{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T21:26:22Z","timestamp":1783545982197,"version":"3.55.0"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"Importance<\/jats:title>Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder characterized by limited variety and\/or quantity of food intake impacting physical health and psychosocial functioning. Children with ARFID often present with diverse psychiatric and somatic symptoms and therefore consult various pediatric subspecialties. Large-scale studies mapping coexisting conditions are, however, lacking.<\/jats:p><\/jats:sec>Objective<\/jats:title>To characterize the health care needs of youth with ARFID.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study used the Child and Adolescent Twin Study in Sweden (CATSS), in combination with inpatient and specialized outpatient clinical diagnoses from the Swedish National Patient Register. Data were collected from July 2004 to April 2020, and data were analyzed from September 2022 to February 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Using a composite measure derived from parent or guardian reports and register data, children with the broad ARFID phenotype occurring between the ages of 6 to 12 years were identified, as well as children without ARFID.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>From more than 1000 diagnostic International Classification of Diseases <\/jats:italic>(ICD<\/jats:italic>) codes, mental and somatic conditions within or across ICD<\/jats:italic> chapters, the number of distinct per-person diagnoses, and inpatient treatment days between participants\u2019 birth and 18th birthdays were specified (90 outcomes). Hazard ratios (HRs) and incidence rate ratios (IRRs) were calculated.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 30\u202f795 CATSS participants, a total of 616 children (2.0%) with the broad ARFID phenotype occurring between the ages of 6 to 12 years were identified, and 30\u202f179 children without ARFID were identified. Of 616 children with ARFID, 241 children were female (39.1%). Relative risks of neurodevelopmental, gastrointestinal, endocrine or metabolic, respiratory, neurological, and allergic disorders were substantially increased in children with ARFID (eg, autism: HR, 9.7; 95% CI, 7.5-12.5; intellectual disability: HR, 10.3; 95% CI, 7.6-13.9; gastroesophageal reflux disease: HR, 6.7; 95% CI, 4.6-9.9; pituitary conditions: HR, 5.6; 95% CI, 2.7-11.3; chronic lower respiratory diseases: HR, 4.9; 95% CI, 2.4-10.1; and epilepsy: HR, 5.8; 95% CI, 4.1-8.2). ARFID was not associated with elevated risks of autoimmune illnesses and obsessive-compulsive disorder. Children with ARFID had significantly more distinct mental diagnoses (IRR, 4.7; 95% CI, 4.0-5.4) and longer hospital stays (IRR, 5.5; 95% CI, 1.7-17.6) compared with children without ARFID. Children with ARFID were diagnosed with a mental condition earlier than children without ARFID. No sex-specific differences emerged.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cohort study yields the broadest and most detailed evidence of coexisting mental and somatic conditions in the largest sample of children with ARFID to date. Findings suggest a complex pattern of health needs in youth with ARFID, underscoring the critical importance of attention to the illness across all pediatric specialties.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2024.6065","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T16:32:37Z","timestamp":1739809957000},"page":"428","source":"Crossref","is-referenced-by-count":17,"title":["Mental and Somatic Conditions in Children With the Broad Avoidant Restrictive Food Intake Disorder Phenotype"],"prefix":"10.1001","volume":"179","author":[{"given":"Marie-Louis","family":"Wronski","sequence":"first","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts"},{"name":"Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany"},{"name":"Department of General Internal Medicine, Spital Interlaken, Spit\u00e4ler Frutigen Meiringen Interlaken AG, Unterseen, Canton Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Kuja-Halkola","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elin","family":"Hedlund","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam I.","family":"Martini","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Lichtenstein","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Lundstr\u00f6m","sequence":"additional","affiliation":[{"name":"Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Larsson","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"School of Medical Sciences, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Micali","sequence":"additional","affiliation":[{"name":"Center for Eating and Feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital \u2013 Mental Health Services CPH, Copenhagen, Denmark"},{"name":"Institute for Biological Psychiatry, Mental Health Centre Sct Hans, Copenhagen University Hospital \u2013 Mental Health Services, Copenhagen, Denmark"},{"name":"Great Ormond Street Institute of Child Health, University College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia M.","family":"Bulik","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Psychiatry, University of North Carolina at Chapel Hill"},{"name":"Department of Nutrition, University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Dinkler","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"3","key":"poi240107r1","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1001\/jamapsychiatry.2022.4612","article-title":"Etiology