A Diet High in Processed Foods, Total Carbohydrates and Added Sugars, and Low in Vegetables and Protein Is Characteristic of Youth with Avoidant/Restrictive Food Intake Disorder

Abstract

Avoidant/restrictive food intake disorder (ARFID) is characterized in part by limited dietary variety, but dietary characteristics of this disorder have not yet been systematically studied. Our objective was to examine dietary intake defined by diet variety, macronutrient intake, and micronutrient intake in children and adolescents with full or subthreshold ARFID in comparison to healthy controls. We collected and analyzed four-day food record data for 52 participants with full or subthreshold ARFID, and 52 healthy controls, aged 9–22 years. We examined frequency of commonly reported foods by logistic regression and intake by food groups, macronutrients, and micronutrients between groups with repeated-measures ANOVA. Participants with full or subthreshold ARFID did not report any fruit or vegetable category in their top five most commonly reported food categories, whereas these food groups occupied three of the top five groups for healthy controls. Vegetable and protein intake were significantly lower in full or subthreshold ARFID compared to healthy controls. Intakes of added sugars and total carbohydrates were significantly higher in full or subthreshold ARFID compared to healthy controls. Individuals with full or subthreshold ARFID had lower intake of vitamins K and B12, consistent with limited vegetable and protein intake compared to healthy controls. Our results support the need for diet diversification as part of therapeutic interventions for ARFID to reduce risk for nutrient insufficiencies and related complications.

Medical comorbidities and endocrine dysfunction in low‐weight females with avoidant/restrictive food intake disorder compared to anorexia nervosa and healthy controls

“…Despite similar low weight and leptin levels in ARFID and AN, a greater waist‐to‐hip ratio (marker of visceral fat) was observed in ARFID. This may reflect dietary differences, that is, a calorie‐dense diet in ARFID (Harshman et al, ) versus a low‐calorie diet in AN. However, waist‐to‐hip ratio no longer differed after controlling for age, indicating that this may simply reflect differences in developmental stage.…”

“…However, ARFID is driven by low appetite, sensory sensitivities, and/or fear of aversive consequences, rather than body image concerns. While individuals with AN often limit food intake to low‐calorie options, those with ARFID favor a calorie‐dense diet high in processed foods, carbohydrates, and added sugars, and low in vegetables and protein (Harshman et al, ). Unlike AN (characterized by low weight), ARFID spans the weight spectrum from underweight to obesity, demonstrating the heterogeneity and complexity of its underlying pathophysiology.…”

Failure to Thrive in the Outpatient Clinic: A New Insight

“…According to the current evidence, we support the need for diet diversification as part of therapeutic interventions for ARFID to reduce the risk of nutrient insufficiencies and related complications [96].…”

“…Electrolyte imbalances, fat-soluble and B vitamins deficiency as well as mercury toxicity may be associated problems [93][94][95]. Harshman et al demonstrated that children with full or sub-threshold ARFID have a significantly higher intake of added sugars, and a lower intake of vitamins K and B12, consistent with limited vegetable and protein intake compared to healthy controls [96].…”

Childhood Eating and Feeding Disturbances

“…Clinical descriptions of avoidant/restrictive food intake disorder highlight a reduced dietary intake of a limited volume and variety of foods. For a systematic characterization of intake, Harshman et al [9] evaluated the dietary variety in youth aged 9-22 years with this disorder using food records. Individuals with full or subthreshold avoidant/restrictive food intake disorder reported a lower consumption of vegetables or fruit, lower intake of protein, and relatedly, of specific vitamins (e.g., vitamins K and B12), but a higher intake of added sugars and total carbohydrates when compared to healthy controls.…”