ABSTRACT
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 I
2, 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 (I
2 ≥ 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.