Pitfalls and Risks of “New Eating Disorders”: Let the Expert Speak!

Salatto, Alessia; Riccio, Maria Pia; Garotti, Raffaele; Bravaccio, Carmela; Spagnuolo, Maria Immacolata

doi:10.3390/nu15061307

Cited by 1 publication

(1 citation statement)

References 27 publications

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“…ARFID can result in a wide range of health problems, including malnutrition, nutritional deficiencies, poor linear growth, dependence on tube feeding or high-energy food supplements, hospitalization for nutritional rehabilitation, and a significant impact on the quality of life (QoL) of both children and their families [ 5 , 6 , 7 , 8 ]. Not infrequently, children and adolescents with ARFID may exhibit signs and symptoms commonly seen in primary care and gastroenterology, such as abdominal pain, vomiting, or low weight and failure to thrive, which may coexist with ARFID and mask this condition [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review to Manage Avoidant/Restrictive Food Intake Disorders in Pediatric Gastroenterological Practice

2023

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Avoidant/Restrictive food intake disorder (ARFID) is a feeding disorder characterized by persistent difficulty eating, such as limited choices of preferred foods, avoidance or restriction of certain foods or food groups, and negative emotions related to eating or meals. Although ARFID mainly affects children, it can also occur in adolescents and adults. ARFID can have serious physical and mental health consequences, including stunted growth, nutritional deficiencies, anxiety, and other psychiatric comorbidities. Despite its increasing importance, ARFID is relatively underrecognized and undertreated in clinical practice. Treatment consists of a multidisciplinary approach involving pediatric gastroenterologists, nutritionists, neuropsychiatrists, and psychologists. However, there are several gaps in the therapeutic approach for this condition, mainly due to the lack of interventional trials and the methodological variability of existing studies. Few studies have explored the nutritional management of ARFID, and no standardized guidelines exist to date. We performed a systematic literature review to describe the different nutritional interventions for children and adolescents diagnosed with ARFID and to assess their efficacy and tolerability. We identified seven retrospective cohort studies where patients with various eating and feeding disorders, including ARFID, underwent nutritional rehabilitation in hospital settings. In all studies, similar outcomes emerged in terms of efficacy and tolerability. According to our findings, the oral route should be the preferred way to start the refeeding protocol, and the enteral route should be generally considered a last resort for non-compliant patients or in cases of clinical instability. The initial caloric intake may be adapted to the initial nutritional status, but more aggressive refeeding regimens appear to be well tolerated and not associated with an increased risk of clinical refeeding syndrome (RS). In severely malnourished patients, however, phosphorus or magnesium supplementation may be considered to prevent the risk of electrolyte imbalance, or RS.

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