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Food Additives and Behavior in 8- to 9-Year-Old Children in Hong Kong: A Randomized, Double-blind, Placebo-Controlled Trial

Lok, Kris Y.W. PhD*; Chan, Ruth S.M. PhD*,†; Lee, Vivian W.Y. PharmD; Leung, Patrick W. PhD; Leung, Cynthia PhD§; Leung, Jason MSc; Woo, Jean MD*

Journal of Developmental & Behavioral Pediatrics: November/December 2013 - Volume 34 - Issue 9 - p 642–650
doi: 10.1097/DBP.0000000000000005
Original Articles

Objectives: To test the individual effect of artificial food colorings (AFCs) and a preservative on the behavior of the general Chinese population.

Method: One hundred thirty children (70 boys and 60 girls) in Hong Kong with a mean age of 8.64 years were enlisted to the study with a within-subject crossover between AFCs, a preservative (sodium benzoate), and a placebo capsule. Two behavior scores were used including the strengths and weaknesses of attention deficit hyperactivity disorder and normal behavior rating scale and the child behavior checklist-teacher report form.

Results: Capsule A containing AFCs and Capsule B containing sodium benzoate had no significant adverse effect compared with placebo in both behavior scores. This result persisted when analysis was restricted to children with 85% consumption of capsule (per protocol analysis).

Conclusion: There seem to be no significant associations between AFCs and a preservative on Chinese children's behavior at the age of 8 to 9 years. Future directions and implications of this research are discussed.

*Department of Medicine & Therapeutics, Centre for Nutritional Studies,

School of Pharmacy, and

Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China;

§Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China; and

Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China.

Address for reprints: Kris Y. W. Lok, PhD, Department of Medicine and Therapeutics/Centre for Nutritional Studies, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China; e-mail:

The project was supervised by J. Woo. K. Lok led the project and wrote the final manuscript, J. Leung assisted with the data analysis with all authors providing critical contributions to reviewing, editing and approving its final version.

Disclosure: This study was funded by the Centre for Nutritional Studies, The Chinese University of Hong Kong. All authors accept full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish. The authors declare no conflict of interest.

Received June , 2013

Accepted August , 2013

© 2013 by Lippincott Williams & Wilkins