Associations between dietary inflammatory index (DII) scores and attention deficit hyperactivity disorder (ADHD) in children.

Fatemeh Navab; Khadijeh Abbasi; Hajar Heidari; Reza Ghiasvand; Cain C T Clark; Mohammad Bagherniya; Shirin Hassanizadeh; Mohammad Hossein Rouhani

doi:10.1038/s41598-025-08919-x

Associations between dietary inflammatory index (DII) scores and attention deficit hyperactivity disorder (ADHD) in children.

Fatemeh Navab
, Khadijeh Abbasi
, Hajar Heidari
, Reza Ghiasvand
, Cain C T Clark
, Mohammad Bagherniya
, Shirin Hassanizadeh
, Mohammad Hossein Rouhani

Isfahan University of Medical Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, yet its underlying mechanisms remain unclear. Genetic, family history, nutritional, lifestyle, and inflammatory factors are considered as contributing factors of ADHD. The dietary inflammatory index (DII) could be used to determine whether a diet has an inflammatory potential. Therefore, the purpose of this study was to find out if DII scores and ADHD were related. This study included 500 Iranian children aged 4-12 (200 ADHD cases and 300 healthy controls). Food frequency questionnaires (FFQs) consisting of 168 items were used to determine dietary intake. DII scores were calculated using data from D-FFQ. Energy-adjusted DII (E-DII) scores were calculated using standardized z-scores for each food item, following established protocols. Analysis of covariance (ANCOVA) assessed energy-adjusted dietary intake across DII tertiles. Multivariable logistic regression estimated ADHD odds ratios (ORs) and 95% confidence intervals (CIs) through two hierarchical models: Model 1 (adjusted for age, gender, income) and Model 2 (Model 1 + BMI). Statistical significance was set at p < 0.05, with analyses performed in SPSS version 21. Overall, 200 ADHD and 300 healthy children participated in this study. Energy-adjusted dietary inflammatory index (E-DII) was directly associated with ADHD risk in the crude model (OR = 1.104; 95% CI: 1.009, 1.208; p = 0.031). This result also remained significant in Model 1 (OR = 1.162; 95% CI: 1.050, 1.285; p = 0.004) and Model 2 (OR = 1.133; 95% CI: 1.021, 1.258; p = 0.019). We found that E-DII had a significant association with the risk of ADHD in Iranian children. Limitations include the case-control design, which precludes causal inference, and potential residual confounding from unmeasured factors. It will be necessary to conduct further studies to confirm these findings.

Original language	English
Article number	30884
Number of pages	8
Journal	Scientific Reports
Volume	15
Issue number	1
DOIs	https://doi.org/10.1038/s41598-025-08919-x
Publication status	Published - 22 Aug 2025

Bibliographical note

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.

Funding

The study was funded by Isfahan University of Medical Science. However, the funder was not involved in designing, collecting, analyzing, interpreting data, writing the report, or deciding whether it should be submitted. Grant/Award Number: 395529.

Funders	Funder number
Isfahan University of Medical Sciences	395529

Keywords

Humans
Inflammation
Diet
Risk Factors
Case-Control Studies
Attention Deficit Disorder with Hyperactivity
Child
Child, Preschool
Iran
Female
Male
Surveys and Questionnaires

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10.1038/s41598-025-08919-xLicence: CC BY

Clark2025VoRFinal published version, 1.32 MBLicence: CC BY

Cite this

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title = "Associations between dietary inflammatory index (DII) scores and attention deficit hyperactivity disorder (ADHD) in children.",

abstract = "Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, yet its underlying mechanisms remain unclear. Genetic, family history, nutritional, lifestyle, and inflammatory factors are considered as contributing factors of ADHD. The dietary inflammatory index (DII) could be used to determine whether a diet has an inflammatory potential. Therefore, the purpose of this study was to find out if DII scores and ADHD were related. This study included 500 Iranian children aged 4-12 (200 ADHD cases and 300 healthy controls). Food frequency questionnaires (FFQs) consisting of 168 items were used to determine dietary intake. DII scores were calculated using data from D-FFQ. Energy-adjusted DII (E-DII) scores were calculated using standardized z-scores for each food item, following established protocols. Analysis of covariance (ANCOVA) assessed energy-adjusted dietary intake across DII tertiles. Multivariable logistic regression estimated ADHD odds ratios (ORs) and 95\% confidence intervals (CIs) through two hierarchical models: Model 1 (adjusted for age, gender, income) and Model 2 (Model 1 + BMI). Statistical significance was set at p < 0.05, with analyses performed in SPSS version 21. Overall, 200 ADHD and 300 healthy children participated in this study. Energy-adjusted dietary inflammatory index (E-DII) was directly associated with ADHD risk in the crude model (OR = 1.104; 95\% CI: 1.009, 1.208; p = 0.031). This result also remained significant in Model 1 (OR = 1.162; 95\% CI: 1.050, 1.285; p = 0.004) and Model 2 (OR = 1.133; 95\% CI: 1.021, 1.258; p = 0.019). We found that E-DII had a significant association with the risk of ADHD in Iranian children. Limitations include the case-control design, which precludes causal inference, and potential residual confounding from unmeasured factors. It will be necessary to conduct further studies to confirm these findings.",

keywords = "Humans, Inflammation, Diet, Risk Factors, Case-Control Studies, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Iran, Female, Male, Surveys and Questionnaires",

