Cargando…

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

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Cucinotta, Ugo, Romano, Claudio, Dipasquale, Valeria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10454601/
https://www.ncbi.nlm.nih.gov/pubmed/37628443
http://dx.doi.org/10.3390/healthcare11162245
_version_ 1785096233695576064
author Cucinotta, Ugo
Romano, Claudio
Dipasquale, Valeria
author_facet Cucinotta, Ugo
Romano, Claudio
Dipasquale, Valeria
author_sort Cucinotta, Ugo
collection PubMed
description 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.
format Online
Article
Text
id pubmed-10454601
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-104546012023-08-26 A Systematic Review to Manage Avoidant/Restrictive Food Intake Disorders in Pediatric Gastroenterological Practice Cucinotta, Ugo Romano, Claudio Dipasquale, Valeria Healthcare (Basel) Systematic Review 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. MDPI 2023-08-10 /pmc/articles/PMC10454601/ /pubmed/37628443 http://dx.doi.org/10.3390/healthcare11162245 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Cucinotta, Ugo
Romano, Claudio
Dipasquale, Valeria
A Systematic Review to Manage Avoidant/Restrictive Food Intake Disorders in Pediatric Gastroenterological Practice
title A Systematic Review to Manage Avoidant/Restrictive Food Intake Disorders in Pediatric Gastroenterological Practice
title_full A Systematic Review to Manage Avoidant/Restrictive Food Intake Disorders in Pediatric Gastroenterological Practice
title_fullStr A Systematic Review to Manage Avoidant/Restrictive Food Intake Disorders in Pediatric Gastroenterological Practice
title_full_unstemmed A Systematic Review to Manage Avoidant/Restrictive Food Intake Disorders in Pediatric Gastroenterological Practice
title_short A Systematic Review to Manage Avoidant/Restrictive Food Intake Disorders in Pediatric Gastroenterological Practice
title_sort systematic review to manage avoidant/restrictive food intake disorders in pediatric gastroenterological practice
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10454601/
https://www.ncbi.nlm.nih.gov/pubmed/37628443
http://dx.doi.org/10.3390/healthcare11162245
work_keys_str_mv AT cucinottaugo asystematicreviewtomanageavoidantrestrictivefoodintakedisordersinpediatricgastroenterologicalpractice
AT romanoclaudio asystematicreviewtomanageavoidantrestrictivefoodintakedisordersinpediatricgastroenterologicalpractice
AT dipasqualevaleria asystematicreviewtomanageavoidantrestrictivefoodintakedisordersinpediatricgastroenterologicalpractice
AT cucinottaugo systematicreviewtomanageavoidantrestrictivefoodintakedisordersinpediatricgastroenterologicalpractice
AT romanoclaudio systematicreviewtomanageavoidantrestrictivefoodintakedisordersinpediatricgastroenterologicalpractice
AT dipasqualevaleria systematicreviewtomanageavoidantrestrictivefoodintakedisordersinpediatricgastroenterologicalpractice