Food additives and hyperactivity.

eDITORIaLS Food additives and hyperactivity Evidence supports a trial period of eliminating colourings and preservatives from the diet Whether preservatives and colourings cause or exacerbate hyperactive behaviours is an important question for many paediatricians and parents. A recent randomised placebo controlled trial in 297 children aged 3-9 years provides evidence of increased hyperactive behaviour after they ate a mixture of food colourings and a preservative (sodium benzoate). 1 In contrast to many previous studies, the children were from the general population and did not have attention-deficit/hyperactivity disorder. The trial found an adverse effect of the mixture on behaviour as measured by a global hyperactivity aggregate score. The daily dose approximated that found in two 56 g bags of sweets. In view of the potential importance of these findings, the European Food Safety Authority (EFSA) recently provided an opinion that takes other evidence into account. 2 The release of the EFSA findings was reported in a news article in the BMJ under the headline " Agency rejects research on food additives " and the EFSA opinion was characterised as a " highly critical assessment. " 3 The news article stated that the EFSA has " rejected suggestions . .. of a link between hyperactivity in children and two mixtures of food colours and the preservative sodium benzoate. " Closer analysis of the EFSA report, however, does not support this negative interpretation. The EFSA panel reanalysed the data and found that their analysis with a recalculated global hyperactivity score " led to broadly similar conclusions " to the original paper. The panel concluded that, " the study provides limited evidence that the two different mixtures. .. had a small and statistically significant effect on activity and attention. " Importantly, the trial examined a cohort of normal (not hyperactive) children, but the findings have obvious implications for children with hyperactivity. The EFSA panel reviewed the evidence linking preservatives and colourings with hyperactive behaviours. The panel reviewed 22 studies from 1975 to 1994 and two meta-analyses. Of the 22 studies, 16 reported positive effects in at least some children. In positive studies, only a subgroup of those with hyperactive behaviours were affected by the additives. The most recent meta-analysis found that artificial food colours had an overall effect size of 0.283 (95% confidence interval 0.079 to 0.488) on the hyperactivity score, and this fell to 0.210 (0.007 to 0.414) after excluding the smallest and …