脂肪酸、镁、锌、硒与注意缺陷多动障碍的相关研究
摘要
目的:通过本研究,了解我国注意缺陷多动障碍(ADHD)儿童体内脂肪酸、镁、锌、硒含量的变化情况。同时了解脂肪酸与镁、锌、硒、行为、智力间的相关性。
方法:对35例注意缺陷多动障碍(ADHD)儿童及25例正常儿童进行血浆脂肪酸,血清镁、锌、硒含量测定。选用Achenbach儿童行为量表(CBCL)及瑞文测验对两组儿童进行行为及智力评定。
结果:①两组在亚油酸(18:2)、DHA(22:6)两种脂肪酸含量上的差异均有统计学意义。亚油酸:ADHD组(31.35±3.43),对照组(29.31±3.31),P=0.025;DHA:ADHD组(3.06±0.97),对照组(3.75±1.30),P=0.022。在16:0、18:0、18:1、20:2、20:4五种脂肪酸含量上的差异均无统计学意义。②两组在镁、硒两种元素含量上的差异均有统计学意义。镁元素:ADHD组(0.84±0.05),对照组(0.87±0.06),P=0.013;硒元素:ADHD组(87.91±10.71),对照组(97.12±7.63),P=0.001。在锌元素含量上的差异无统计学意义。③两组在CBCL活动情况及躯体主诉两方面的差异均无统计学意义。其余各方面的差异均有统计学意义:社会能力部分,ADHD组得分均低于对照组;行为问题部分,ADHD组得分均高于对照组。④两组智力方面的差异有统计学意义:ADHD组智商(IQ)低于对照组。⑤16:0、20:4两种脂肪酸与镁、锌、硒、行为、智力间的相关性均无统计学意义。其余五种脂肪酸与这些内容的相关性均有统计学意义:18:0与躯体主诉呈负相关;18:1与退缩呈负相关;18:2与锌、硒元素、学校情况、社会能力总分呈负相关,与退缩、焦虑/抑郁、社交问题、注意问题、违纪行为、攻击性行为、内向性行为问题、外向性行为问题、行为问题总分呈正相关;20:2与硒元素呈正相关; 22:6与学校情况、智商(IQ)呈正相关,与社交问题、注意问题、攻击性行为、外向性行为问题、行为问题总分呈负相关。⑥将镁、锌、硒元素、脂肪酸16:0、18:0、18:1、18:2、20:2、20:4、22:6作为自变量,将组别(ADHD组、对照组)作为因变量引入Logistic回归模型,最后镁、硒、16:0、22:6进入方程。
结论:①ADHD组儿童较对照组儿童有明显高的血浆亚油酸(18:2,ω-6)水平及明显低的血浆DHA(22:6,ω-3)水平。②ADHD组儿童较对照组儿童有明显低的血清镁元素含量及血清硒元素含量。③在镁、锌、硒元素、脂肪酸16:0、18:0、18:1、18:2、20:2、20:4、22:6十种因素与儿童ADHD发生关系的研究中,镁、硒、16:0、22:6对ADHD发生的影响较大。镁、硒含量增加,患ADHD的可能性减少。当16:0与22:6在人体内满足一定比例时,它们含量增加,会减少患ADHD的可能性。④血浆脂肪酸尤其亚油酸(18:2,ω-6)、DHA(22:6,ω-3)与锌、硒、行为、智力间存在一定关联。
Objectives: To evaluate the status of fatty acids, magnesium, zinc and selenium in Chinese children with attention-deficit hyperactivity disorder (ADHD). To find out the correlations between magnesium, zinc, selenium, behavior, intelligence and fatty acids.
Methods: This study measured the content of plasma fatty acids and serum magnesium, zinc, selenium in 35 ADHD children and 25 control children. The two groups of children were assessed the condition of behavior and intelligence through Child Behavior Checklist (CBCL) and Combined Raven,s Test (CRT).
