ARFID Characteristics Differ Among Youth by Sex and Age

By Lisa Rapaport

October 18, 2021

(Reuters Health) - Children and teens with avoidant restrictive food intake disorder (ARFID) differ in how they present based on their sex and age, a new study suggests.

Researchers examined data on patients with ARFID who were part of the Canadian Pediatric Surveillance Program, which surveyed 2,700 pediatricians monthly in 2016 and 2017. Overall, there were 207 youth with ARFID in the study (mean age 13.1 years), which translated into an incidence of 2.02 cases per 100,000 youth 5 to 18 years of age.

Endorsement of eating too little increased with age from 76.7% of children 5 to 9 years to 95.6% of teens 15 to 18 years, the study found. Loss of appetite also became more common with age, climbing from 53.3% of kids 5 to 9 years to 80.0% of adolescents 15 to 18 years.

However, the proportion of youth reporting avoidance of certain foods declined from 90.0% of kids 5 to 9 years to 62.2% among teens 15 to 18 years. And food refusal based on sensory characteristics also decreased with age from 66.7% of kids 5 to 9 years to 22.2% of adolescents 15 to 18 years.

More girls (75.5%) than boys (68.5%) didn't eat enough food overall. But more boys (51.2%) than girls (31.5%) refused to eat certain foods based on sensory characteristics.

"The findings of this study suggest that ARFID is a relatively common eating disorder in children and adolescents that is associated with important age- and sex-related clinical characteristics and behaviors," said lead study author Dr. Debra Katzman, a professor of pediatrics at the Hospital for Sick Children and the University of Toronto, Ontario.

"Thus, this study underscores the need for pediatric healthcare professionals to be familiar with these age-and sex-related clinical characteristics so that can better identify these children and adolescents with ARFID," Dr. Katzman said by email.

The risk of being medically compromised based on weight also increased with age. Compared with kids 5 to 9 years, children 10 to 14 years had mean BMI z scores 1.31 units lower. And compared with youth 10 to 14 years, mean BMI z scores were 0.04 points lower among adolescents 15 to 18 years.

Anxiety was less common among younger children, affecting 26.75 of children 5 to 9 years but slightly more than 50% of older youth in the study, the study team reports in JAMA Pediatrics. None of the youngest children had depression, but 6.8% of children 10 to 14 years did and 26.7% of teens 15 to 18 years did.

Hospitalization also increased with age, from 13.3% of children 5 to 9 years to 55.6% of teens 15 to 18 years.

One Limitation of the study is the potential for ARFID to be underestimated due to reporting bias, the study team notes. It's also possible that ARFID was overlooked in some children or teens with normal weight or with overweight, the authors point out.

ARFID is a relatively new category of eating disorder and there are no validated screening tools for use with children and adolescents, said Dr. Laura Grubb, director of adolescent medicine at Tufts Children's Hospital in Boston and author of an editorial accompanying the study.

"This study offers information about who is a risk of ARFID and some common symptoms," Dr. Grubb said by email. "Pediatricians can have increased awareness of ARFID among children and adolescents with autism spectrum disorder, anxiety, obsessive compulsive disorder, and depression, and those who present with symptoms such as food avoidance, history of nausea, early satiety or abdominal pain, or reduction in proportion size."

SOURCE: and JAMA Pediatrics, online October 11, 2021.