Fatores clínicos e sociodemográficos associados ao excesso de peso em crianças e adolescentes com Transtorno do Déficit de Atenção e Hiperatividade (TDAH): um estudo transversal

Abstract

Attention Deficit Hyperactivity Disorder is one of the most common neurobehavioral disorders in childhood, with an estimated prevalence of 5%. Recently, studies have identified an association between ADHD and excess body weight in children and adolescents. Objective: To evaluate the clinical and sociodemographic factors associated with excess body weight in children and adolescents with ADHD treated at a University Hospital in Rio de Janeiro. Method: Cross-sectional study, that included 40 children and adolescents, aged 6 to 18 years and diagnosed with ADHD attended between March and September 2021. Participants who refused to take the 24-hour dietary recall; using medications with an effect on weight gain; with association of other diagnoses that could bias the sample and with malabsorptive syndromes. Weight and height were obtained for the calculation of BMI and classification of the Height/Age and BMI/Age indices. Nutritional status was assessed using BMI/Age and excess body weight defined as values above +1 escore z (overweight > +1 and < +2, and obesity > +2 escore z). Body composition was evaluated by electrical bioimpedance, obtaining the variables of percentage of fat-free mass (%FFM) and fat mass (%FM) and its classification was performed using the “Manual de Orientação para Avaliação Nutricional da Criança e do Adolescente da SBP”. The lipid profile was evaluated according to the recommendations of the “Atualização da Diretriz de Prevenção Cardiovascular da Sociedade Brasileira de Cardiologia”, clinical data was collected from medical records and sociodemographic information obtained through interviews. Categorical variables were described using frequencies and continuous variables by medians and interquartile ranges. For categorical variables, Pearson's chi-square test was used. Principal component analysis (MCA) was used to investigate the association between clinical and sociodemographic categorical variables and excess body weight. Logistic Regression was used to calculate the Odds Ratio of clinical and sociodemographic variables. The significance level adopted was 0.05. Results: The frequency of excess body weight was 42.5% (n=17), with 25% (n=10) of obesity. Regarding body composition, 67% (n=20) showed inadequacy of %FM. Laboratory evaluation indicated a frequency of dyslipidemia of 27.5% (n=11) due to total cholesterol, 15% (n=6) high LDL-cholesterol, 40% (n=16) normal HDL-cholesterol, 22.5% (n=9) high triglyceride and 22.5% (n=9) high non-HDL. According to the MCA, the variables “greater number of people in the family”, “lower maternal education”, “presence of comorbidities” and “generalized anxiety disorder” were more frequent among those with excess body weight. There was a tendency to increase the risk of excess body weight according to the longer duration of the disease, using the logistic regression model. Conclusions: The results reinforce the findings of the literature on the high frequency of excess body weight and bring new perspectives on clinical and sociodemographic variables, reinforcing the importance of monitoring the nutritional status of children and adolescents with ADHD for the early detection of inadequacies in nutritional status.