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AU - Heidari, Hajar

AU - Ghiasvand, Reza

AU - Clark, Cain C T

AU - Bagherniya, Mohammad

AU - Hassanizadeh, Shirin

AU - Rouhani, Mohammad Hossein

N1 - Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.

PY - 2025/8/22

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N2 - Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, yet its underlying mechanisms remain unclear. Genetic, family history, nutritional, lifestyle, and inflammatory factors are considered as contributing factors of ADHD. The dietary inflammatory index (DII) could be used to determine whether a diet has an inflammatory potential. Therefore, the purpose of this study was to find out if DII scores and ADHD were related. This study included 500 Iranian children aged 4-12 (200 ADHD cases and 300 healthy controls). Food frequency questionnaires (FFQs) consisting of 168 items were used to determine dietary intake. DII scores were calculated using data from D-FFQ. Energy-adjusted DII (E-DII) scores were calculated using standardized z-scores for each food item, following established protocols. Analysis of covariance (ANCOVA) assessed energy-adjusted dietary intake across DII tertiles. Multivariable logistic regression estimated ADHD odds ratios (ORs) and 95% confidence intervals (CIs) through two hierarchical models: Model 1 (adjusted for age, gender, income) and Model 2 (Model 1 + BMI). Statistical significance was set at p < 0.05, with analyses performed in SPSS version 21. Overall, 200 ADHD and 300 healthy children participated in this study. Energy-adjusted dietary inflammatory index (E-DII) was directly associated with ADHD risk in the crude model (OR = 1.104; 95% CI: 1.009, 1.208; p = 0.031). This result also remained significant in Model 1 (OR = 1.162; 95% CI: 1.050, 1.285; p = 0.004) and Model 2 (OR = 1.133; 95% CI: 1.021, 1.258; p = 0.019). We found that E-DII had a significant association with the risk of ADHD in Iranian children. Limitations include the case-control design, which precludes causal inference, and potential residual confounding from unmeasured factors. It will be necessary to conduct further studies to confirm these findings.

AB - Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, yet its underlying mechanisms remain unclear. Genetic, family history, nutritional, lifestyle, and inflammatory factors are considered as contributing factors of ADHD. The dietary inflammatory index (DII) could be used to determine whether a diet has an inflammatory potential. Therefore, the purpose of this study was to find out if DII scores and ADHD were related. This study included 500 Iranian children aged 4-12 (200 ADHD cases and 300 healthy controls). Food frequency questionnaires (FFQs) consisting of 168 items were used to determine dietary intake. DII scores were calculated using data from D-FFQ. Energy-adjusted DII (E-DII) scores were calculated using standardized z-scores for each food item, following established protocols. Analysis of covariance (ANCOVA) assessed energy-adjusted dietary intake across DII tertiles. Multivariable logistic regression estimated ADHD odds ratios (ORs) and 95% confidence intervals (CIs) through two hierarchical models: Model 1 (adjusted for age, gender, income) and Model 2 (Model 1 + BMI). Statistical significance was set at p < 0.05, with analyses performed in SPSS version 21. Overall, 200 ADHD and 300 healthy children participated in this study. Energy-adjusted dietary inflammatory index (E-DII) was directly associated with ADHD risk in the crude model (OR = 1.104; 95% CI: 1.009, 1.208; p = 0.031). This result also remained significant in Model 1 (OR = 1.162; 95% CI: 1.050, 1.285; p = 0.004) and Model 2 (OR = 1.133; 95% CI: 1.021, 1.258; p = 0.019). We found that E-DII had a significant association with the risk of ADHD in Iranian children. Limitations include the case-control design, which precludes causal inference, and potential residual confounding from unmeasured factors. It will be necessary to conduct further studies to confirm these findings.

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KW - Inflammation

KW - Diet

KW - Risk Factors

KW - Case-Control Studies

KW - Attention Deficit Disorder with Hyperactivity

KW - Child

KW - Child, Preschool

KW - Iran

KW - Female

KW - Male

KW - Surveys and Questionnaires

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DO - 10.1038/s41598-025-08919-x

M3 - Article

SN - 2045-2322

VL - 15

JO - Scientific Reports

JF - Scientific Reports

IS - 1

M1 - 30884

ER -

Associations between dietary inflammatory index (DII) scores and attention deficit hyperactivity disorder (ADHD) in children.

Abstract

Bibliographical note

Funding

Keywords

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