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Pediatrics

Exploring the bidirectional associations of ADHD symptomatology, nutritional status, and body composition in childhood: evidence from a Brazilian Birth Cohort Study

International Journal of Obesity volume 49, pages 965–972 (2025)Cite this article

Subjects

Abstract

Background

Attention deficit hyperactivity disorder (ADHD) has been linked to excessive weight; however, the underlying mechanisms of this association are not well understood. To date, the bidirectional associations between ADHD and nutritional status in childhood have been explored in a limited number of studies, with particularly few of those incorporating body composition data. This study aims to evaluate the associations of ADHD symptoms, nutritional status, and body composition in childhood.

Methods

We analyzed data from 3940 children from the 2015 Pelotas (Brazil) Birth Cohort at 4 and 6–7 years of age. Linear regression was performed to evaluate the association between ADHD symptoms and nutritional status (weight, height, and body mass index [BMI]) at ages 4 and 6–7, as well as body composition, specifically fat mass (FF) and fat-free mass (FFM) at ages 6–7. Moreover, a cross-lagged panel model (CLPM) analysis between ADHD symptoms and BMI was performed to explore the bidirectional associations.

Results

ADHD symptoms were associated with increased height (β 0.01, 95%CI 0.001, 0.026) and FFM (β 0.02, 95%CI 0.008–0.035) at age 4, and increased BMI (β0.02, 95%IC 0.002, 0.038), weight (β 0. 02, 95%CI 0.005, 0.039), height (β 0.01, 95%CI 0.000, 0.024), and FFM (β 0.02, 95%CI 0.012, 0.040) at ages 6–7. Although the CLPM indicated a small effect suggesting a bidirectional relationship between ADHD symptoms and BMI, the observed associations were not statistically significant: ADHD scores at age 4 predicting BMI z-scores at ages 6–7 (β 0.003; 95% CI: –0.026, 0.020), and BMI z-scores at age 4 predicting ADHD scores at ages 6–7 (β 0.013; 95% CI: –0.018, 0.044).

Conclusion

Children with higher ADHD symptoms showed increased growth in weight, height, and BMI. The observed increase in weight and BMI was attributed to greater FFM in these children.

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Fig. 1: Effect size (beta coefficient) of the bidirectional association tests between ADHD symptoms and body mass index z score in the 2015 Pelotas (Brazil) Birth Cohort.

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Data availability

The datasets generated and analyzed during this study are not publicly available due to confidentiality and data protection commitments to the participants. However, they can be obtained from the corresponding author upon reasonable request.

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Acknowledgements

This article is based on data from the study “Pelotas Birth Cohort, 2015” conducted by the Postgraduate Program in Epidemiology at Universidade Federal de Pelotas, with the collaboration of the Brazilian Public Health Association (ABRASCO). The first phase of the 2015 Pelotas (Brazil) Birth Cohort was funded by the Wellcome Trust (095582). Funding for specific follow-up visits was also received from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundação de Amparo a Pesquisa do Estado do Rio Grande do Sul (FAPERGS), Bernard van Leer Foundation (BRA-2018-178) and Department of Science and Technology (DECIT/Brazilian Ministry of Health) for the 4-year follow-up. The 6–7 years follow-up received funding from the Department of Science and Technology of the Ministry of Health (Department of Science and Technology (DECIT/Brazilian Ministry of Health), Instituto Todos Pela Saúde, Celer Biotecnologia SA, FAPERGS PqG 21/2551-0002004 -0 and CNPq through public notices: 407813/2021-7, 406582/2021-1 and 406582/2021-1. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

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Authors and Affiliations

  1. Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil

    Bárbara Peter Gonçalves, Thais Martins-Silva, Joseph Murray, Luciana Tovo-Rodrigues & Andréa Dâmaso Bertoldi

  2. Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil

    Thais Martins-Silva & Joseph Murray

  3. Postgraduate Program in Public Health, University of the Extreme South of Santa Catarina, Criciúma, Santa Catarina, Brazil

    Isabel Bierhals

  4. Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil

    Marlos R. Domingues

  5. Department of Health and Kinesiology, University of Illinois Urbana-Champaign, Champaign, USA

    Pedro C. Hallal

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  1. Bárbara Peter Gonçalves
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  2. Thais Martins-Silva
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  6. Pedro C. Hallal
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  7. Luciana Tovo-Rodrigues
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  8. Andréa Dâmaso Bertoldi
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Contributions

BPG, TM-S, LT-R, and ADB conceived the study and conducted the analyses. BPG drafted the initial version of the manuscript. BPG, TM-S, IB, JM, MRD, PCH, LT-R and ADB critically revised the manuscript and contributed to the interpretation of the findings. All authors approved the final version for publication.

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Correspondence to Bárbara Peter Gonçalves.

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Gonçalves, B.P., Martins-Silva, T., Bierhals, I. et al. Exploring the bidirectional associations of ADHD symptomatology, nutritional status, and body composition in childhood: evidence from a Brazilian Birth Cohort Study. Int J Obes 49, 965–972 (2025). https://doi.org/10.1038/s41366-025-01745-1

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