Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
JAMA Pediatr. 2021 Dec 1;175(12):e213861. doi: 10.1001/jamapediatrics.2021.3861. Epub 2021 Dec 6.
To our knowledge, this is the first pediatric surveillance study of children and adolescents with avoidant restrictive food intake disorder (ARFID).
To examine the incidence and age- and sex-specific differences in the clinical presentation of ARFID in children and adolescents in Canada.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, patients with ARFID were identified through the Canadian Paediatric Surveillance Program by surveying 2700 Canadian pediatricians monthly from January 1, 2016, to December 31, 2017.
The incidence of ARFID in Canadian children (5-18 years of age) and age- and sex-specific clinical characteristics at presentation.
In total, 207 children and adolescents (mean [SD] age, 13.1 [3.2] years; 127 [61.4%] female) were included in this study. The incidence of ARFID in children 5 to 18 years of age was 2.02 (95% CI, 1.76-2.31) per 100 000 patients. Older children and adolescents were more likely to endorse eating too little (5-9 years of age: 76.7%; 95% CI, 58%-88.6; 10-14 years of age: 90.9%; 95% CI, 84.6%-94.8%; 15-18 years of age: 95.6%; 95% CI, 83.6%-98.9%; P = .02), have a loss of appetite (5-9 years of age: 53.3%; 95% CI, 35.4%-70.4%; 10-14 years of age: 74.2%; 95% CI, 66.0%-81.0%; 15-18 years of age: 80.0%; 95% CI, 65.5%-89.4%; P = .03), be medically compromised (mean body mass index z score: 10-14 vs 5-9 years of age: -1.31; 95% CI, -2.0 to -0.6; 15-18 vs 5-9 years of age: -1.35; 95% CI, -2.2 to -0.5; 15-18 vs 10-14 years of age: -0.04; 95% CI, -0.6 to 0.5; P < .001; mean percentage of treatment goal weight: 10-14 vs 5-9 years of age: -8.6; 95% CI, -14.3 to -2.9; 15-18 vs 5-9 years of age: -9.8; 95% CI, -16.3 to -3.3; 15-18 vs 10-14 years of age: -1.2; 95% CI, -5.8 to 3.4; P < .001; mean heart rate (beats per min): 10-14 vs 5-9 years of age: -10; 95% CI, -21.9 to 1.9; 15-18 vs 5-9 years of age: -19.7; 95% CI, -33.1 to -6.2; 15-18 vs 10-14 years of age: -9.7; 95% CI, -18.7 to -0.7; P = .002), have higher rates of anxiety (5-9 years of age: 26.7%; 95% CI, 13.7-45.4; 10-14 years of age: 52.3%; 95% CI, 43.7%-60.7%; 15-18 years of age: 53.3%; 95% CI, 38.6%-67.5%; P = .03) and depression (5-9 years of age: 0%; 10-14 years of age: 6.8%; 95% CI, 3.6%-12.7%; 15-18 years of age: 26.7%; 95% CI, 15.7%-41.6%; P < .001), and be more likely to be hospitalized (5-9 years of age: 13.3%; 95% CI, 5.0%-31.1%; 10-14 years of age: 41.7%; 95% CI, 33.5%-50.3%; 15-18 years of age: 55.6%; 95% CI, 40.7%-69.5%; P = .001). Younger children were more likely to endorse lack of interest in food (5-9 years of age: 56.7%; 95% CI, 38.4%-73.2%; 10-14 years of age: 75.0%; 95% CI, 66.8%-81.7%; 15-18 years of age: 57.8%; 95% CI, 42.8%-71.4%; P = .03), avoidance of certain foods (5-9 years of age: 90.0%; 95% CI, 72.6%-96.8%; 10-14 years of age: 69.7%; 95% CI, 61.3%-77.0%; 15-18 years of age: 62.2%; 95% CI, 47.2%-75.3%; P = .03), and refusal based on sensory characteristics (5-9 years of age: 66.7%; 95% CI, 47.9%-81.3%; 10-14 years of age: 38.6%; 95% CI, 30.7%-47.3%; 15-18 years of age: 22.2%; 95% CI, 12.3%-36.9%; P < .001). Eating but not enough was more common in girls (75.0%; 95% CI, 64.1%-83.4%) vs boys (68.5%; 95% CI, 59.8%-76.1; P = .04), and boys had a higher rate of refusal based on sensory characteristics (51.2%; 95% CI, 40.2%-62.2%) compared with girls (31.5%; 95% CI, 23.9%-40.2%; P = .007).
