JMIR Publications

ABSTRACT

Background:

Attention-deficit/hyperactivity disorder (ADHD), a neurodevelopmental condition affecting around 2.5%-3% of adults, is characterized by impairing symptoms of hyperactivity, inattention, and impulsivity. Due to side effects and low adherence to pharmacotherapy, increasing attention is being paid to lifestyle factors, such as nutrition and physical activity (PA), as potential complementary treatment options. Previous research indicates that sugar and saturated fat intake may be linked to increased impulsivity, while protein intake and PA may be related to reduced impulsivity. However, most studies rely on cross-sectional data which lack microtemporal resolution and ecological validity, wherefore questions of microtemporal dynamics (eg, Is the consumption of foods high in sugar associated with increased impulsivity within minutes or hours?) remain largely unanswered. Mobile approaches, such as Ecological Momentary Assessment (EMA), have the potential to bridge this gap.

Objective:

This study is the first to apply EMA to assess microtemporal associations between macronutrient intake, PA, and state impulsivity in daily life of adults with and without ADHD.

Methods:

Over a 3-day-period, participants reported state-impulsivity 8 times per day (signal-contingent), recorded food and drink intake (event-contingent), and wore an accelerometer. Multilevel two-part models were used to study the association between macronutrient intake, PA, and the probability to be impulsive as well as the intensity of impulsivity (NADHD=36, Ncontrol=137).

Results:

No association between macronutrient intake and state-impulsivity was found. PA was not related to the intensity of impulsivity, but to the probability to be impulsive (ADHD: ß=-0.09, 95% CI −0.14 to −0.04; Control: ß=−0.03, 95% CI −0.05 to −0.01). No evidence was found that the combined intake of saturated fat and sugar amplified the increase in state-impulsivity and that PA alleviated the positive association between sugar or fat intake (or both) and state-impulsivity.

Conclusions:

Important methodological considerations are discussed which can contribute to the optimization of future EMA protocols. EMA research in the emerging field of Nutritional Psychiatry is still in its infancy, yet, EMA is a highly promising and innovative approach as it offers insights into microtemporal dynamics of psychiatric symptomology, dietary intake, and PA in daily life.