Relationship Between ADHD Symptoms and Multidimensional Obesity Phenotypes in School-Aged Children： The Potential Mediating Role of Unhealthy Eating Behaviors

doi:10.3870/j.issn.1672-0741.26.02.013

Abstract

Abstract: Objective To explore the association between attention-deficit/hyperactivity disorder （ADHD） symptoms and multidimensional obesity phenotypes defined by BMI and body composition indicators in school-aged children, and further analyze the potential mediating role of unhealthy eating behaviors. Methods A cross-sectional study was conducted among 6624 children aged 6–18 years from Zhuhai, China, recruited via stratified cluster sampling in 2023. Height and weight were measured to calculate BMI, and body composition indicators, including body fat percentage and waist-to-hip ratio, were assessed by bioelectrical impedance analysis. ADHD symptoms were evaluated with the parent-rated Swanson Nolan and Pelham-Ⅳ （SNAP-Ⅳ）, while eating behaviors were assessed with the children's self-reported Dutch Eating Behavior Questionnaire. Four obesity phenotypes were defined：obesity by BMI;obesity with a high waist-to-hip ratio;obesity with high body fat percentage; and obesity with high trunk fat percentage. Multilevel logistic regression was performed for association analysis, and mediation effects were tested using the bootstrap method. Results The positive screening rate for ADHD symptoms was 6.9%, and the detection rate of obesity was 10.3%. Among all participants,hyperactive-impulsive symptom scores were positively associated with obesity （OR=1.31） and obesity with a high waist-to-hip ratio （OR=1.31）. Among girls, these scores were also significantly positively associated with obesity with high body fat percentage （OR=1.40） and obesity with high trunk fat percentage （OR=1.38）,whereas no significant associations of these indicators were found in boys. Restrained eating scores showed a potential mediating effect in these associations, explaining 61.0%-72.2% of the total effect in the overall sample and 35.9%-39.1% in girls. Conclusion ADHD symptoms in school-aged children are associated not only with the risk of obesity but also with multidimensional obesity phenotypes characterized by central fat accumulation. Restrained eating may be an important potential mediator in this association. For obesity prevention and control, attention should be paid to children with hyperactive-impulsive symptoms and their eating behaviors. Body composition indicators may facilitate refined phenotyping, yet their value in routine monitoring requires validation in prospective studies.

Key words: attention-deficit/hyperactivity disorder, school-aged children, obesity, body fat percentage, unhealthy eating behaviors

CLC Number:

R749.94

Zhang Zengzhen, Ning Ting, Deng Weixi et al. Relationship Between ADHD Symptoms and Multidimensional Obesity Phenotypes in School-Aged Children： The Potential Mediating Role of Unhealthy Eating Behaviors[J]. Acta Medicinae Universitatis Scientiae et Technologiae Huazhong, 2026, 55(5): 659-665.

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