A Diet High in Processed Foods, Total Carbohydrates and Added Sugars, and Low in Vegetables and Protein Is Characteristic of Youth with Avoidant/Restrictive Food Intake Disorder.

Stephanie G Harshman,Reitumetse L Pulumo,Madhusmita Misra,Alyssa M Izquierdo,Elisa Asanza,Olivia Wons,Tara M Holmes,Elizabeth A Lawson,Kamryn T Eddy,Madeline S Rogers,Nadia Micali,Jennifer J Thomas

doi:10.3390/nu11092013

Abstract

Avoidant/restrictive food intake disorder (ARFID) is characterized in part by limited dietary variety, but dietary characteristics of this disorder have not yet been systematically studied. Our objective was to examine dietary intake defined by diet variety, macronutrient intake, and micronutrient intake in children and adolescents with full or subthreshold ARFID in comparison to healthy controls. We collected and analyzed four-day food record data for 52 participants with full or subthreshold ARFID, and 52 healthy controls, aged 9–22 years. We examined frequency of commonly reported foods by logistic regression and intake by food groups, macronutrients, and micronutrients between groups with repeated-measures ANOVA. Participants with full or subthreshold ARFID did not report any fruit or vegetable category in their top five most commonly reported food categories, whereas these food groups occupied three of the top five groups for healthy controls. Vegetable and protein intake were significantly lower in full or subthreshold ARFID compared to healthy controls. Intakes of added sugars and total carbohydrates were significantly higher in full or subthreshold ARFID compared to healthy controls. Individuals with full or subthreshold ARFID had lower intake of vitamins K and B12, consistent with limited vegetable and protein intake compared to healthy controls. Our results support the need for diet diversification as part of therapeutic interventions for ARFID to reduce risk for nutrient insufficiencies and related complications.

Highlights

Avoidant/restrictive food intake disorder (ARFID) was recently added to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) Feeding and Eating Disorders section to replace and expand upon the former DSM-IV diagnosis of feeding disorder of infancy and early childhood
To empirically characterize dietary intake patterns associated with ARFID, we evaluated differences in four-day food record data in children and adolescents with full or subthreshold ARFID compared to healthy controls
We found that, compared to heathy children and adolescents, the diet of youth with full or subthreshold ARFID is higher in refined-carbohydrate processed foods, as well as total carbohydrates and added sugars, and lower in protein, vegetables, and vitamins K and B12

Summary

Introduction

Avoidant/restrictive food intake disorder (ARFID) was recently added to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) Feeding and Eating Disorders section to replace and expand upon the former DSM-IV diagnosis of feeding disorder of infancy and early childhood. Individuals with ARFID have a unique psychological profile manifesting as sensory sensitivity, fear of aversive consequences (e.g., choking or vomiting), and/or lack of interest in food or eating. Case reports suggest that individuals with ARFID often limit their intake to highly palatable carbohydrate-rich processed foods, and—in more extreme cases—only eat foods within two food groups (e.g., grains and dairy), or even just one or two foods total (e.g., pasta and bread) [2]. This severely selective diet can lead to nutrition-related medical issues such as electrolyte imbalances, fat-soluble vitamin deficiencies, B vitamin deficiencies

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