Bone health in avoidant/restrictive food intake disorder: a narrative review

Abstract

Background Avoidant/restrictive food intake disorder (ARFID) is an eating/feeding disturbance characterized by severe food avoidance or restriction that results in faltering growth, nutritional deficiencies, dependence on formula supplementation, and/or significant psychosocial impairment. Compared to other eating disorders, ARFID is observed to have an earlier childhood onset and chronic course without intervention. Childhood represents a sensitive period for longitudinal growth and bone accrual, setting the stage for long-term health outcomes associated with longevity and quality of life, including risk for fracture and osteoporosis. Results This narrative review discusses published scientific literature on bone health in individuals with ARFID by describing the current understanding of ARFID’s effect on bone health, how common dietary constraints characteristic of ARFID may present unique risks to bone health, and the current clinical recommendations for bone health assessment. Reviewing what is known of clinical data from anorexia nervosa (AN) and similar cohorts, the chronicity and etiology of dietary restriction observed in ARFID are hypothesized to compromise bone health significantly. Although limited, examination of bone health in ARFID patients suggests children with ARFID tend to have shorter stature compared to healthy reference datasets and have lower bone density compared to healthy individuals, similar to those with AN. There remains a substantial knowledge gap in how ARFID may interrupt bone accrual during childhood and adolescence, and subsequent impact on attainment of peak bone mass and peak bone strength. The longitudinal effects of ARFID may be subtle and overlooked clinically in the absence of severe weight loss or growth stunting. Early identification and remediation of threats to bone mass accrual have significant personal and population-level implications. Conclusion For patients with ARFID, delayed identification and intervention to address feeding disturbances may have a long-lasting impact on various body systems and processes, including those relating to longitudinal growth and bone mass accrual. Further research employing rigorous prospective observational and/or randomized study designs are required to clearly define effects of ARFID, as well as clinical interventions aimed at addressing ARFID-related feeding disturbances, on bone accrual.

Health behavior and psychological treatment utilization in adults with avoidant/restrictive food intake disorder symptoms

“…According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5; 3) ARFID results in nutrient or energy deficiencies and can be associated with significant weight loss (or failure to achieve expected growth in children), significant nutritional deficiency, dependence on enteral feeding or nutritional supplements, and/or marked interference with psychosocial functioning [ 3 , 4 ]. Research in children and adults suggests that these health consequences are also linked to further health risk, for instance, decreased bone density [ 5 ] and higher rates of medical comorbidities (e.g., endocrine dysfunction and asthma [ 2 ]). In contrast to other eating disorders, such as anorexia nervosa, ARFID is not associated with body image and weight concerns [ 3 ].…”