Results:①There were significant differences of the levels about linoleic acid (18:2) and DHA (22:6) in the two groups of children except the fatty acids about 16:0, 18:0, 18:1, 20:2 and 20:4. Linoleic acid: ADHD group (31.35±3.43), control group (29.31±3.31), P=0.025; DHA: ADHD group (3.06±0.97), control group (3.75±1.30), P=0.022.②There were significant differences of the concentrations about magnesium and selenium in the two groups of children except zinc. Magnesium: ADHD group (0.84±0.05), control group (0.87±0.06), P=0.013; selenium: ADHD group (87.91±10.71), control group (97.12±7.63), P=0.001.③There were significant differences about social competence and behavior problems of CBCL in the two groups of children except activity status and somatic complaint. ADHD children had lower social competence and more behavior problems than control children.④There was significant difference about intelligence in the two groups of children. ADHD children had lower intelligence than control children.⑤Significant correlations were observed between magnesium, selenium, zinc, behavior, intelligence and fatty acids except 16:0, 20:4. Inverse correlations: 18:0 and somatic complaint; 18:1 and withdrawal; 18:2 and zinc, selenium, school status, total social competence; 22:6 and social interaction, attention, aggression, extroversion, total behavior problem. Consistent correlation: 18:2 and withdrawal, anxiety/depression, social interaction, attention, delinquency, aggression, introversion, extroversion, total behavior problem; 20:2 and selenium; 22:6 and school status, intelligence quotient (IQ).⑥Logistic regression model was established by the dependent variable of group and the covariates variables of magnesium, zinc, selenium, 16:0, 18:0, 18:1, 18:2, 20:2, 20:4, 22:6. Finally variables in the equation were magnesium, selenium, 16:0 and 22:6.
Conclusions:①ADHD children had the significant higher lever of plasma linoleic acid (18:2,ω-6) and the significant lower lever of plasma DHA (22:6,ω-3) versus controls.②ADHD children had the significant lower concentrations of serum magnesium and selenium versus controls.③Magnesium, selenium, 16:0, 22:6 influenced ADHD greater than zinc, 18:0, 18:1, 18:2, 20:2, 20:4. The possibility of suffering from ADHD was decreased, when the content was increased about magnesium, selenium, as well as 16:0 and 22:6, which perhaps met a proper ratio in human body.④Plasma fatty acids had certain correlations with zinc, selenium, behavior and intelligence, especially linoleic acid (18:2,ω-6) and DHA (22:6,ω-3).
方法:对35例注意缺陷多动障碍(ADHD)儿童及25例正常儿童进行血浆脂肪酸,血清镁、锌、硒含量测定。选用Achenbach儿童行为量表(CBCL)及瑞文测验对两组儿童进行行为及智力评定。
结果:①两组在亚油酸(18:2)、DHA(22:6)两种脂肪酸含量上的差异均有统计学意义。亚油酸:ADHD组(31.35±3.43),对照组(29.31±3.31),P=0.025;DHA:ADHD组(3.06±0.97),对照组(3.75±1.30),P=0.022。在16:0、18:0、18:1、20:2、20:4五种脂肪酸含量上的差异均无统计学意义。②两组在镁、硒两种元素含量上的差异均有统计学意义。镁元素:ADHD组(0.84±0.05),对照组(0.87±0.06),P=0.013;硒元素:ADHD组(87.91±10.71),对照组(97.12±7.63),P=0.001。在锌元素含量上的差异无统计学意义。③两组在CBCL活动情况及躯体主诉两方面的差异均无统计学意义。其余各方面的差异均有统计学意义:社会能力部分,ADHD组得分均低于对照组;行为问题部分,ADHD组得分均高于对照组。④两组智力方面的差异有统计学意义:ADHD组智商(IQ)低于对照组。⑤16:0、20:4两种脂肪酸与镁、锌、硒、行为、智力间的相关性均无统计学意义。其余五种脂肪酸与这些内容的相关性均有统计学意义:18:0与躯体主诉呈负相关;18:1与退缩呈负相关;18:2与锌、硒元素、学校情况、社会能力总分呈负相关,与退缩、焦虑/抑郁、社交问题、注意问题、违纪行为、攻击性行为、内向性行为问题、外向性行为问题、行为问题总分呈正相关;20:2与硒元素呈正相关; 22:6与学校情况、智商(IQ)呈正相关,与社交问题、注意问题、攻击性行为、外向性行为问题、行为问题总分呈负相关。⑥将镁、锌、硒元素、脂肪酸16:0、18:0、18:1、18:2、20:2、20:4、22:6作为自变量,将组别(ADHD组、对照组)作为因变量引入Logistic回归模型,最后镁、硒、16:0、22:6进入方程。
