Abstract
Although case studies in avoidant/restrictive food intake disorder (ARFID) indicate severe nutritional deficiencies in those with a highly limited amount or variety of food intake, systematic analyses on food intake in treatment-seeking children and adolescents with ARFID are lacking. Within this study, n = 20 patients with an interview-based diagnosis of ARFID (0–17 years) were included and compared to n = 20 healthy controls individually matched for age and sex. Children or parents completed three-day food diaries and a food list. Macronutrient, vitamin, and mineral supply was determined based on the percentage of their recommended intake. The results showed a significantly lower total energy and protein intake in ARFID versus controls, with trends for lower fat and carbohydrate intake. ARFID subtypes of limited amount versus variety of food intake significantly differed in macro-, but not micronutrient intake. Those with ARFID met only 20–30% of the recommended intake for most vitamins and minerals, with significantly lower intake relative to controls for vitamin B1, B2, C, K, zinc, iron, and potassium. Variety of food intake was significantly reduced in ARFID versus controls in all food groups except carbohydrates. This study demonstrated that ARFID goes along with reduced everyday life macro- and micronutrient intake, which may increase the risk for developmental and health problems. Future studies additionally assessing serum nutrient levels in a larger sample may further explore differences in food intake across diverse ARFID presentations.
Highlights
The achieved percentage of recommended energy intake was significantly lower in those with avoidant/restrictive food intake disorder (ARFID) than controls (p = 0.006) with a large effect, as shown in Regarding vitamin intake, group differences emerged in vitamin B1, B2, C, and K, with significantly lower values in the ARFID versus control group (p < 0.006, medium to large effects), while no differences were observed in the intake of vitamin B6, B12, D, E, and folate (p ≥ 0.006)
This study demonstrated that children and adolescents seeking treatment for ARFID were characterized by an inadequate amount and variety of food intake compared to individually matched healthy controls
Children and adolescents with ARFID showed a lower intake of the majority of vitamins and minerals compared with controls, which was further supported by a lower range of accepted foods for all food groups except carbohydrates and bakery products
Summary
Disorders (DSM-5) in 2013, avoidant/restrictive food intake disorder (ARFID) has been introduced in the newly combined feeding and eating disorder section [1]. ARFID extended and replaced the DSM-IV diagnosis of Feeding Disorder of Infancy and Early Childhood [2], describing individuals across ages who show a persistently low amount and/or variety of food intake that may go along with other physical or mental impairments than weight loss only, including nutritional deficiencies, the need for supplemental feeding, and reduced psychosocial functioning. The avoidant or restrictive food intake cannot be accounted for by body image disturbances or weight loss intentions, and is not entirely attributable to a medical or mental disorder, a lack of food, or culturally accepted reasons such as a vegan diet. Recent research indicated a high prevalence of ARFID in samples seeking treatment for feeding or eating disorders and consistently revealed a range of mental comorbidities, including anxiety and neurodevelopmental disorders [3,4]
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