{"id":9377,"date":"2013-08-14T14:37:07","date_gmt":"2013-08-14T18:37:07","guid":{"rendered":"http:\/\/yang-sheng.com\/?p=9377"},"modified":"2013-08-24T06:27:48","modified_gmt":"2013-08-24T10:27:48","slug":"research-findings-on-diet-and-nutritional-therapy","status":"publish","type":"post","link":"https:\/\/yang-sheng.com\/?p=9377","title":{"rendered":"Research Findings on Diet and Nutritional Therapy"},"content":{"rendered":"

[Research Update]<\/strong><\/a><\/p>\n

Recent Research Findings <\/b><\/span><\/h2>\n

on Diet and Nutritional Therapy <\/b><\/span><\/h2>\n

Compiled by Kevin W Chen, PhD \u00a0MPH<\/p>\n

\"blood-analysis\"<\/p>\n

Effect of lower sodium intake on health: systematic\u00a0review\u00a0and meta-analyses<\/b>.\u00a0 BMJ<\/i>.\u00a02013 Apr 3; 346:f1326. By Aburto NJ,\u00a0Ziolkovska A,\u00a0Hooper L,\u00a0et al. from Dept of\u00a0Nutrition\u00a0for Health and Development, World Health Organization, Switzerland. nancy.aburto@wfp.org<\/a><\/p>\n

OBJECTIVE:<\/b>\u00a0 To assess the effect of decreased sodium intake on blood pressure, related cardiovascular diseases, and potential adverse effects such as changes in blood lipids, catecholamine levels, and renal function. \u00a0DATA SOURCES<\/b>:\u00a0 Cochrane Central Register of Controlled Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, the Latin American and Caribbean health science literature database, and the reference lists of previous reviews. \u00a0\u00a0STUDY SELECTION<\/b>: Randomised controlled trials (RCT) and prospective cohort studies in non-acutely ill adults and children assessing the relations between sodium intake and blood pressure, renal function, blood lipids, and catecholamine levels, and in non-acutely ill adults all cause mortality, cardiovascular disease, stroke, and coronary heart disease.\u00a0 Potential studies were screened independently and in duplicate and study characteristics and outcomes extracted. When possible we conducted a meta-analysis to estimate the effect of lower sodium intake using the inverse variance method and a random effects model. We present results as mean differences or risk ratios, with 95% confidence intervals. \u00a0\u00a0RESULTS<\/b>:\u00a0 We included 14 cohort studies and five RCTs reporting all cause mortality, cardiovascular disease, stroke, or coronary heart disease; and 37 RCTs measuring blood pressure, renal function, blood lipids, and catecholamine levels in adults. Nine controlled trials and one cohort study in children reporting on blood pressure were also included. In adults a reduction in sodium intake significantly reduced resting systolic blood pressure by 3.39 mm Hg (95% confidence interval 2.46 to 4.31) and resting diastolic blood pressure by 1.54 mm Hg (0.98 to 2.11). When sodium intake was <2 g\/day versus \u2265 2 g\/day, systolic blood pressure was reduced by 3.47 mm Hg (0.76 to 6.18) and diastolic blood pressure by 1.81 mm Hg (0.54 to 3.08). Decreased sodium intake had no significant adverse effect on blood lipids, catecholamine levels, or renal function in adults (P>0.05). There were insufficient RCTs to assess the effects of reduced sodium intake on mortality and morbidity. The associations in cohort studies between sodium intake and all cause mortality, incident fatal and non-fatal cardiovascular disease, and coronary heart disease were non-significant (P>0.05). Increased sodium intake was associated with an increased risk of stroke (risk ratio 1.24, 95% confidence interval 1.08 to 1.43), stroke mortality (1.63, 1.27 to 2.10), and coronary heart disease mortality (1.32, 1.13 to 1.53). In children, a reduction in sodium intake significantly reduced systolic blood pressure by 0.84 mm Hg (0.25 to 1.43) and diastolic blood pressure by 0.87 mm Hg (0.14 to 1.60).\u00a0CONCLUSIONS<\/b>:\u00a0 High quality evidence in non-acutely ill adults shows that reduced sodium intake reduces blood pressure and has no adverse effect on blood lipids, catecholamine levels, or renal function, and moderate quality evidence in children shows that a reduction in sodium intake reduces blood pressure. Lower sodium intake is also associated with a reduced risk of stroke and fatal coronary heart disease in adults. The totality of evidence suggests that most people will likely benefit from reducing sodium intake.<\/p>\n