of the broad avoidant restrictive food intake disorder phenotype in Swedish twins aged 6 to 12 years.","volume":"80","author":"Dinkler","year":"2023","journal-title":"JAMA Psychiatry"},{"issue":"12","key":"poi240107r2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2021.3861","article-title":"Incidence and age- and sex-specific differences in the clinical presentation of children and adolescents with avoidant restrictive food intake disorder.","volume":"175","author":"Katzman","year":"2021","journal-title":"JAMA Pediatr"},{"issue":"5","key":"poi240107r4","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.20m13831","article-title":"A moving target: how we define avoidant\/restrictive food intake disorder can double its prevalence.","volume":"82","author":"Harshman","year":"2021","journal-title":"J Clin Psychiatry"},{"issue":"4","key":"poi240107r5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-052889","article-title":"Differentiating eosinophilic esophagitis and eating\/feeding disorders.","volume":"149","author":"Cifra","year":"2022","journal-title":"Pediatrics"},{"issue":"6","key":"poi240107r6","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.4302","article-title":"Delayed diagnosis of avoidant\/restrictive food intake disorder and autism spectrum disorder in a 14-year-old boy.","volume":"9","author":"Rajendram","year":"2021","journal-title":"Clin Case Rep"},{"issue":"2","key":"poi240107r7","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1002\/erv.2964","article-title":"What do we know about the epidemiology of avoidant\/restrictive food intake disorder in children and adolescents? a systematic review of the literature.","volume":"31","author":"Sanchez-Cerezo","year":"2023","journal-title":"Eur Eating Disord Rev"},{"issue":"2","key":"poi240107r8","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1002\/eat.23191","article-title":"Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant\/restrictive food intake disorder.","volume":"53","author":"Kambanis","year":"2020","journal-title":"Int J Eat Disord"},{"issue":"4","key":"poi240107r9","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1002\/eat.23261","article-title":"Medical comorbidities and endocrine dysfunction in low-weight females with avoidant\/restrictive food intake disorder compared to anorexia nervosa and healthy controls.","volume":"53","author":"Aulinas","year":"2020","journal-title":"Int J Eat Disord"},{"issue":"6","key":"poi240107r10","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1002\/eat.23536","article-title":"The diagnosis of avoidant restrictive food intake disorder in the presence of gastrointestinal disorders: Opportunities to define shared mechanisms of symptom expression.","volume":"54","author":"Nicholas","year":"2021","journal-title":"Int J Eat Disord"},{"issue":"7","key":"poi240107r11","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1097\/MCG.0000000000001853","article-title":"The intersection of disorders of gut-brain interaction with avoidant\/restrictive food intake disorder.","volume":"57","author":"Weeks","year":"2023","journal-title":"J Clin Gastroenterol"},{"key":"poi240107r12","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2021.105243","article-title":"Ghrelin and PYY in low-weight females with avoidant\/restrictive food intake disorder compared to anorexia nervosa and healthy controls.","volume":"129","author":"Becker","year":"2021","journal-title":"Psychoneuroendocrinology"},{"issue":"3","key":"poi240107r13","doi-asserted-by":"publisher","DOI":"10.1002\/jcv2.12094","article-title":"Early neurodevelopmental problems and risk for avoidant\/restrictive food intake disorder (ARFID) in 4-7-year-old children: a Japanese birth cohort study.","volume":"2","author":"Dinkler","year":"2022","journal-title":"JCPP Adv"},{"issue":"1","key":"poi240107r14","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1186\/s40337-022-00654-2","article-title":"Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature.","volume":"10","author":"Hambleton","year":"2022","journal-title":"J Eating Disord"},{"issue":"1","key":"poi240107r15","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1186\/s40337-023-00908-7","article-title":"Birth-related, medical, and diagnostic characteristics in younger versus older children with avoidant\/restrictive food intake disorder (ARFID).","volume":"11","author":"Brosig","year":"2023","journal-title":"J Eating Disord"},{"issue":"6","key":"poi240107r16","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1375\/twin.14.6.495","article-title":"The Child and Adolescent Twin Study in Sweden (CATSS).","volume":"14","author":"Anckars\u00e4ter","year":"2011","journal-title":"Twin Res Hum Genetics"},{"key":"poi240107r18","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register.","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health"},{"issue":"7","key":"poi240107r19","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1002\/pds.1294","article-title":"The new Swedish Prescribed Drug Register\u2013opportunities for pharmacoepidemiological research and experience from the first six months.","volume":"16","author":"Wettermark","year":"2007","journal-title":"Pharmacoepidemiol Drug Safety"},{"issue":"1","key":"poi240107r21","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing.","volume":"57","author":"Benjamini","year":"1995","journal-title":"J Royal Stat Soc: Series B (Methodological)"},{"key":"poi240107r22","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.102190","article-title":"The clinical presentation of avoidant restrictive food intake disorder in children and adolescents is largely independent of sex, autism spectrum disorder and anxiety traits.","volume":"63","author":"Watts","year":"2023","journal-title":"EClinicalMedicine"},{"issue":"6","key":"poi240107r23","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1002\/eat.23553","article-title":"The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant\/restrictive food intake disorder: functional or pathophysiologic?