{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T05:45:48Z","timestamp":1782539148448,"version":"3.54.5"},"reference-count":13,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Avoidant\/restrictive food intake disorder (ARFID) and selective eating are increasingly recognized in pediatric nutrition, but food selectivity has been predominantly studied in dedicated eating disorder settings and in underweight children, potentially underestimating its prevalence across broader clinical populations. This study aimed to characterize food selectivity as a transdiagnostic feature in children referred to a tertiary pediatric nutrition center, regardless of referral diagnosis or BMI status. Methods: This retrospective observational study included 417 consecutive children and adolescents (median age 9.3 years, IQR 4.1\u201312.9; 47.5% male) assessed at the General Pediatric Eating Disorders Outpatient Unit of Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, Rome, Italy, between May 2024 and April 2026. Food selectivity was defined as clinician-documented avoidance of at least one of four food groups (vegetables, fruit, fish, and legumes). Patients were classified as having primary selective eating\/ARFID (Group A, n = 141), unrecognized selective eating (Group B, n = 163), or no selectivity (Group C, n = 113). Results: Food selectivity was identified in 293 patients (70.3%), including 70.8% of those referred for obesity or overweight and 50.0% of those referred for eating disorders. Prevalence did not differ across BMI categories (p = 0.554), confirming that selective eating is independent of anthropometric status. Ferritin deficiency showed a significant gradient across groups (Group A 32.2%, Group B 17.9%, Group C 10.8%; p = 0.002). Screen use during meals and ultra-processed food consumption were similarly elevated in Groups A and B and significantly higher than in Group C (p = 0.002 and p &lt; 0.001, respectively), with no difference between the two selective groups. Conclusions: Food selectivity is a transdiagnostic and BMI-independent feature affecting the majority of children referred for pediatric nutritional evaluation. Children with unrecognized selective eating share the same nutritional risks and behavioral correlates as those formally diagnosed with ARFID, supporting the integration of a brief food group avoidance screen into routine nutritional assessment regardless of the primary referral diagnosis.<\/jats:p>","DOI":"10.3390\/nu18132059","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T01:03:56Z","timestamp":1782349436000},"page":"2059","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Avoidant\/Restrictive Food Intake and Selective Eating in Children: Clinical Profile, Nutritional Deficiencies, and Behavioral Correlates in a Tertiary Pediatric Center"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0316-6359","authenticated-orcid":false,"given":"Livia","family":"Gargiullo","sequence":"first","affiliation":[{"name":"General Pediatrics, Infectious Diseases and Level II Pediatric Emergency Department Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Colistra","sequence":"additional","affiliation":[{"name":"General Pediatrics, Infectious Diseases and Level II Pediatric Emergency Department Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Grandin","sequence":"additional","affiliation":[{"name":"General Pediatrics, Infectious Diseases and Level II Pediatric Emergency Department Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosaria","family":"Marotta","sequence":"additional","affiliation":[{"name":"General Pediatrics, Infectious Diseases and Level II Pediatric Emergency Department Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Italo","family":"Pretelli","sequence":"additional","affiliation":[{"name":"Anorexia and Eating Disorders Unit, Child and Adolescent Psychiatry Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica","family":"Ricci","sequence":"additional","affiliation":[{"name":"Pediatrics Residency Program, Department of Pediatrics, University of Rome Tor Vergata, 00100 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"Irrera","sequence":"additional","affiliation":[{"name":"General Pediatrics, Infectious Diseases and Level II Pediatric Emergency Department Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3316-957X","authenticated-orcid":false,"given":"Antonio","family":"Musolino","sequence":"additional","affiliation":[{"name":"General Pediatrics, Infectious Diseases and Level II Pediatric Emergency Department Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Tarissi de Jacobis","sequence":"additional","affiliation":[{"name":"General Pediatrics, Infectious Diseases and Level II Pediatric Emergency Department Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rosaria","family":"Marchili","sequence":"additional","affiliation":[{"name":"General Pediatrics, Infectious Diseases and Level II Pediatric Emergency Department Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9120-0424","authenticated-orcid":false,"given":"Alberto","family":"Villani","sequence":"additional","affiliation":[{"name":"General Pediatrics, Infectious Diseases and Level II Pediatric Emergency Department Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.appet.2017.11.111","article-title":"Initial validation of the Nine Item Avoidant\/Restrictive Food Intake disorder screen (NIAS): A measure of three restrictive eating patterns","volume":"123","author":"Zickgraf","year":"2018","journal-title":"Appetite"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.arcped.2019.08.005","article-title":"Nutritional risks of ARFID (avoidant restrictive food intake disorders) and related behavior","volume":"26","author":"Feillet","year":"2019","journal-title":"Arch. 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Child Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1001\/jamapediatrics.2025.4786","article-title":"Prevalence, Characteristics, and Genetic Architecture of Avoidant\/Restrictive Food Intake Phenotypes","volume":"180","author":"Corfield","year":"2026","journal-title":"JAMA Pediatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e19444","DOI":"10.7717\/peerj.19444","article-title":"Adult picky eating and associations with childhood picky eating, maternal feeding, aversive sensory responsiveness, disgust and obsessive-compulsive symptoms","volume":"13","author":"Zohar","year":"2025","journal-title":"PeerJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.jand.2020.10.017","article-title":"Nutritional Deficiency Disease Secondary to ARFID Symptoms Associated with Autism and the Broad Autism Phenotype: A Qualitative Systematic Review of Case Reports and Case Series","volume":"121","author":"Yule","year":"2021","journal-title":"J. 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Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"851","DOI":"10.32641\/andespediatr.v93i6.3903","article-title":"Parental feeding strategies in children with Avoidant\/Restrictive Food Intake Disorder (ARFID): Association with food refusal behavior","volume":"93","author":"Saravia","year":"2022","journal-title":"Andes Pediatr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/13\/2059\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T04:51:14Z","timestamp":1782535874000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/13\/2059"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":13,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["nu18132059"],"URL":"https:\/\/doi.org\/10.3390\/nu18132059","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]}}}