\"hole<\/a><\/p>\n

Dietary\u00a0fiber intake and risk of first stroke: a systematic\u00a0review\u00a0and meta-analysis<\/b>.\u00a0 Stroke<\/i>.\u00a02013 May;44(5):1360-8. By\u00a0 Threapleton DE,\u00a0Greenwood DC,\u00a0Evans CE,\u00a0et al. from School of Food Science &\u00a0Nutrition, University of Leeds, Leeds, UK. D.E.Threapleton@Leeds.ac.uk<\/a><\/p>\n

BACKGROUND<\/b>:\u00a0\u00a0 Fiber intake is associated with reduced stroke risk in prospective studies, but no meta-analysis has been published to date. \u00a0METHODS<\/b>: Multiple electronic databases were searched for healthy participant studies reporting fiber intake and incidence of first hemorrhagic or ischemic stroke, published between January 1990 and May 2012. \u00a0RESULTS<\/b>: Eight cohort studies from the United States, northern Europe, Australia, and Japan met inclusion criteria. Total\u00a0dietary\u00a0fiber intake was inversely associated with risk of hemorrhagic plus ischemic stroke, with some evidence of heterogeneity between studies (I(2); relative risk per 7 g\/day, 0.93; 95% confidence interval, 0.88-0.98; I(2)=59%). Soluble fiber intake, per 4 g\/day, was not associated with stroke risk reduction with evidence of low heterogeneity between studies, relative risk 0.94 (95% confidence interval, 0.88-1.01; I(2)=21%). There were few studies reporting stroke risk in relation to insoluble fiber or fiber from cereals, fruit, or vegetables. \u00a0CONCLUSIONS<\/b>:\u00a0 Greater\u00a0dietary\u00a0fiber intake is significantly associated with lower risk of first stroke. Overall, findings\u00a0support\u00a0dietary recommendations to increase intake of total\u00a0dietary\u00a0fiber. However, a paucity of data on fiber from different foods precludes conclusions regarding the association between fiber type and stroke. There is a need for future studies to focus on fiber type and to examine risk for ischemic and hemorrhagic strokes separately.<\/p>\n

http:\/\/stroke.ahajournals.org\/content\/44\/5\/1360.long<\/a><\/p>\n

\"shutterstock_1013247\"<\/a><\/p>\n

Nutritional support\u00a0and functional capacity in chronic obstructive pulmonary disease: a systematic\u00a0review\u00a0and meta-analysis<\/b>.\u00a0 Respirology<\/span><\/i>.\u00a02013 May;18(4):616-29. By Collins PF,\u00a0Elia M,\u00a0Stratton RJ. From\u00a0 Institute of Human\u00a0Nutrition, Southampton General Hospital, University of Southampton, Southampton, UK.<\/p>\n

Currently, there is confusion about the value of using\u00a0nutritional support\u00a0to treat malnutrition and improve functional outcomes in chronic obstructive pulmonary disease (COPD). This systematic\u00a0review\u00a0and meta-analysis of randomized, controlled trials (RCT) aimed to clarify the effectiveness of nutritional support\u00a0in improving functional outcomes in COPD. A systematic\u00a0review\u00a0identified 12 RCT (n\u2009=\u2009448) in stable COPD patients investigating the effects of\u00a0nutritional support\u00a0(dietary\u00a0advice (1 RCT), oral\u00a0nutritional\u00a0supplements (10 RCT), enteral tube feeding (1 RCT)) versus control on functional outcomes. Meta-analysis of the changes induced by intervention found that while respiratory function (forced expiratory volume in 1\u2009s, lung capacity, blood gases) was unresponsive to\u00a0nutritional support, both inspiratory and expiratory muscle strength (maximal inspiratory mouth pressure +3.86 standard error (SE) 1.89\u2009cm H2 O, P\u2009=\u20090.041; maximal expiratory mouth pressure +11.85 SE 5.54\u2009cm H2 O, P\u2009=\u20090.032) and handgrip strength (+1.35 SE 0.69\u2009kg, P\u2009=\u20090.05) were significantly improved and associated with weight gains of \u22652\u2009kg.\u00a0Nutritional support\u00a0produced significant improvements in quality of life in some trials, although meta-analysis was not possible. It also led to improved exercise performance and enhancement of exercise rehabilitation programmes. This systematic\u00a0review\u00a0and meta-analysis demonstrates that\u00a0nutritional support\u00a0in COPD results in significant improvements in a number of clinically relevant functional outcomes, complementing a previous\u00a0review\u00a0showing improvements innutritional\u00a0intake and weight.<\/p>\n

