作者：Laurie Barclay, MD
審閱：Gary D. Vogin, MD
May 27, 2004 - 食品添加物與注意力缺乏過動症(ADHD)有關，這項隨機試驗的結果刊載於六月份的Archives of Diseases in Childhood中，研究人員建議，儘量別讓兒童吃這類食物。
英國Southampton 大學的B. Bateman及其同事指出，自從第一次宣稱人工添加物，對兒童行為的有害影響之後，沒有以人群為對象的研究，調查過動症的流行率與食物添加物的關係；而隨後的研究，儘管方法有改善，但卻不能支持這樣的宣稱，或是只顯示微小的影響。
之後，給這些孩子沒有人工色素和benzoate防腐劑的食物一個星期，在之後的三個星期，以隨機的方式，除了飲食外，給予含人工色素的飲料 (每日20 mg)和苯甲酸鈉(每日45 mg)，或安慰劑。
研究的侷限，包括對受試家庭的自我選擇，所有階段的完成率只有70% (397個中有277個完成) ；此外，根據心裡測試不能顯示過動症的變化；研究人員建議，在其他人群重複研究，並將結果擴展至更大的年齡層。
By Laurie Barclay, MD
Medscape Medical News
May 27, 2004 — Food additives are associated with symptoms of attention deficit hyperactivity disorder (ADHD), according to the results of a randomized trial published in the June issue of the Archives of Diseases in Childhood. The investigators suggest removing these from the diet of all children.
"There have been no population based studies examining the prevalence of hyperactivity related to intolerance to food additives following the initial claims of the detrimental effect of artificial additives on children's behaviour," write B. Bateman, from the University of Southampton in the U.K., and colleagues. "Subsequent studies, despite improved methodology, have failed to substantiate this claim or have only shown a small effect."
To determine whether artificial food coloring and preservatives in the diet influence hyperactive behavior in three-year-old children, a sample of 1,873 children were screened for the presence of hyperactivity at baseline. Skin prick tests to identify atopy were performed in 1,246 children.
After baseline testing, children were given a diet free of artificial colorings and benzoate preservatives for one week. For the next three weeks they received, in random order, periods of dietary challenge with a drink containing artificial colorings (20 mg daily) and sodium benzoate (45 mg daily), or a placebo mixture, in addition to their diet.
During the withdrawal phase, there were significant reductions in hyperactive behavior. Based on parental reports, there were significantly greater increases in hyperactive behavior when children were given the drink containing additives than when given the placebo drink. The presence or absence of hyperactivity or of atopy did not influence these effects. There were no significant differences detected based on objective behavioral testing in the clinic by a tester blind to dietary status.
"There is a general adverse effect of artificial food colouring and benzoate preservatives on the behaviour of 3 year old children which is detectable by parents but not by a simple clinic assessment," the authors write. "Subgroups are not made more vulnerable to this effect by their prior levels of hyperactivity or by atopy."
Study limitations include possible self-selection of families to take part in the food challenge, completion of all phases of the study by only 70% (277of 397) of those invited, and inability to demonstrate changes in hyperactivity on the basis of psychologist-administered tests. The authors recommend attempts at replication in other general population samples and extension of this study to older age groups.
"These findings therefore suggest that significant changes in children's hyperactive behaviour could be produced by the removal of artificial colourings and sodium benzoate from their diet," the authors conclude. "The potential long term public health benefit that might arise is indicated by the follow up studies which have shown that the young hyperactive child is at risk of continuing behavioural difficulties, including the transition to conduct disorder and educational difficulties."
The Food Standards Agency and the South West Regional Research and Development Directorate funded this study. Smith Kline Beecham contributed to the challenge materials.
Arch Dis Child. 2004;89:506-511
Reviewed by Gary D. Vogin, MD
Food Additives Associated With ADHD Symptoms