two times the US FDA ADI (accepted daily intake) for some children’s pain reliever syrups and almost three times the US FDA ADI for some cough/cold/allergy syrups.
The performance of 10 natural yellow colourants at different concentrations (0.001–0.3% w/v) was investigated in a model beverage system at various pH levels (3.5, 5.5 and 7.5) containing 10% w/v of sucrose, with or without ethanol (15% v/v) to simulate both alcoholic and non-alcoholic lemon-like beverages. Thus, the incidence of pH, ethanol and colourant concentration on spectral properties as well as turbidity were evaluated. The λmax was found to be independent from concentration in the tested range (0.001– 0.3% w/v), whereas the specific absorbance at λmax increased linearly. Moreover, the absorption spectrum and λmax of yellow pigments were found to be independent of pH and ethanol. Gardenia, safflower, and curcumin had the highest colour intensity and the lowest turbidity level. Heat and light stability were studied for these as well. Safflower was found to be the most stable colourant against heat (25, 40, 60, 80°C) and light (550 W/m², 30°C).
Naturally sourced colorants and dyes are currently gaining demand over synthetic alternatives due to an increase in consumer awareness brought forward by health and environmental issues. Microalgae are unicellular organisms which are microscopic in size and represent major photosynthesizers with the ability to efficiently convert available solar energy to chemical energy. Due to their distinct advantages over terrestrial plants such as faster growth rates, ability to grow on non-arable land, and diversity in the production of various natural bioactive compounds (e.g., lipids, proteins, carbohydrate, and pigments), microalgae are currently gaining promise as a sustainable source for the production of natural food-grade colorants. The versatility of microalgae to produce various pigments (e.g., chlorophylls, carotenoids, xanthophylls, and phycobiliproteins) that can be commercially exploited as a source of natural colorant is there to be explored. Various growth factors such as temperature, pH, salinity, and light in terms of both quality and quantity have been shown to significantly impact pigment production. In this chapter, we comprehensively review the characteristics of microalgal pigments and factors that affect pigment production in microalgae while evaluating the overall feasibility of exploiting them as a natural source of food colorants.
The aim of the study is to present the results of the 2017 National Assessment of Basic
Competencies (NABC), in view of pupils with Integration, Learning and Behavioral disorder (BTM) and a group of pupils with Special Educational Need (SEN). The Authors
present the groups of BTM and SEN, as well as the short and long term consequences of
belonging to these groups. They then present their prevalence rates in the sample and the
performance of these children in the National Assessment of Basic Competencies (NABC).
The results are presented by age group, gender and school type. It can be seen that the
performance of SEN and BTM children may require a more complex analysis, as their
relative error (due to lower case numbers) is higher for the students in these categories.
The difference between school types is well illustrated, ie, the stronger the learning expectation in the given school type, the greater the backlog of SEN and BTM children.
Kivonat A tanulmány célja a 2017-es országos kompetenciamérés eredményeinek ismertetése, a beilleszkedési tanulási és magatartás zavaros (Btm) tanulók és a sajátos nevelésű ta-nulók (SNi) egy csoportjának szempontjából. A szerzők ismertetik a Btm és SNi cso-portjait, illetve rövid és hosszú távú következményeit e csoportokhoz tartozásnak. ez-után bemutatják a mintában az előfordulási arányaikat, és ezen gyermekek teljesítmé-nyét az országos kompetenciateszten. Az eredmények ismertetése korosztályok, nemek és iskolatípusok szerint történik. látható, hogy az SNi-s illetve Btm-es gyerekek telje-sítménye sokkal összetettebb elemzést igényelhet, ugyanis a relatív hibája (az alacso-nyabb esetszámok okán) magasabb e kategóriákba sorolt diákok teljesítményének. Jól kirajzolódik az iskolatípusok közötti eltérés, vagyis minél erősebb a tanulmányi elvárás az adott iskolatípusban, annál nagyobb az SNi-s és Btm-es gyerekek lemaradása. Kulcsszavak: sajátos nevelési igény (SNi) ADHD diszlexia beilleszkedési, tanulási és magatartási zavar Abstract the aim of the study is to present the results of the 2017 National Assessment of Basic competencies (NABc), in view of pupils with integration, learning and Behavioral disorder (Btm) and a group of SeN pupils (SeN). the authors present the groups of Btm and SeN, as well as the short and long term consequences of belonging to these groups. they then present their prevalence rates in the sample and the performance of these children in the National Assessment of Basic competencies (NABc). the results are presented by age group, gender and school type. it can be seen that the performance of SeN and Btm children may require a more complex analysis, as their relative error (due to lower case numbers) is higher for the students in these categories. the difference be-1 károli Gáspár református egyetem, Pszichológiai intézet, Budapest, 1034, Bécsi út 324.