-a systematic review.","volume":"54","author":"Gibson","year":"2021","journal-title":"Int J Eating Disord"},{"issue":"1","key":"poi240107r24","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s40337-023-00735-w","article-title":"Pulmonary complications of eating disorders: a literature review.","volume":"11","author":"Nitsch","year":"2023","journal-title":"J Eating Disord"},{"issue":"2","key":"poi240107r26","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.jaacop.2023.05.001","article-title":"Prevalence and characterization of avoidant restrictive food intake disorder in a pediatric population.","volume":"1","author":"Sader","year":"2023","journal-title":"JAACAP Open"},{"issue":"7","key":"poi240107r27","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1111\/jcpp.12958","article-title":"Bidirectional relationship between eating disorders and autoimmune diseases.","volume":"60","author":"Hedman","year":"2019","journal-title":"J Child Psychol Psychiatry"},{"issue":"16","key":"poi240107r28","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1001\/jama.2023.19207","article-title":"Large number of people diagnosed with type 1 diabetes after age 30.","volume":"330","author":"Harris","year":"2023","journal-title":"JAMA"},{"issue":"7","key":"poi240107r29","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1093\/rheumatology\/ket363","article-title":"Age at disease onset: a key factor for understanding psoriatic disease.","volume":"53","author":"Queiro","year":"2014","journal-title":"Rheumatology (Oxford)"},{"issue":"1","key":"poi240107r30","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1089\/cap.2014.0063","article-title":"Disordered eating and food restrictions in children with PANDAS\/PANS.","volume":"25","author":"Toufexis","year":"2015","journal-title":"J Child Adolesc Psychopharmacol"},{"issue":"6","key":"poi240107r31","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1111\/acps.13410","article-title":"Temporal changes in sex- and age-specific incidence profiles of mental disorders-a nationwide study from 1970 to 2016.","volume":"145","author":"Plana-Ripoll","year":"2022","journal-title":"Acta Psychiatrica Scand"},{"key":"poi240107r32","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.671631","article-title":"Feeding and eating disorder and risk of subsequent neurodevelopmental disorders: a population-based cohort study.","volume":"9","author":"Shan","year":"2021","journal-title":"Front Pediatr"},{"issue":"5","key":"poi240107r33","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1097\/MOP.0000000000001267","article-title":"Avoidant restrictive food intake disorder and pediatric feeding disorder: the pediatric gastroenterology perspective.","volume":"35","author":"Noel","year":"2023","journal-title":"Curr Opin Pediatr"},{"issue":"6","key":"poi240107r34","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1111\/dmcn.15139","article-title":"Avoidant\/restrictive food intake disorder and severe food selectivity in children and young people with autism: a scoping review.","volume":"64","author":"Bourne","year":"2022","journal-title":"Dev Med Child Neurol"},{"key":"poi240107r35","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102440","article-title":"Subtypes of avoidant\/restrictive food intake disorder in children and adolescents: a latent class analysis.","volume":"68","author":"Sanchez-Cerezo","year":"2024","journal-title":"EClinicalMedicine"},{"key":"poi240107r36","doi-asserted-by":"publisher","first-page":"S187","DOI":"10.1016\/j.jpeds.2016.04.055","article-title":"Child health systems in Sweden.","volume":"177S","author":"Wettergren","year":"2016","journal-title":"J Pediatr"},{"key":"poi240107r3","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2013","edition":"5th ed"},{"key":"poi240107r17","volume-title":"International Statistical Classification of Diseases and Related Health Problems, Tenth Revision","author":"World Health Organization","year":"1992"},{"key":"poi240107r20","unstructured":"The R Project for Statistical Computing. The R Foundation. Accessed January 10, 2024. https:\/\/www.R-project.org\/"},{"key":"poi240107r25","doi-asserted-by":"crossref","unstructured":"Nyholmer? M, Wronski? ML, Hog? L, . Neurodevelopmental and psychiatric conditions in 600 Swedish children with the ARFID phenotype.? medRxiv. Preprint posted online May 16, 2024. doi:10.1101\/2024.05.16.24307471","DOI":"10.1101\/2024.05.16.24307471"}],"container-title":["JAMA Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/articlepdf\/2830394\/jamapediatrics_wronski_2025_oi_240107_1743626871.59606.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T18:30:41Z","timestamp":1744050641000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/fullarticle\/2830394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":36,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamapediatrics.2024.6065","relation":{},"ISSN":["2168-6203"],"issn-type":[{"value":"2168-6203","type":"print"}],"subject":[],"published":{"date-parts":[[2025,4,1]]}}}