\"fire<\/a><\/p>\n

Systematic\u00a0review\u00a0and meta-analysis of different\u00a0dietary\u00a0approaches to the management of type 2 diabetes.<\/b>\u00a0 Am J Clin Nutr.<\/a>\u00a02013 Mar;97(3):505-16.\u00a0 By Ajala O,\u00a0English P,\u00a0Pinkney J. from Dept of Diabetes and Endocrinology, Peninsula College of Medicine and Dentistry, Plymouth, UK. olubukola.ajala@nhs.net<\/a><\/p>\n

BACKGROUND<\/b>: There is evidence that reducing blood glucose concentrations, inducing weight loss, and improving the lipid profile reduces cardiovascular risk in people with type 2 diabetes. OBJECTIVE<\/b>: We assessed the effect of various diets on glycemic control, lipids, and weight loss.\u00a0 DESIGN:<\/b> We conducted searches of PubMed, Embase, and Google Scholar to August 2011. We included randomized controlled trials (RCTs) with interventions that lasted \u22656 mo that compared low-carbohydrate, vegetarian, vegan, low-glycemic index (GI), high-fiber, Mediterranean, and high-protein diets with control diets including low-fat, high-GI, American Diabetes Association, European Association for the Study of Diabetes, and low-protein diets.\u00a0 RESULTS<\/b>:\u00a0 A total of 20 RCTs were included (n = 3073 included in final analyses across 3460 randomly assigned individuals). The low-carbohydrate, low-GI, Mediterranean, and high-protein diets all led to a greater improvement in glycemic control [glycated hemoglobin reductions of -0.12% (P = 0.04), -0.14% (P = 0.008), -0.47% (P < 0.00001), and -0.28% (P < 0.00001), respectively] compared with their respective control diets, with the largest effect size seen in the Mediterranean\u00a0diet. Low-carbohydrate and Mediterranean diets led to greater weight loss [-0.69 kg (P = 0.21) and -1.84 kg (P < 0.00001), respectively], with an increase in HDL seen in all diets except the high-protein\u00a0diet.\u00a0\u00a0 CONCLUSION<\/b>:\u00a0 Low-carbohydrate, low-GI, Mediterranean, and high-protein diets are effective in improving various markers of cardiovascular risk in people with diabetes and should be considered in the overall strategy of diabetes management.<\/p>\n

http:\/\/ajcn.nutrition.org\/content\/97\/3\/505.long<\/a><\/p>\n

 <\/p>\n

Fat\u00a0Intake\u00a0After Diagnosis and Risk of Lethal Prostate Cancer and All-Cause Mortality<\/b>.\u00a0 JAMA\u00a0Intern Med.<\/i>\u00a02013\u00a0Jun 10:1-8.\u00a0 By Richman EL,\u00a0Kenfield SA,\u00a0Chavarro JE,\u00a0et al.<\/p>\n

