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飲食與注意力不足過動症的關係

維基百科，自由的百科全書

有人懷疑注意力不足過動症與飲食存在關聯。關注的焦點主要為食品添加物、人工色素、含糖食物和衍生的食物過敏、食物不耐、和維他命、礦物質及Ω-3脂肪酸等營養素的缺乏[1]。整體來說，飲食並不會影響一個人的言行舉止到需要就醫的情形，而且飲食也不是絕大多數注意力不足過動症的成因。[2] 只有極少數人的言行舉止會受到食品添加物、人工色素、攝取過度的糖分、缺乏維生素礦物質與Ω-3脂肪酸的的影響。[2]

食品添加物與人工色素

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迄今未有證據能證明「食品添加物與人工色素」會導致兒童出現食物不耐症和注意力不足過動症的症狀。[3]:452 雖然有些人工色素可能真的會誘發些本來就帶有食物不耐症和注意力不足過動症基因或體質的人之症狀，但這個結論的證據力被認為是薄弱的，因為那些文獻似乎存在「不中立（bias）」、「統計數據的樣本數不足」的問題。[1][4][5]

血糖控制

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研究發現，讓ADHD患者改用無糖飲食，並不會顯著改善其ADHD的症狀；平常少吃含糖食物的人，改吃較多量的含醣食物後，也未出現ADHD的症狀。[6] 然而不排除仍有極少數的人對於糖較為敏感，畢竟多數研究所使用的含糖食物，其所含的糖分，都不至於到非常高的地步。[7]

精緻糖

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有些人認為攝取糖分、甜食、人工香料（英語：artificial flavors）（包含：阿斯巴甜）等會導致過動[8]，不過一旦回顧那些曾經比較學齡兒童（英語：school-aged children）和學齡前兒童（英語：preschooler）的對照實驗會發現，受試者即便將糖分攝取至遠高於正常範圍的程度，對受試者的「注意力」及「行為」並沒有產生影響[9]，如果將實驗組成員（受試者）換成是「其父母對糖分敏感的兒童試驗者」，得到的結果也相同。[10]

除此之外，美國小兒科醫學會舉出一個研究顯示，數名被其父母認為對糖分有反應的（reactive）的男孩子，當攝取較多量的糖分時，反而會變得較不活躍。[11] 美國小兒科醫學會另表示，不同研究人員通過數項比對血糖的研究，都得到ADHD患者與非ADHD患者在生活中的糖分攝取量並無不同的結論[11][12]。據此，「美國小兒科醫學會」決定不建議患者透過任何「特別飲食」來治療ADHD。[11]

MedlinePlus則表示，精緻糖可能對孩子的活動量有些許 影響，MedlinePlus認為精緻糖（英語：refined sugar）和碳水化合物能快速進入血管中，使血糖迅速升高，這可能使得孩子變得較為活躍。[8]雖然MedlinePlus不認為攝取精緻糖與ADHD有直接關係，仍建議不要過量甚至建議節制精緻糖的攝取，並且以更健康的飲食型態取而代之。[8]

截至2019年7月，沒有任何科學證據顯示糖、或甜食（包括：糖分含量遠高於一般菜餚的食物）會影響人類的行為或導致ADHD[13] [11][8][14][15]。

魚油

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有些研究指出，Ω-3脂肪酸在ADHD患者的血液中，含量較低。[16] 然而，「Ω-3脂肪酸在血液中的濃度是否會直接導致或改變ADHD的症狀」以及「ADHD患者中較低的Ω-3脂肪酸濃度之成因」，迄今仍不得而知。[16][17] 而「攝取Ω-3脂肪酸是否能改善ADHD的核心症狀」，學術界的研究至今仍未有結論。[18]

維生素與礦物質

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補充維生素和礦物質（例如：維他命B群、維他命C、鐵、鎂及碘等）對於改善ADHD病情的功效，尚有待更多的實驗證明。[19][20][21][註 1] （頁面存檔備份，存於網際網路檔案館）</ref> 在美國，沒有膳食補充劑被 FDA 批准用於治療多動症。[23]