Nutrition is one of the most basic needs for the continuation of human life. When compared with almost fifty years ago, we can say that our eating habits changed completely. Today, because of attractive images, without thinking too much on the prepared food that we consume, we are rapidly moving away from natural foods. Food additives are used to impart color, to extend the shelf life of prepared food and to protect from pathogens that cause spoilage. Synthetic food dyes not found in nature according to their chemical structures, but are produced via chemical synthesis. This study aimed to investigate the effect of Brilliant Blue and Dark Green food dyes on the Escherichia coli which is part of the intestinal flora. The 3 different concentrations studied of each food dyes. The bacteria treated for 20 days and bacterial counts daily performed. The effects of each dyes on the growth of bacteria and Lac Z expression were determined by real time PCR. Especially after 12 day, bacterial growth in the group of bacteria that treated with Brilliant Blue and Dark Green have been found to decrease compared to control group. Both food dyes were found to not influence significantly on generation of E. coli by the expression of the LacZ gene
עבודה זו עוסקת בשאלה "כיצד משפיעה התזונה על התפתחות המוח בשלבי החיים השונים, ובאיזה אופן היא משפיעה על ילדים ומתבגרים בעלי ADHD ו-ASD?"
מוצג בה הקשר המדעי בין התזונה למוח ולהופעתן של הפרעות נוירולוגיות, כמו גם סקירה של מקום התזונה בשלבים הראשונים של האדם – כעובר וכתינוק. פרק אחד מוקדש לתזונת האם, המהווה את מקור תזונתו של הילד בתקופות אלה ולאחר מכן ישנה סקירה של תקופות הילדות וההתבגרות, תוך חקירת השפעתם של רכיבי מזון שונים על הופעתם של תסמיני ADHD ו-ASD. העבודה חותמת בסממנים המאותתים כי התנהגות הילד עשויה להיות קשורה בתזונה ולאחר סיכום הדברים מציעה מסקנות יישומיות להורים.
The amplified antimicrobial activities of poly(arbutin) [poly(arb)] and its 10% octylated derivative [poly(arb)-C8 10 ] are described in this paper. Poly(arb) was prepared from monomeric arbutin via oxidative polymerization in an aqueous media, and poly(arb)-C8 10 was prepared by alkylation of poly(arb) with octyl isocyanate. The minimum inhibitory concentration of arbutin, poly(arb), and poly(arb)-C8 10 were determined to be 111, 15.2, and 52.6 mg/mL against Escherichia coli and 111, 1.00, and 1.00 mg/mL against StapHylococcus aureus, respectively. The higher antimicrobial activity of polymeric arbutin compared with monomeric arbutin was proposed to be the result of the neighboring effect of phenolic groups of polymers along with the concentration effect of the polymers on the surface of the culture plate, which was proved by ultraviolet–visible spectrophotometry.
Tests for experiments with matched groups or repeated measures designs use error terms that involve the correlation between the measures as well as the variance of the data. The larger the correlation between the measures, the smaller the error and the larger the test statistic. If an effect size is computed from the test statistic without taking the correlation between the measures into account, effect size will be overestimated. Procedures for computing effect size appropriately from matched groups or repeated measures designs are discussed.