Nearly 2.5 million men currently live with prostate cancer in the United States, yet little is known about the association between diet after diagnosis and prostate cancer progression and overall mortality. \u00a0\u00a0OBJECTIVE<\/b> To examine postdiagnostic\u00a0fat\u00a0intake\u00a0in relation to lethal prostate cancer and all-cause mortality. \u00a0DESIGN AND PARTICIPANTS<\/b>: Prospective study of 4577 men with nonmetastatic prostate cancer in the Health Professionals Follow-up Study (1986-2010). \u00a0EXPOSURES<\/b>: Post-diagnostic\u00a0intake\u00a0of saturated, monounsaturated, polyunsaturated, trans, animal, and vegetable\u00a0fat. \u00a0MAIN OUTCOMES<\/b>:\u00a0 Lethal prostate cancer (distant metastases or prostate cancer-specific death) and all-cause mortality. \u00a0\u00a0RESULTS<\/b>: We observed 315 events of lethal prostate cancer and 1064 deaths (median follow-up,\u00a08.4 years). Crude rates per 1000 person-years for lethal prostate cancer were as follows (highest vs lowest quintile of\u00a0fat\u00a0intake): 7.6 vs 7.3 for saturated, 6.4 vs 7.2 for monounsaturated, 5.8 vs 8.2 for polyunsaturated, 8.7 vs 6.1 for trans, 8.3 vs 5.7 for animal, and 4.7 vs 8.7 for vegetable\u00a0fat. For all-cause mortality, the rates were 28.4 vs 21.4 for saturated, 20.0 vs 23.7 for monounsaturated, 17.1 vs 29.4 for polyunsaturated, 32.4 vs 17.1 for trans, 32.0 vs 17.2 for animal, and 15.4 vs 32.7 for vegetable\u00a0fat. Replacing 10% of energy\u00a0intake\u00a0from carbohydrate with vegetable\u00a0fat\u00a0was associated with a lower risk of lethal prostate cancer (hazard ratio [HR], 0.71; 95% CI, 0.51-0.98; P\u00a0=\u00a0.04) and all-cause mortality (HR, 0.74; 95% CI, 0.61-0.88; P\u00a0=\u00a0.001). No other fats were associated with lethal prostate cancer. Saturated and trans fats after diagnosis (replacing 5% and 1% of energy from carbohydrate, respectively) were associated with higher all-cause mortality (HR, 1.30 [95% CI, 1.05-1.60; P\u00a0=\u00a0.02] and 1.25 [95% CI, 1.05-1.49; P\u00a0=\u00a0.01], respectively). \u00a0CONCLUSIONS<\/b>:\u00a0 Among men with nonmetastatic prostate cancer, replacing carbohydrates and animal\u00a0fat\u00a0with vegetable\u00a0fat\u00a0may reduce the risk of all-cause mortality.<\/span> The potential benefit of vegetable\u00a0fat\u00a0for prostate cancer-specific outcomes merits further research.<\/p>\n

\"YANGSHENG_ginger_tea1\"<\/a><\/p>\n

Nutritional\u00a0interventions for reducing morbidity and mortality in people with HIV<\/b>.\u00a0 Cochrane Database Syst Rev.\u00a02013 Feb 28;2:CD004536. By Grobler L,\u00a0Siegfried N,\u00a0Visser ME,\u00a0et al. from Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa. liesl.nicol@gmail.com<\/a> .<\/p>\n

BACKGROUND:<\/b>\u00a0 Adequate\u00a0nutrition\u00a0is important for optimal immune and metabolic function. \u00a0Dietary\u00a0support\u00a0may, therefore, improve clinical outcomes in HIV-infected individuals by reducing the incidence of HIV-associated complications and attenuating progression of HIV disease, improving quality of life and ultimately reducing disease-related mortality. \u00a0OBJECTIVES:<\/b> To evaluate the effectiveness of various macronutrient interventions, given orally, in reducing morbidity and mortality in adults and children living with HIV infection. \u00a0METHODS:<\/b> We searched CENTRAL (up to August 2011), MEDLINE (1966 to August 2011), EMBASE (1988 to August 2011), LILACS (up to February 2012), and Gateway (March 2006-February 2010). We also scanned reference lists of articles and contacted authors of relevant studies and other researchers. \u00a0SELECTION CRITERIA<\/b>:\u00a0 Randomised controlled trials evaluating the effectiveness of macronutrient interventions compared with no\u00a0nutritionalsupplements or placebo in the management of adults and children infected with HIV.\u00a0DATA COLLECTION & ANALYSIS<\/b>: Three reviewers independently applied study selection criteria, assessed study quality, and extracted data. Effects were assessed using mean difference and 95% confidence intervals. Homogenous studies were combined wherever it was clinically meaningful to do so and a meta-analysis using the random effects model was conducted.\u00a0MAIN RESULTS:<\/b>\u00a0 Fourteen trials (including 1725 HIV positive adults and 271 HIV positive children), were included in this\u00a0review. Neither supplementary food nor daily supplement of Spirulina significantly altered the risk of death compared with no supplement or placebo in malnourished, ART naive adult participants in the two studies which reported on this outcome. A\u00a0nutritional\u00a0supplement enhanced with protein did not significantly alter the risk of death compared to standard\u00a0nutritional\u00a0care in children with prolonged diarrhoea. Supplementation with macronutrient formulas given to provide protein and\/or energy and fortified with micronutrients, in conjunction with\u00a0nutrition\u00a0counselling, significantly improved energy intake (3 trials; n=131; MD 393.57 kcal\/day; 95% CI: 224.66 to 562.47;p<0.00001) and protein intake (2 trials; n=81; MD 23.5 g\/day; 95% CI: 12.68, 34.01; p<0.00001) compared with no\u00a0nutritional\u00a0supplementation or\u00a0nutrition\u00a0counselling alone in adult participants with weight loss. In general supplementation with specific macronutrients such as amino acids, whey protein concentration or Spirulina did not significantly alter clinical, anthropometric or immunological outcomes compared with placebo in HIV-infected adults and children. \u00a0CONCLUSIONS<\/b>:\u00a0 Given the current evidence base, which is limited to fourteen relatively small trials all evaluating different macronutrient supplements in different populations at different stages of HIV infection and with varying treatment status, no firm conclusions can be drawn about the effects of macronutrient supplementation on morbidity and mortality in people living with HIV. It is, however, promising to see more studies being conducted in low-income countries, and particularly in children, where macronutrient supplementation both pre-antiretroviral treatment and in conjunction with antiretroviral treatment might prove to be beneficial.<\/p>\n