一些用於管理多動症症狀的流行補充劑：

  • 咖啡因 — 多動症與咖啡因攝入量增加有關，咖啡因對認知的刺激作用可能對多動症有一些好處。[24] 有限的證據表明，其治療效果明顯不如哌醋甲酯和右旋安非他命等標準治療，但仍會產生類似或更大的副作用。[24][25]
  • 尼古丁 — 多動症和尼古丁攝入之間的關聯是眾所周知的，有限的證據表明尼古丁可能有助於改善多動症的某些症狀，儘管效果通常很小。[26][27][28]
  • Omega-3 脂肪酸 — 2012 年 Cochrane 綜述發現，幾乎沒有證據表明補充 omega-3 或其他多不飽和脂肪酸可以改善兒童或青少年的 ADHD 症狀。[29]2011 年的一項薈萃​​分析發現了「小而顯着的益處」，其益處「與目前可用的 ADHD 藥物治療的功效相比是適度的」。[30] 該評論得出結論，由於其「相對良性的副作用」，補充劑可能值得考慮作為與藥物組合的增強治療，但不作為主要治療。[30] 大多數關於 Omega-3 脂肪酸的研究被認為質量很差，存在廣泛的方法學缺陷。[29][30]
  • 鋅 – 儘管鋅在 ADHD 中的作用尚未闡明，但有少量有限證據表明較低的組織鋅水平可能與 ADHD 相關。[31] 在沒有證明缺鋅的情況下（在發展中國家以外很少見），不建議將補鋅作為 ADHD 的治療選擇。

[32]

  • 在 1980 年代，維生素 B6 被推廣為對學習困難（包括多動症）的兒童有益的補救措施；然而，一項針對多動症兒童的大劑量維生素研究表明，它們對改變行為無效。[33]
  • 維生素D [34]

參見

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註解

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  1. ^ 攝取過多的維他命可能產生健康問題。[22]