Tests for experiments with matched groups or repeated measures designs use error terms that involve the correlation between the measures as well as the variance of the data. The larger the correlation between the measures, the smaller the error and the larger the test statistic. If an effect size is computed from the test statistic without taking the correlation between the measures into account, effect size will be overestimated. Procedures for computing effect size appropriately from matched groups or repeated measures designs are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A questionnaire evaluation of 486 hyperactive children (HA) (82% boys, aged 7-13 years and 18% girls, aged 8-13 years) showed that more than 60% of cases reported a positive behavioural response (i.e. increased problems) in relation to consuming or being exposed to synthetic colourings and flavourings, food and beverage preservatives, cow's milk and associated products, chemical detergents and perfume. In contrast, 172 sex- and age-matched control children (C) reported only 12% of cases responding to synthetic colourings and flavourings and chemical solvents. The main health problems reported by the 96% of hyperactive children affected by synthetic colourings and flavourings were persistent thirst problems, the development of eczema, ear and/or chest infections, and the production of excessive amounts of catarrh. Trace element measurements undertaken by inductively coupled plasma mass spectrometry showed that a low zinc and iron status is associated with hyperactive children when compared with control children for blood serum, urine and washed scalp hair (HA C). In many cases, hyperactive children also had very highly significant raised levels of aluminium, cadmium and/or lead (HA C), particularly in urine and washed scalp hair samples. Hyperactive children with a known behavioural response following the consumption of a beverage containing tartrazine, E ( n= 23), sunset yellow, E ( n= 12) 102 110 and amaranth, E ( n= 12) were given a dose of chemical food colour (50 mg) and their zinc 123 levels (blood serum and urine) and behavioural activity were monitored for 120 min. A sexand age-matched control group was also studied. Only hyperactive children showed a significant reduction in blood serum zinc levels and an increase in urinary zinc output following the consumption of E and E . Amaranth had no effect on their zinc status over 102 110 the study time period. There were no significant changes in the zinc levels for control children for all three chemical food colours. The main behavioural changes were observed in the hyperactive children given E and E . For the 23 children who consumed a tartrazine 102 110 beverage there were increased levels of overactivity ( n= 18 children), aggressive ( n= 16) and/or violent ( n= 4) activity, poor speech ( n= 2), poor coordination ( n= 12), and the development of asthma and/or eczema ( n= 8). Most of these were severe or moderate changes. Only one control child showed minor behavioural responses to tartrazine.
This study was designed to maximize the likelihood of demonstrating a diet effect in one child whose history indicated clear behavioral improvement on the diet. Preliminary trials evaluated the dose-response relationship, and an intensive multiple crossover study permitted statistical analysis.
We performed an objective evaluation of 39 children whose behaviour was observed by their parents to improve on an artificial food additive free diet and to deteriorate with dietary lapses. Only 19 children completed a double blind placebo controlled challenge study with artificial food colours. In these children food colours were shown to have an adverse effect on a daily Conners' rating of behaviour, but most parents could not detect these changes. A pharmacological mechanism of food additive intolerance is proposed to explain these effects.
The Feingold diet continues to be a matter of controversy. In this marginal comment, Dr Esther Wender discusses the findings of two studies recently reported in Science. Rebuttals by the authors of these two studies follow in sequence .—Ed.
• The "Feingold diet," which eliminates artificial food colorings, has been claimed to be beneficial to hyperactive children. Previous studies have yielded equivocal results. We sought to maximize the likelihood of demonstrating behavioral effects of artificial food colorings by (1) studying only children who were already on the Feingold diet and who were reported by their parents to respond markedly to artificial food colorings, (2) attempting to exclude placebo responders, and (3) administering high dosages of coloring. The design was a double-blind crossover with order randomized; 11 children maintained on the Feingold diet were challenged with food coloring and placebo (one each week). Evaluations by parents, teachers, and psychiatrists and psychological testing yielded no evidence of a food coloring effect.
David P. Rail, Director of the National Institute of Environmental Health Sciences and of the National Toxicology Program, once challenged an audience with the following question: Suppose that thalidomide, rather than inducing structural deformities, had instead depressed IQ scores by 10%; would we ever have suspected it of adverse effects?
The answer to that question is disquietingly obvious. Rall framed it to illustrate the problems now taunting the science of environmental toxicology. Absence of death and frank disease are too blunt to serve alone as evidence of safety. The community demands protection against the subtle, insidious, often delayed consequences of exposure to toxic environmental agents, consequences exemplified by behavioral disturbances. Behavioral toxicology is a discipline created by that concern. Although a young discipline—the first meeting was organized in 19721—it is exerting a widening influence. In the Toxic Substances Control Act of 1976, which mandates premarket toxicity evaluation of
There are many professionals in multiple disciplines proposing treatment approaches for individuals with learning disabilities. when research has been done to support an approach, the reports and data may be published in journals normally not read by parents, educators, or other professionals. When research data are not available, the information may be in a popular book, the newspapers, lay magazines, or on television. Thus, parents may hear of ideas and suggestions before professionals. It is understandable that parents would seek out improved ways of helping their son or daughter. It is the purpose of this paper to review the significant literature in an effort to assist parents and professionals in assessing controversial approaches to treatment.
