Watts Rosie, Archibald Tanith, Hembry Pippa, Howard Maxine, Kelly Cate, Loomes Rachel, Markham Laura, Moss Harry, Munuve Alfonce, Oros Anca, Siddall Amy, Rhind Charlotte, Uddin Mohammed, Ahmad Zain, Bryant-Waugh Rachel, Hübel Christopher
Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
Avoidant Restrictive Food Intake Disorder Outpatient Service, Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, United Kingdom.
EClinicalMedicine. 2023 Aug 30;63:102190. doi: 10.1016/j.eclinm.2023.102190. eCollection 2023 Sep.
Avoidant restrictive food intake disorder (ARFID) is a new eating disorder with a heterogeneous clinical presentation. It is unclear which patient characteristics contribute to its heterogeneity.
To identify these patient characteristics, we performed symptom-level correlation and driver-level regression analyses in our cross-sectional study in up to 261 ARFID patients (51% female; median age = 12.7 years) who were assessed at the Maudsley Centre for Child and Adolescent Eating Disorders, London between November 2019 and July 2022.
Symptoms across the three drivers 1) avoidance based on sensory characteristics of food; 2) apparent lack of interest in eating; and 3) concern about aversive consequences positively correlated with each other. Patients' anxiety traits showed the greatest positive correlations with symptoms of concern about aversive consequences of eating. Patient sex was not significantly associated with any of the three ARFID drivers. Patients with comorbid autism spectrum disorder (ASD; 28%) showed more food-related sensory sensitivities (RR = 1.26) and greater lack of interest in eating (RR = 1.18) than those of patients without ASD (49%).
In our clinical sample, the ARFID drivers occurred together and did not show clinically meaningful differences between the sexes. ASD may accentuate food-related sensory sensitivities and lack of interest, but may not drive a completely different symptom presentation. ARFID is multi-faceted and heterogenous, requiring a comprehensive multidisciplinary assessment to sufficiently understand the drivers of the restrictive eating behaviour. Results need replication in larger samples with more statistical power.
None.
回避性限制性食物摄入障碍（ARFID）是一种临床表现异质性的新型饮食障碍。目前尚不清楚哪些患者特征导致了其异质性。
为了确定这些患者特征，我们在2019年11月至2022年7月期间于伦敦莫兹利儿童与青少年饮食障碍中心对多达261名ARFID患者（51%为女性；中位年龄 = 12.7岁）进行的横断面研究中，进行了症状水平的相关性分析和驱动因素水平的回归分析。
在三个驱动因素方面的症状，即1）基于食物感官特征的回避；2）明显缺乏进食兴趣；3）对不良后果的担忧，相互之间呈正相关。患者的焦虑特质与对进食不良后果担忧的症状显示出最强的正相关。患者性别与ARFID的三个驱动因素均无显著关联。患有共病自闭症谱系障碍（ASD；28%）的患者比无ASD的患者（49%）表现出更多与食物相关的感官敏感性（相对风险 = 1.26）和对进食更大的缺乏兴趣（相对风险 = 1.18）。
在我们的临床样本中，ARFID的驱动因素共同出现，且在性别之间未显示出具有临床意义的差异。ASD可能会加重与食物相关的感官敏感性和缺乏兴趣，但可能不会导致完全不同的症状表现。ARFID是多方面且异质的，需要进行全面的多学科评估，以充分理解限制性饮食行为的驱动因素。结果需要在具有更大统计效力的更大样本中进行重复验证。
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