消除性饮食和健康饮食对注意力缺陷/多动障碍儿童的影响:双臂随机对照研究(TRACE 研究)的 1 年前瞻性随访

JCPP advances Pub Date : 2024-07-08 DOI:10.1002/jcv2.12257
Annick Huberts‐Bosch, M. Bierens, J. Rucklidge, Verena Ly, R. Donders, G. V. D. van de Loo-Neus, A. Arias-Vásquez, H. Klip, Jan K. Buitelaar, Saskia W. van den Berg, Nanda Rommelse
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摘要

对165名患有注意力缺陷/多动障碍(ADHD)的儿童(5-12岁)进行了为期一年的前瞻性跟踪调查,这些儿童被随机(非盲法;1:1)安排接受为期5周的消除饮食(ED)(84人)或健康饮食(HD)(81人)治疗,另外58名儿童接受了非随机对比组的常规护理(CAU)治疗。饮食治疗参与者可在 5 周后增加或改用 CAU 治疗。主要研究结果是根据家长和教师对儿童多动症和调节障碍问题的评分,在为期一年的前瞻性随访后确定的5点序数改善程度。在意向治疗的基础上进行了序数回归分析和线性混合模型分析。此外,还进行了治疗分析。该试验已经结束,并在荷兰试验登记处进行了登记,编号为 NL5324。在一年的随访中,24% 的参与者仍在接受 ED 治疗,37% 的参与者仍在接受 HD 治疗。在 ED(+CAU)轨迹中,与 HD(+CAU)轨迹相比,在 1 年的前瞻性随访后出现(部分)改善的参与者较少(47% 对 64%,χ2 (4, N = 152) = 11.97, p = 0.018)。与非随机CAU轨迹相比,HD(+CAU)--而非ED(+CAU)--轨迹的1年疗效相当。次要结果(如健康、父母压力)在 ED(+CAU)轨迹和 HD(+CAU)轨迹之间没有差异。与非随机CAU轨迹相比,ED(+CAU)和HD(+CAU)轨迹的精神兴奋剂使用率较低(分别为38%、45%和78%)。从饮食治疗中长期获益的预测因素包括最初多动症问题严重程度高、情绪问题严重程度低以及父母有足够的精神资源。最初使用 HD 进行为期 5 周的治疗,必要时/首选 CAU,这样可以减少精神刺激剂的使用,而不会对 1 年的治疗结果产生负面影响。
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Effects of an elimination diet and a healthy diet in children with Attention‐Deficit/Hyperactivity Disorder: 1‐Year prospective follow‐up of a two‐arm randomized, controlled study (TRACE study)
An Elimination Diet (ED) or Healthy Diet (HD) may be effective in reducing symptoms of Attention‐Deficit/Hyperactivity Disorder (ADHD), but long‐term maintenance effects and feasibility have never been examined.One‐year prospective follow‐up of a sample of 165 children (5–12 years) with ADHD randomized (unblinded; 1:1) to 5 weeks treatment with either ED (N = 84) or HD (N = 81) and a non‐randomized comparator arm including 58 children being treated with Care as Usual (CAU). Dietary participants were allowed to add or switch to CAU treatment after 5 weeks. The primary outcome was a 5‐point ordinal measure of improvement based on both parent and teacher ratings on ADHD and dysregulation problems, determined after 1 year prospective follow‐up. Ordinal regression analyses and linear mixed models analyses were conducted on an intention to treat basis. In addition, as‐treated analyses were performed. The trial is closed and registered in the Dutch trial registry, number NL5324.At 1 year follow‐up, 24% of the participants still complied with the ED and 37% still complied with the HD. In the ED (+CAU) trajectory, fewer participants showed (partial) improvement after 1‐year prospective follow‐up compared to the HD (+CAU) trajectory (47% vs. 64%, χ2 (4, N = 152) = 11.97, p = 0.018). The HD (+CAU) ‐ but not ED (+CAU) ‐ trajectory had comparable 1‐year outcomes compared to the non‐randomized CAU‐trajectory. Results for secondary outcomes (e.g. health, parental stress) did not differ between the ED (+CAU) and HD (+CAU) trajectories. The prevalence of psychostimulant use was lower in the ED (+CAU) and HD (+CAU) trajectories compared to the non‐randomized CAU‐trajectory (38%, 45%, 78%, respectively). Predictors for long‐term benefit from dietary treatments included high initial severity of ADHD problems, low severity of emotional problems and sufficient parental mental resources.In line with the short‐term effects, prospective 1‐year follow‐up outcomes are in favor of treatment with HD and not ED. Initial 5‐week treatment with HD and if needed/preferred followed by CAU may reduce psychostimulant use without negatively impacting 1‐year outcomes.
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