The double-blind, double-crossover study tested Feingold's hypothesis that synthetic food colors cause hyperactivity in some children. Each of 6 hyperactive boys constituted a single-subject experiment. All subjects were on the Feingold diet eliminating artificial colors and flavors. All mothers claimed the diet had been effective. Subjects were challenged twice, for 3-day periods, with synthetic colors introduced in cookies eaten on challenge days. Identically appearing and tasting cookies containing no synthetics were eaten on control days. Data analyses suggested that 1 of the 6 subjects responded with hyperactive behavior to the challenge cookies. This result, however, was not duplicated in a replication study. Results from other diet challenges were reviewed. The authors conclude that evidence for Feingold's hypothesis is weak.
Diana B. Petitti, Oxford University Press, New York, 1994. No. of pages: x+246. Price: £32.50. ISBN: 0-19-507334-7
This is the fourth edition of a very successful textbook on clinical trials methodology, written by three recognized experts who have long and extensive experience in all areas of clinical trials. Most chapters have been revised considerably from the third edition. A chapter on ethics has been added and topics such as noninferiority and adaptive designs now receive considerable discussion. There is much new material on adverse events, adherence, data monitoring, and issues in analysis. This book is intended for the clinical researcher who is interested in designing a clinical trial and developing a protocol. It is also of value to researchers and practitioners who must critically evaluate the literature of published clinical trials and assess the merits of each trial and the implications for the care and treatment of patients. The authors use numerous examples of published clinical trials from a variety of medical disciplines to illustrate the fundamentals. The text is organized sequentially from defining the question to trial closeout. One chapter is devoted to each of the critical areas to aid the clinical trial researcher. These areas include pre-specifying the scientific questions to be tested and appropriate outcome measures, determining the organizational structure, estimating an adequate sample size, specifying the randomization procedure, implementing the intervention and visit schedules for participant evaluation, establishing an interim data and safety monitoring plan, detailing the final analysis plan, and reporting the trial results according to the pre-specified objectives. Although a basic introductory statistics course is helpful in maximizing the benefit of this book, a researcher or practitioner with limited statistical background would still find most if not all the chapters understandable and helpful. While the technical material has been kept to a minimum, the statistician may still find the principles and fundamentals presented in this text useful. This book has been successfully used for teaching courses in clinical trial methodology. © Springer Science + Business Media, LLC 2010. All rights aeserved.
Twenty hyperactive male children were assessed for zinc status and compared with 20 age-matched controls, and a double-blind placebo-controlled study of the effect of the chemical additive tartrazine (E102) on the zinc status of 10 hyperactive males versus 10 age-matched controls is reported. Analysis of tartrazine in commercial orange beverages was performed by high performance liquid chromatography using a reverse-phase ion-pair system. The influence of tartrazine upon zinc status of blood sera, washed scalp hair, urine, saliva and fingernails of hyperactive and control children is assessed. Zinc measurements were undertaken by inductively-coupled plasma-source mass spectrometry (ICP-MS). The tartrazine content of various commercial orange beverages ranged from 0.58–4.16 μg ml−1. Low zinc status is associated with the hyperactive compared with control for urine (p<0.001), scalp hair (p<0.001), serum (p<0.01), 24-hour urine (p<0.01) and fingernails (p<0.01). Saliva showed no statistically significant difference. Tartrazine induces a reduction in serum and saliva zinc concentrations and an increase in urinary zinc content with a corresponding deterioration in behaviour/ emotional responses of the hyperactive children but not the controls.
Conners Teacher Rating Scales were completed on 124 boys aged between 5 and 11 years who attended the child guidance clinics of a large southeast London psychiatric hospital. Comparisons were made with the data provided by Conners (Am. J. Psychiat., 1969,126, 884–888) in which the factor structure of the scale was first identified. This was in response to a reported failure to replicate the scales factor structure in a clinic population despite a number of confirmatory studies on large numbers of children in general populations. Of the scale's five original factors, three were clearly identified. The other two, labeled Hyperactivity and Inattentive-Passive, comprised a single factor. A fifth weaker factor not identified by Conners (1969) was found, consisting principally of antisocial conduct items. The results are seen as providing further evidence of the scales robustness in this, the only other reported clinic study and one in which British children were used for the first time.
