Children with ARFID face increased risk of disease

Children with avoidant restrictive food intake disorder (ARFID) have an elevated risk of developing psychiatric and physical conditions, a new study from Karolinska Institutet published in JAMA Pediatrics reports. The study highlights the importance of early identification to improve care of these children.

People with ARFID avoid many foods due to sensory aversions to taste, consistency, smell or appearance. They can also experience a fear of negative consequences of eating, such as choking or vomiting. Many individuals also have poor appetite and lack interest in eating.

“The eating disorder has serious consequences, including malnutrition, weight loss and faltering growth, while some individuals may become overweight,” says the study’s last author Lisa Dinkler, assistant professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet. “For example, a child might only want to eat beige-coloured food, limiting their diet to chips, ice cream, crisps and pancakes. In extreme cases, children have even developed blindness due to vitamin A deficiency.”

In this study, the researchers examined the risk of developing other psychiatric and somatic conditions. The study included nearly 31,000 children from the Swedish Twin Registry, 616 (2 %) of whom had ARFID between the ages of 6 and 12.

The researchers found that children with ARFID were ten times more likely to have an intellectual disability or autism than children without ARFID.

Other conditions, like gastro-oesophageal reflux disease (seven times the risk), epilepsy (six times the risk) and chronic lung diseases (five times the risk) were also much more common in this group.

More diagnoses and longer hospitalisation

In addition to the elevated risk of disease, the study also showed that children with ARFID, regardless of sex, had more medical diagnoses and required longer hospital stays than other children.

“Our results show that ARFID is more than just an eating disorder – it’s a complex disorder that often co-exists with other serious health issues,” says Dr Dinkler. “This underscores how important it is that healthcare services take a holistic approach to these children’s needs. We hope that these insights can contribute to improved detection and more personalised care, which could improve the prognosis for children with ARFID.”

The researchers now plan to study how the disorder develops in adulthood and the genetic and environmental factors influencing its association with other psychiatric and physical conditions.

The study was financed by several funding bodies, including the Swedish Society for Medical Research, the Swedish Mental Health Fund, the Fredrik and Ingrid Thuring Foundation and the Swedish Research Council. Three of the researchers have received research grants and/or fees from Medici, Evolan, Shire/Takeda, Pearson, Baxter Medical and Fresenius Kabi outside this study. The other researchers report no conflicts of interest.

Publication: “Mental and somatic conditions in Swedish children with the broad avoidant restrictive food intake disorder phenotype”, Marie-Louis Wronski, Ralf Kuja-Halkola, Elin Hedlund, Miriam I. Martini, Paul Lichtenstein, Sebastian Lundström, Henrik Larsson, Mark J. Taylor, Nadia Micali, Cynthia M. Bulik, Lisa Dinkler, JAMA Pediatrics, online 17 February 2025, doi:  10.1001/jamapediatrics.2024.6065