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- Title
Bone health in avoidant/restrictive food intake disorder: a narrative review.
- Authors
Proctor, Kaitlin B.; Rodrick, Eugene; Belcher, Staci; Sharp, William G.; Kindler, Joseph M.
- 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. Plain English summary: An extensive body of evidence reports threatened bone health in people with eating disorders, focusing primarily on people with anorexia nervosa. The Diagnostic and Statistical Manual of Mental Disorders (DSM) Fifth Edition reclassified and expanded upon the DSM-IV diagnosis of "feeding disorder of infancy or early childhood," introducing a new diagnostic term, avoidant/restrictive food intake disorder (ARFID). This has led to an increased need to understand effects of ARFID on bone health. Among the studies that have reported bone health outcomes in people with ARFID, authors have reported shorter stature and lower bone mineral density (BMD) in children and adults with ARFID compared to reference datasets. Malnutrition resulting in under-consumption of energy and/or nutrients that are integral to bone health can also cause conditions that impact the musculoskeletal system, including low body weight, scurvy due to vitamin C deficiency, and rickets due to vitamin D deficiency. Research in individuals with ARFID focusing on longitudinal changes in BMD, bone micro-structure, and bone strength during clinical intervention are required. These efforts will help identify long-term health risks in people with ARFID, inform comprehensive medical assessment, improve long-term health outcomes, and provide a benchmark for assessing treatment outcomes over time.
- Subjects
DIAGNOSTIC &; Statistical Manual of Mental Disorders (Book); BONE health; STUNTED growth; FOOD consumption; INGESTION disorders; VITAMIN C deficiency; SCIENTIFIC literature; BONE density; LUMBAR vertebrae
- Publication
Journal of Eating Disorders, 2023, Vol 11, Issue 1, p1
- ISSN
2050-2974
- Publication type
Article
- DOI
10.1186/s40337-023-00766-3