文獻

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  1. ^ 1.0 1.1 Center for Food Safety and Applied Nutrition. Background Document for the Food Advisory Committee: Certified Color Additives in Food and Possible Association with Attention Deficit Hyperactivity Disorder in Children (PDF) (報告). Food and Drug Administration. 30 March 2011 [2019-08-03]. （原始內容存檔 (PDF)於2015-11-06）.  （頁面存檔備份，存於網際網路檔案館）
  2. ^ 2.0 2.1 Author:Kevin R Krull, PhDSection Editor:Marilyn Augustyn, MDDeputy Editor:Mary M Torchia, MD. Attention deficit hyperactivity disorder in children and adolescents: Epidemiology and pathogenesis. UpToDate. [2019-08-03]. （原始內容存檔於2019-08-03）.  （頁面存檔備份，存於網際網路檔案館）
  3. ^ Tomaska, LD; Brooke-Taylor, S. Food Additives - General. Motarjemi, Y; Moy, G; Todd, ECD (編). Hazards and Diseases. Encyclopedia of Food Safety 2 1st. Amsterdam: Elsevier. 2014: 449–454. ISBN 978-0-12-378613-5. 
  4. ^ Millichap, JG; Yee, MM. The diet factor in attention-deficit/hyperactivity disorder. Pediatrics. February 2012, 129 (2): 330–337 [2019-08-03]. PMID 22232312. doi:10.1542/peds.2011-2199. （原始內容存檔於2015-09-11）.  （頁面存檔備份，存於網際網路檔案館）
  5. ^ Nigg, Joel T.; Lewis, Kara; Edinger, Tracy; Falk, Michael. Meta-Analysis of Attention-Deficit/Hyperactivity Disorder or Attention-Deficit/Hyperactivity Disorder Symptoms, Restriction Diet, and Synthetic Food Color Additives. Journal of the American Academy of Child and Adolescent Psychiatry (Elsevier BV). 2012, 51 (1): 86–97.e8. ISSN 0890-8567. PMC 4321798 可免費查閱. PMID 22176942. doi:10.1016/j.jaac.2011.10.015. 
  6. ^ pubmeddev; ML, Wolraich; Al., Et. The effect of sugar on behavior or cognition in children. A meta-analysis. - PubMed. NCBI. 1995-11-22 [2019-08-03]. （原始內容存檔於2020-01-12）.  （頁面存檔備份，存於網際網路檔案館）
  7. ^ Rojas, Neal L.; Chan, Eugenia. Old and new controversies in the alternative treatment of attention-deficit hyperactivity disorder. Mental retardation and developmental disabilities research reviews (Wiley). 2005, 11 (2): 116–130. ISSN 1080-4013. PMID 15977318. doi:10.1002/mrdd.20064. 
  8. ^ 8.0 8.1 8.2 8.3 Hyperactivity and sugar: MedlinePlus Medical Encyclopedia. MedlinePlus. 2018-07-09 [2018-07-13]. （原始內容存檔於2017-12-23）. In some cases, a special diet of foods without artificial flavors or colors works for a child, because the family and the child interact in a different way when the child eliminates these foods. These changes, not the diet itself, may improve the behavior and activity level.
    Refined (processed) sugars may have some effect on children's activity. Refined sugars and carbohydrates enter the bloodstream quickly. Therefore, they cause rapid changes in blood sugar levels. This may make a child become more active.
    Several studies have shown a link between artificial colorings and hyperactivity. On the other hand, other studies do not show any effect. This issue is yet to be decided.      （頁面存檔備份，存於網際網路檔案館）
  9. ^ Kanarek, RB. Does sucrose or aspartame cause hyperactivity in children?. Nutrition reviews. 1994, 52 (5): 173–5. ISSN 0029-6643. PMID 8052458. 
  10. ^ Krummel, Debra A.; Seligson, Frances H.; Guthrie, Helen A.; Gans, Dian A. Hyperactivity: Is candy causal?. Critical Reviews in Food Science and Nutrition (Informa UK Limited). 1996, 36 (1-2): 31–47. ISSN 1040-8398. doi:10.1080/10408399609527717. 
  11. ^ 11.0 11.1 11.2 11.3 American Academy of Pediatrics. Allergies and Hyperactivity. HealthyChildren.org. 2018-07-13 [2018-07-13]. （原始內容存檔於2017-12-21）.  （頁面存檔備份，存於網際網路檔案館）
  12. ^ Dietz, William. Nutrition : what every parent needs to know. Elk Grove Village, IL: American Academy of Pediatrics. 2012. ISBN 978-1-58110-631-2. OCLC 767736204. 
  13. ^ Wolraich, Mark L. The Effect of Sugar on Behavior or Cognition in Children. JAMA (American Medical Association (AMA)). 1995-11-22, 274 (20): 1617. ISSN 0098-7484. doi:10.1001/jama.1995.03530200053037. The meta-analytic synthesis of the studies to date found that sugar does not affect the behavior or cognitive performance of children. The strong belief of parents may be due to expectancy and common association. However, a small effect of sugar or effects on subsets of children cannot be ruled out.(JAMA. 1995;274:1617-1621) 
  14. ^ Busting the Sugar-Hyperactivity Myth. WebMD. 2018-04-05 [2018-07-13]. （原始內容存檔於2018-02-22）.  （頁面存檔備份，存於網際網路檔案館）
  15. ^ Hyperactivity and sugar: MedlinePlus Medical Encyclopedia. MedlinePlus. 2018-07-09 [2018-07-13]. （原始內容存檔於2017-12-23）. Recommendations. There are many reasons to limit the sugar a child has other than the effect on activity level.
