Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

Clinical characteristics of attention-deficit/hyperactivity disorder with sarcopenia in children: a case-control study

Pediatric Research (2026)Cite this article

Abstract

Background

This study aimed to investigate the characteristics of body composition, core symptoms, functional impairment, and comorbidities in children with attention-deficit hyperactivity disorder (ADHD) and sarcopenia.

Methods

A case-control study compared children with ADHD and sarcopenia (n = 85) with matched ADHD-only controls (n = 85). Comprehensive evaluations included body composition analysis and standardized behavioral assessments (SNAP-IV, Vanderbilt, WFIRS).

Results

Compared to the control group, the ADHD with sarcopenia group exhibited significantly lower values on total body water, protein, minerals, body fat mass, fat-free mass, bone mineral content, body mass index, fat mass index, and fat-free mass index (False Discovery Rate (FDR) corrected P < 0.05), while exhibiting higher muscle-to-fat ratio. They also demonstrated lower ADHD core symptom severity, decreased comorbidity proportion (including oppositional defiant disorder [ODD]), and impaired family function (FDR corrected P < 0.05). Regression analysis identified hyperactive-impulsive symptom severity (OR 3.97, 95% CI:2.22–7.12) and increased soft lean mass (SLM) (OR 1.13, 95% CI:1.05–1.21) as predictors of comorbid ODD risk.

Conclusion

ADHD children with sarcopenia had lower body composition values, milder core symptoms, and fewer comorbidities (including ODD). SLM and hyperactive-impulsive symptoms exhibited positive associations with comorbid ODD risk in children with ADHD.

Impact

  • Children with ADHD and sarcopenia show skeletal muscle wasting alongside declines in fat mass, protein content, and bone mineral content compared with the control group (children with ADHD without sarcopenia).

  • The ADHD-sarcopenia group (participants with both ADHD and sarcopenia) had significantly lower ADHD core symptom scores (inattention and hyperactivity-impulsivity) and a reduced comorbidity proportion.

  • Hyperactivity-impulsivity symptoms and soft lean mass increased the risk of comorbid oppositional defiant disorder in children with ADHD.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Salari, N. et al. The Global Prevalence of Adhd in Children and Adolescents: A Systematic Review and Meta-Analysis. Ital. J. Pediatr. 49, 48 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Li, F. et al. Prevalence of mental disorders in school children and adolescents in china: diagnostic data from detailed clinical assessments of 17,524 individuals. J. Child Psychol. Psychiatry 63, 34–46 (2022).

    Article  PubMed  Google Scholar 

  3. Leffa, D. T., Caye, A. & Rohde, L. A. Adhd in children and adults: diagnosis and prognosis. Curr. Top. Behav. Neurosci. 57, 1–18 (2022).

    Article  CAS  PubMed  Google Scholar 

  4. Du Rietz, E. et al. Mapping phenotypic and aetiological associations between adhd and physical conditions in adulthood in Sweden: a genetically informed register study. Lancet Psychiatry 8, 774–783 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chung, S. Body Mass Index and Body Composition Scaling to Height in Children and Adolescent. Ann. Pediatr. Endocrinol. Metab. 20, 125–129 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Liu, C. Y. et al. Are there causal relationships between attention-deficit/hyperactivity disorder and body mass index? Evidence from multiple genetically informed designs. Int J. Epidemiol. 50, 496–509 (2021).

    Article  PubMed  Google Scholar 

  7. Chula de Castro, J. A., Lima, T. R. & Silva, D. A. S. Body composition estimation in children and adolescents by bioelectrical impedance analysis: a systematic review. J. Bodyw. Mov. Ther. 22, 134–146 (2018).

    Article  PubMed  Google Scholar 

  8. Egan, M. F. et al. The Bdnf Val66met polymorphism affects activity-dependent secretion of bdnf and human memory and hippocampal function. Cell 112, 257–269 (2003).

    Article  CAS  PubMed  Google Scholar 

  9. Inoue, T. et al. Diagnostic criteria, prevalence, and clinical outcomes of pediatric sarcopenia: a scoping review. Clin. Nutr. 43, 1825–1843 (2024).

    Article  PubMed  Google Scholar 

  10. Woolfson, J. P. et al. Sarcopenia in Children with End-Stage Liver Disease on the Transplant Waiting List. Liver Transpl. 27, 641–651 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ritz, A. et al. Sarcopenia Is a Prognostic Outcome Marker in Children with High-Risk Hepatoblastoma. Pediatr. Blood Cancer 68, e28862 (2021).