The Feingold hypothesis postulates that many children who exhibit disturbed behavior improve on a diet devoid of certain food additives. Its validity has been examined on the basis of controlled trials. The total evidence, although not wholly consistent, nevertheless suggests that the hypothesis is, in principle, correct. Such a conclusion poses difficult problems and new issues for etiology, treatment, toxicology, and regulation.Journal of the American Academy of Child Psychiatry, 21, 2:144–152, 1982.
The Conners' Parent Rating Scales (CPRS) have undergone a considerable amount of scrutiny—and subsequent refining, reshaping, and revising—since their development in 1970. While such longitudinal scrutiny has ultimately led to a more reliable, valid assessment tool, it has left behind a wake of literature filled with misinformation and ambiguity. Multiple versions of the Conners' Rating Scales (CRS), their misuse, and inaccurate reporting by researchers have created a body of literature that is difficult to interpret and misleading to both researchers and clinicians. This review is aimed at clarifying issues regarding the proper use of the CPRS as both a diagnostic instrument and a research tool.
Typescript. Thesis--University of Florida. Vita. Includes bibliographical references (leaves 64-67).
Thesis (Ed. D.)--Hofstra University. Spine title: Study of effect of Feingold diet on reading achievement and behavior. Includes bibliographical references (leaves [160]-173).
Thesis (M.S.)--Texas A & I University, 1993. Major subject: Guidance and counseling. Includes bibliographical references (leaves 37-39). Vita.
A mixture of seven food dyes inhibited the accumulation of eight neurotransmitters or neurotransmitter precursors by rat brain
homogenate. At a low concentration (1 microgram per milliliter), erythrosin B (FD&C red 3) was the only dye that inhibited
dopamine accumulation. Erythrosin also was effective in decreasing the accumulation of all the other transmitter substances,
suggesting that the inhibition is nonspecific and probably secondary to general membrane alteration.
A pilot study was conducted on 22 children (19 boys and three girls) aged between four and eight years, who were selected as hyperactive on the basis of developmental history and clinical judgement. Conners' parent-teacher ratings, objective tests of attention, standard perceptualmotor tests and subtests from the Wechsler Intelligence Scale for Children (WISC), were used as response variables. The children were tested before and after four weeks on the elimination diet, after a tartrazine and placebo challenge, and, finally, after a four-week washout period on the diet. Results showed a statistically significant improvement in the mothers' ratings of the children's behaviour after the first four weeks of the diet. The improvement was maintained in a combined analysis of the initial four-week diet period and four-week washout period. This result was not substantiated by the statistical analysis of the results from objective tests. The rating scales and objective tests for the full sample did not show a statistically significant deterioration in the children's behaviour when they were challenged under double-blind test conditions with the Yellow Dye No. 5, tartrazine, and the tests were conducted the day after a two-week challenge period. A comparison of mother ratings of behaviour during challenge and placebo double-blind trial and in the 24 hours preceding tests, in a subgroup of the children who, while on the diet, showed a 25% reduction of symptoms on the Conner's rating scale, indicated a significant challenge effect (P less than 0.025), with mothers reporting more symptoms during the challenge period. Dietary infringements with suspected trigger substances occurred throughout the trial.
In a test of Feingold's hypothesis that food additives trigger the hyperactive response, 26 hyperactive children were randomly assigned to treatment conditions whereby they were given active or placebo medications in combination with challenge cookies with artificial food colors or control cookies without the additives. The children were crossed over into each of the four treatment conditions and experimental procedures were employed, including double-blind assessments through the completion of behavior checklists, by teachers and parents.
Stimulant medications were clearly more effective than diet in reducing hyperactive behavior. The parent ratings indicate strong drug effects and inconclusive diet effects. Drug effects are marked in teacher ratings as well. However, when the children were receiving placebos, their hyperactive behaviors in the classroom were greater when eating cookies with artificial colors than when eating cookies without artificial colors.
According to the ratings, approximately seven children were no longer hyperactive. There is evidence to suggest that the behavior of three to eight children was diet-responsive, depending on the criteria used. There is evidence, particularly in teacher ratings, in support of Feingold's hypothesis if it is modified.
Further research is required to specify which subtypes of hyperactive children respond to a diet free of artificial food colors.
