Dataset Information

Co-existing mental and somatic conditions in Swedish children with the avoidant restrictive food intake disorder phenotype.

ABSTRACT:

Background

Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder, characterized by limited variety and/or quantity of food intake impacting physical health and psychosocial functioning. Children with ARFID often present with a range of psychiatric and somatic symptoms, and therefore consult various pediatric subspecialties; large-scale studies mapping comorbidities are however lacking. To characterize health care needs of people with ARFID, we systematically investigated ARFID-related mental and somatic conditions in 616 children with ARFID and >30,000 children without ARFID.

Methods

In a Swedish twin cohort, we identified the ARFID phenotype in 6-12-year-old children based on parent-reports and register data. From >1,000 diagnostic ICD-codes, we specified mental and somatic conditions within/across ICD-chapters, number of distinct per-person diagnoses, and inpatient treatment days between birth and 18^th birthday (90 outcomes). Hazard ratios (HR) and incidence rate ratios (IRR) were calculated.

Findings

Relative risks of neurodevelopmental, gastrointestinal, endocrine/metabolic, respiratory, neurological, and allergic disorders were substantially increased in ARFID (e.g., autism HR[CI_95%]=9.7[7.5-12.5], intellectual disability 10.3[7.6-13.9], gastroesophageal reflux disease 6.7[4.6-9.9], pituitary conditions 5.6[2.7-11.3], chronic lower respiratory diseases 4.9[2.4-10.1], epilepsy 5.8[4.1-8.2]). ARFID was not associated with elevated risks of autoimmune illnesses and obsessive-compulsive disorder. Children with ARFID had a significantly higher number of distinct mental diagnoses (IRR[CI_95%]=4.7[4.0-5.4]) and longer duration of hospitalizations (IRR[CI_95%]=5.5[1.7-17.6]) compared with children without ARFID. Children with ARFID were diagnosed earlier with a mental condition than children without ARFID. No sex-specific differences emerged.

Interpretation

This study yields the broadest and most detailed evidence of co-existing mental and somatic conditions in the largest sample of children with ARFID to date. Findings suggest a complex pattern of health needs in youth with ARFID, underscoring the critical importance of attention to the illness across all pediatric specialties.

Funding

Fredrik and Ingrid Thurings Foundation, Mental Health Foundation.

SUBMITTER: Wronski ML

PROVIDER: S-EPMC10980122 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Co-existing mental and somatic conditions in Swedish children with the avoidant restrictive food intake disorder phenotype.

Wronski Marie-Louis ML Kuja-Halkola Ralf R Hedlund Elin E Martini Miriam I MI Lichtenstein Paul P Lundström Sebastian S Larsson Henrik H Taylor Mark J MJ Micali Nadia N Bulik Cynthia M CM Dinkler Lisa L

medRxiv : the preprint server for health sciences 20240315

<h4>Background</h4>Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder, characterized by limited variety and/or quantity of food intake impacting physical health and psychosocial functioning. Children with ARFID often present with a range of psychiatric and somatic symptoms, and therefore consult various pediatric subspecialties; large-scale studies mapping comorbidities are however lacking. To characterize health care needs of people with ARFID, we systematically ...[more]

PMID: 38558975

Similar Datasets

Project description:ImportanceAvoidant restrictive food intake disorder (ARFID) is characterized by an extremely limited range and/or amount of food eaten, resulting in the persistent failure to meet nutritional and/or energy needs. Its etiology is poorly understood, and knowledge of genetic and environmental contributions to ARFID is needed to guide future research.ObjectiveTo estimate the extent to which genetic and environmental factors contribute to the liability to the broad ARFID phenotype.Design, setting, and participantsThis nationwide Swedish twin study includes 16 951 twin pairs born between 1992 and 2010 whose parents participated in the Child and Adolescent Twin Study in Sweden (CATSS) at twin age 9 or 12 years. CATSS was linked to the National Patient Register (NPR) and the Prescribed Drug Register (PDR). Data were collected from July 2004 to April 2020, and data were analyzed from October 2021 to October 2022.Main outcomes and measuresFrom CATSS, NPR, and PDR, all parent reports, diagnoses, procedures, and prescribed drugs that were relevant to the DSM-5 ARFID criteria were extracted when twin pairs were aged 6 to 12 years and integrated into a composite measure for the ARFID phenotype (ie, avoidant/restrictive eating with clinically significant impact, such as low weight or nutritional deficiency, and with fear of weight gain as an exclusion). In sensitivity analyses, autism and medical conditions that could account for the eating disturbance were controlled for. Univariate liability threshold models were fitted to estimate the relative contribution of genetic and environmental variation to the liability to the ARFID phenotype.ResultsOf 33 902 included children, 17 151 (50.6%) were male. A total of 682 children (2.0%) with the ARFID phenotype were identified. The heritability of ARFID was 0.79 (95% CI, 0.70-0.85), with significant contributions from nonshared environmental factors (0.21; 95% CI, 0.15-0.30). Heritability was very similar when excluding children with autism (0.77; 95% CI, 0.67-0.84) or medical illnesses that could account for the eating disturbance (0.79; 95% CI, 0.70-0.86).Conclusions and relevancePrevalence and sex distribution of the broad ARFID phenotype were similar to previous studies, supporting the use of existing epidemiological data to identify children with ARFID. This study of the estimated genetic and environmental etiology of ARFID suggests that ARFID is highly heritable, encouraging future twin and molecular genetic studies.

