Risk factors for avoidant/restrictive food intake disorder in children: A systematic review

OBJECTIVES: Avoidant/restrictive food intake disorder (ARFID) is a relatively new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, since 2013. The restrictive and/or selective eating-driven by a lack of interest, sensory sensitivity, and/or concern over aversive consequences-is associated with significant medical and/or psychosocial problems. However, little is known about risk factors of this feeding/eating disorder. Our objective was to investigate which factors predispose to ARFID in children. METHODS: Databases CINAHL, Embase, PsycINFO, PubMed, and Web of Science were searched to identify peer-reviewed articles published from inception to August 27, 2024. Articles that included children with ARFID, a control group, and a potential risk factor were selected. RESULTS: A total of six studies were included in this review. In these studies, data regarding potential risk factors and their risk of bias were evaluated. All studies were of cross-sectional design. Despite an extensive search strategy, only a small number of studies could be included for analysis. A total of 18 factors were reported, of which 10 factors were significantly associated with ARFID. These factors include physical factors, psychiatric comorbidities, and maternal psychopathological risk. CONCLUSIONS: This systematic review shows which factors are associated with ARFID in children. To better clarify the direction of associations between potential risk factors and ARFID, longitudinal and interventional studies are needed. This knowledge may support early recognition and timely intervention in ARFID.