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Dietary inflammatory index of mothers during pregnancy and Attention Deficit-Hyperactivity Disorder symptoms in the child at preschool age: a prospective investigation in the INMA and RHEA cohorts

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Abstract

Inflammation provides a substrate for mechanisms that underlie the association of maternal diet during pregnancy with Attention Deficit-Hyperactivity Disorder (ADHD) symptoms in childhood. However, no previous study has quantified the proinflammatory potential of maternal diet as a risk factor for ADHD. Thus, we evaluated the association of maternal dietary inflammatory index (DII®) scores during pregnancy with ADHD symptoms in 4-year-old children born in two Mediterranean regions. We analyzed data from two population-based birth cohort studies—INMA (Environment and Childhood) four subcohorts in Spain (N = 2097), and RHEA study in Crete (Greece) (N = 444). The DII score of maternal diet was calculated based on validated food frequency questionnaires completed during pregnancy (12th and/or 32nd week of gestation). ADHD symptoms were assessed by ADHD-DSM-IV in INMA cohort and by ADHDT test in RHEA cohort, with questionnaires filled-out by teachers and parents, respectively. The associations between maternal DII and ADHD symptoms were analysed using multivariable-adjusted zero-inflated negative binomial regression models in each cohort study separately. Meta-analysis was conducted to combine data across the cohorts for fitting within one model. The DII was significantly higher in RHEA (RHEA = 2.09 [1.94, 2.24]) in comparison to INMA subcohorts (Asturias = − 1.52 [− 1.67, − 1.38]; Gipuzkoa = − 1.48 [− 1.64, − 1.33]; Sabadell = − 0.95 [− 1.07, − 0.83]; Valencia = − 0.76 [− 0.90, − 0.62]). Statistically significant reduced risk of inattention symptomatology (OR = 0.86; CI 95% = 0.77–0.96), hyperactivity symptomatology (OR = 0.82; CI 95% = 0.72–0.92) and total ADHD symptomatology (OR = 0.82; CI 95% = − 0.72 to 0.93) were observed with increased maternal DII in boys. No statistically significant associations were observed in girls between maternal DII and inattention, hyperactivity and total ADHD symptomatology. We found reduced risk of ADHD symptomatology with increased DII only in boys. This relationship requires further exploration in other settings.

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Acknowledgements

The authors would particularly like to thank all the cohort participants for their generous collaboration. A full roster of the INMA Project Investigators can be found at http://www.proyectoinma.org/presentacioninma/listadoinvestigadores/en_listadonvestigadores.html[V1] and of the Rhea project Investigators at http://www.rhea.gr/en/about-rhea/the-rhea-team/.

Funding

This study was funded by grants from Spanish Ministry of Health-Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041, FIS-PI041436, FIS- PI081151, FIS- PI042018, FISPI09/02311, FIS-PI06/0867, FIS-PS09/00090, FIS-FEDER PI11/1007 FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, and 09/02647), Generalitat de Catalunya- CIRIT 1999SGR 00241, Conselleria de Sanitat Generalitat Valenciana, FISS-FEDER PI13/02429, FISS-FEDER PI18/00909, Universidad de Oviedo, Obra Social Cajastur-LIBERBANK, Department of Health of the Basque Government (2005111093 and 2009111069), the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001), Fundación Roger Torné, and Alicia Koplowitz Foundation 2017. Drs. Valvi and Chatzi are currently receiving funding from the National Institute of Environmental Health Sciences (R21 ES029328, R21 ES028903).

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Authors and Affiliations

  1. University of the Basque Country UPV/EHU, Donostia-San Sebastián, Spain

    Nerea Lertxundi, Arantxa Gorostiaga, Nekane Balluerka & Jesus Ibarluzea

  2. Health Research Institute BIODONOSTIA, Donostia-San Sebastián, Spain

    Nerea Lertxundi, Arantxa Gorostiaga, Nekane Balluerka & Jesus Ibarluzea

  3. Public Health Division of Gipuzkoa, Donostia-San Sebastian, Spain

    Amaia Molinuevo & Jesus Ibarluzea

  4. Department of Environmental Medicine and Public Health, Icahn School of Medicine At Mount Sinai, New York, NY, USA

    Dania Valvi

  5. Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Nitin Shivappa & James Hebert

  6. Connecting Health Innovations LLC, Columbia, SC, USA

    Nitin Shivappa & James Hebert

  7. Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain

    Eva María Navarrete-Muñoz, Jesus Vioque, Martine Vrijheid & Jesus Ibarluzea

  8. Institute for Health and Biomedical Research, ISABIAL-UMH, Alicante, Spain

    Eva María Navarrete-Muñoz & Jesus Vioque

  9. Department of Surgery and Pathology, Miguel Hernández University, Alicante, Spain

    Eva María Navarrete-Muñoz

  10. IUOPA, University of Oviedo and ISPA, Oviedo, Spain

    Adonina Tardón

  11. ISGlobal Institute for Global Health, Barcelona, Spain

    Martine Vrijheid

  12. Universitat Pompeu Fabra (UPF), Barcelona, Spain

    Martine Vrijheid

  13. Department of Psychology, School of Social Sciences, University of Crete, Heraklion, Greece

    Theano Roumeliotaki & Katerina Koutra

  14. Department of Preventive Medicine, University of Southern California, Los Angeles, USA

    Leda Chatzi

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  1. Nerea Lertxundi
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  2. Amaia Molinuevo
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  3. Dania Valvi
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  7. James Hebert
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  8. Eva María Navarrete-Muñoz
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  9. Jesus Vioque
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  15. Jesus Ibarluzea
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Corresponding author

Correspondence to Nerea Lertxundi.

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Conflict of interest

Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company planning to license the right to his invention of the dietary inflammatory index (DII) from the University of South Carolina to develop computer and smart phone applications for patient counselling and dietary intervention in clinical settings. Dr. Nitin Shivappa is an employee of CHI. All other authors declare that they have no conflict of interest.

Ethical approval

The INMA Project was approved by the Hospital Ethics Committees in the participating regions and hospitals. The RHEA study was approved by the ethical committee of the University Hospital in Heraklion, Crete (Greece).

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Lertxundi, N., Molinuevo, A., Valvi, D. et al. Dietary inflammatory index of mothers during pregnancy and Attention Deficit-Hyperactivity Disorder symptoms in the child at preschool age: a prospective investigation in the INMA and RHEA cohorts. Eur Child Adolesc Psychiatry 31, 615–624 (2022). https://doi.org/10.1007/s00787-020-01705-2

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