Plant-based fat supply is associated with reduced ADHD disease burden

Objectives Attention-Deficit/Hyperactivity Disorder (ADHD) is emerging as a major neurodevelopmental disorder on a global scale, affecting both children and increasingly adult population. Its aetiology is unclear but seems to involve genetic and environmental factors, particularly diets and nutrients. However, most studies so far only focused on specific nutrients or dietary patterns, lacking systematic perspectives of their potential interactions, and also neglecting other confounding factors like socioeconomic status. Thus, we aim to systematically interrogate the association between nutrient supply, reflecting the food exposure and environment, socioeconomic status and ADHD disease burden at a global level over time. Methods ADHD disease burden, macronutrient supply and gross domestic product (GDP) were collated from more than 150 countries from 1990 to 2018 and analyzed with nutritional geometry generalized additive mixed models (GAMMs). Results Modelling results suggested the interactive effects of nutrients and socioeconomic status on ADHD. Fat, especially plant-based fat supply, is associated with decreased ADHD disease burden. These associations were conserved across sexes and ages and were not confounded by the total energy supply. Conclusions Globally, far, particularly plant-based fat supply seemed to drive the reduction of ADHD disease burden, which is supported by previous reports about the amelioration of ADHD by ketogenic diets. Further in-depth studies are needed to elucidate the underlying mechanistic and may inform future targeted dietary interventions for ADHD prevention and/or treatment. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This project is supported by the Norman Ernest Bequest Fund. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors