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Abstract
Avoidant/Restrictive Food Intake Disorder (ARFID) is a feeding/eating disorder characterized by food avoidance leading to undernutrition, growth failure/weight loss, reliance on nutritional formula, and/or severe psychosocial impairment. Few studies have evaluated bone health and the feasibility of bone health assessment in children with ARFID. The objective of this dissertation was to examine the effects of ARIFID on bone health outcomes and to determine the feasibility of utilizing dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral computed tomography (HR-pQCT) in a pediatric cohort with ARFID. Manuscript #1 is a narrative review examining the processes of bone accrual and peak bone mass attainment. Manuscript #2 is a cross-sectional study comparing bone and body composition outcomes in 23 children with ARFID against a historical healthy control (HC) group from the Bone Mineral Density in Childhood Study. Compared to the HC, the ARFID cohort demonstrated significantly lower bone mineral density Z-scores, adjusted for height, at the total body less-head and lumbar spine regions. Children with ARFID also had higher fat mass index Z-scores than the HC. Manuscript #3 is a secondary analysis of the ARFID and bone health study, described above in Manuscript #2, assessing the feasibility of performing DXA and HR-pQCT measurements in children with ARFID. Our findings suggest that the feasibility of bone imaging in children with ARFID is highly variable but may have utility in some individuals. The proportion of subjects who were able to complete a DXA scan of acceptable quality to be analyzed did not differ with respect to age, height, autism, or anxiety diagnoses. For HR-pQCT, scan feasibility was less optimal in younger and shorter individuals at the radius. In conclusion, these results suggest that children with ARFID have lower bone density and higher fat mass compared to a historical HC, potentially increasing the risk for fracture and chronic cardiorenal metabolic disease. Children with ARFID may benefit from a DXA evaluation; however, a child’s ability to remain motionless during a scan must be considered when deciding to perform a skeletal imaging assessment in children with ARFID, given the cost, radiation use, and application in guiding clinical care.