    A diet high in sugar is a major cause of tooth decay.
    High-sugar foods tend to have fewer vitamins and minerals. These foods may replace foods with more nutrition. High-sugar foods also have extra calories that can lead to obesity.
    Some people have allergies to dyes and flavors. If a child has a diagnosed allergy, talk to a dietitian.
    Add fiber to your child's diet to keep blood sugar levels more even. For breakfast, fiber is found in oatmeal, shredded wheat, berries, bananas, whole-grain pancakes. For lunch, fiber is found in whole-grain breads, peaches, grapes, and other fresh fruits.
    Provide "quiet time" so that children can learn to calm themselves at home.
    Talk to your health care provider if your child cannot sit still when other children of his or her age can, or cannot control impulses.      （頁面存檔備份，存於網際網路檔案館）
  16. ^ 16.0 16.1 Young, G; Conquer, J. Omega-3 fatty acids and neuropsychiatric disorders. Reproduction, Nutrition, Development. January 2005, 45 (1): 1–28. PMID 15865053. doi:10.1051/rnd:2005001. 
  17. ^ Haag, M. Essential fatty acids and the brain. Canadian Journal of Psychiatry. April 2003, 48 (3): 195–203. PMID 12728744. doi:10.1177/070674370304800308. 
  18. ^ Author:Kevin R Krull, PhDSection Editor:Marilyn Augustyn, MDDeputy Editor:Mary M Torchia, MD. Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis. UpToDate. [2019-08-03]. （原始內容存檔於2018-02-24）.  （頁面存檔備份，存於網際網路檔案館）
  19. ^ Rucklidge, Julia J.; Johnstone, Jeanette; Gorman, Brigette; Boggis, Anna; Frampton, Christopher M. Moderators of treatment response in adults with ADHD treated with a vitamin–mineral supplement. Progress in neuro-psychopharmacology & biological psychiatry (Elsevier BV). 2014-04-03, 50: 163–171. ISSN 0278-5846. PMID 24374068. doi:10.1016/j.pnpbp.2013.12.014. 
  20. ^ Helen Briggs. Vitamins ‘effective in treating ADHD symptoms’. BBC News. 2014-01-30 [2017-04-13]. （原始內容存檔於2017-04-14）. After eight weeks of treatment those on supplements reported greater improvements in both their inattention and hyperactivity/impulsivity compared with those taking the placebo. "Our study provides preliminary evidence of the effectiveness for micronutrients in the treatment of ADHD symptoms in adults," said Prof Julia Rucklidge, who led the study.  （頁面存檔備份，存於網際網路檔案館）
  21. ^ Rucklidge, Julia J.; Eggleston, Matthew J.F.; Johnstone, Jeanette M.; Darling, Kathryn; Frampton, Chris M. Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo-controlled trial. Journal of child psychology and psychiatry, and allied disciplines (Wiley). 2018, 59 (3): 232–246. ISSN 0021-9630. PMID 28967099. doi:10.1111/jcpp.12817. 
  22. ^ Vitamins: MedlinePlus. MedlinePlus. 2017-10-06 [2017-11-02]. （原始內容存檔於2017-11-07）.  （頁面存檔備份，存於網際網路檔案館）
  23. ^ FDA Asks Attention-Deficit Hyperactivity Disorder (ADHD) Drug Manufacturers to Develop Patient Medication Guides. Food and Drug Administration. 21 September 2007 [13 April 2009]. （原始內容存檔於21 February 2008）.  （頁面存檔備份，存於網際網路檔案館）
  24. ^ 24.0 24.1 Ioannidis, K; Chamberlain, SR; Müller, U. Ostracising caffeine from the pharmacological arsenal for attention-deficit hyperactivity disorder—was this a correct decision? A literature review. Journal of Psychopharmacology (Oxford, England). September 2014, 28 (9): 830–6. PMID 24989644. doi:10.1177/0269881114541014. 
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  28. ^ Potter, AS; Schaubhut, G; Shipman, M. Targeting the nicotinic cholinergic system to treat attention-deficit/hyperactivity disorder: rationale and progress to date.. CNS Drugs. December 2014, 28 (12): 1103–13. PMC 4487649 可免費查閱. PMID 25349138. doi:10.1007/s40263-014-0208-9. 
  29. ^ 29.0 29.1 Gillies D, Sinn JK, Lad SS, Leach MJ, Ross MJ. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2012, 7 (7): CD007986. PMC 6599878 可免費查閱. PMID 22786509. doi:10.1002/14651858.CD007986.pub2. 
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  34. ^ Mohammadpour, Nakisa; Jazayeri, Shima; Tehrani-Doost, Mehdi; Djalali, Mahmoud; Hosseini, Mostafa; Effatpanah, Mohammad; Davari-Ashtiani, Rozita; Karami, Elham. Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial. Nutritional neuroscience (Informa UK Limited). 2018, 21 (3): 202–209. ISSN 1028-415X. PMID 27924679. doi:10.1080/1028415x.2016.1262097. 
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