Beyond the Food: A Scoping Review of Avoidant/Restrictive Food Intake Disorder (ARFID)'s Comorbidities, Nutrition, and Growth Outcomes

Objective A scoping review design was chosen for this study to appropriately assess and understand the knowledge on ARFID and to identify psychological or developmental comorbidities, growth outcomes, and nutrient deficiencies and/or excesses in children and adolescents. Introduction Avoidant/Restrictive Food Intake Disorder (ARFID) is a relatively new eating disorder, characterized by the DSM-5 in 2013.1 Individuals with ARFID exhibit selective eating due to lack of interest in eating food, sensory sensitivity, or a fear of possible vomiting or choking.2 The malnutrition seen in individuals with ARFID can result in physical health complications including weight loss, malnutrition, growth delay, decreased bone density, and nutrient deficiencies, all of which can lead to further health issues.6 Psychiatric and developmental comorbidities including autism, anxiety disorders, and ADHD are also common among individuals with ARFID. The aim of this review was to provide insight into the specific nutrient deficiencies, growth outcomes, and comorbidities of ARFID specifically in children and adolescents, as the disorder is frequently seen in this population. Inclusion Criteria Articles from any geographical area were considered if they met the following inclusion criteria: 1) published during or after 2013, 2) subjects were children and adolescents with an ARFID diagnosis (up to age 18), 3) Nutrient deficiencies, physical growth outcomes, or comorbid diagnoses found in participants, 4) content was original research, and 5) written in the English language. Methods Five academic literature databases were selected including PubMed, ProQuest, Science Direct, Springer, and Wiley based on their relevance to science and health. The data were compiled into a table that included the characteristics and results of each article, along with the research question(s) addressed by each individual source of evidence. Content analysis was done to answer each research question and factors considered were age, location, and comorbidities while using percentages and frequency counts. Results After a full-text review of articles, 37 articles were included in this review. Nearly half of the articles included in this review addressed the impact of ARFID on growth and development. These studies reported low BMI, low weight, and bone abnormalities as common growth outcomes. 27% of studies included in this review reported nutrient deficiencies resulting from ARFID. Nutrient deficiencies found frequently among studies included vitamins A, D, E, K, C, B12, calcium, zinc, and iron. More than half the articles included in this review reported comorbid diagnoses with ARFID such as autism spectrum disorder, anxiety disorders, and ADHD in children and ASD and anxiety disorders in adolescents. Conclusions This scoping review on ARFID’s comorbidities, growth outcomes, and nutritional status in children and adolescents reported in existing literature identified that ARFID often presents with a comorbid diagnosis, low weight, and multiple nutrient deficiencies.