The presence of a functional relationship between the ingestion of artificial food colors and an increase in the frequency and/or duration of selected behaviors that are representative of the hyperactive behavior syndrome was experimentally investigated. Two eight-year-old females, who had been on the Feingold K-P diet for a minimum of 11 months, were the subjects studied. The experimental design was a variation of the BAB design, with double-blind conditions. This design allowed an experimental analysis of the placebo phases as well as challenge phases. Data were obtained by trained observers on Out of Seat, On Task, and Physically Aggressive behaviors, as they occurred in the subjects' regular class setting. Results indicated (a) the existence of a functional relationship between the ingestion of artificial food colors and an increase in both the duration and frequency of hyperactive behaviors, (b) the absence of a placebo effect, and (c) differential sensitivity of the dependent variables to the challenge effects.
Nine hyperactive male subjects, selected on the basis of showing a favorable "response" to the Feingold diet in an earlier study, were maintained on a strict elimination (Feingold) diet for 11 weeks, and were given multiple trials of placebo and challenge food materials. Parental and teacher ratings, classroom behavior observations, and neuropsychological test scores obtained during baseline, placebo, and challenge conditions, in general, were not found to be adversely affected by the artificial color challenge materials. As expected, comparable data gathered on a matched control group showed them to receive substantially better ratings than the hyperactive subjects on the majority of the comparison measures employed. Possible explanations for the discrepancy between the dramatic clinical-anecdotal reports that have been given and the much more equivocal findings from formal experimental projects are presented.
While a number of reports suggest that ingestion of food dyes may provoke behavioral and learning problems in children, few investigators have explored these agents in the developing organism. We have examined the consequences of chronic oral administration of food dyes on activity levels and avoidance learning in normal developing rat pups and littermates treated with 6-hydroxydopamine (6-OHDA) at 5 days of age to produce a behavior similar to attention deficit disorder with hyperactivity (ADD) observed in children. The food dyes were administered orally each morning beginning at 5 days of age and activity and avoidance learning were determined throughout the first month of postnatal life. Administration of food dyes produced significant effects with activity averaging 54.5%, 52.1%, 44.2% and 64.9% at respective doses of 0, 0.5, 1.0 and 2.0 mg/kg. At every age the highest dose of food dye (2.0 mg/kg) produced the greatest activity. This dose also resulted in significant effects on habituation of activity. Pups who did not receive food dye decreased their activity by 32.1% over the first 30 minutes of observation while in groups who received 2.0 mg/kg of food dye a reduction in activity of only 7.25% was noted over the same time period. Avoidance learning was also affected in pups fed the dyes. Escape latency in a T-maze at 21 days was significantly prolonged in the vehicle group fed 0.5 mg/kg of dye, but by 28 days, avoidance performance in a shuttle box was normal in all vehicle treated animals regardless of the food coloring. Food dyes did not affect either activity or avoidance learning in 6-OHDA treated animals but ceiling effects in both measures would tend to obscure increases in activity or prolongation of escape latency. We urge caution before generalizing these findings in developing rat pups to similar effects in children. In addition to basic and obvious species difference, practical coniderations such as equivalence of doses, rate of consumption and absorption make such extrapolations between animals and children difficult. Finally, no information is yet available which would relate ingestion of food dyes to any known central nervous system mechanism.
The attempt to obtain outpatient ECGs during periods of heart rhythm disturbances is hectic and frequently unproductive. The treadmill stress ECG is only occasionally helpful in arrhythmias that are precipitated by physical stress. Many models of the Holter monitor, useful in evaluation of frequently recurrent arrhythmias, have only a 24-hour continuous tape, the resolution is variable on replay, and carrying the recorder is cumbersome, particularly for children. Therefore, at the Arizona Heart Institute and the St. Joseph's Hospital and Medical Center, the authors have adopted transtelephonic electrocardiography as our preferred method of documentation of intermittent symptomatic arrhythmias of short duration.
Through the 1970s, Benjamin Feingold has published a series of studies in which he claimed that a diet free of salicylates, artificial food flavours and colours results in a remission of symptoms in 30 to 50 percent of children diagnosed as hyperactive. Parents of hyperactive children have responded strongly to the hypothesis and have requested that their children be placed on the diet. A series of clinical studies of the Feingold diet have produced mixed results. More recently, there have been four sets of experimental studies which have resulted in rigorous tests of the original diet and a modified diet with salicylates included but artificial additives excluded. None of the studies give unqualified support for the hypothesized diet effects, and there are reports which refute the thesis. There are findings which suggest that some hyperactive children (10 to 25 percent), particularly younger ones, respond favourably to a diet free of artificial additives. The lack of conclusive evidence dictates that additional research be conducted to test the hypothesis.
