Täljemark Jakob, Råstam Maria, Lichtenstein Paul, Anckarsäter Henrik, Kerekes Nóra
Lund University, Medical Faculty, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Baravägen 1, S-221 85 Lund, Sweden.
Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.
J Eat Disord. 2017 Aug 21;5:25. doi: 10.1186/s40337-017-0154-2. eCollection 2017.
Restrictive eating problems are rare in children but overrepresented in those with neurodevelopmental problems. Comorbidities decrease wellbeing in affected individuals but research in the area is relatively scarce. This study describes phenotypes, regarding psychiatric and gastrointestinal comorbidities, in children with restrictive eating problems.
A parental telephone interview was conducted in 9- or 12-year old twins ( = 19,130) in the Child and Adolescent Twin Study in Sweden. Cases of restrictive eating problems and comorbid problems were established using the Autism, Tics-AD/HD and other Comorbidities inventory, parental reports of comorbidity as well as data from a national patient register. In restrictive eating problem cases, presence of psychiatric and gastrointestinal comorbidity was mapped individually in probands and their co-twin. Two-tailed Mann-Whitney U tests were used to test differences in the mean number of coexisting disorders between boys and girls. Odds ratios were used to compare prevalence figures between individuals with or without restrictive eating problems, and Fisher exact test was used to establish significance.
Prevalence of restrictive eating problems was 0.6% (concordant in 15% monozygotic and 3% of dizygotic twins). The presence of restrictive eating problems drastically increased odds of all psychiatric problems, especially autism spectrum disorder in both sexes (odds ratio = 11.9 in boys, odds ratio = 10.1 in girls), obsessive-compulsive disorder in boys (odds ratio = 11.6) and oppositional defiant disorder in girls (odds ratio = 9.22). Comorbid gastrointestinal problems, such as lactose intolerance (odds ratio = 4.43) and constipation (odds ratio = 2.91), were the most frequent in girls. Boy co-twins to a proband with restrictive eating problems generally had more psychiatric problems than girl co-twins and more girl co-twins had neither somatic nor any psychiatric problems at all.
In children with restrictive eating problems odds of all coexisting psychiatric problems and gastrointestinal problems are significantly increased. The study shows the importance of considering comorbidities in clinical assessment of children with restrictive eating problems.
限制性饮食问题在儿童中较为罕见，但在神经发育问题儿童中比例过高。合并症会降低受影响个体的幸福感，但该领域的研究相对较少。本研究描述了患有限制性饮食问题儿童的精神和胃肠道合并症的表型。
在瑞典儿童和青少年双胞胎研究中，对9岁或12岁的双胞胎（n = 19130）进行了家长电话访谈。使用自闭症、抽动症-注意力缺陷多动障碍及其他合并症量表、家长关于合并症的报告以及国家患者登记数据来确定限制性饮食问题和合并症病例。在限制性饮食问题病例中，分别对先证者及其双胞胎同胞的精神和胃肠道合并症情况进行了梳理。采用双尾曼-惠特尼U检验来检验男孩和女孩共存疾病平均数量的差异。比值比用于比较有无限制性饮食问题个体之间的患病率数据，费舍尔精确检验用于确定显著性。
限制性饮食问题的患病率为0.6%（同卵双胞胎中15%一致，异卵双胞胎中3%一致）。存在限制性饮食问题会大幅增加所有精神问题的患病几率，尤其是自闭症谱系障碍在男女中均有增加（男孩比值比 = 11.9，女孩比值比 = 10.1），男孩的强迫症（比值比 = 11.6）和女孩的对立违抗障碍（比值比 = 9.22）。合并的胃肠道问题，如乳糖不耐受（比值比 = 4.43）和便秘（比值比 = 2.91），在女孩中最为常见。患有限制性饮食问题先证者的男性双胞胎同胞通常比女性双胞胎同胞有更多精神问题，且更多女性双胞胎同胞既没有躯体问题也没有任何精神问题。
在患有限制性饮食问题的儿童中，所有共存的精神问题和胃肠道问题的患病几率均显著增加。该研究表明在对患有限制性饮食问题儿童进行临床评估时考虑合并症的重要性。
