Nutrition and attention deficit hyperactivity disorder: developmental follow-up of the anthropometric variables of a group of patients receiving treatment with osmotic controlled-release methylphenidate
*Correspondencia: Dr. Teodoro Durá Travé. Unidad de Neuropediatría. Complejo Hospitalario de Navarra. Irunlarrea, 4. E-31008 Pamplona (Navarra).
E-mail: tduratra@cfnavarra.es
Aim: To perform a developmental analysis of the anthropometric variables of a group of patients diagnosed with attention deficit hyperactivity disorder (ADHD) in order to determine the repercussions of treatment with osmotic controlled-release methylphenidate (MTF-OROS).
Patients and methods: The medical records of 187 patients with ADHD under treatment with MTF-OROS over a period of 30 months were reviewed. Data collected included weight, height and body mass index at diagnosis (baseline) and at 6, 12, 18, 24 and 30 months' follow-up.
Results: The mean age at diagnosis was 8.14 ± 1.6 years. The dose of MTF-OROS was progressively increased until 36.9 ± 12.1 mg/day (1.05 mg/kg/day) at day 30 of the follow-up. At diagnosis, 34.9% of patients had a deficient nutritional situation (subnutrition or malnutrition), which affected 50.3% of the patients at 30 months. The baseline value for weight (Z-score) progressively decreased during treatment until values that were significantly lower than the baseline value at 12 months were reached (p < 0.05); these values remained significantly lower until 30 months. The baseline value for height (Z-score) also progressively decreased during treatment until values that were significantly lower than the baseline value at 24 and 30 months were reached (p < 0.05).
Conclusions: At the time they were diagnosed with ADHD, one out of every three patients was in a deficient nutritional situation (subnutrition or malnutrition). Continued treatment with MTF-OROS for 30 months had a negative influence on height, which could perhaps be attenuated by improving the patients' nutrition.
Pacientes y métodos Se han revisado retrospectivamente las historias clínicas de 187 pacientes con TDAH en tratamiento con MTF-OROS durante 30 meses, registrándose los pesos y tallas e índice de masa corporal al diagnóstico (basal) y a los 6, 12, 18, 24 y 30 meses de seguimiento.
Resultados La edad media al diagnóstico era de 8,14 ± 1,6 años. La dosis de MTF-OROS fue incrementándose progresivamente hasta 36,9 ± 12,1 mg/día (1,05 mg/kg/día) a los 30 meses del seguimiento. Al diagnóstico, el 34,9% de los pacientes tenía una situación nutricional deficiente (subnutrición o malnutrición), que a los 30 meses de tratamiento afectaba al 50,3% de los pacientes. El valor basal del peso (Z-score) disminuía progresivamente durante el tratamiento, llegando a alcanzar unos valores significativamente inferiores (p < 0,05) respecto al valor basal a los 12 meses, y se mantenía significativamente inferior hasta los 30 meses. El valor basal de la talla (Z-score) también disminuía progresivamente durante el tratamiento, llegando a alcanzar unos valores significativamente inferiores (p < 0,05) respecto al valor basal a los 24 y 30 meses.
Conclusiones En el momento del diagnóstico de TDAH, uno de cada tres pacientes se hallaba en una situación nutricional deficiente (subnutrición o malnutrición). El tratamiento continuado con MTF-OROS durante 30 meses ejerce una influencia negativa sobre la talla, que posiblemente podría atenuarse mejorando la nutrición de los pacientes.