TY - JOUR
T1 - ADHD and metabolic syndrome: behavioral and weight-related pathways to cardiovascular risk
AU - Ziegler, Georg C.
AU - Kürten, Katharina
AU - Roshop, Karla
AU - Nieberler, Matthias
AU - Warrings, Bodo
AU - Kittel-Schneider, Sarah
AU - Lesch, Klaus Peter
AU - Herrmann, Martin J.
AU - Störk, Stefan
AU - Deckert, Jürgen
N1 - © 2026, the Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0
PY - 2026/5/19
Y1 - 2026/5/19
N2 - Background: Attention-deficit/hyperactivity disorder (ADHD) has been linked to obesity and type 2 diabetes, suggesting heightened cardiovascular risk. Whether adults with ADHD also show increased rates of metabolic syndrome (MetS), a cluster of central obesity, dyslipidemia, impaired glucose regulation, and hypertension, remains unclear. Methods: We examined a young to middle-aged adult cohort of 83 patients and 82 healthy controls (HC). The primary objective was to test whether MetS (Joint Interim Statement criteria) was more prevalent in ADHD than in HC. To explore potential pathways linking ADHD with cardiovascular risk, we additionally assessed anthropometric indices, 24-h blood pressure (BP), heart rate (HR), and inflammatory markers (interleukin-6, C-reactive protein). Finally, we fitted a serial mediation model examining whether hyperactivity/impulsivity (HI), eating behavior, and body mass index (BMI) mediated the association between ADHD and BP. Results: A higher proportion of ADHD patients fulfilled MetS criteria (OR 2.29). Adults with ADHD showed higher waist circumference, BMI, and overweight/obesity rates but did not differ in glucose and blood lipid levels. Non-stimulant medication and psychiatric comorbidity were more common among patients with MetS. Inflammatory markers were unrelated to ADHD. However, ADHD patients demonstrated slightly higher mean 24-h HR and nighttime systolic BP. The association between ADHD and nighttime systolic BP was mediated by obesity as a MetS constituent, and by HI and disordered eating as behavioral risk factors. Conclusion: Young to middle-aged adults with ADHD displayed increased MetS prevalence and subtle elevations in nighttime BP and HR, suggesting an early cardiovascular risk trajectory. Behavioral factors, particularly overeating and weight gain, and psychiatric comorbidity appear to contribute to this risk. These findings support early cardiovascular screening and weight-management interventions in adults with ADHD.
AB - Background: Attention-deficit/hyperactivity disorder (ADHD) has been linked to obesity and type 2 diabetes, suggesting heightened cardiovascular risk. Whether adults with ADHD also show increased rates of metabolic syndrome (MetS), a cluster of central obesity, dyslipidemia, impaired glucose regulation, and hypertension, remains unclear. Methods: We examined a young to middle-aged adult cohort of 83 patients and 82 healthy controls (HC). The primary objective was to test whether MetS (Joint Interim Statement criteria) was more prevalent in ADHD than in HC. To explore potential pathways linking ADHD with cardiovascular risk, we additionally assessed anthropometric indices, 24-h blood pressure (BP), heart rate (HR), and inflammatory markers (interleukin-6, C-reactive protein). Finally, we fitted a serial mediation model examining whether hyperactivity/impulsivity (HI), eating behavior, and body mass index (BMI) mediated the association between ADHD and BP. Results: A higher proportion of ADHD patients fulfilled MetS criteria (OR 2.29). Adults with ADHD showed higher waist circumference, BMI, and overweight/obesity rates but did not differ in glucose and blood lipid levels. Non-stimulant medication and psychiatric comorbidity were more common among patients with MetS. Inflammatory markers were unrelated to ADHD. However, ADHD patients demonstrated slightly higher mean 24-h HR and nighttime systolic BP. The association between ADHD and nighttime systolic BP was mediated by obesity as a MetS constituent, and by HI and disordered eating as behavioral risk factors. Conclusion: Young to middle-aged adults with ADHD displayed increased MetS prevalence and subtle elevations in nighttime BP and HR, suggesting an early cardiovascular risk trajectory. Behavioral factors, particularly overeating and weight gain, and psychiatric comorbidity appear to contribute to this risk. These findings support early cardiovascular screening and weight-management interventions in adults with ADHD.
KW - ADHD
KW - Cardiovascular risk
KW - Eating behavior
KW - Impulsivity
KW - Metabolic syndrome
KW - Obesity
KW - [Medicine]
KW - [APCMicrobiome]
UR - https://www.scopus.com/pages/publications/105039462633
U2 - 10.1007/s00406-026-02246-6
DO - 10.1007/s00406-026-02246-6
M3 - Article
AN - SCOPUS:105039462633
SN - 0940-1334
SP - 1
EP - 13
JO - European Archives of Psychiatry and Clinical Neuroscience
JF - European Archives of Psychiatry and Clinical Neuroscience
ER -
SDG 3 Good Health and Well-being