Qual a evidência da restrição do consumo de açúcar nas crianças com PHDA?

Abstract

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is considered the most prevalent neurobehavioral pathology in infancy, affecting about 3 to 7 % of children in school age. The main goal of therapeutic intervention is the development of an emotional equilibrium and the optimization of the academic, occupational and relational performance. A multimodal therapeutic approach is favoured, including psychological and pedagogical interventions, as well as pharmacological and nutriti-onal. The role of diet as a treatment for ADHD is still controversial, but the topic continues to interest parents and health professionals that prefer an alternative or a complement to the given medication. Goal: To elucidate if there is evidence to support the dietary restriction to sugars in the control of the symptomatology of ADHD. Methodology: In March 2016 a literature search was done using the MESH terms “Attention Deficit Disorder with Hyperactivity” and “Dietary Carbohydrates” in different databases, for articles written in English, Portuguese or Spanish, and published in the last 15 years. The following inclusion criteria were defined: a population of children and teenagers (< 18 years old) with ADHD; an intervention that would evaluate the restriction of simple sugars in the diet of this group, in comparison to a placebo or methylphenidate; and an outcome in the improvement of the symptomology. In order to evaluate the quality of the studies and the strength of the recommendation for the dietary restriction of sugars, the Strength of Recommendation Taxonomy (SORT) scale, from the American Family Physician, was used. Results: The search resulted in a total of 54 articles. The repeated articles, those that disagreed with the goal of the revision and those that did not fulfil all the inclusion criteria, were excluded. Thus, three articles were included and analysed: an observational study and two non-systematic revisions. Discussion: A great heterogeneity in the presented studies was verified, as well as a fragility in the design of the studies. The challenge of conducting well-structured clinical trials with dietary interventions is acknowledged, as multiple factors susceptible to interference need to be taken into account. Currently, the available evidence is insufficient to suggest that a restriction to the consumption of refined sugars can lead to improvements in the symptoms of ADHD (Sort C).