Children With Avoidant Restrictive Food Intake Disorder Face Higher Risk of Mental and Physical Health Conditions: Study

"Children with avoidant restrictive food intake disorder (ARFID) faced a significantly higher risk of GERD (HR: 6.7), epilepsy (HR: 5.8), lower respiratory diseases (HR: 4.9), and pituitary conditions (HR: 5.6) compared to their peers. Additionally, autism and intellectual disability were nearly 10 times more prevalent in this group, along with increased mental health diagnoses and prolonged hospital stays," the researchers reported.

These findings highlight the necessity of a multidisciplinary approach to effectively manage ARFID and its associated health challenges.

Avoidant restrictive food intake disorder is a feeding and eating disorder marked by severely limited food intake, affecting both physical health and psychosocial well-being. Children with ARFID frequently experience a wide range of psychiatric and somatic symptoms, leading them to seek care from multiple pediatric specialties. Despite the complexity of the condition, large-scale studies examining coexisting health issues remain scarce.

Against the above background, Marie-Louis Wronski, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, and colleagues aimed to provide a comprehensive understanding of the healthcare needs of children with ARFID, highlighting the necessity for multidisciplinary care to address their diverse medical and psychological challenges.

For this purpose, the researchers conducted a cohort study using data from the Child and Adolescent Twin Study in Sweden (CATSS) and clinical diagnoses from the Swedish National Patient Register. Data were collected between July 2004 and April 2020 and analyzed from 2022 to 2024. Children with the broad ARFID phenotype, identified between ages 6 to 12, were compared to those without ARFID. Using over 1000 ICD diagnostic codes, researchers assessed mental and physical conditions, the number of diagnoses per person, and inpatient treatment days up to age 18, calculating hazard ratios (HRs) and incidence rate ratios (IRRs).

Key Findings:

• Among 30,795 CATSS participants, 616 children (2.0%) were identified with the broad ARFID phenotype between ages 6 to 12, while 30,179 children did not have ARFID. Of the children with ARFID, 39.1% (241) were female.
• Children with ARFID had significantly higher risks of neurodevelopmental, gastrointestinal, endocrine/metabolic, respiratory, neurological, and allergic disorders.
• The risk was notably higher for autism (HR: 9.7), intellectual disability (HR: 10.3), GERD (HR: 6.7), pituitary conditions (HR: 5.6), chronic lower respiratory diseases (HR: 4.9), and epilepsy (HR: 5.8).
• There were no increased risks for autoimmune diseases or obsessive-compulsive disorder.
• Children with ARFID had significantly more distinct mental health diagnoses (IRR: 4.7) and longer hospital stays (IRR: 5.5) compared to those without ARFID.
• Mental health conditions were diagnosed earlier in children with ARFID.
• No significant sex-based differences were observed.

"This cohort study provides the most comprehensive evidence to date on the coexisting mental and physical health conditions in children with ARFID, highlighting the complexity of their healthcare needs. The increased risk of a broad range of conditions emphasizes the necessity for early recognition and multidisciplinary management," the researchers wrote.

"These findings underscore the importance of addressing ARFID across all pediatric specialties to ensure comprehensive care and improve health outcomes in affected children," they concluded.

Reference:

Wronski M, Kuja-Halkola R, Hedlund E, et al. Mental and Somatic Conditions in Children With the Broad Avoidant Restrictive Food Intake Disorder Phenotype. JAMA Pediatr. Published online February 17, 2025. doi:10.1001/jamapediatrics.2024.6065