Food additives and behaviour in children.

Jim Stevenson20 May 2008

Presentation to the

Associate Parliamentary Food and Health Forum

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Hyperactivity

A pattern of behaviour showing marked individual differences in the general population and comprises overactive, impulsive and inattentive behaviour.

Children with an extreme degree of hyperactivity may be diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD).

Increased hyperactivity is associated with later educational difficulties and antisocial behaviour.

A wide range of contributing factors act in concert to increase the degree of hyperactivity shown by a child.

Pharmacological effect of artificial food colours, flavours and natural salicylates.

“No consistent evidence of effect”NIH (1983)

Feingold hypothesis

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-1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0 2.5 3.0

Row e & Row e 1994Spring et a 1981

Adams 1981Connors 1980

Harley et al 1978Levy et al 1978

Goyette et al 1978bRose 1977

Williams et al 1978Rapp 1978

Sw anson & Kinsbourne 1980Levy & Hobbs 1978Goyette et al 1978aSaratinos et al 1990

Mattes & Gittleman-Klein 1978

Summary

Efect size + 95% CI

Sig. effect of additives

Schab, D.W. & Trinh, N-A. (2004). Journal of Developmental

and Behavioral Pediatrics, 25, 423-434.

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Southampton Study

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Design of Southampton StudyRandomised, double-blind, placebo controlled, crossover trial.

3-year-olds (N= 153) and 8/9-year-olds (N = 144) from the general population.

Baseline week on usual diet, then additives withdrawn.

Over subsequent 6 weeks series of placebo or additive mix drinks given daily in a randomised sequence.

Hyperactivity measured using parent and teacher ratings, observations of child in preschool setting or classroom and a computerised test of attention for 8/9-year-olds

Combined to form Global Hyperactivity Aggregate (GHA)

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Mix contents

E Number Name of Additive Mix A Mix B

E102 Colour Tartrazine

E104 Colour Quinoline yellow

E110 Colour Sunset Yellow

E122 Colour Carmoisine

E124 Colour Ponceau 4R

E129 Colour Allura Red AC

E211 Preservative Sodium benzoate

Mix A was the same as the active challenge employed in the Isle of Wight study published in 2004.

Mix B reflected the average daily consumption of the additives by 3 and 8/9 year old UK children at the time the study was commissioned (2004).

McCann et al. (2007) Lancet, 370, 1560-7.

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A vs.

P

B vs.

P

-0.4-0.3-0.2-0.1-0.00.10.20.30.40.5

whole sample

A vs.

P

B vs.

P

p<.05 ns ns p<.05

3 year olds 8 year olds

EF

FE

CT

SIZ

ED

iffe

ren

ce

in

es

tim

ate

dm

ea

ns

+C

I .95

McCann et al. (2007) Lancet, 370, 1560-7.

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ConclusionsMixtures of certain artificial colours together with a

sodium benzoate preservative in the diet increased hyperactivity in 3 and 8/9 year old children in the general population.

The average effect in these general population samples (0.18) is similar to that found by Schab and Trinh in well designed studies of clinic samples (0.21).

Although the results of the study suggest that some mixtures of certain artificial food colours and benzoate preservative may affect the level of hyperactive behaviour in children, removal of these additives from the diet would not be a panacea for ADHD.

McCann et al. (2007) Lancet, 370, 1560-7.

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Informing policy

Hazard – effect size 0.18

Exposure – high

Risk – “There were strong linear relationships between early hyperactivity and later adverse outcomes. Adjustment for other childhood variables suggested that early hyperactivity was associated with continuing school difficulties, problems with attention and poor reading in adolescence.” (McGee et al. 2002)

and for colours there is no technological role or benefit

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Precautionary principle

the absence of full scientific certainty should not be used as a reason to delay measures where there is a risk of serious or irreversible harm to public health or to the environment.

from:

United Kingdom Interdepartmental Liaison Group on Risk Assessment (UK-ILGRA)

http://www.hse.gov.uk/aboutus/meetings/ilgra/pppa.htm#1

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Action recommended by the FSA Council 10 April 2008

Option 5 – Phasing out the use of colours in food and drink in the EU over a specific period. Voluntary action by 2009 in the UK

Prof. Jim Stevenson Psychologist

Prof. John Warner Paediatrician

Prof. Edmund Sonuga-Barke Psychologist

Dr. Donna McCann Psychologist

Kate Grimshaw Dietitian

Yuet-Wan Lok Dietitian

Debbie Crumpler Secretary

Research assistant psychologists:

Angelina Barrett Alison Cooper Lyndy Dalen

Elizabeth Kitchin Lucy Porteous Emily Prince

Catherine Varcoe-Baylis

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Jim Stevenson

Developmental Brain-Behaviour Laboratory

School of Psychology

University of Southampton

For further details please email:

jsteven@soton.ac.uk