| Objective:Attention deficit hyperactivity disorder(ADHD)is one of the most common psychological behavioral disorders in childhood.Among them,70%of childhood symptoms and functional impairments persist into puberty,and 30-50%of symptoms persist into adulthood with lifelong.In addition to the behavioral abnormalities caused by ADHD itself,it multiple comorbidities also cause serious damage to children's physical and mental health.Among the co-morbidities of ADHD in children,overweight and obesity are getting more and more attention.Related studies based on clinical and epidemiological studies have shown that ADHD has a certain correlation with the incidence of overweight and obesity,and overweight and obesity is a comorbidity of ADHD.However,there are few domestic studies on the comorbidity between ADHD and overweight and obesity in children,especially the lack of population-based epidemiological research evidence.In addition,to date,empirical studies exploring the behavioral pathways of ADHD symptoms and overweight and obesity have been very limited.Therefore,this study is based on population-based epidemiological investigation of ADHD and overweight and obesity among school-age children and adolescents in Shenyang,aiming to explore 1)prevalence of ADHD symptoms and individual and family influence factors;2)the relationship between ADHD symptoms and overweight and obesity in children and adolescents;3)the relevant behavioral mechanism between ADHD symptoms,overeating symptoms and overweight and obesity;4)the mediating effect of depressive symptoms between ADHD symptoms and abnormal eating behaviors.Identifying the risk factors of ADHD and overweight and obesity will contribute to the exploration and establishment of an effective early prevention and intervention mechanism,and will provide a theoretical basis for the subsequent intervention research from the perspective of behavioral psychology.Methods:In our study,the method of random cluster sampling was adopted to select a total of 13 public primary and secondary schools in the Huanggu District of Shenyang city as the research object.The age range of our sample was 8-18 years old,and the class was taken as the unit for questionnaire survey and body measurements.A total of 8335questionnaires were distributed in our study,7293 questionnaires were returned,and 6606valid questionnaires,the effective rate was 90.58%.The questionnaire included demographic information for children and adolescents,personal factors,family environmental factors,and psychosocial scales related to ADHD,depression,and eating disorders.Body measurements were taken within one week of the completion of the questionnaire.The survey data was entered,sorted and verified using Epidata 3.1 software,and the data was statistically analyzed using Stata 13.0 software and Amos 17.0 software.In the statistical analysis method,the t test and the?~2 test were used to compare the differences between different groups.Multivariate linear regression analysis and binary logistic regression analysis were used to test the influencing factors of ADHD.An ordered logistic regression analysis was used to examine the association between ADHD and overweight and obesity after adjusting for individual and family confounders.The structural equation model was used to validate the path model between ADHD symptoms,depressive symptoms,overeating symptoms,and obesity in children and adolescents.Results:1.The prevalence of ADHD in children and adolescents in Shenyang was 9.5%,the prevalence of ADHD in boys and girls was 12.9%and 6.4%respectively.The gender difference was statistically significant(?~2=82.21,p<0.001).2.Multiple linear regression analysis showed that male,younger age,picky eater,playing mobile phone for more than one hour in weekday,disharmonious classmates relationship,symptom of anxiety and depression,symptom of conduct disorder,symptom of opposite defiant disorder,higher father's BMI,lower mother education,low-income family,maternal smoking during pregnancy,father smoking during mother pregnancy,history of asphyxia at birth,and corporal punishment in children and adolescents had more ADHD symptoms,while children and adolescents who spent more than one hour on outdoor activity every day had less ADHD symptoms.3.Binary logistic regression analysis showed that,after adjusting for possible confounders,male,playing mobile phone for more than one hour in weekday,disharmonious classmates relationship,symptom of anxiety and depression,symptom of conduct disorder,symptom of opposite defiant disorder,higher father's BMI,lower mother education,low-income family,maternal smoking during pregnancy,father smoking during mother pregnancy,history of asphyxia at birth,and corporal punishment in children and adolescents had more ADHD symptoms.4.The prevalence of overweight in children and adolescents was 22.1%.The prevalence of overweight in boys and girls was 22.2%and22.1%respectively.The prevalence of obesity in children and adolescents was 20.6%.The prevalence of obesity in boys and girls was 29.6%and 12.2%respectively.There was a significant difference in the distribution of overweight and obesity between boys and girls(?~2=331.80,p<0.001).5.Ordered logistic regression analysis showed that male,younger age,macrosomia,playing mobile phone for more than one hour in weekend,watching TV for more than one hour per day,higher parental BMI,only children,lower mother education,father smoking during mother pregnancy and cesarean in children and adolescents were more likely to be overweight and obesity,while the prevalence of overweight and obesity was lower in children and adolescents who had picky eating habits and spent more than one hour on outdoor activity every day.6.Orderly logistic regression analysis showed that,after adjusting for individual and family factors,compared with the non-adhd symptom group,children and adolescents with ADHD symptoms had a 1.37times risk of overweight and obesity(OR=1.37).7.In the children sample,ADHD symptoms were positively predictive of overeating symptoms(?=0.38,p<0.001),while the association between overeating symptoms and BMI was not significant(?=0.04,p=0.969);ADHD symptoms were positively predictive of depressive symptoms(?=0.35,p<0.001),depressive symptoms were predictive of overeating symptoms(?=0.21,p<0.001),while the association between overeating symptoms and BMI was not significant(?=0.05,p=0.637).8.In the adolescent sample,all pathways were statistically significant,ADHD symptoms were positively predictive of overeating symptoms(?=0.37,p<0.001),which in turn led to an increase in BMI(?=0.14,p<0.001);ADHD symptoms were positively predictive of depressive symptoms(?=0.36,p<0.001),depressive symptoms were predictive of overeating symptoms(?=0.44,p<0.001),which in turn led to an increase in BMI(?=0.17,p<0.001).Conclusion:1.Male,younger age,picky eater,playing mobile phone for more than one hour in weekday,disharmonious classmates relationship,symptom of anxiety and depression,symptom of conduct disorder,symptom of opposite defiant disorder,higher father's BMI,lower mother education,low-income family,maternal smoking during pregnancy,father smoking during mother pregnancy,history of asphyxia at birth,and corporal punishment in children were risk factors for ADHD,while daily outdoor activity?1 hour was a protective factor for ADHD.2.Male,younger age,macrosomia,playing mobile phone for more than one hour in weekend,watching TV for more than one hour per day,higher parental BMI,only children,lower mother education,father smoking during mother pregnancy and cesarean in children and adolescents were risk factors for overweight and obesity,while children and adolescents who had picky eating habits and spent more than one hour on outdoor activity every day were less likely to be overweight and obese.3.After adjustment for individual and family confounders,the risk of overweight and obesity was 1.37 times in children and adolescents with ADHD symptoms compared with non-ADHD symptom groups.4.ADHD symptoms in children were positively predictive of overeating symptoms,and ADHD symptoms could also predict overeating symptoms indirectly through depressive symptoms.5.There are two different pathways between ADHD symptoms and overweight and obesity in adolescents.First,ADHD symptoms are predictive of overeating symptoms,which in turn leads to an increase in BMI;Second,ADHD symptoms were positively predictive of depressive symptoms,and depressive symptoms were positively predictive of overeating symptoms,which in turn leads to an increase in BMI. |
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