Socioeconomic status and its impact on the prevalence of severe ADHD in the Maltese Islands

Attention deficit hyperactivity disorder (ADHD) is a common disorder associated with hyperactivity, impulsivity and reduced attention. If left untreated this may possibly lead to various impairments in other areas, such as lack of educational attainment, increased risk of accident-prone behaviour, substance misuse and antisocial behaviours. Although the exact aetiology is still not fully understood, various studies have demonstrated the presence of both a genetic and an environmental component. ADHD is highly hereditable, demonstrating a strong genetic component. Furthermore, increased rates of ADHD have been linked with a low socioeconomic status. The islands of Malta have traditionally been divided for statistical purposes into 6 districts, with certain districts more often being associated with low socioeconomic demographics. The main aim of this study was to assess whether higher prevalence rates of ADHD were present in the districts, which are classically associated with a low socioeconomic status. All persons aged 0 to 18 years attending the governmental clinics, having a documented diagnosis of severe ADHD and therefore being prescribed pharmacotherapy were identified and included in this study. 9 youngsters were living in institutional care and were therefore excluded from the study. A significant difference (p<0.0001) in the point prevalence of ADHD between the 6 Malta districts was found, with higher rates of ADHD occurring in the harbour districts. Though not statistically significant, a positive correlation was demonstrated between the ADHD prevalence and a number of socioeconomic variables, these included; the rate of smoking (p=0.111), number of people classified as at-risk-of-poverty per district (p=0.397), and number of people with no schooling per district (p=0.156). The overall point prevalence for ADHD in Malta obtained was 0.85, a value which is less than the average prevalence noted worldwide. The authors believe this value is an underestimation since the data collection in this study did not include ADHD cases off pharmacological treatment and any ADHD cases assessed and treated in the private sector.peer-reviewe

Adiposity and hepatic lipid in healthy full-term, breastfed, and formula-fed human infants: a prospective short-term longitudinal cohort study

Background: The effect of mode of infant feeding on adiposity deposition is not fully understood. Objective: The objective was to test the hypothesis that differences in total and regional adipose tissue content and intrahepatocellular lipid (IHCL) arise in early infancy between breast- and formula-fed infants and to describe longitudinal changes. Design: This prospective longitudinal cohort study was performed in 2 hospitals in the United Kingdom. Healthy, full-term, appropriate weight-for-gestational age infants were recruited; adipose tissue volume and distribution were directly quantified by using whole-body magnetic resonance imaging; IHCL was assessed by in vivo proton magnetic resonance spectroscopy. Measurements were performed after birth (median age: 13 d) and at 6–12 wk of age. Method of infant feeding was recorded prospectively by using maternally completed feeding diaries. Breastfed was defined as >80% of feeds consisting of breast milk at both points; formula-fed was defined as >80% of feeds consisting of formula milk at both points. Results: Longitudinal results were obtained from 70 infants (36 breastfed, 9 mixed-fed, and 25 formula-fed). No differences were found in total or regional adipose tissue or IHCL between breastfed and formula-fed infants. In pooled analyses including all feeding groups, IHCL and total adipose tissue approximately doubled between birth and 6–12 wk: IHCL after birth (median: 0.949; IQR: 0.521–1.711) and at 6–12 wk (1.828; 1.376–2.697; P < 0.001) and total adipose tissue after birth (0.749 L; 0.620–0.928 L) and at 6–12 wk (1.547 L; 1.332–1.790 L; P < 0.001). Increasing adiposity was characterized by greater relative increases in subcutaneous than in internal adipose tissue depots. Conclusions: No differences were detectable in adipose tissue or IHCL accretion between breastfed and formula-fed infants up to 2 mo. The substantial increase in IHCL seen over this period in both breastfed and formula-fed infants is a novel observation, which suggests that hepatic storage of lipids may be physiologic up to 2 mo. This trial was registered at www.clinicaltrials.gov as NCT02033005