    Article  CAS  PubMed  Google Scholar 

  12. Clark, B. C. & Carson, R. G. Sarcopenia and Neuroscience: Learning to Communicate. J. Gerontol. A Biol. Sci. Med Sci. 76, 1882–1890 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lurz, E. et al. Paediatric Reference Values for Total Psoas Muscle Area. J. Cachexia Sarcopenia Muscle 11, 405–414 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kim, J. et al. Decrease of Muscle Mass in Young Patients with Neuromuscular Disease: Assessment of Sarcopenia. J. Korean Med Sci. 38, e187 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Fhon, J. R. S. et al. Association between sarcopenia, falls, and cognitive impairment in older people: a systematic review with meta-analysis. Int. J. Environ. Res. Public Health 20, 4156 (2023).

  16. Zhao, X. et al. Genetic association between attention-deficit/hyperactivity disorder and sarcopenia: a bidirectional two-sample, two-step Mendelian randomized study. Psychiatry Investig. 22, 304–310 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cao, M. Y. et al. Reference Values of Skeletal Muscle Mass for Children in Nanjing Area. Zhonghua Er Ke Za Zhi 62, 423–429 (2024).

    CAS  PubMed  Google Scholar 

  18. Hall, C. L. et al. The Validity of the Snap-Iv in Children Displaying Adhd Symptoms. Assessment 27, 1258–1271 (2020).

    Article  PubMed  Google Scholar 

  19. Gau, S. S. et al. Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, version IV scale - parent form. Int J. Methods Psychiatr. Res 17, 35–44 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Thompson, T., Lloyd, A., Joseph, A. & Weiss, M. The Weiss functional impairment rating scale-parent form for assessing ADHD: evaluating diagnostic accuracy and determining optimal thresholds using ROC analysis. Qual. Life Res 26, 1879–1885 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gajria, K. et al. Psychometric validation of the weiss functional impairment rating scale-parent report form in children and adolescents with attention-deficit/hyperactivity disorder. Health Qual. Life Outcomes 13, 184 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ying, Q., Xin, D. Q. & Shan, Q. U. Reliability and validity of the Chinese version of Weiss functional impairment scale-parent form for school-age children. Chin. Ment. Health J. 25, 767–771 (2011).

    Google Scholar 

  23. Becker, S. P., Langberg, J. M., Vaughn, A. J. & Epstein, J. N. Clinical utility of the Vanderbilt ADHD diagnostic parent rating scale comorbidity screening scales. J. Dev. Behav. Pediatr. 33, 221–228 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  24. Xiao, Z. H., Wang, Q. H., Luo, T. T. & Zhong, L. Diagnostic value of vanderbilt ADHD parent rating scale in attention deficit hyperactivity disorder. Zhongguo Dang Dai Er Ke Za Zhi 15, 348–352 (2013).

    PubMed  Google Scholar 

  25. Bard, D. E., Wolraich, M. L., Neas, B., Doffing, M. & Beck, L. The psychometric properties of the vanderbilt attention-deficit hyperactivity disorder diagnostic parent rating scale in a community population. J. Dev. Behav. Pediatr. 34, 72–82 (2013).

    Article  PubMed  Google Scholar 

  26. Zhu, Y. et al. Association between sarcopenia and osteoporosis: the cross-sectional study from NHANES 1999–2020 and a bi-directions mendelian randomization study. Front. Endocrinol. 15, 1399936 (2024).

    Article  Google Scholar 

  27. Torres-Costoso, A., Zymbal, V., Janz, K. F., Martinez Vizcaino, V. & Baptista, F. Body composition and musculoskeletal fitness: a cluster analysis for the identification of risk phenotypes for pediatric sarcopenia. Clin. Nutr. 42, 1151–1158 (2023).

    Article  PubMed  Google Scholar 

  28. Reed, C., Cortese, S., Golm, D. & Brandt, V. Longitudinal associations between ADHD and weight from birth to adolescence. J. Am. Acad. Child. Adolesc. Psychiatry (2024).

  29. Wu, D. et al. Eating Behavior-Mediated Association between Attention Deficit Hyperactivity Disorder and Body Fat Mass. Heliyon 9, e13641 (2023).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Chang, J. P. et al. Cortisol, inflammatory biomarkers and neurotrophins in children and adolescents with attention deficit hyperactivity disorder (ADHD) in Taiwan. Brain Behav. Immun. 88, 105–113 (2020).

