Abstract
Studies suggest that the bidirectional relationship existent between the gut microbiome (GM) and the central nervous system (CNS), or so-called the microbiome–gut–brain axis (MGBA), is involved in diverse neuropsychiatric diseases in children and adults. In pediatric age, most studies have focused on patients with autism. However, evidence of the role played by the MGBA in attention deficit/hyperactivity disorder (ADHD), the most common neurodevelopmental disorder in childhood, is still scanty and heterogeneous. This review aims to provide the current evidence on the functioning of the MGBA in pediatric patients with ADHD and the specific role of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) in this interaction, as well as the potential of the GM as a therapeutic target for ADHD. We will explore: (1) the diverse communication pathways between the GM and the CNS; (2) changes in the GM composition in children and adolescents with ADHD and association with ADHD pathophysiology; (3) influence of the GM on the ω-3 PUFA imbalance characteristically found in ADHD; (4) interaction between the GM and circadian rhythm regulation, as sleep disorders are frequently comorbid with ADHD; (5) finally, we will evaluate the most recent studies on the use of probiotics in pediatric patients with ADHD.
Highlights
Billions of microorganisms inhabit the human body (“microbiota”), including bacteria, archaea, fungi, viruses and protozoa
Several limitations are highlighted for this study: first, a food frequency questionnaire was completed by participants only at baseline, it was unlikely to have included possible dynamic changes in dietary patterns over the 9-week intervention period; second, after stratifying for vascular cell adhesion molecule-1 (VCAM-1) levels and medication, the sample sizes were substantially diminished; third, C-reactive protein (CRP) and VCAM-1 levels were only measured at baseline, so it was not possible to observe effects of the synbiotic on proinflammatory markers; fourth, patients were taking melatonin, omega-3 polyunsaturated fatty acids (PUFAs) and other types of probiotics at baseline, which were not considered as confounding factors for the statistical analysis; fifth, no information on the intake of attention deficit/hyperactivity disorder (ADHD) medication was reported
We have aimed to provide the current evidence on: the role of the gut microbiome in ADHD pathophysiology and possible association with symptoms; implication of the gut microbiome in the omega-3/omega-6 PUFA imbalance found in patients with ADHD; interaction between the gut microbiome and circadian rhythms; and the therapeutic role of probiotics in pediatric patients with ADHD
Summary
Billions of microorganisms inhabit the human body (“microbiota”), including bacteria, archaea, fungi, viruses and protozoa. Modern life and the consequent impact on the gut microbiome have made fundamental changes in the pattern of human illnesses, which has shifted from traditional infectious diseases towards increasingly frequent autoimmune diseases, such as asthma and allergies; cardiovascular diseases, such as hypertension; metabolic diseases, like diabetes; mental diseases, such as depression and anxiety; and a variety of neurological and neurodevelopmental disorders, such as multiple sclerosis, Alzheimer’s, Parkinson, autism spectrum disorders (ASD) and attention-deficit and/or hyperactivity disorder (ADHD) All of these conditions have been associated with an imbalance in the gut microbiome composition [23,24]. We will focus on the participation of the gut microbiome into the pathophysiological mechanisms of ADHD and the therapeutic potential of these microorganisms in pediatric patients with this disorder
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