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Etiology of the Broad Avoidant Restrictive Food Intake Disorder Phenotype in Swedish Twins Aged 6 to 12 Years
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany; Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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2023 (English)In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 80, no 3, p. 260-269Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE: Avoidant restrictive food intake disorder (ARFID) is characterized by an extremely limited range and/or amount of food eaten, resulting in the persistent failure to meet nutritional and/or energy needs. Its etiology is poorly understood, and knowledge of genetic and environmental contributions to ARFID is needed to guide future research. OBJECTIVE: To estimate the extent to which genetic and environmental factors contribute to the liability to the broad ARFID phenotype.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide Swedish twin study includes 16 951 twin pairs born between 1992 and 2010 whose parents participated in the Child and Adolescent Twin Study in Sweden (CATSS) at twin age 9 or 12 years. CATSS was linked to the National Patient Register (NPR) and the Prescribed Drug Register (PDR). Data were collected from July 2004 to April 2020, and data were analyzed from October 2021 to October 2022.

MAIN OUTCOMES AND MEASURES: From CATSS, NPR, and PDR, all parent reports, diagnoses, procedures, and prescribed drugs that were relevant to the DSM-5 ARFID criteria were extracted when twin pairs were aged 6 to 12 years and integrated into a composite measure for the ARFID phenotype (ie, avoidant/restrictive eating with clinically significant impact, such as low weight or nutritional deficiency, and with fear of weight gain as an exclusion). In sensitivity analyses, autism and medical conditions that could account for the eating disturbance were controlled for. Univariate liability threshold models were fitted to estimate the relative contribution of genetic and environmental variation to the liability to the ARFID phenotype.

RESULTS: Of 33 902 included children, 17 151 (50.6%) were male. A total of 682 children (2.0%) with the ARFID phenotype were identified. The heritability of ARFID was 0.79 (95% CI, 0.70-0.85), with significant contributions from nonshared environmental factors (0.21; 95% CI, 0.15-0.30). Heritability was very similar when excluding children with autism (0.77; 95% CI, 0.67-0.84) or medical illnesses that could account for the eating disturbance (0.79; 95% CI, 0.70-0.86).

CONCLUSIONS AND RELEVANCE: Prevalence and sex distribution of the broad ARFID phenotype were similar to previous studies, supporting the use of existing epidemiological data to identify children with ARFID. This study of the estimated genetic and environmental etiology of ARFID suggests that ARFID is highly heritable, encouraging future twin and molecular genetic studies.

Place, publisher, year, edition, pages
American Medical Association , 2023. Vol. 80, no 3, p. 260-269
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-103975DOI: 10.1001/jamapsychiatry.2022.4612ISI: 000926119600004PubMedID: 36723946Scopus ID: 2-s2.0-85147924721OAI: oai:DiVA.org:oru-103975DiVA, id: diva2:1733372
Funder
Swedish Research Council, 538-2013-8864Swedish Psychiatric FoundationFredrik och Ingrid Thurings Stiftelse, 2021-00660
Note

Funding agencies:

United States Department of Health & Human Services

National Institutes of Health (NIH) - USA

NIH National Institute of Mental Health (NIMH) R56MH129437 R01MH120170 R01MH124871 R01MH119084 R01MH118278 R01 MH124871

Brain and Behavior Research Foundation Distinguished Investigator grant

Lundbeckfonden R276-2018-4581

 

Available from: 2023-02-02 Created: 2023-02-02 Last updated: 2023-12-08Bibliographically approved

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