结论:①ADHD组儿童较对照组儿童有明显高的血浆亚油酸(18:2,ω-6)水平及明显低的血浆DHA(22:6,ω-3)水平。②ADHD组儿童较对照组儿童有明显低的血清镁元素含量及血清硒元素含量。③在镁、锌、硒元素、脂肪酸16:0、18:0、18:1、18:2、20:2、20:4、22:6十种因素与儿童ADHD发生关系的研究中,镁、硒、16:0、22:6对ADHD发生的影响较大。镁、硒含量增加,患ADHD的可能性减少。当16:0与22:6在人体内满足一定比例时,它们含量增加,会减少患ADHD的可能性。④血浆脂肪酸尤其亚油酸(18:2,ω-6)、DHA(22:6,ω-3)与锌、硒、行为、智力间存在一定关联。
Objectives: To evaluate the status of fatty acids, magnesium, zinc and selenium in Chinese children with attention-deficit hyperactivity disorder (ADHD). To find out the correlations between magnesium, zinc, selenium, behavior, intelligence and fatty acids.
Methods: This study measured the content of plasma fatty acids and serum magnesium, zinc, selenium in 35 ADHD children and 25 control children. The two groups of children were assessed the condition of behavior and intelligence through Child Behavior Checklist (CBCL) and Combined Raven,s Test (CRT).
Results:①There were significant differences of the levels about linoleic acid (18:2) and DHA (22:6) in the two groups of children except the fatty acids about 16:0, 18:0, 18:1, 20:2 and 20:4. Linoleic acid: ADHD group (31.35±3.43), control group (29.31±3.31), P=0.025; DHA: ADHD group (3.06±0.97), control group (3.75±1.30), P=0.022.②There were significant differences of the concentrations about magnesium and selenium in the two groups of children except zinc. Magnesium: ADHD group (0.84±0.05), control group (0.87±0.06), P=0.013; selenium: ADHD group (87.91±10.71), control group (97.12±7.63), P=0.001.③There were significant differences about social competence and behavior problems of CBCL in the two groups of children except activity status and somatic complaint. ADHD children had lower social competence and more behavior problems than control children.④There was significant difference about intelligence in the two groups of children. ADHD children had lower intelligence than control children.⑤Significant correlations were observed between magnesium, selenium, zinc, behavior, intelligence and fatty acids except 16:0, 20:4. Inverse correlations: 18:0 and somatic complaint; 18:1 and withdrawal; 18:2 and zinc, selenium, school status, total social competence; 22:6 and social interaction, attention, aggression, extroversion, total behavior problem. Consistent correlation: 18:2 and withdrawal, anxiety/depression, social interaction, attention, delinquency, aggression, introversion, extroversion, total behavior problem; 20:2 and selenium; 22:6 and school status, intelligence quotient (IQ).⑥Logistic regression model was established by the dependent variable of group and the covariates variables of magnesium, zinc, selenium, 16:0, 18:0, 18:1, 18:2, 20:2, 20:4, 22:6. Finally variables in the equation were magnesium, selenium, 16:0 and 22:6.
