Sanchez-Cerezo Javier, Neale Josephine, Julius Nikita, Croudace Tim, Lynn Richard M, Hudson Lee D, Nicholls Dasha
Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK.
Department of Psychiatry, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
EClinicalMedicine. 2024 Feb 1;68:102440. doi: 10.1016/j.eclinm.2024.102440. eCollection 2024 Feb.
The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) describes three primary avoidant/restrictive food intake disorder (ARFID) subtypes including sensory sensitivity, lack of interest in food or eating, and fear of aversive consequences. Studies exploring these subtypes have yielded varying results. We used latent class analysis (LCA) based on the psychopathology of ARFID in a sample of children and adolescents to empirically identify classes.
We carried out a surveillance study of ARFID in collaboration with the British Paediatric Surveillance Unit (BPSU) and the Child and Adolescent Psychiatry Surveillance System (CAPSS) in the United Kingdom and the Republic of Ireland from 1st of March 2021 to 31st of March 2022. Paediatricians and child and adolescent psychiatrists were contacted monthly to report newly diagnosed cases of ARFID electronically and complete a detailed clinical questionnaire. Cases aged 5-18 years were included. LCA was performed specifying 1-6 classes and likelihood-based tests for model selection. The Bayesian Information Criterion (BIC), the Akaike Information Criterion (AIC) and the Sample-Size Adjusted BIC were used to determine the most parsimonious model. Analysis of variance (ANOVA) and χ2 tests were used to compare the characteristics of the identified classes. A multinomial logistic regression (MLR) was performed to investigate predicting factors for the latent classes.
We identified 319 children and adolescents with ARFID. LCA revealed four distinct classes which were labelled as , , , and . The probability of being classified as these were 7.2% ( = 23), 25.1% ( = 80), 29.5% ( = 94) and 38.2% ( = 122), respectively. Age at diagnosis, sex, weight loss, distress associated with eating, and autism spectrum disorder diagnosis were identified as predictors of class membership.
LCA identified four different classes in a sample of children and adolescents with ARFID. The , a mixed presentation was the most common. The other three classes resembled the subtypes described in the literature. Clinicians should be aware of these different presentations of ARFID as they may benefit from different clinical interventions.
This study was funded by the Former EMS Ltd (charity number 1098725, registered October 9th 2017).
《精神疾病诊断与统计手册》第五版（DSM - 5）描述了三种主要的回避/限制性食物摄入障碍（ARFID）亚型，包括感官敏感、对食物或进食缺乏兴趣以及害怕不良后果。探索这些亚型的研究得出了不同的结果。我们在儿童和青少年样本中基于ARFID的精神病理学进行潜在类别分析（LCA），以实证确定类别。
我们于2021年3月1日至2022年3月31日与英国儿科监测单位（BPSU）以及英国和爱尔兰共和国的儿童与青少年精神病学监测系统（CAPSS）合作开展了一项ARFID监测研究。每月联系儿科医生和儿童与青少年精神科医生，以电子方式报告新诊断的ARFID病例并完成一份详细的临床问卷。纳入年龄在5 - 18岁的病例。进行LCA，指定1 - 6个类别，并进行基于似然性的模型选择测试。使用贝叶斯信息准则（BIC）、赤池信息准则（AIC）和样本量调整后的BIC来确定最简约的模型。使用方差分析（ANOVA）和χ²检验来比较所确定类别的特征。进行多项逻辑回归（MLR）以研究潜在类别的预测因素。
我们确定了319名患有ARFID的儿童和青少年。LCA揭示了四个不同的类别，分别标记为 、 、 和 。被归类为这些类别的概率分别为7.2%（ = 23）、25.1%（ = 80）、29.5%（ = 94）和38.2%（ = 122）。诊断年龄、性别、体重减轻、与进食相关的困扰以及自闭症谱系障碍诊断被确定为类别归属的预测因素。
LCA在患有ARFID的儿童和青少年样本中确定了四个不同的类别。 ，一种混合表现形式是最常见的。其他三个类别类似于文献中描述的亚型。临床医生应意识到ARFID的这些不同表现形式，因为他们可能会从不同的临床干预中受益。
本研究由前EMS有限公司（慈善编号1098725，2017年10月9日注册）资助。
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