Trialling a microbiome-targeted dietary intervention in children with ADHD-the rationale and a non-randomised feasibility study

Kate Lawrence, Kyriaki Myrissa, Miguel Toribio-Mateas, Lori Minini, Alice M Gregory, Kate Lawrence, Kyriaki Myrissa, Miguel Toribio-Mateas, Lori Minini, Alice M Gregory

Abstract

Background: Dietary interventions have been previously explored in children with ADHD. Elimination diets and supplementation can produce beneficial behaviour changes, but little is known about the mechanisms mediating change. We propose that these interventions may work, in part, by causing changes in the gut microbiota. A microbiome-targeted dietary intervention was developed, and its feasibility assessed.

Methods: A non-randomised feasibility study was conducted on nine non-medicated children with ADHD, aged 8-13 years (mean 10.39 years), using a prospective one-group pre-test/post-test design. Participants were recruited from ADHD support groups in London and took part in the 6-week microbiome-targeted dietary intervention, which was specifically designed to impact the composition of gut bacteria. Children were assessed pre- and post-intervention on measures of ADHD symptomatology, cognition, sleep, gut function and stool-sample microbiome analysis. The primary aim was to assess the study completion rate, with secondary aims assessing adherence, adverse events (aiming for no severe and minimal), acceptability and suitability of outcome measures.

Results: Recruitment proved to be challenging and despite targeting 230 participants directly through support groups, and many more through social media, nine families (of the planned 10) signed up for the trial. The completion rate for the study was excellent at 100%. Exploration of secondary aims revealed that (1) adherence to each aspect of the dietary protocol was very good; (2) two mild adverse events were reported; (3) parents rated the treatment as having good acceptability; (4) data collection and outcome measures were broadly feasible for use in an RCT with a few suggestions recommended; (5) descriptive data for outcome measures is presented and suggests that further exploration of gut microbiota, ADHD symptoms and sleep would be helpful in future research.

Conclusions: This study provides preliminary evidence for the feasibility of a microbiome-targeted dietary intervention in children with ADHD. Recruitment was challenging, but the diet itself was well-tolerated and adherence was very good. Families wishing to trial this diet may find it an acceptable intervention. However, recruitment, even for this small pilot study, was challenging. Because of the difficulty experienced recruiting participants, future randomised controlled trials may wish to adopt a simpler dietary approach which requires less parental time and engagement, in order to recruit the number of participants required to make meaningful statistical interpretations of efficacy.

Trial registration: ClinicalTrials.gov Identifier: NCT03737877 . Registered 13 November 2018-retrospectively registered, within 2 days of the first participant being recruited.

Keywords: ADHD; Actigraphy; Attention-deficit hyperactivity disorder; Children; Diet; Feasibility study; Kefir; Microbiome; Microbiota; Sleep.

Conflict of interest statement

Nourish Kefir supplied organic cow’s milk kefir for the study free of charge. Rhythm Health supplied the coconut kefir at a reduced cost for the study. AMG is an advisor for a project sponsored by Johnson’s Baby. She receives royalties for two books Nodding Off (Bloomsbury Sigma, 2018) and The Sleepy Pebble (Flying Eye, 2019). She is a regular contributor to BBC Focus magazine and has contributed to other outlets (such as The Conversation, The Guardian and Balance Magazine). She occasionally receives sample products related to sleep (e.g. blue light blocking glasses) and has given a paid talk to a business. KL previously held a paid role as Research Editor for a food allergy website and is an editor for the British Association for Nutrition and Lifestyle Medicine, Nutrition Evidence Database. She is occasionally paid, or receives hospitality, to deliver talks on her research. MT-M was previously employed by Atlas Biomed as Director of Health and Nutrition Research. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow of participants through the study
Fig. 2
Fig. 2
Participants’ adherence to the protocol. Error bars represent 95% confidence intervals. Percentage adherence refers to the proportion of days they complied—i.e. 41 out of 42 days (97.62%)

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Source: PubMed

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