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The effect of vitamin D and magnesium supplementation on the mental health status of attention-deficit hyperactive children: a randomized controlled trial.
Hemamy, M, Pahlavani, N, Amanollahi, A, Islam, SMS, McVicar, J, Askari, G, Malekahmadi, M
BMC pediatrics. 2021;21(1):178
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Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder and studies have found it to be associated with nutrient deficiencies, namely magnesium and vitamin D. The aim of this randomized, controlled study is to assess the effect of vitamin D and magnesium supplementation on mental health and behavioral outcomes in children with ADHD. Sixty-six children with ADHD were randomly allocated to receive both vitamin D plus magnesium or placebo for eight weeks, and a validated children’s mental health questionnaire was assessed. After eight weeks, serum vitamin D and magnesium, as well as various behavioural outcomes (emotional problem, peer problem, total difficulties and internalising), were all significantly improved among the treatment group compared to placebo. Based on these results, the authors conclude co-supplementing vitamin D and magnesium can improve the behavioral function and mental health of children with ADHD. They suggest larger, well-designed studies are needed to both validate these findings and further explore whether micronutrient deficiencies in ADHD are a cause or effect of the disorder.
Abstract
BACKGROUND Attention-Deficit / Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, characterized by varying severity in attention deficit and hyperactivity. Studies have shown deficiencies in the serum level of magnesium and vitamin D in people with ADHD. The aim of this study is to determine the effect of vitamin D and magnesium supplementation on mental health in children with ADHD. METHODS We conducted a randomized, double blind, placebo-controlled clinical trial of 66 children with ADHD. Participants were randomly allocated to receive both vitamin D (50,000 IU/week) plus magnesium (6 mg/kg/day) supplements (n = 33) or placebos (n = 33) for 8-weeks. Strengths and difficulties questionnaire was used to evaluate children's mental health at baseline and the end of the study. RESULTS After eight weeks of intervention, the serum levels of 25-hydroxy-vitamin D3 and magnesium increased significantly in the intervention group compared with the control group. Also, children receiving vitamin D plus magnesium showed a significant reduction in emotional problems (p = 0.001), conduct problems (p = 0.002), peer problems (p = 0.001), prosocial score (p = 0.007), total difficulties (p = 0.001), externalizing score (p = 0.001), and internalizing score (p = 0.001) compared with children treated with the placebo. CONCLUSION Vitamin D (50,000 IU/week) and magnesium (6 mg/kg/day) co-supplementation for a duration of 8-weeks could improve the behavioral function and mental health of children with ADHD. However, further well-designed studies with a larger sample size are needed. TRIAL REGISTRATION IRCT2016030326886N1 .
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Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care.
Smith, J, Griffiths, LA, Band, M, Hird-Smith, R, Williams, B, Bold, J, Bradley, E, Dilworth, R, Horne, D
Frontiers in endocrinology. 2020;11:577691
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Young people with psychosis have higher rates of obesity, diabetes risk, premature cardiovascular disease, and overall reduced life expectancy in comparison to their non-psychotic peers. This is primarily due to adverse health behaviours and changes in metabolic regulation due to antipsychotic medication. This study aimed to evaluate a 12-week combined exercise and health behaviour intervention (SHAPE - Supporting Health And Promoting Exercise) as part of the routine Early Intervention in Psychosis service in the UK. The program itself included educational series on health behaviours alongside supportive materials, followed by guided exercise sessions encompassing a variety of activities, focused on promoting self-efficacy. 26 individuals, predominantly male, completed the program. Their health behaviours and clinical measurements were assessed at the beginning of the intervention and after 12 months. At the start of the program, the average baseline data of the participants showed an elevated risk for adverse health outcomes, ranging from high BMI, smoking and substance use, low vegetable consumption, altered metabolic markers or medication side effects. After the 12-week program, individuals managed to reduce their health risks and sustained such benefits 12 months onwards. The effectiveness of the intervention in managing antipsychotic drug-induced weight gain was particularly highlighted here by the authors. In summary, the early management of cardiometabolic risk factors associated with psychosis is critical. Early intervention with behavioural and physical health strategies through i.e. carefully considered programs can enhance routine care. The study highlights the importance of a multifactorial approach in the management of mental health conditions, and the importance of health behaviour and physical activities in the mitigation of health risks associated with psychosis.
Abstract
Aim: Young people with psychosis have higher rates of obesity, premature cardiovascular disease, and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK. Methods: Participants (n = 27) completed a 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min). Anthropometric data from participants (n = 26) were collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviors and clinical measurements were assessed at baseline and 12 months. Results: Mean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate < 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications (i.e., Olanzapine). At 12 weeks and 12 months, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n = 2), alcohol use (n = 2), and smoking (n = 4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence. Conclusions: The 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12-month follow-up. Self-reported positive health behavior changes are likely to have contributed to the prevention of excessive weight gain in this high-risk period. The evaluation was designed to have validity for a "real world EIP setting" and reflect the complexity of delivery to this participant group. Evaluation findings influenced subsequent commissioning of the physical health intervention as an ongoing element of routine EIP care within the participant site.