    Article  CAS  PubMed  Google Scholar 

  31. Aube, D. et al. Progressive resistance training volume: effects on muscle thickness, mass, and strength adaptations in resistance-trained individuals. J. Strength Cond. Res. 36, 600–607 (2022).

    Article  PubMed  Google Scholar 

  32. Bowling, A. B., Tiemeier, H. W., Jaddoe, V. W. V., Barker, E. D. & Jansen, P. W. ADHD symptoms and body composition changes in childhood: a longitudinal study evaluating directionality of associations. Pediatr. Obes. 13, 567–575 (2018).

    Article  CAS  PubMed  Google Scholar 

  33. Martins-Silva, T. et al. ADHD in childhood predicts bmi and body composition measurements over time in a population-based birth cohort. Int J. Obes. 46, 1204–1211 (2022).

    Article  Google Scholar 

  34. Mohammadi, M. R. et al. Prevalence of ADHD and Its Comorbidities in a Population-Based Sample. J. Atten. Disord. 25, 1058–1067 (2021).

    Article  PubMed  Google Scholar 

  35. Chen, S. et al. Identification of risk factors and development of a predictive nomogram for sarcopenia in Alzheimer’s disease. Alzheimers Dement. 21, e14503 (2025).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Hildebrand, P. et al. Effects of dietary tryptophan and phenylalanine-tyrosine depletion on phasic alertness in healthy adults - a pilot study. Food Nutr. Res. 59, 26407 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Predescu, E., Vaidean, T., Rapciuc, A. M. & Sipos, R. Metabolomic markers in attention-deficit/hyperactivity disorder (ADHD) among children and adolescents-a systematic review. Int. J. Mol. Sci. 25, 4385 (2024).

  38. Sanchez, C. L., Van Swearingen, A. E., Arrant, A. E., Kuhn, C. M. & Zepf, F. D. Dietary Manipulation of Serotonergic and Dopaminergic Function in C57bl/6j Mice with Amino Acid Depletion Mixtures. J. Neural Transm. 121, 153–162 (2014).

    Article  CAS  PubMed  Google Scholar 

  39. Selah, K. et al. Associations between computationally derived parent emotional sentiment scores and child adhd and odd over time. Res Child Adolesc. Psychopathol. 52, 1663–1676 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank all children and their family members for their interest and cooperation.

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Healthcare, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China

    Xiao-lin Zhang, Yi Zhou, Yan Wang, Chen-yi Li, Lu Zhao, Jin-xin Gong & Shi-zhong Cai

  2. Shanghai Jiao Tong University School of Public Health, Shanghai, China

    Chong-huai Yan

  3. Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Chong-huai Yan

  4. Department of Cardiac Surgery, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China

    Xin Li

Authors
  1. Xiao-lin Zhang
    View author publications

    Search author on:PubMed Google Scholar

  2. Yi Zhou
    View author publications

    Search author on:PubMed Google Scholar

  3. Yan Wang
    View author publications

    Search author on:PubMed Google Scholar

  4. Chen-yi Li
    View author publications

    Search author on:PubMed Google Scholar

  5. Lu Zhao
    View author publications

    Search author on:PubMed Google Scholar

  6. Jin-xin Gong
    View author publications

    Search author on:PubMed Google Scholar

  7. Chong-huai Yan
    View author publications

    Search author on:PubMed Google Scholar

  8. Xin Li
    View author publications

    Search author on:PubMed Google Scholar

  9. Shi-zhong Cai
    View author publications

    Search author on:PubMed Google Scholar

Contributions

X.Z. wrote the main manuscript text, conducted the statistical analysis, and drafted the manuscript. Y.Z., Y.W., and C.L. collected the data. J.G., L.Z., C.Y., X.L., and S.C. interpreted the data, with C.Y. also revising the manuscript. X.L. and S.C. were responsible for writing the methodology and the final approval of the version to be published. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Xin Li or Shi-zhong Cai.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics

This study was approved by the Ethics Committee of the Children’s Hospital of Soochow University (No. 2021CS092). Oral informed consent was obtained from the parent or legal guardian of all the participating children.

Consent statement

This study was approved by the Ethics Committee of the Children’s Hospital of Soochow University (No. 2021CS092). Oral informed consent was obtained from the parent or legal guardian of all the participating children.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, Xl., Zhou, Y., Wang, Y. et al. Clinical characteristics of attention-deficit/hyperactivity disorder with sarcopenia in children: a case-control study. Pediatr Res (2026). https://doi.org/10.1038/s41390-026-04813-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • DOI: https://doi.org/10.1038/s41390-026-04813-y

Search

Advanced search

Quick links