Project description:ImportanceThe neurobiology of avoidant/restrictive food intake disorder (ARFID) is poorly understood.ObjectiveTo evaluate whether individuals with ARFID exhibit disruptions in fear, appetite, and disgust brain regions compared with healthy control (HC) participants when shown images of food and objects.Design, setting, and participantsIn this case-control study conducted from July 2016 to January 2021, children, adolescents, and young adults completed structured interviews and a validated functional magnetic resonance imaging (fMRI) food cue paradigm. The study was conducted at a single academic medical center. Data analysis was conducted from April 2023 to August 2024.ExposuresPresence vs absence of ARFID and its phenotypes (ARFID-fear, ARFID-lack of interest in eating, ARFID-sensory sensitivity); pictures of food vs objects during fMRI food cue paradigm.Main outcomes and measuresBlood oxygenation level-dependent activation in regions of interest (ROIs; amygdala, hypothalamus, insula, anterior cingulate cortex [ACC]) and the whole brain.ResultsParticipants were 110 children, adolescents, and young adults with full or subthreshold ARFID (75 participants; mean [SD] age, 16.2 [3.8] years; 41 [55%] female) and age-matched HC participants (35 participants; mean [SD] age, 17.3 [4.0] years; 27 [69%] female) recruited for studies of the neurobiology of ARFID and restrictive eating disorders. Participants with ARFID demonstrated greater activation than HC participants of the ACC (mean difference, 0.48 [95% CI, 0.19 to 0.77]; P = .009), sensory association cortex (mean difference on left side, 0.54 [95% CI, 0.29 to 0.79]; P = .005; right side, 0.52 [95% CI, 0.28 to 0.76]; P = .02), and supplementary motor cortex (mean difference, 0.81 [95% CI, 0.47 to 1.15]; P = .04). The ARFID-fear group showed greater amygdala activation vs HC (mean difference, 0.49 [95% CI, 0.16 to 0.82]; P = .04), and greater lack of interest was associated with lower hypothalamus activation in the ARFID-lack of interest group (r = -0.38 [95% CI, -0.69 to -0.11]; P = .03). The ARFID-sensory sensitivity group did not show greater insula activation vs HC but showed greater activation of the ACC (mean difference, 0.48 [95% CI, 0.22 to 0.74]; P = .005) and somatosensory cortex (mean difference on left side, 0.60 [95% CI, 0.33-0.87]; P = .001; right side, 0.54 [95% CI, 0.29 to 0.80]; P = .03).Conclusions and relevanceResults indicate generalized hyperactivation of ACC, sensory association cortex, and supplementary motor cortex in response to visual food stimuli in children, adolescents, and young adults with ARFID, suggesting a novel neurobiological circuit associated with this disorder. Activation appears consistent with ARFID phenotypic rationales for food avoidance, with hyperactivation of fear regions in ARFID-fear and hypoactivation of appetite regions with increasing ARFID-lack of interest severity.

Project description:ObjectiveAvoidant/restrictive food intake disorder (ARFID) is a relatively new feeding and eating disorder category in DSM-5 characterized by extreme food avoidance/restriction. Much is unknown about ARFID, with limited understanding of its prevalence and comorbidities in general pediatric populations. This study aimed to classify ARFID prevalence and characteristics in children within the Generation R Study, a population-based Dutch cohort (N = 2,862).MethodARFID was assessed via an Index that comprised parent-reported questionnaires and researcher-assessed measures of picky eating, energy intake, diet quality, growth, and psychosocial impact, all in the absence of body/weight dissatisfaction to align with DSM-5 criteria. Parents also reported on child appetitive traits and emotional/behavioral problems (eg, anxiety, depression, attention problems).ResultsUsing DSM-5-based categorization, 183 (6.4%) of 2,862 children were classified as presenting with ARFID symptoms. Compared with children not exhibiting symptoms, children classified with ARFID symptomatology expressed other avoidant eating behavior, including decreased enjoyment of food (d = -1.06, false discovery rate-corrected p [p FDR] < .001), increased satiety responsiveness (d = 1.06, p FDR < .001), and emotional undereating (d = 0.21, p FDR < .01), as well as more emotional problems, including withdrawn/depressed (d = 0.38, p FDR < .001), social problems (d = 0.34, p FDR < 0.001), attention problems (d = 0.38, p FDR < .001), anxiety (d = 0.30, p FDR < .001), obsessive/compulsive problems (d = 0.15, p FDR < .05), and autistic traits (d = 0.22; p FDR < .05). Associations did not differ by sex.ConclusionThis is the first large-scale community-based study to characterize ARFID and to demonstrate that ARFID symptom classification is common in children aged ≤10 years. Findings suggest that appetitive, emotional, and behavioral comorbidities may underlie or reinforce the presentation of ARFID.Diversity & inclusion statementWe worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. Diverse cell lines and/or genomic datasets were not available. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. We actively worked to promote sex and gender balance in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

Dataset Information

Co-existing mental and somatic conditions in Swedish children with the avoidant restrictive food intake disorder phenotype.

Background

Methods

Findings

Interpretation

Funding

Publications

Co-existing mental and somatic conditions in Swedish children with the avoidant restrictive food intake disorder phenotype.

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