This study suggests that ARFID is a relatively common eating disorder and is associated with important age- and sex- specific clinical characteristics that may help in early recognition and timely treatment of the presenting symptoms.
据我们所知，这是第一项针对患有回避性限制性食物摄入障碍 (ARFID) 的儿童和青少年的儿科监测研究。
检查加拿大儿童和青少年 ARFID 的临床表现在年龄和性别方面的发生率和差异。
设计、地点和参与者：在这项横断面研究中，通过每月对 2700 名加拿大儿科医生进行调查，从 2016 年 1 月 1 日至 2017 年 12 月 31 日对加拿大儿科监测计划中的 ARFID 患者进行了识别。
5-18 岁加拿大儿童（ARFID）的发病率和发病时的年龄和性别特异性临床特征。
共纳入 207 名儿童和青少年（平均[SD]年龄，13.1[3.2]岁；127[61.4%]女性）。5 至 18 岁儿童的 ARFID 发病率为每 100000 名患者 2.02（95%CI，1.76-2.31）。年龄较大的儿童和青少年更有可能出现进食过少（5-9 岁：76.7%；95%CI，58%-88.6%；10-14 岁：90.9%；95%CI，84.6%-94.8%；15-18 岁：95.6%；95%CI，83.6%-98.9%；P=0.02）、食欲不振（5-9 岁：53.3%；95%CI，35.4%-70.4%；10-14 岁：74.2%；95%CI，66.0%-81.0%；15-18 岁：80.0%；95%CI，65.5%-89.4%；P=0.03）、身体状况不佳（平均体重指数 z 分数：10-14 岁比 5-9 岁：-1.31；95%CI，-2.0 至-0.6；15-18 岁比 5-9 岁：-1.35；95%CI，-2.2 至-0.5；15-18 岁比 10-14 岁：-0.04；95%CI，-0.6 至 0.5；P<0.001；平均治疗目标体重的百分比：10-14 岁比 5-9 岁：-8.6；95%CI，-14.3 至-2.9；15-18 岁比 5-9 岁：-9.8；95%CI，-16.3 至-3.3；15-18 岁比 10-14 岁：-1.2；95%CI，-5.8 至 3.4；P<0.001；平均心率（每分钟心跳数）：10-14 岁比 5-9 岁：-10；95%CI，-21.9 至 1.9；15-18 岁比 5-9 岁：-19.7；95%CI，-33.1 至-6.2；15-18 岁比 10-14 岁：-9.7；95%CI，-18.7 至-0.7；P=0.002）、更高的焦虑率（5-9 岁：26.7%；95%CI，13.7%-45.4%；10-14 岁：52.3%；95%CI，43.7%-60.7%；15-18 岁：53.3%；95%CI，38.6%-67.5%；P=0.03）和抑郁率（5-9 岁：0%；10-14 岁：6.8%；95%CI，3.6%-12.7%；15-18 岁：26.7%；95%CI，15.7%-41.6%；P<0.001）、更有可能住院（5-9 岁：13.3%；95%CI，5.0%-31.1%；10-14 岁：41.7%；95%CI，33.5%-50.3%；15-18 岁：55.6%；95%CI，40.7%-69.5%；P=0.001）。年龄较小的儿童更有可能出现缺乏对食物的兴趣（5-9 岁：56.7%；95%CI，38.4%-73.2%；10-14 岁：75.0%；95%CI，66.8%-81.7%；15-18 岁：57.8%；95%CI，42.8%-71.4%；P=0.03）、避免某些食物（5-9 岁：90.0%；95%CI，72.6%-96.8%；10-14 岁：69.7%；95%CI，61.3%-77.0%；15-18 岁：62.2%；95%CI，47.2%-75.3%；P=0.03）和基于感官特征的拒绝（5-9 岁：66.7%；95%CI，47.9%-81.3%；10-14 岁：38.6%；95%CI，30.7%-47.3%；15-18 岁：22.2%；95%CI，12.3%-36.9%；P<0.001）。女孩（75.0%；95%CI，64.1%-83.4%）比男孩（68.5%；95%CI，59.8%-76.1%；P=0.04）更常见的是进食不足，但女孩拒绝基于感官特征的食物的比例更高（51.2%；95%CI，40.2%-62.2%），男孩为 31.5%；95%CI，23.9%-40.2%；P=0.007）。
本研究表明，ARFID 是一种相对常见的饮食障碍，与重要的年龄和性别特定的临床特征相关，这些特征可能有助于早期识别和及时治疗出现的症状。