Conclusions:①ADHD children had the significant higher lever of plasma linoleic acid (18:2,ω-6) and the significant lower lever of plasma DHA (22:6,ω-3) versus controls.②ADHD children had the significant lower concentrations of serum magnesium and selenium versus controls.③Magnesium, selenium, 16:0, 22:6 influenced ADHD greater than zinc, 18:0, 18:1, 18:2, 20:2, 20:4. The possibility of suffering from ADHD was decreased, when the content was increased about magnesium, selenium, as well as 16:0 and 22:6, which perhaps met a proper ratio in human body.④Plasma fatty acids had certain correlations with zinc, selenium, behavior and intelligence, especially linoleic acid (18:2,ω-6) and DHA (22:6,ω-3).
引文
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28. G Burr, M Burr. On the nature and role of the fatty acids essential in nutrition. J Biol Chem 1930; 86: 587-621.
29. A Hansen, M Haggard, A Boelsche, D Adam, H Wiese. Essential fatty acids in infant nutrition.Ⅲ. Clinical manifestations of linoleic acid deficiency. J Nutr 1958; 66: 565-576.
30. Stevens LJ, Zentall SS, Deck JL, Abate ML, Watkins BA, Lipp SR, Burgess JR.Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr 1995; 62(4) 761-768.
31. John R Burgess, Laura Stevens, Wen Zhang, and Louise Peck. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Am J Clin Nutr 2000; 71(suppl): 327S-330S.
32. Marianne Haag, MSc, DSc. Essential Fatty Acids and the Brain. Can J Psychiatry 2003; 48(3): 195-203.
33. Karen L Harding, Richard D Judah, Charles E Gant. Outcome-Based Comparison of Ritalin versus Food-Supplement Treated Children with AD/HD. Alternative Medicine Review 2003; 8(3): 319-330.
34. Jiun-Rong Chen, Shiou-Fung Hsu, Cheng-Dien Hsu, Lih-Hsueh Hwang, Suh-Ching Yang. Dietary patterns and blood fatty acid composition in children with attention-deficit hyperactivity disorder in Taiwan. Journal of Nutritional Biochemistry 2004; 15: 467-472.
35. Singh M. Essential fatty acids, DHA and Human brain. Indian J Pediatr 2005; 72: 239-242.
36. Kalpana Joshi, Sagar Lad, Mrudula Kale, Bhushan Patwardhan, Sahebrao P.Mahadik, Bindu Patni, Arti Chaudhary, Sheila Bhave, Anand Pandit. Supplementation with flax oil and vitamin C improves the outcome of Attention Deficit Hyperactivity Disorder (ADHD). Prostaglandins, Leukotrienes and Essential Fatty Acids 2006; 74: 17-21.
37. Cary J Antalis, Laura J Stevens, Mary Campbell, Robert Pazdro, Karen Ericson, John R Burgess. Omega-3 fatty acid status in attention-deficit/hyperactivity disorder. Prostaglandins, Leukotrienes and Essential Fatty Acids 2006; 75: 299-308.
38. Voigt RG, Llorente AM, Jensen CL, Fraley JK, Berretta MC, Heird W. A randomized, double-blind, placebo-controlled trial of docosahexanoic acid supplementation in children with attention deficit/hyperactivity disorder. J Pediatr 2001; 139: 173-174.
39. Neal L.Rojas, Eugenia Chan. Old and New Controversies in the Alternative Treatment of Attention-Deficit Hyperactivity Disorder. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11: 116-130.
40. Sinn N, Bryan J. Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. JDev Behav Pediatr 2007 Apr; 28(2): 82-91.
41.苏宜香主编.小儿营养与营养性疾病.广州:广东科技出版社, 2005.
42.张勤,王欣欣,朱海峤.儿童注意缺陷/多动障碍与血铅、微量元素水平关系的探讨.浙江医学2002; 24(9): 517-519.
