The Relationship Between Blood Lipid and Attention-Deficit/Hyperactivity Disorder (ADHD) in an Obese Population of Chinese Children: An Obesity-Stratified Cross-Sectional Study

Figures & data

Table 1 The Characteristics of Study Population (N=1179)

Variables	M±SD or n (%)
Age (Years)	10.4±3.6
Gender (male), n (%)	593 (50.3)
Height (cm)	141.5±16.7
Weight (kg)	39.2±9.3
BMI (kg/m^2)	18.6±3.4
Residence
Urban, n (%)	793 (67.4)
Rural, n (%)	386 (32.7)
Maternal smoking pregnancy, n (%)	20 (1.7)
Breastfeeding, n (%)	998 (84.6)
Breastfeeding length (months)	6.2 ±3.1
Maternal educational level, n (%)
More than primary school, n (%)	1125 (95.4)
Primary school and lower, n (%)	54 (4.6)
Paternal educational level, n (%)
More than primary school, n (%)	1162 (98.6)
Primary school and lower, n (%)	17 (1.4)
Marital status of parents
Separated/divorced, n (%)	178 (15.1)
Others, n (%)	1001 (84.9)
Nutritional status
Adequate, n (%)	1160 (98.4)
Inadequate, n (%)	19 (1.6)
Physical activity (kcal/d)	1195.4 ±717.4
ADHD, n (%)	97 (8.2)
Serum lipid level
Triglycerides (mmol/L)	1.95±1.25
LDL (mmol/L)	2.13±0.84
HDL (mmol/L)	1.43±0.15
Total cholesterol (mmol/L)	4.04±1.21

Note: M ±SD for normally distributed data and n (%) for categoric variables.

Abbreviations: BMI, body mass index; ADHD, attention-deficit/hyperactivity disorder; LDL, low density lipoprotein; HDL, high density lipoprotein.

Table 2 Logistic Regression Analysis of the Relationship Between the Lipid Levels and Risk of ADHD in Children

Variables	Model 1	Model 2	Model 3
Total cholesterol
Quartile 1	1.000 (ref.)	1.000 (ref.)	1.000 (ref.)
Quartile 2	1.625 (1.147–2.821)	1.570 (1.114–2.368)	1.484 (1.053–2.220)
Quartile 3	1.856 (1.247–3.155)	1.722 (1.162–2.872)	1.619 (1.116–2.877)
Quartile 4	2.248 (1.380–4.226)	2.105 (1.311–3.988)	2.001 (1.247–3.541)
P-trend	0.009	0.011	0.024
Triglycerides
Quartile 1	1.000 (ref.)	1.000 (ref.)	1.000 (ref.)
Quartile 2	1.447 (1.312–1.915)	1.414 (1.303–1.879)	1.397 (1.256–1.833)
Quartile 3	1.634 (1.437–2.371)	1.497 (1.325–2.166)	1.459 (1.307–2.072)
Quartile 4	1.885 (1.501–3.099)	1.801 (1.467–2.302)	1.776 (1.448–2.187)
P-trend	<0.001	0.001	0.003
LDL
Quartile 1	1.000 (ref.)	1.000 (ref.)	1.000 (ref.)
Quartile 2	1.624 (1.246–2.41)	1.490 (1.114–2.368)	1.484 (1.053–2.290)
Quartile 3	1.803 (1.211–3.164)	1.713 (1.157–2.972)	1.706 (1.137–2.811)
Quartile 4	2.326 (1.527–4.772)	2.147 (1.356–4.280)	2.016 (1.335–3.966)
P-trend	<0.001	<0.001	<0.001
HDL
Quartile 1	1.000 (ref.)	1.000 (ref.)	1.000 (ref.)
Quartile 2	0.766 (0.291–1.008)	0.810 (0.299–1.013)	0.831 (0.383–1.131)
Quartile 3	0.637 (0.148–0.946)	0.751 (0.238–0.964)	0.766 (0.370–0.979)
Quartile 4	0.455 (0.090–0.812)	0.534 (0.158–0.866)	0.577 (0.298–0.948)
P-trend	0.008	0.017	0.023

Notes: Model 1: Adjusted for age and gender. Model 2: Adjusted for age, BMI, gender, residence, maternal smoking pregnancy, breastfeeding and breastfeeding length. Model 3: Adjusted for age, gender, BMI, residence, maternal smoking pregnancy, breastfeeding, breastfeeding length, maternal educational level, paternal educational level, marital status of parents and physical activity.ADHD, attention-deficit/hyperactivity disorder; LDL, low density lipoprotein; HDL, high density lipoprotein; BMI, body mass index.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; LDL, low density lipoprotein; HDL, high density lipoprotein; BMI, body mass index.

Table 3 Logistic Regression Analysis for the Relationship Between the Lipid Levels and Risk of ADHD in Children by Stratified Analysis Using “Obese”

	Obese			Non-Obese
Variables	OR	95% CI	P value	HR	95% CI	P value
Serum cholesterol (per 1-SD increase)	2.234	1.112–5.103	<0.001	1.232	1.008–2.336	0.205
P value for interaction	0.003
Serum triglycerides (per 1-SD increase)	1.585	1.037–2.572	0.010	1.458	1.016–2.752	0.176
P value for interaction	0.003
Serum LDL (per 1-SD increase)	2.568	1.358–4.267	<0.001	1.649	1.204–3.135	0.071
P value for interaction	0.005
Serum HDL (per 1-SD increase)	0.446	0.125–0.802	0.008	0.679	0.133–1.089	0.059
P value for interaction	0.014

Notes: Adjusted for age, gender, BMI, residence, maternal smoking pregnancy, breastfeeding, breastfeeding length, maternal educational level, paternal educational level and marital status of parents.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; LDL, low density lipoprotein; HDL, high density lipoprotein; BMI, body mass index.

Table 4 Sensitivity Analysis for the Relationship Between the Lipid Levels and Risk of ADHD in Children by Using “Physical Activity”

	Obese			Non-Obese
Variables	HR	95% CI	P value	HR	95% CI	P value
Serum cholesterol (per 1-SD increase)	2.223	1.109–5.102	<0.001	1.231	1.007–2.325	0.212
P value for interaction	0.004
Serum triglycerides (per 1-SD increase)	1.573	1.029–2.561	0.011	1.436	1.004–2.654	0.178
P value for interaction	0.002
Serum LDL (per 1-SD increase)	2.589	1.363–4.293	<0.001	1.627	1.164–3.129	0.082
P value for interaction	0.007
Serum HDL (per 1-SD increase)	0.454	0.127–0.871	0.009	0.693	0.138–1.090	0.062
P value for interaction	0.018

Notes: Adjusted for age, gender, BMI, residence, maternal smoking pregnancy, breastfeeding, breastfeeding length, maternal educational level, paternal educational level, marital status of parents and physical activity.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; LDL, low density lipoprotein; HDL, high density lipoprotein; BMI, body mass index.