European eating disorders review : the journal of the Eating Disorders Association · 2026
Prevalence of Medical and Psychiatric Comorbidities in Paediatric ARFID: A Meta-Analysis.
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Borch Nuria Blay, González Patricia Sanazario, Del Pozo Rut Vila, Duque-Yemail Juan David, Gisbert-Gustemps Laura, Setién-Ramos Imanol, Martínez-Ramírez María, Ramos-Quiroga Josep Antoni, Lugo-Marín Jorge
Аннотация
BACKGROUND: Avoidant/Restrictive Food Intake Disorder (ARFID) is increasingly recognized as a complex paediatric feeding and eating disorder associated with significant medical and psychiatric burden.
METHODS: This systematic review and meta-analysis followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251241490). PsycINFO, PubMed, Scopus, and Web of Science were searched. Observational and clinical studies reporting medical and/or psychiatric comorbidities in paediatric ARFID samples were included. Random-effects models generated pooled prevalence estimates; heterogeneity, publication bias, and evidence certainty were evaluated using I2, Egger's test, and GRADE, respectively.
RESULTS: Eighty-four studies met inclusion criteria. Gastrointestinal disorders (30%; 95% CI: 21%-42%) and nutritional deficiencies (32%; 95% CI: 23%-42%) were the most prevalent medical comorbidities. Food allergies were present in 15% (95% CI: 9%-23%). Among psychiatric conditions, anxiety disorders were most common (44%; 95% CI: 39%-49%), followed by depression (18%; 95% CI: 15%-21%), autism spectrum disorder (19%; 95% CI: 15%-24%), attention-deficit/hyperactivity disorder (15%; 95% CI: 13%-18%), and obsessive-compulsive disorder (11%; 95% CI: 9%-13%). Heterogeneity was high across outcomes (I2 ≥ 75%). Publication bias was detected for anxiety, depression, and nutritional deficiencies. Overall certainty of evidence ranged from very low to low.
CONCLUSIONS: Paediatric ARFID is associated with substantial medical and psychiatric comorbidity, particularly anxiety and neurodevelopmental conditions. Findings support comprehensive, multidisciplinary assessment and developmentally informed interventions. Further high-quality, population-based studies are needed to reduce heterogeneity and strengthen evidence certainty.
METHODS: This systematic review and meta-analysis followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251241490). PsycINFO, PubMed, Scopus, and Web of Science were searched. Observational and clinical studies reporting medical and/or psychiatric comorbidities in paediatric ARFID samples were included. Random-effects models generated pooled prevalence estimates; heterogeneity, publication bias, and evidence certainty were evaluated using I2, Egger's test, and GRADE, respectively.
RESULTS: Eighty-four studies met inclusion criteria. Gastrointestinal disorders (30%; 95% CI: 21%-42%) and nutritional deficiencies (32%; 95% CI: 23%-42%) were the most prevalent medical comorbidities. Food allergies were present in 15% (95% CI: 9%-23%). Among psychiatric conditions, anxiety disorders were most common (44%; 95% CI: 39%-49%), followed by depression (18%; 95% CI: 15%-21%), autism spectrum disorder (19%; 95% CI: 15%-24%), attention-deficit/hyperactivity disorder (15%; 95% CI: 13%-18%), and obsessive-compulsive disorder (11%; 95% CI: 9%-13%). Heterogeneity was high across outcomes (I2 ≥ 75%). Publication bias was detected for anxiety, depression, and nutritional deficiencies. Overall certainty of evidence ranged from very low to low.
CONCLUSIONS: Paediatric ARFID is associated with substantial medical and psychiatric comorbidity, particularly anxiety and neurodevelopmental conditions. Findings support comprehensive, multidisciplinary assessment and developmentally informed interventions. Further high-quality, population-based studies are needed to reduce heterogeneity and strengthen evidence certainty.