The lead author of today’s paper is Brazilian surgeon/researcher, Dr. Alexandre Amato. This paper is titled The Association Between Lipedema and Attention-Deficit/Hyperactivity Disorder. It was published in Cureus in February 2023.
This study aimed to assess the prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) in women diagnosed with lipedema.
The authors state that their initial interest in looking at the correlation in the occurrence of these two conditions was due to the speculation that both lipedema and ADHD are associated with inflammation.
What is Attention-Deficit/Hyperactivity Disorder (ADHD)?
Attention-deficit/hyperactivity disorder (ADHD) is a very common disorder that affects children and can persist into adulthood. Some of the symptoms of ADHD include the inability to maintain focus, hyperactivity (meaning excess movement or fidgeting that is inappropriate for the setting), and acting with excessive impulsivity.
Who were the participants?
354 women were recruited as participants from a non-profit Brazilian lipedema website (www.lipedema.org.br). Participants included those who were and were not diagnosed with lipedema.
The inclusion criteria included 18 years or older, signed a digital consent form, and took at least 5 minutes to complete the online surveys.
Of the 354 women recruited in the study, 130 had lipedema and 224 were not diagnosed with lipedema. The average age was just under 37 years. The average weight was 173 lbs or 79 kg. The average BMI was 29.4.
How did they collect data?
After consenting to participation, the initial respondents completed two online surveys. A total of 547 participants completed the surveys, but 190 were excluded when they did not meet the inclusion criteria. The two online surveys were…
- A previously validated lipedema screening questionnaire, with an average completion time of 3 minutes. The results of this survey determined if a participant was placed in the lipedema group or in the non-lipedema group.
- Adult Self-Report Scale (ASRS-18) is available in Portuguese. This is an 18-item questionnaire on current ADHD symptoms and has an average completion time of two (2) minutes. The results of this survey determined how likely it was that the participant had a diagnosis of ADHD.
What are the limitations of the study?
Past research has shown a link between increased inflammation and both lipedema and ADHD symptoms. The fact that the levels of inflammation can fluctuate may have impacted the severity of lipedema or ADHD symptoms in the participants at the time of this study. Secondly, self-report questionnaires require introspection. Individuals with ADH have a decreased ability for self-reflection could impair their ability to respond to questions and thus confound the study’s results.
Additionally, there may have been a selection bias in the sample of women used in this study because they all came to the website to learn more about lipedema. They may have more severe symptoms than the general population, which may skew the results. Lastly, because participation was all done online, neither a lipedema nor ADHD diagnosis could be confirmed clinically.
What were the key results?
The characteristics of 130 participants who met the criteria for lipedema were as follows:
The average age was 38 years. The average weight was 182 lbs or 82.7 kg. The average BMI was 30.9.
Meanwhile, the characteristics of 224 participants who did not meet the criteria for lipedema were as follows:
The average age was 36 years. The average weight was 168 lbs or 76.3 kg. The average BMI was 28.5.
77% (100 out of 130) of participants in the lipedema group were positive for ADHD symptoms, while only 54% (121 out of 224) of the participants without lipedema were positive for ADHD symptoms. There was a positive correlation not only between a diagnosis of lipedema and an ADHD diagnosis but also a positive correlation between the severity of lipedema symptoms and increased ADHD symptoms.
Here are the characteristics of the ASRS positive and ASRS negative groups. In the group that was ASRS positive, the average age was 36 years, the average weight was 173.5 lbs (78.5 kg) and the average BMI was 29.3. In the ASRS negative group, the average age was 38 years, the average weight was 173 lbs. (78.7 kg) and the average BMI was 29.5.
There is some discussion that ADHD symptoms tend to decrease with age. The authors suggest that this is not reflected in their own data, despite the slightly younger age by 2 years in the ASRS positive group. There is some conjecture that decreased symptoms may be due to the identification and treatment of ADHD in childhood that result in improvements by adulthood.
Anxiety and Depression
Anxiety and depression are also found in both lipedema and ADHD. People with ADHD are at a higher risk for these mood disorders and one study found 61% of patients with lipedema have anxiety and almost 39% have depression.
People with ADHD have been found to have poorer surgical outcomes due to poor follow-up after surgery. They also don’t do well with bariatric surgery due to the higher prevalence of eating disorders. These are important risks to be aware of for the patient with lipedema who is considering surgery. If she has ADHD, this should be addressed prior to surgical intervention to improve her outcomes.
What were the conclusions?
Here are the key conclusions of the study:
- There was a higher prevalence of self-reported symptoms of ADHD in patients with lipedema symptoms, suggesting a potential overlap between the two conditions.
- The role of inflammation in ADHD and lipedema needs to be further explored.
- It would be beneficial to incorporate considerations for mental health, including screening for ADHD, into treatment approaches for lipedema.
- Increasing awareness about ADHD with healthcare professionals who treat lipedema may improve treatment outcomes.
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