| 1. |
|
|
| 2. |
- Dinkler, Lisa, et al.
(författare)
-
Heritability of the Avoidant/Restrictive Food Intake Disorder (ARFID) Phenotype in 6-to-12-Year-Old Swedish Twins
- 2022
-
Ingår i: Behavior Genetics. - : Springer. - 0001-8244 .- 1573-3297. ; 52:6, s. 357-357
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Little is known about the etiology of avoidant/restrictive food intake disorder (ARFID) and no twin studies of ARFID exist yet. Validated screening instruments for ARFID are only starting to emerge and accordingly, few large-scale epidemiological studies specifically aimed at measuring ARFID are available. We leveraged the rich existing datasets of the Swedish Twin Registry to develop a proxy for the ARFID phenotype and determine its twin-based heritability. We extracted all data relevant to ARFID from the Child and Adolescent Twin Study in Sweden and national health registers, and identified children with avoidant/restrictive eating with clinically significant impact, but without body image concerns such as fear of weight gain and excluding major medical illnesses that could account for the eating behavior. Among 34,382 twins born 1992–2010, 678 children (2.0%, 39% female) were identified with the ARFID phenotype between age 6 and 12 years. In the best fitting model, variation in the liability to ARFID was largely explained by additive genetic factors (0.80, 95% confidence interval [CI] 0.71–0.86), with significant contributions from non-shared environmental factors (0.20, 95% CI 0.14–0.29) and sibling contrast effects (-0.11, 95% CI -0.16—-0.04). Prevalence and sex distribution of the ARFID phenotype were similar to previous studies, supporting the use of epidemiological data to identify ARFID. This first heritability estimate of ARFID suggests that ARFID is highly heritable, encouraging future twin and molecular genetic studies. In a next step we will use multivariate twinmodels to test whether, etiologically, ARFID is related to neurod-velopmental disorders.
|
|
| 3. |
- Dinkler, Lisa
(författare)
-
Restrictive eating disorders: aetiological, epidemiological and neurodevelopmental aspects
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Restrictive Eating Disorders (EDs), including Avoidant/Restrictive Food Intake Disorder (ARFID) and Anorexia Nervosa (AN), are characterised by severely restricted food intake, commonly leading to substantial weight loss and significantly low weight, and the need for nutritional supplementation. The overarching aim of this thesis was to elucidate specific aetiological, epidemiological, and neurodevelopmental aspects of ARFID and AN, including the genetic aetiology of AN, the link between AN and autism spectrum disorder (ASD), the prevalence of ARFID, and the comorbidity of ARFID with neurodevelopmental disorders (NDDs). Studies I and II were based on the Child and Adolescent Twin Study in Sweden, making use of parent- and/or child-reported survey data and clinical diagnoses from the Swedish National Patient Register. Using twin modelling, Study I examined whether adolescent-onset EDs (excluding ARFID) can be viewed aetiologically as the extreme manifestation of continuous variation in ED traits in the population (e.g., drive for thinness). Genetic factors influencing continuous variation of ED traits were less associated with AN than with other EDs, suggesting that EDs other than AN are on an aetiological continuum with ED traits, while AN is more genetically demarcated. Considering the previously observed overrepresentation of autistic traits in individuals with AN, Study II prospectively examined whether autistic traits in AN are already present in childhood. Individuals later diagnosed with AN did not show elevated autistic traits at age 9. At age 18, autistic traits were elevated in girls with acute AN, but not in girls with a history of AN. Potential elevations of autistic traits in childhood might have been concealed by coping strategies and the different/less overt female ASD phenotype. Using a novel experimental design, Study III examined the ability and strategy to recognise facial emotional expressions—often impaired in ASD—in women recovered from AN who were part of the 30-year follow-up in a Swedish case-control study. Women recovered from AN without ASD did not have deficits in emotion recognition, suggesting that impairments might be limited to the acute AN phase and/or the ASD subgroup. Studies IV and V were based on a parent-reported screening tool for ARFID developed by our group, applied in a sub-cohort of 4-7-year-old children from the Japan Environment and Children's Study. Study IV aimed to estimate the prevalence of ARFID and found a point prevalence of ~1%. ARFID was equally common in boys and girls. Using ICD-11 diagnostic criteria resulted in a higher prevalence than using DSM-5 criteria. Taking advantage of additional parent-reported data, Study V found that children with ARFID had an elevated risk of a broadly atypical/delayed neurodevelopment and a 3-4 times increased likelihood of being diagnosed with NDDs. In summary, this thesis showed that AN might have a different aetiology than other adolescent-onset EDs, and that prospective studies are important to help disentangle the relationship between AN and ASD. Contrary to AN, ARFID is associated with increased risk for a range of neurodevelopmental problems/NDDs. Future studies should investigate whether ARFID in young children might be more strongly associated with NDDs than with later-onset EDs.
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
- Wronski, Marie-Louis, et al.
(författare)
-
Co-existing mental and somatic conditions in Swedish children with the avoidant restrictive food intake disorder phenotype
- 2024
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: 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 a range of psychiatric and somatic symptoms, and therefore consult various pediatric subspecialties; large-scale studies mapping comorbidities are however lacking. To characterize health care needs of people with ARFID, we systematically investigated ARFID-related mental and somatic conditions in 616 children with ARFID and >30,000 children without ARFID.METHODS: In a Swedish twin cohort, we identified the ARFID phenotype in 6-12-year-old children based on parent-reports and register data. From >1,000 diagnostic ICD-codes, we specified mental and somatic conditions within/across ICD-chapters, number of distinct per-person diagnoses, and inpatient treatment days between birth and 18th birthday (90 outcomes). Hazard ratios (HR) and incidence rate ratios (IRR) were calculated.FINDINGS: Relative risks of neurodevelopmental, gastrointestinal, endocrine/metabolic, respiratory, neurological, and allergic disorders were substantially increased in ARFID (e.g., autism HR[CI95%]=9.7[7.5-12.5], intellectual disability 10.3[7.6-13.9], gastroesophageal reflux disease 6.7[4.6-9.9], pituitary conditions 5.6[2.7-11.3], chronic lower respiratory diseases 4.9[2.4-10.1], epilepsy 5.8[4.1-8.2]). ARFID was not associated with elevated risks of autoimmune illnesses and obsessive-compulsive disorder. Children with ARFID had a significantly higher number of distinct mental diagnoses (IRR[CI95%]=4.7[4.0-5.4]) and longer duration of hospitalizations (IRR[CI95%]=5.5[1.7-17.6]) compared with children without ARFID. Children with ARFID were diagnosed earlier with a mental condition than children without ARFID. No sex-specific differences emerged.INTERPRETATION: This study yields the broadest and most detailed evidence of co-existing 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.FUNDING: Fredrik and Ingrid Thurings Foundation, Mental Health Foundation.
|
|