43. Arnold LE, Bozzolo H, Hollway J, Cook A, DiSilvestro RA, Bozzolo DR, Crowl L, Ramadan Y, Williams C. Serum zinc correlates with parent- and teacher- rated inattention in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2005 Aug; 15(4): 628-636.
44. Liu J, Raine A. The effect of childhood malnutrition on externalizing behavior. Curr Opin Pediatr 2006 Oct; 18(5): 565-570.
45. B Starobrat-Hermelin, T Kozielec. The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test. Magnes Res 1997; 10: 149-156.
46. M Mousain-Bosc, M Roche, J Rapin, J P Bali. Magnesium VitB6 intake reduces central nervous system hyperexcitability in children. J Am Coll Nutr 2004; 23: 545S-548S.
47.郭玉章,周延安,付清流,陈青. 103例智力低下患儿血清锌、铜、硒含量测定及其临床意义.实用儿科杂志1992; 7(6): 326-327.
48.布淑琴,邓焕霞,李宝萍.精神发育迟滞儿童血锌硒铅含量测量分析. Chin J Child Health Care 1999; 7(2): 126.
49. Fanjiang G, Kleinman RE. Nutrition and performance in children. Curr Opin Clin Nutr Metab Care 2007 May; 10(3): 342-347.
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14. Jiun-Rong Chen, Shiou-Fung Hsu, Cheng-Dien Hsu, Lih-Hsueh Hwang, Suh-Ching Yang. Dietary patterns and blood fatty acid composition in children with attention-deficit hyperactivity disorder in Taiwan. Journal of Nutritional Biochemistry 2004; 15: 467-472.
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30. B Starobrat-Hermelin, T Kozielec. The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test. Magnes Res 1997; 10: 149-156.
31. M Mousain-Bosc, M Roche, J Rapin, J P Bali. Magnesium VitB6 intake reduces central nervous system hyperexcitability in children. J Am Coll Nutr 2004; 23: 545S-548S.
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34.布淑琴,邓焕霞,李宝萍.精神发育迟滞儿童血锌硒铅含量测量分析. Chin J Child Health Care 1999; 7(2): 126.
35. L E Arnold, H Bozzolo, J Hollway, A Cook, R A DiSilvestro, D R Bozzolo, L Crowl, Y Ramadan, C Williams. Serum zinc correlates with parent-and teacher-rated inattention in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2005; 15: 628-636.
36. Brian Hallahan, Malcolm R Garland. Essential fatty acids and their role in the treatment of impulsivity disorders. Prostaglandins, Leukotrienes and Essential Fatty Acids 2004; 71: 211-216.
1.黄绍良,陈述枚,何政贤主编.小儿内科学.北京:人民卫生出版社, 2004.
2.苏林雁主编.儿童多动症.北京:人民军医出版社, 2004.
3.吴希如,林庆主编.小儿神经系统疾病基础与临床.北京:人民卫生出版社, 1999.
4.熊忠贵,石淑华,徐海青.儿童注意缺陷多动障碍病因及影响因素研究.国外医学社会学分册2004; 21(3): 116-119.
5.王镜岩,朱圣庚,徐长法主编.生物化学上册3版.北京:高等教育出版社, 2002.
6.庞伟编译.长链多不饱和脂肪酸与大脑生长发育和学习记忆的关系.国外医学卫生学分册2005; 32(2): 125-126.
7.顾景范,杜寿玢,查良锭,关桂梧主编.现代临床营养学.北京:科学出版社, 2003.
8.杭晓敏,唐涌濂,柳向龙.多不饱和脂肪酸的研究进展.生物工程进展2001; 21(4): 18-21.
9. Schachter HM, Kourad K, Merali Z, Lumb A, Tran K, Miguelez M. Effects of omega-3 fatty acids on mental health. Evid Rep Technol Assess (Summ) 2005 Jul; (116): 1-11.