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Threshold\u00a0for\u00a0Improvement\u00a0in\u00a0Insulin Sensitivity\u00a0with\u00a0Adolescent\u00a0Weight Loss<\/b>.\u00a0 Journal\u00a0 Pediatr<\/i>. \u00a02013 May 22. pii: S0022-3476(13)00420-4. By Abrams P,\u00a0Levitt Katz LE,\u00a0Moore RH,\u00a0et al. from Division of Endocrinology and Diabetes, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA. Email: abramsp@email.chop.edu<\/a>.<\/p>\n

OBJECTIVES<\/b>:\u00a0 To assess the association of weight loss and\u00a0insulin sensitivity, glucose tolerance, and metabolic syndrome (MS) in obese adolescents following weight loss treatment, and to determine the\u00a0threshold\u00a0amount of weight loss required to observe improvements in these measures. \u00a0STUDY DESIGN<\/b>:\u00a0 A randomized, controlled behavioral weight loss trial was conducted with 113 obese adolescents. Changes in fasting\u00a0insulin, homeostasis model assessment of\u00a0insulin resistance, whole body\u00a0insulin sensitivity\u00a0index (WBISI), body mass index (BMI), and MS criteria were assessed at baseline and at month\u00a04.\u00a0 RESULTS: There was significant\u00a0improvement\u00a0in all measures of\u00a0insulin sensitivity\u00a0at month 4. Mean fasting\u00a0insulin\u00a0dropped from 22.3 to 16.6 \u03bcU\/mL (P\u00a0<\u00a0.0001). Homeostasis model assessment of\u00a0insulin resistance\u00a0decreased significantly from 4.9 to 3.7 (P\u00a0=\u00a0.001) and WBISI increased significantly from 2.87 to 3.98 (P\u00a0<\u00a0.0001). An 8% reduction in BMI led to a significant\u00a0improvement\u00a0in WBISI (P\u00a0=\u00a0.03) and was the optimal\u00a0threshold. Fewer individuals met criteria for MS after weight loss (P\u00a0=\u00a0.0038), although there were no significant changes in the individual features of the syndrome. \u00a0CONCLUSIONS<\/b>:\u00a0 In this trial, weight loss at month 4 was associated with improved\u00a0insulin sensitivity\u00a0in obese adolescents. An approximate decrease in BMI of 8% was the\u00a0threshold\u00a0level at which\u00a0insulin sensitivity\u00a0improved. As more weight loss programs are designed for obese adolescents, it will be important to have reasonable weight loss goals that will yield improvements in metabolic and cardiovascular disease risk factors.<\/p>\n

http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0022347613004204<\/a><\/p>\n

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Early parenteral\u00a0nutrition\u00a0and growth outcomes in preterm infants: a systematic\u00a0review\u00a0and meta-analysis<\/b>.\u00a0 Am J Clin Nutr.\u00a02013 Apr;97(4):816-26. By Moyses HE,\u00a0Johnson MJ,\u00a0Leaf AA,\u00a0Cornelius VR.\u00a0From National Institute for Health Research Foundation Trust, Southampton, UK. h.e.moyses@soton.ac.uk<\/a><\/p>\n

