Low bone mineral density is found in low weight female youth with avoidant/restrictive food intake disorder and associated with higher PYY levels

Abstract

Background Avoidant/restrictive food intake disorder (ARFID) is a restrictive eating disorder commonly associated with medical complications of undernutrition and low weight. In adolescence, a critical time for bone accrual, the impact of ARFID on bone health is uncertain. We aimed to study bone health in low-weight females with ARFID, as well as the association between peptide YY (PYY), an anorexigenic hormone with a role in regulation of bone metabolism, and bone mineral density (BMD) in these individuals. We hypothesized that BMD would be lower in low-weight females with ARFID than healthy controls (HC), and that PYY levels would be negatively associated with BMD. Methods We performed a cross-sectional study in 14 adolescent low-weight females with ARFID and 20 HC 10–23 years old. We assessed BMD (total body, total body less head and lumbar spine) using dual x-ray absorptiometry (DXA) and assessed fasting total PYY concentration in blood. Results Total body BMD Z-scores were significantly lower in ARFID than in HC (− 1.41 ± 0.28 vs. − 0.50 ± 0.25, p = 0.021). Mean PYY levels trended higher in ARFID vs. HC (98.18 ± 13.55 pg/ml vs. 71.40 ± 5.61 pg/ml, p = 0.055). In multivariate analysis within the ARFID group, PYY was negatively associated with lumbar BMD adjusted for age (β = -0.481, p = 0.032). Conclusion Our findings suggest that female adolescents with low-weight ARFID may have lower BMD than healthy controls and that higher PYY levels may be associated with lower BMD at some, but not all, sites in ARFID. Further research with larger samples will be important to investigate whether high PYY drives bone loss in ARFID.

The relationship between food selectivity and stature in pediatric patients with avoidant-restrictive food intake disorder – an electronic medical record review

“…We found that smaller body size, as indicated by a lower weight and/or BMI Z-score, as well as lower intake of several key nutrients in musculoskeletal development, calcium and vitamin D, were inversely correlated with height Z-score. Results from this small, cross-sectional investigation of medical record data support the limited data available in the literature and affirms the need for rigorous research involving growth in pediatric patients with ARFID [ 6 , 8 , 9 ].…”

“…Children may experience comorbid psychosocial and cognitive disturbances because of malnutrition, including anxiety and depression, along with comorbid eating disorders [ 11 , 28 – 30 ]. Moreover, malnutrition may have a substantial impact on physiologic functions, such as hormonal pathways (e.g., menarche and menstruation) and bone mass accrual [ 9 ]. It is well known that malnutrition interferes with hypothalamic pathways, causing amenorrhea due to lack of estrogen [ 18 ].…”

“…There is extensive research in pediatric patients with anorexia nervosa (AN) indicating that malnutrition from restricted intake, particularly when co-occurring with low BMI, is associated with deficits in longitudinal growth and bone accrual [ 6 , 7 ]. Growth in stature and bone accrual might also be threatened in ARFID [ 8 , 9 ], but there is need for additional research given that ARFID typically has an earlier onset and a more chronic course compared to AN [ 6 , 8 , 10 – 12 ].…”

Physical health complications in children and young people with avoidant restrictive food intake disorder (ARFID): a systematic review and meta-analysis

“…We found 12 studies that reported data on BMD within ARFID ( online supplemental table 1 ) 22 24 25 59 84–88 ; eight of which were case studies, 59 70 80 81 84–87 one compared BMD in ARFID to HC 22 and two compared BMD in ARFID to AN. 24 25 …”

“…In the one study that compared BMD z-scores in ARFID to HC, individuals with ARFID had significantly lower BMD z-scores in Total body (−1.41 vs −0.5; p=0.021) and total body less head (−1.67 vs −0.74; p=0.055); however, in the lumbar spine the difference not significant (−0.95 vs −0.67). 22 …”