10.魏宏伟.注意缺陷多动障碍与多不饱和脂肪酸关联性研究进展.中国儿童保健杂志2004; 12(3): 244-246.
11.刘长征,田安思,陈陵.不饱和脂肪酸与脑功能关系的研究进展.医学综述2003; 9(7): 401-403.
12.杨慧明.多不饱和脂肪酸与婴幼儿的健康和疾病.国外医学儿科学分册2002; 29(3): 153-155.
13. Marszalek JR, Lodish HF. Docosahexaenoic acid, fatty acid-interacting proteins, and neuronal function: breastmilk and fish are good for you. Annu Rev Cell Dev Biol 2005; 21: 633-657.
14. Chalon S, Vancassel S, Zimmer L, et al. Polyunsaturated fatty acids and cerebral function: focus on monoaminergic neurotransmission. Lipids 2001; 36: 937-944.
15. Chen C, Bazan NG. Lipid signaling: sleep, synaptic plasticity and neuroprotection. Prostaglandins Other Lipid Mediat 2005; 77: 65-76.
16. Busch B. Polyunsaturated fatty acid supplementation for ADHD? Fishy, fascinating, and far from clear. J Dev Behav Pediatr 2007 Apr: 28(2): 139-144.
17. Cannune S. Modelling human infant requirements for long-chain polyunsaturated fatty acids. Brit J Nutr 1999; 82(1): 163-164.
18.陈文雄,陈达光,程贤芬,张镜源.ω-3多不饱和脂肪酸和牛磺酸对大鼠脑神经发育的影响.营养学报1998; 20(4): 407-412.
19. N Salem Jr, B Litman, H Y Kim, K Gawrisch. Mechanisms of action of docosahexaenoic acid in the nervous system. Lipids 2001; 36: 945-959.
20. Youdim KA, Martin A, Joseph JA. Essential fatty acids and the brain: possible health implications. Int J Develop Neurosci 2000; 18(2): 383-399.
21. Connor DL, Connor WE, Hall R, et al. Growth and development in preterm infants fed long-chain polyunsaturated fatty acids: a prospective, randomized controlled trial. Pediatrics 2001; 108(2): 359-371.
22. Neuringer M. Cerebral cortex docosahexanoic acid is lower in formula-fed than in breast-fed infants. Nutr Rev 1993; 51: 238-241.
23. Birch EE, Garfield S, Hoffmann DR, Uatry R, Birch DG. A randomized controlled trial of early dietary supply of long-chain poly-unsaturated fatty acids and mental development in term infants. Dev Med Child Neurol 2000; 42:174-181.
24. Jamieson EC, Farquarson J, Logan RW, Howatson AG, Patrick WJ, Weaver LT, and others. Infant cerebellar grey and white matter fatty acids in relation to age and diet. Lipids 1999; 34: 1065-1071.
25. Salem N, Ward GR. Are omega-3 fatty acids essential nutrients for animals? World Rev Nutr Diet 1993; 72: 128-147.
26. Brian Hallahan, Malcolm RGarland. Essential fatty acids and their role in the treatment of impulsivity disorders. Prostaglandins, Leukotrienes and Essential Fatty Acids 2004; 71: 211-216.
27. Mitchell EA, Aman MG, Turbott SH, Manku M. Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr (Phila) 1987; 26(8): 406-411.
28. G Burr, M Burr. On the nature and role of the fatty acids essential in nutrition. J Biol Chem 1930; 86: 587-621.
29. A Hansen, M Haggard, A Boelsche, D Adam, H Wiese. Essential fatty acids in infant nutrition.Ⅲ. Clinical manifestations of linoleic acid deficiency. J Nutr 1958; 66: 565-576.
30. Stevens LJ, Zentall SS, Deck JL, Abate ML, Watkins BA, Lipp SR, Burgess JR.Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr 1995; 62(4) 761-768.