Conflicting reports make it difficult to determine if foods, food coloring, or allergies are related to hyperactivity. Twenty-four hyperactive children were tested with sublingual foods and dyes followed by a seven-day diet omitting milk, wheat, egg, cocoa, corn, sugar, and food coloring, and by subsequent individual ingestion challenges with these same food items. More than 70% of the children had evidence of allergy in their personal and family history, as well as positive allergy skin tests. The sublingual dye, but not the sublingual mixed-food test, correlated well with repeated ingestion challenges. Twelve children improved to a moderate or marked degree during the seven-day diet. A simple sublingual food-coloring test or a one-week experimental diet can be used to detect a subgroup of children hyperactive from specific food dyes or foods. Improvement persisted in children who avoided offending food dyes or foods for at least 12 weeks.
A double-blind crossover trial involving a control diet and a diet eliminating artificial flavors, colors, and natural salicylates as recommended by Feingold was conducted on 15 hyperkinetic children. Teachers and parents observed the children for one month prior to treatment, using standardized rating scales. Both parents and teachers reported fewer hyperkinetic symptoms on the K-P diet as compared to the pretreatment baseline. The teachers noted a highly significant reduction of symptoms on the K-P diet as compared to the control diet but the parents did not. The control diet ratings did not differ from the baseline period ratings for either parents or teachers. It is concluded that the K-P diet may reduce hyperkinetic symptoms, though this result is put forth with caution in view of several features inherent in the present study which need further evaluation, including objective measures of change, manipulation of the independent variable, and reducing the independent variable to more specific components.
Food intolerance seems to be an important cause of the hyperkinetic syndrome, but restricted diets are expensive, socially disruptive, and often nutritionally inadequate. Enzyme-potentiated desensitisation (EPD) may overcome some of these difficulties. EPD was tested in a double-blind placebo-controlled trial among 40 children with food-induced hyperkinetic behaviour disorder. A total of 185 children with established hyperkinetic syndrome underwent oligoantigenic dietary treatment for four weeks. 116 whose behaviour responded had provoking foods identified by sequential reintroduction. Foods that reproducibly provoked overactivity were avoided. 40 patients who were then invited to take part in the hyposensitisation trial were randomly assigned to treated and control groups. Treated patients received three doses of EPD (beta-glucuronidase and small quantities of food antigens) intradermally at two-monthly intervals. Controls received buffer only. Thereafter, patients were allowed to eat known provoking foods. Of 20 patients who received active treatment, 16 became tolerant towards provoking foods compared with 4 of 20 who received placebo (p less than 0.001). Our results show that EPD permits children with food-induced hyperkinetic syndrome to eat foods that had previously been identified as responsible for their symptoms. These results also support the notion that food allergy is a possible mechanism of the hyperkinetic syndrome.
Overviews of clinical trials are an efficient and important means of summarizing information about a particular scientific area. When the outcome is a continuous variable, both treatment effect and variance estimates are required to construct a confidence interval for the overall treatment effect. Often, only partial information about the variance is provided in the publication of the clinical trial. This paper provides heuristic suggestions for variance imputation based on partial variance information. Both pretest-posttest (parallel groups) and crossover designs are considered. A key idea is to use separate sources of incomplete information to help choose a better variance estimate. The imputation suggestions are illustrated with a data set.
Of 220 children referred for suspected 'hyperactivity', 55 were subjected to a 6 week trial of the Feingold diet. Forty (72.7%) demonstrated improved behaviour and 26 (47.3%) remained improved following liberalization of the diet over a period of 3-6 months. The parents of 14 children claimed that a particular cluster of behaviours was associated with the ingestion of foods containing synthetic colourings. A double-blind crossover study, employing a single-subject repeated measures design was conducted, using eight of these children. Subjects were maintained on a diet free from synthetic additives and were challenged daily for 18 weeks with either placebo (during lead-in and washout periods) or 50 mg of either tartrazine or carmoisine, each for 2 separate weeks. Two significant reactors were identified whose behavioural pattern featured extreme irritability, restlessness and sleep disturbance. One of the reactors did not have inattention as a feature. The findings raise the issue of whether the strict criteria for inclusion in studies concerned with 'hyperactivity' based on 'attention deficit disorder' may miss children who indicate behavioural changes associated with the ingestion of food colourings. Moreover, for further studies, the need to construct a behavioural rating instrument specifically validated for dye challenge is suggested.