6340 Nutritional deficiencies identified in patients referred to a tertiary feeding clinic with ARFID feeding pattern

Objectives This project aimed to describe nutritional deficiencies seen in patients referred to the local specialty feeding clinic with an ARFID feeding pattern. The feeding clinic offers an MDT approach for children with complex feeding issues, who may be at risk of medical complications. Methods A retrospective electronic case record analysis was completed for new referrals to the service in 2022. 3 records were rejected due to insufficient information, with further analysis completed on 46 records. Data included: reason for referral, nutritional deficiencies identified on laboratory testing and dietary history. Results Three main reasons for referral were identified: avoidant/restrictive feeding behaviour (ARFID) n=26 (56.5%), weaning from enteral tube feeding n=12 (26%) and weight faltering n=9 (19.5%). Further analysis was carried out for the 26 patients with an ARFID feeding pattern. In these patients the most common coexistent diagnosis was autism or suspected autism (73% n=19). 21 patients (81%) were referred for bloods. Fourteen of these patients had at least one nutritional deficiency identified. The commonest deficiencies were iron (n=8), vitamin D (n=4), and vitamin C (n=4). Vitamin A, vit B12, folate, phosphate, calcium and zinc deficiencies were also found. Analysis of dietary history indicated that vit C deficiency was commonly found in those with dairy based diets, whereas those with vit A or B12 deficiency had predominantly potato based diets. Similar to findings in other studies.1 Those with iron deficiency alone were often on a multivitamin. None of those with nutritional deficiencies were documented as having nutritional deficiency disease e.g. scurvy or xerophthalmia. Conclusion In these patients with an ARFID feeding pattern referred to a specialist clinic, there was a high pick up rate of nutritional deficiencies for those who had blood tests checked. No nutritional deficiency disease was reported in this group. However the challenge of performing investigations in this group, such as visual fields/acuity to identify nutritional optic neuropathy, are evident. Also, patient reporting of symptoms may be impaired.2 There was variation in the nutritional bloods ordered by clinicians, which will have impacted pick-up rates. Dietary history is key to identify those at risk of deficiency and the most likely deficiencies. Not all nutritional deficiency will be identified on laboratory testing as plasma levels may not reflect whole body stores.3 Following a detailed dietary history, there should be a low threshold to consider nutritional screening in those with significantly restricted eating, particularly if they do not tolerate multivitamin supplementation. References Yule S, et al. Nutritional deficiency disease secondary to ARFID symptoms associated with autism and the broad autism phenotype: a qualitative systematic review of case reports and case series. J Acad Nutr Diet, 2021. Schimansky S. et al. Nutritional blindness from avoidant-restrictive food intake disorder – recommendations for the early diagnosis and multidisciplinary management of children at risk from restrictive eating. Archives of Disease in Childhood, 2023. Assessment and Treatment of Children and Young people with Avoidant Restrictive Food Intake Disorder (ARFID): BDA ARFID Special Interest Group, June 2022.