31. John R Burgess, Laura Stevens, Wen Zhang, and Louise Peck. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Am J Clin Nutr 2000; 71(suppl): 327S-330S.
32. Marianne Haag, MSc, DSc. Essential Fatty Acids and the Brain. Can J Psychiatry 2003; 48(3): 195-203.
33. Karen L Harding, Richard D Judah, Charles E Gant. Outcome-Based Comparison of Ritalin versus Food-Supplement Treated Children with AD/HD. Alternative Medicine Review 2003; 8(3): 319-330.
34. Jiun-Rong Chen, Shiou-Fung Hsu, Cheng-Dien Hsu, Lih-Hsueh Hwang, Suh-Ching Yang. Dietary patterns and blood fatty acid composition in children with attention-deficit hyperactivity disorder in Taiwan. Journal of Nutritional Biochemistry 2004; 15: 467-472.
35. Singh M. Essential fatty acids, DHA and Human brain. Indian J Pediatr 2005; 72: 239-242.
36. Kalpana Joshi, Sagar Lad, Mrudula Kale, Bhushan Patwardhan, Sahebrao P.Mahadik, Bindu Patni, Arti Chaudhary, Sheila Bhave, Anand Pandit. Supplementation with flax oil and vitamin C improves the outcome of Attention Deficit Hyperactivity Disorder (ADHD). Prostaglandins, Leukotrienes and Essential Fatty Acids 2006; 74: 17-21.
37. Cary J Antalis, Laura J Stevens, Mary Campbell, Robert Pazdro, Karen Ericson, John R Burgess. Omega-3 fatty acid status in attention-deficit/hyperactivity disorder. Prostaglandins, Leukotrienes and Essential Fatty Acids 2006; 75: 299-308.
38. Voigt RG, Llorente AM, Jensen CL, Fraley JK, Berretta MC, Heird W. A randomized, double-blind, placebo-controlled trial of docosahexanoic acid supplementation in children with attention deficit/hyperactivity disorder. J Pediatr 2001; 139: 173-174.
39. Neal L.Rojas, Eugenia Chan. Old and New Controversies in the Alternative Treatment of Attention-Deficit Hyperactivity Disorder. Mental Retardation and Developmental Disabilities Research Reviews 2005; 11: 116-130.
40. Sinn N, Bryan J. Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. JDev Behav Pediatr 2007 Apr; 28(2): 82-91.
41.苏宜香主编.小儿营养与营养性疾病.广州:广东科技出版社, 2005.
42.张勤,王欣欣,朱海峤.儿童注意缺陷/多动障碍与血铅、微量元素水平关系的探讨.浙江医学2002; 24(9): 517-519.
43. Arnold LE, Bozzolo H, Hollway J, Cook A, DiSilvestro RA, Bozzolo DR, Crowl L, Ramadan Y, Williams C. Serum zinc correlates with parent- and teacher- rated inattention in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2005 Aug; 15(4): 628-636.
44. Liu J, Raine A. The effect of childhood malnutrition on externalizing behavior. Curr Opin Pediatr 2006 Oct; 18(5): 565-570.
45. B Starobrat-Hermelin, T Kozielec. The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test. Magnes Res 1997; 10: 149-156.
46. M Mousain-Bosc, M Roche, J Rapin, J P Bali. Magnesium VitB6 intake reduces central nervous system hyperexcitability in children. J Am Coll Nutr 2004; 23: 545S-548S.
47.郭玉章,周延安,付清流,陈青. 103例智力低下患儿血清锌、铜、硒含量测定及其临床意义.实用儿科杂志1992; 7(6): 326-327.
48.布淑琴,邓焕霞,李宝萍.精神发育迟滞儿童血锌硒铅含量测量分析. Chin J Child Health Care 1999; 7(2): 126.
49. Fanjiang G, Kleinman RE. Nutrition and performance in children. Curr Opin Clin Nutr Metab Care 2007 May; 10(3): 342-347.