591 - Exploring the Connection Between ARFID, Weight Status, and Nutrient Deficiencies

Publication Number: 591.4734

Lisa A. Mancini, Boston Children's Hospital, Somerville, MA, United States; Carly E.. Milliren, Boston Children's Hospital, Boston, MA, United States; Olivia Eldredge, Boston Children's Hospital, Centerville, MA, United States; Julia Carmody, Boston Children's Hospital, Boston, MA, United States; McGreggor AM. Crowley, Boston Children's Hospital, Boston, MA, United States; Elana M. Bern, Boston Children's Hospital, Boston, MA, United States

Background: Avoidant restrictive food intake disorder (ARFID) may lead to malnutrition shown by both macronutrient and micronutrient deficiencies.

Objective: To examine the frequency of micronutrient laboratory studies and prevalence of abnormal low findings overall and by weight status based on BMI percentile among treatment seeking patients with ARFID.

Design/Methods: This study included treatment seeking patients (ages 5-17) who presented to an outpatient ARFID clinic from January 1, 2021 – March 31, 2024. We extracted demographic characteristics, clinical factors, and laboratory findings from the electronic medical record. We examined the associations of BMI percentile for age-and-sex with the presence and findings from micronutrient laboratory studies using chi-squared tests for categorical BMI percentile and Kruskal-Wallis tests for continuous BMI percentile. BMI percentile was classified based on CDC criteria into underweight ( < 5th), normal weighted (5th-84.9th) and overweight/obese (≥85th).

Results: We included N=384 patients during the study period. Mean age was 12.1 years (SD=3.2) and 53% identified as male. Median BMI percentile was 18.9 (IQR=47.1) with 102 (26.6%) underweight, 246 (64.1%) normal weighted, and 36 (9.4%) overweight/obese. The most frequent micronutrient labs performed were Vitamin D (39.1%), transferrin (32.0%), and total iron binding capacity (31.5%). Patients who were underweight were more likely to have labs performed, with statistically significant differences for Vitamin B6 (p=0.04), Vitamin B12 (p=0.005), and zinc (p < 0.001) specifically. Among those who had a given micronutrient lab performed, abnormal low findings were most frequent for zinc (40%), Vitamin C (37%), Vitamin D (35%). The prevalence of abnormal labs also differed by BMI percentile category for Vitamin B1 (p=0.03) and Vitamin C (p=0.04) with a higher prevalence among those who were higher weighted. Results for Vitamin C were similar when comparing continuous BMI percentile between those with and without abnormal low findings (median 18.3 vs. 8.90; p=0.04), with higher average BMI percentile among those with abnormal findings.

Conclusion(s): Our results indicate that micronutrient deficiencies are frequent among patients with ARFID. Importantly, patients at a lower weight status were more likely to have micronutrient labs performed, however, those who were higher weighted had a similar or increased prevalence of deficiencies. These findings suggest that micronutrient deficiency may be under identified in patients who are higher weighted, perhaps reflecting a clinical bias about weight and nutrient risk.

Lab Results by BMI percentage
Associations of BMI percentile for age-and-sex with the presence and findings from micronutrient laboratory studies