The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Neurology and Developmental Unit, Loewenstein Rehabilitation Medical Center, Raanana, Israel.
J Pediatr. 2021 Nov;238:296-304.e4. doi: 10.1016/j.jpeds.2021.07.018. Epub 2021 Jul 20.
To evaluate the sex-specific effects of stimulants in children with attention-deficit/hyperactivity disorder (ADHD) on body mass index (BMI) z and height z trajectories.
A retrospective cohort study using the database of Israel Clalit Health Services was performed. Participants included 5- to 18-year-old insured patients with documentation of at least 2 consecutive prescriptions of stimulant drugs for ADHD. Participants were further compared with sex- and age-matched insured control patients without ADHD.
A total of 4561 (66% boys) participants with ADHD were included. Of these, 2151 (70% boys) had follow-up data for ≥2 years of treatment. A decline of ≥1 SD in height and BMI z score was observed in 10.1% and 13.2% of the cohort, respectively. During ≥2 years follow-up, boys had a greater decline in height z score (0.2 SD) than girls (0.06 SD). Boys' height z score continued to decline after 1 and ≥2 years, and girls' height z score declined after 1 year, and then stabilized. The trajectory of BMI z score of boys and girls was similar, showing a greater decline after 1 year, followed by an incline after ≥2 years. Younger age at stimulants initiation, better adherence, longer treatment duration, and lower socioeconomic status were correlated with a greater impact on growth attenuation. The non-ADHD group (n = 4561, 66% boys) had baseline height z score and BMI z score similar to those in children with ADHD before treatment initiation. Height z score and BMI z score were greater in children without ADHD compared with children with ADHD following 1 year of treatment (P < .001).
These findings highlight the importance of growth monitoring accompanied with dietary counseling in children with ADHD treated with stimulants.
评估儿童注意缺陷多动障碍（ADHD）中兴奋剂的性别特异性对体重指数（BMI）z 和身高 z 轨迹的影响。
使用以色列克利利特健康服务数据库进行回顾性队列研究。参与者包括 5 至 18 岁的保险患者，这些患者至少有 2 次连续的 ADHD 兴奋剂药物处方记录。参与者进一步与性别和年龄匹配的无 ADHD 的保险对照患者进行比较。
共纳入 4561 名（66%为男孩）ADHD 参与者。其中，2151 名（70%为男孩）有≥2 年治疗的随访数据。队列中分别有 10.1%和 13.2%的患者身高和 BMI z 评分下降≥1 个标准差。在≥2 年的随访期间，男孩的身高 z 评分下降幅度（0.2 个标准差）大于女孩（0.06 个标准差）。男孩的身高 z 评分在 1 年和≥2 年后仍继续下降，而女孩的身高 z 评分在 1 年后下降，然后稳定。男孩和女孩的 BMI z 评分轨迹相似，在 1 年后下降更大，然后在≥2 年后上升。兴奋剂起始年龄较小、依从性较好、治疗持续时间较长和社会经济地位较低与生长抑制的影响较大相关。非 ADHD 组（n=4561，66%为男孩）在开始治疗前的身高 z 评分和 BMI z 评分与 ADHD 患儿相似。治疗 1 年后，无 ADHD 儿童的身高 z 评分和 BMI z 评分均高于 ADHD 儿童（P<0.001）。
这些发现强调了在接受兴奋剂治疗的 ADHD 儿童中进行生长监测并辅以饮食咨询的重要性。
