Food additives and behaviour in children. Jim Stevenson 20 May 2008 Presentation to the Associate Parliamentary Food and Health Forum

2 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

4 Sig. effect of additives Schab, D.W. & Trinh, N-A. (2004). Journal of Developmental and Behavioral Pediatrics, 25,

5 Southampton Study

6 Design of Southampton Study Randomised, 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 Baseline week on usual diet, then additives withdrawn.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)

7 Mix contents E NumberName of AdditiveMix AMix B E102 ColourTartrazine  E104 ColourQuinoline yellow  E110 ColourSunset Yellow E122 ColourCarmoisine E124 ColourPonceau 4R  E129 ColourAllura Red AC  E211 PreservativeSodium benzoate Mix A was the same as the active challenge employed in the Isle of Wight study published in 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,

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9 Conclusions Mixtures 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,

10 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

11 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)

12 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 StevensonPsychologist Prof. John WarnerPaediatrician Prof. Edmund Sonuga-BarkePsychologist Dr. Donna McCannPsychologist Kate GrimshawDietitian Yuet-Wan Lok Dietitian Debbie CrumplerSecretary Research assistant psychologists: Angelina Barrett Alison Cooper Lyndy Dalen Elizabeth Kitchin Lucy Porteous Emily Prince Catherine Varcoe-Baylis

14 Jim Stevenson Developmental Brain-Behaviour Laboratory School of Psychology University of Southampton For further details please