BACKGROUND<\/b>:\u00a0 The achievement of adequate\u00a0nutritional\u00a0intakes in preterm infants is challenging and may explain the poor growth often seen in this group. The use of early parenteral\u00a0nutrition\u00a0(PN) is one potential strategy to address this problem, although the benefits and harms are unknown. \u00a0OBJECTIVE<\/b>: We determined whether earlier administration of PN benefits growth outcomes in preterm infants. \u00a0DESIGN<\/b>:\u00a0 We conducted a systematic\u00a0review\u00a0of randomized controlled trials (RCTs) and observational studies.\u00a0RESULTS:<\/b>\u00a0 Eight RCTs and 13 observational studies met the inclusion criteria (n = 553 and 1796 infants). The meta-analysis was limited by disparate growth-outcome measures. An assessment of bias was difficult because of inadequate reporting. Results are given as mean differences (95% CIs). Early PN reduced the time to regain birth weight by 2.2 d (1.1, 3.2 d) for RCTs and 3.2 d (2.0, 4.4 d) in observational studies. The maximum percentage weight loss with early PN was lower by 3.1 percentage points (1.7, 4.5 percentage points) for RCTs and by 3.5 percentage points (2.6, 4.3 percentage points) for observational studies. Early PN improved weight at discharge or 36 wk postmenstrual age by 14.9 g (5.3, 24.5 g) (observational studies only), but no benefit was shown for length or head circumference. There was no evidence that early PN significantly affects risk of mortality, necrotizing enterocolitis, sepsis, chronic lung disease, intraventricular hemorrhage, or cholestasis. \u00a0CONCLUSIONS<\/b>:\u00a0 The results of this\u00a0review, although subject to some limitations, show that early PN provides a benefit for some short-term growth outcomes. No evidence that early PN increases morbidity or mortality was found. Neonatal research would benefit from the development of a set of core growth outcome measures.<\/p>\n

http:\/\/ajcn.nutrition.org\/content\/97\/4\/816.long<\/a><\/p>\n

 <\/p>\n

Nonpharmacological interventions for ADHD: systematic\u00a0review\u00a0and meta-analyses of randomized controlled trials of\u00a0dietary\u00a0and psychological treatments<\/b>.\u00a0 Am J Psychiatry<\/span><\/i>.\u00a02013 Mar 1;170(3):275-89. \u00a0By Sonuga-Barke EJ,\u00a0Brandeis D,\u00a0Cortese S,\u00a0et al and\u00a0European ADHD Guidelines Group. From Dept of Psychology, University of Southampton, UK. ejb3@soton.ac.uk<\/a><\/p>\n

OBJECTIVE:<\/b>\u00a0 Nonpharmacological treatments are available for attention deficit hyperactivity disorder (ADHD), although their efficacy remains uncertain. The authors undertook meta-analyses of the efficacy of\u00a0dietary\u00a0(restricted elimination diets, artificial food color exclusions, and free fatty acid supplementation) and psychological (cognitive training, neurofeedback, and behavioral interventions) ADHD treatments. \u00a0METHOD<\/b>: Using a common systematic search and a rigorous coding and data extraction strategy across domains, the authors searched electronic databases to identify published randomized controlled trials that involved individuals who were diagnosed with ADHD (or who met a validated cutoff on a recognized rating scale) and that included an ADHD outcome. \u00a0RESULTS:<\/b> Fifty-four of the 2,904 nonduplicate screened records were included in the analyses. Two different analyses were performed. When the outcome measure was based on ADHD assessments by raters closest to the therapeutic setting, all\u00a0dietary\u00a0(standardized mean differences=0.21-0.48) and psychological (standardized mean differences=0.40-0.64) treatments produced statistically significant effects. However, when the best probably blinded assessment was employed, effects remained significant for free fatty acid supplementation (standardized mean difference=0.16) and artificial food color exclusion (standardized mean difference=0.42) but were substantially attenuated to nonsignificant levels for other treatments. \u00a0CONCLUSIONS:<\/b>\u00a0 Free fatty acid supplementation produced small but significant reductions in ADHD symptoms even with probably blinded assessments, although the clinical significance of these effects remains to be determined. Artificial food color exclusion produced larger effects but often in individuals selected for food sensitivities. Better evidence for efficacy from blinded assessments is required for behavioral interventions, neurofeedback, cognitive training, and restricted elimination diets before they can be supported as treatments for core ADHD symptoms.<\/p>\n

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